Resources

The Commercial Determinants of Violence: Identifying Opportunities for Violence Prevention through a Public Health-Based Framework Analysis

This paper uses a conceptual framework for the commercial determinants of health to map the potential commercial determinants of violence. It examines commercial practices directly linked with violence (e.g., firearms) and those that indirectly impact violence through the design and promotion of products; employment practices; and impacts on environment, poverty, and local resources. The paper aims to apply the framework to consider its utility for identifying risk and protective factors for violence, existing good practices, challenges, and opportunities for violence prevention.

Understanding the burden and costs of unintentional injuries and violence to European health systems

Injuries and violence are a major public health problem in the WHO European Region. Violence is a leading cause of death and with injury, is a major contributor to health care costs. Identifying the burden and costs of injuries and violence to the health care system can be a useful starting point for demonstrating the ‘size of the problem’ to policy makers and in influencing decision-making. This project aimed to estimate the costs of injuries and violence to the health care systems across the WHO European Region. The objectives were to review costing approaches used in the existing literature, identify data to enable robust estimates of the costs of injury and violence and to develop an analytical framework that can be applied uniformly across WHO European Region countries.

Everybody’s Business: Early Intervention Crime Reduction

This report aims to aid understanding of how multi-agency partners, including police and justice, health and social care, local government, education, and the third sector, can work together to prevent harms that cross the public health and criminal justice landscape, such as violence, substance use and mental health. It provides examples of ways in which multi-agency partners can work to implement whole system approaches to addressing harm and examines areas where early intervention and preventative policing approaches have been or are likely to be successful.

A practical handbook on Adverse Childhood Experiences (ACEs) Delivering prevention, building resilience and developing trauma-informed systems: A resource for professionals and organisations

This new resource aims to support action on ACEs by providing practical advice on implementing work to prevent ACEs, build resilience, and develop trauma-informed organisations, sectors and systems. It supports the development of a trauma-informed society that is invested in action to prevent ACEs and better support those affected by them.

Cold indoor temperatures and their association with health and well-being: a systematic literature review

Evidence suggests that indoor temperatures <18°C are associated with negative health effects. This study aimed to identify, appraise and update evidence on the association between cold temperatures (i.e. <18°C) within homes (i.e. dwellings) and health and well-being outcomes. Significant gaps in the current evidence base are identified, including research on the impacts of cold indoor temperatures on mental health and well-being, studies involving young children, and the long-term health effects of cold indoor temperatures.

The rising cost of living and health and wellbeing in Wales: a national survey

Households across Wales and worldwide are experiencing an increase in the cost of living. Since late 2021, price rises for basic items such as food and energy have outstripped increases in average wages and welfare payments, leading to a fall in real disposable incomes. As a result, increasing pressure on household budgets is making it harder for people to afford the basics and is often referred to as a ‘cost of living crisis’. This report presents the findings of a survey developed to understand how the cost of living crisis is affecting health and wellbeing among the Welsh public; their approaches and decision-making relating to rising living costs; and their awareness of and access to financial support and schemes.

Identifying evidence to support action to reduce socioeconomic inequalities in health: A systematic scoping and mapping review

This report examines the review-level evidence that is available to guide action on reducing socioeconomic inequalities in health. Evidence about public health interventions, programmes and policies applied to populations, groups and other geographically defined areas or jurisdictions was sought to explore whether they preferentially improve the health outcomes of people experiencing socioeconomic inequalities.

Measuring changes in adult health and well-being during the COVID-19 pandemic and their relationship with adverse childhood experiences and current social assets: a cross-sectional survey

Adverse childhood experiences (ACEs) can impact mental and physical health, leaving people with less resilience to health challenges across the life-course. This study examines whether individuals’ levels and changes in levels of mental health, physical health and sleep quality reported across the first year of the COVID-19 pandemic are associated with ACEs and moderated by social assets such as having trusted family and friends.

ACEtimation-The Combined Effect of Adverse Childhood Experiences on Violence, Health-Harming Behaviors, and Mental Ill-Health: Findings across England and Wales

Adverse childhood experiences (ACEs) encompass various adversities, e.g., physical and/or emotional abuse. Understanding the effects of different ACE types on various health outcomes can guide targeted prevention and intervention. We estimated the association between three categories of ACEs in isolation and when they co-occurred. Specifically, the relationship between child maltreatment, witnessing violence, and household dysfunction and the risk of being involved in violence, engaging in health-harming behaviors, and experiencing mental ill-health.

Is parental unemployment associated with increased risk of adverse childhood experiences? A systematic review and meta-analysis

Unemployment has adverse consequences for families and can put children at risk of harm. This review examines associations between parental unemployment and adverse childhood experiences (ACEs). Findings highlight that increasing employment opportunities and parental support interventions may help break multigenerational cycles of ACEs.

International Horizon Scanning and Learning Summary Calendar 2022/23

This International Horizon Scanning and Learning Summary Calendar is the third in the series, following the Summary Calendars from 2020/21 and 2021/22. This Summary Calendar has collated, synthesised, and presented a clear and concise synopsis of the five International Horizon Scanning Reports over the past year, since April 2022 through to March 2023. In addition, the two summary reports (published in 2022) are included. The International Horizon Scanning and Learning work stream has proved to showcase informative and impactful research whilst collating data from other countries and has provided guidance, recommendations, and useful insights regarding the evolving nature and uncertainties of emerging public health topics, which has sought to improve and inform such actions and approaches in Wales.

The summary aims to inform a succinct overview of comprehensive, coherent, inclusive and evidence-informed policy action, which has supported and continues to support the national strategies towards a healthier, more equal, resilient, prosperous and globally responsible Wales. This calendar includes key messages and key recommendations from the high level synthesis pages of each International Horizon Scanning report.

Themes include:
• Intermediate care
• The cost of living crisis
• COVID-proofing the educational environment: 4-18 years
• Early childhood education and care
• Communication campaigns for vaccine acceptance
• The impact of COVID-19 on mental health and increasing vulnerability
• The impact of COVID-19 on increasing the health gap and vulnerability

Comparing relationships between single types of adverse childhood experiences and health related outcomes across the life course: a combined primary data study of eight surveys

Adverse childhood experiences (ACEs) show strong cumulative associations with ill-health across the life course. Harms can arise even in those exposed to a single ACE type but few studies examine such exposure. For individuals experiencing a single ACE type, we examine which ACEs are most strongly related to different health harms.

Tackling Adverse Childhood Experiences (ACEs) State of the Art and Options for Action

This new report brings together what is known about ACEs across Europe and internationally, showing the on-going toxic impact that ACEs can have across the life course and how ACEs and their consequences can be prevented. The report supports the development of a trauma-informed society that is invested in action to prevent ACEs and better support those affected by them.

Associations between Adverse Childhood Experiences (ACEs) and Lifetime Experience of Car Crashes and Burns: A Cross-Sectional Study

Using a UK general population sample, this study has identified relationships between exposure to ACEs and lifetime experience of car crashes and burns; two major markers of unintentional injury. Findings highlight the need for effective interventions to prevent ACEs and reduce their impacts on health and well-being. A better understanding of the relationships between ACEs and unintentional injury, and the mechanisms that link childhood adversity to injury risks, can benefit the development of multifaceted approaches to injury prevention.

Predicted and observed impacts of COVID-19 lockdowns: two Health Impact Assessments in Scotland and Wales

Health Impact Assessment is a key approach used internationally to identify positive or negative impacts of policies, plans and proposals on health and well-being. In 2020, HIAs were undertaken in Scotland and Wales to identify the potential health and well-being impacts of the ‘stay at home’ and physical distancing measures implemented at the start of the coronavirus disease (COVID-19) pandemic. There is sparse evidence evaluating whether the impacts predicted in HIAs occur following policy implementation. This paper evaluates the impacts anticipated in the COVID-19 HIAs against actual observed trends.

Toward an economy of wellbeing: The economic impact of the Welsh healthcare sector

Population health and wellbeing is both a result, as well as a driver, of economic development and prosperity on global, European, national and sub-national (local) levels. In this paper, the economic importance of the healthcare sector to the Welsh economy is explored. We use a large number of data sources for the UK and Welsh economy to derive an economic model for 2017. We estimate output, income, employment, value-added, and import multipliers of the healthcare sector. Results suggest that the healthcare sector has an above average contribution in four explored economic aspects of the Welsh economy (output, income, employment, value-added), according to its impact on the surrounding economic ecosystem.

International Horizon Scanning and Learning Report: COVID-proofing the educational environment: 4-18 years

The International Horizon Scanning and Learning reports were initiated as part of the COVID-19 public health response, to support dynamic response and recovery measures and planning in Wales. In spring 2022, the scope of the reports was expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health.

In focus: COVID-proofing the educational environment: 4-18 years

Facilitators, Barriers and Views on the Role of Public Health Institutes in Promoting and Using Health Impact Assessment—An International Virtual Scoping Survey and Expert Interviews

Public health institutes have an important role in promoting and protecting the health and well-being of populations. A key focus of such institutes are the wider determinants of health, embracing the need to advocate for ‘Health in All Policies’ (HiAP). A valuable tool to support this is the health impact assessment. This scoping study aims to support public health institutes to advocate more successfully for the use of health impact assessments and HiAP in order to promote and protect health, well-being and equity. It highlights the enablers and barriers to the use of HIA in the contexts of the participants and suggests some actions which PHIs can take and Units they can learn from. The results from this study can serve as a platform to help build knowledge, networks and expertise, to help support a ‘Health in All Policies’ approach and address inequalities which exist in all societies.

Parental adverse childhood experiences and perpetration of child physical punishment in Wales

In 2022, Wales joined the growing number of countries to ban physical punishment of children in all settings. Using data collected a year prior to legislative change, this study explores relationships between Welsh parents’ exposure to ACEs whilst growing up and their use of physical punishment towards children.

Climate Change and Health in Wales: Views from the public

This report presents initial findings from a survey of adult residents in Wales on their perceptions of climate change and health. Whilst work to understand and mitigate climate change is gaining momentum in Wales, there remains a lack of information on population views and behaviours. Such data are critical for the co-creation of effective and acceptable approaches to climate change that help protect public health; the targeting of key messages and information; and the establishment of long-term solutions across Wales that will continue to be supported across multiple generations. To address this gap, a public survey was developed to seek the population’s views about climate change, its relationship with health, their current climate friendly behaviours, their willingness to engage in action, and views on policy solutions. This report presents initial findings from the survey, providing population-level views on climate change among adult residents in Wales.

Cost of health inequality to the NHS in Wales

There are wide inequalities in health and healthcare use between people living in more deprived neighborhoods and those living in less deprived neighborhoods in Wales. Tackling health inequality through a combination of health promotion and early intervention policies targeted toward deprived communities could yield substantial improvement in health and wellbeing, as well as savings for the Welsh NHS.

The public health impact of loneliness during the COVID‑19 pandemic

Social distancing measures have been effective in mitigating the spread of COVID-19; however, they have imposed a significant burden on population mental health and well-being. This study established an association between loneliness and self-reported worsening health during the pandemic, and identified factors increasing the risk of loneliness. The effect that social control measures have on loneliness should influence the design of future public health policy.

Exploring the social value of Public Health Institutes: An international scoping survey and expert interviews

Making the case for investing in preventative public health by illustrating not only the health impact but the social, economic and environmental value of Public Health Institutes is imperative. This is captured by the concept of Social Value, which when measured, demonstrates the combined intersectoral value of public health. This research can inform future work to understand how to measure the holistic social value of Public Health Institutes, in order to strengthen institutional capacity and impact, as well as to achieve a more equitable society, and a more sustainable health system and economy, making the case for investing in public health, as we recover from COVID-19.

Public Engagement Survey on Health and Wellbeing during Coronavirus Measures – August 2022

Public Health Wales conducted a public engagement telephone survey to ask members of the public in Wales how coronavirus and related control measures are affecting their health and wellbeing. This report presents trends in responses to a selection of core questions over the two year period, including: worry about coronavirus; mental and physical health; worry about finances; and perceptions of the national response. It examines differences in responses by deprivation, gender and age.

Influencing the Health Gap in Wales: Decomposition analysis discussion paper

The aim of this discussion paper is to help inform further policy action and potential solutions in order to reduce the health gap in Wales and beyond.
It provides a snapshot of the health inequalities experienced by different population groups in the years leading up to the Coronavirus (COVID-19) pandemic, applying an innovative statistical methodology, a ‘Decomposition analysis’.

The paper attempts to quantify the health gap in Wales, as well as to provide a better understanding of its main drivers across the five essential conditions for healthy prosperous lives for all, using a novel World Health Organization framework. It uses three measures of self-reported health: 1) the prevalence of fair/poor health; 2) the prevalence of low mental well-being; and 3) the prevalence of low life satisfaction, comparing these between:
• Those who are able to make a saving of at least £10/month and those who are not;
• Those who report being in material deprivation and those who do not; and
• Those who report a limiting longstanding illness, disability or infirmity and those who do not.

The analysis has generated an insight into the drivers of health inequities, identifying those which contribute the most, namely ‘Social and Human Capital’ and ‘Income Security and Social Protection’; while ‘Health Services’ has accounted the least. However, systematic differences are able to explain less than half (<50%) of the health gaps for the majority of the health outcomes, based on the statistical models.

The paper highlights the need for a basket of policy and investment decisions, prioritising the key drivers of health inequity, in consensus across sectors. Further exploration and engagement with experts, stakeholders, relevant groups and communities is essential to improve understanding of the health equity gap and its drivers.

It hopes to inform the following national and international stakeholders:
• Public health professionals
• Public policy makers and budget holders on national and local levels
• Statisticians, health scientists and data analysts
• All those who have a role in influencing the health equity gap in Wales and further afield

Adverse childhood experiences and their relationship with poor sexual health outcomes: results from four cross-sectional surveys

Improving understanding of risk factors for risky sexual behaviour is fundamental to achieve better population sexual health. This study explored associations between ACEs and poor sexual health outcomes in the UK. Findings highlight the need for effective interventions to prevent and ameliorate the lifelong effects of ACEs. Trauma-informed relationships and sex education, sexual health services, and antenatal/postnatal services, particularly for teenagers and young parents, could provide opportunities to prevent ACEs and support those affected.

Protecting the mental wellbeing of our future generations: learning from COVID-19 for the long term

This comprehensive Mental Wellbeing Impact Assessment (MWIA) has been carried out by the Wales Health Impact Assessment Support Unit to identify the impacts of the COVID-19 pandemic, and associated policy responses, on the mental wellbeing of young people aged 10-24 in Wales.

The MWIA was carried out with the engagement of young people, teachers and lecturers and the support of a Strategic Advisory Group with representatives from a range of organisations in Wales.

The report aims to provide evidence and learning to inform cross-sector policy and practice directed at pandemic recovery, future emergencies and improving population mental wellbeing for the long term.

International Horizon Scanning and Learning to Inform Wales’ COVID-19 Public Health Response and Recovery Summary Calendar UPDATE April 2021 – March 2022

International Horizon Scanning and Learning: Summary Calendar UPDATE
This International Horizon Scanning and Learning Summary Calendar is an update from the previous Summary Calendar which can be found here and covered the period of April 2020 through to March 2021. This Summary Calendar has collated, synthesised and presented a clear and concise summary of the COVID-19 International Horizon Scanning Reports over the past year, since April 2021 through to March 2022. The International Horizon Scanning and Learning work stream has proved to showcase informative and impactful research whilst collating data from other countries and has provided guidance, recommendations and useful insights regarding the evolving nature and uncertainties of the COVID-19 pandemic, which has sought to improve and inform such actions and approaches in Wales. The summary aims to inform a succinct overview of comprehensive, coherent, inclusive and evidence-informed policy action, which has supported and continues to support the national strategies towards a healthier, more equal, resilient, prosperous and globally responsible Wales. This calendar includes key messages and key recommendations from the high level synthesis page of each International Horizon Scanning report.

The use of mobile phone applications to enhance personal safety from interpersonal violence – an overview of available smartphone applications in the United Kingdom

Interpersonal violence has devastating implications for individuals, families, and communities across the globe, placing a significant burden on health, justice, and social welfare systems. Smartphone technology may provide a platform for violence prevention interventions. This paper explores the evidence on the availability and user experience of UK smartphone applications aimed to prevent violence and improve personal safety. The findings have implications for the development of policy on applications to improve personal safety, especially given recent national policy (e.g. UK) discussions about their utility.

International Horizon Scanning and Learning Report: Intermediate care

The International Horizon Scanning and Learning work stream was initiated as a product of, and to inform upon, the evolving COVID-19 public health response and recovery plans in Wales. In spring 2022, the scope of the reports has been expanded to cover priority public health topics, including in the areas of health improvement and promotion, health protection, and health care public health. This report focuses on intermediate care.

These reports were used during the period of the Covid 19 pandemic in order to inform the Public Health Wales response and therefore only available in English.