Understanding health inequalities in Wales using the Blinder-Oaxaca decomposition method

Throughout Wales and the world, health inequality remains a problem that is interconnected with a wider and complex social, economic and environmental dynamic. Subsequently, action to tackle inequality in health needs to take place at a structural level, acknowledging the constraints affecting an individual’s (or community’s) capability and opportunity to enable change. While the ‘social determinants of health’ is an established concept, fully understanding the composition of the health gap is dependent on capturing the relative contributions of a myriad of social, economic and environmental factors within a quantitative analysis. The decomposition analysis sought to explain the differences in the prevalence of these outcomes in groups stratified by their ability to save at least £10 a month, whether they were in material deprivation, and the presence of a limiting long-standing illness, disability of infirmity. The analysis not only quantified the significant health gaps that existed in the years leading up to the COVID-19 pandemic, but it has also shown what determinants of health were most influential. Understanding the factors most closely associated with disparities in health is key in identifying policy levers to reduce health inequalities and improve the health and well-being across populations.

Authors: James Allen, Andrew Cotter-Roberts+ 4 more
, Oliver Darlington, Mariana Dyakova, Rebecca Masters, Luke Munford

Social Return on Investment (SROI) of mental health related interventions—A scoping review

Social Return on Investment (SROI) is a methodological approach which incorporates all three aspects for evaluating interventions. Mental health problems are one of the leading causes of ill health and disability worldwide. This study aims to map existing evidence on the social value of mental health interventions that uses the SROI methodology. This scoping review is a first of its kind to focus on SROI of mental health interventions, finding a good number of SROI studies that show a positive return on investment of the identified interventions. This review illustrates that SROI could be a useful tool and source of evidence to help inform policy and funding decisions for investment in mental health and wellbeing, as it accounts for the wider social, economic, and environmental benefits of public health interventions.

Authors: Rajendra Kadel, Anna Stielke+ 3 more
, Kathryn Ashton, Rebecca Masters, Mariana Dyakova

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

As part of a wider project to determine whether current indoor temperature standards for households in Wales are optimal for people’s comfort, health, and well-being, this review aims to identify and appraise the current evidence on the association between cold homes and health and well-being.

Authors: Hayley Janssen, Ben Gascoyne+ 4 more
, Kat Ford, Rebecca Hill, Manon Roberts, Sumina Azam

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.

Authors: Kat Ford, Karen Hughes+ 3 more
, Katie Creswell, Nel Griffith, Mark Bellis

Responding to the climate crisis: applying behavioural science

The climate crisis presents a persistent and growing environmental burden of disease with significant public health consequences. Addressing the crisis via mitigation and adaptation methods requires changing our behaviour. This guide is for professionals/practitioners working on policy, services or communications to tackle the climate crisis, offering useful tips on incorporating behavioural insights and increasing the likelihood of a change in behaviour being adopted.

Authors: Oliver Williams, Ashley Gould

Cost of living crisis in Wales: A public health lens

The cost of living crisis is having, and will continue to have, wide-ranging and long-term impacts on the day-to-day lives of people in Wales.
This report summarises the ways in which the cost of living crisis can impact on health and well-being. It takes a public health lens to identify actions for policy makers and decision-makers to protect and promote the health and well-being of people in Wales in their response to the cost of living crisis, outlining what a public health approach to the crisis could look like in the short and longer-term.

Authors: Manon Roberts, Louisa Petchey+ 4 more
, Aimee Challenger, Sumina Azam, Rebecca Masters, Jo Peden

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.

Authors: Liz Green, Kathryn Ashton+ 3 more
, Mark Bellis, Timo Clements, Margaret Douglas

Improving health and wellbeing: A guide to using behavioural science in policy and practice

This guide for practitioners and policy makers provides a brief introduction to behavioural science and a step-by-step process for developing behaviour change interventions – whether policy, service or communications. It’s designed to support topic-matter experts to optimise their interventions – helping to ensure we more often ‘get what we aim for’. Improving health and wellbeing: a guide to using behavioural science in policy and practice

Authors: Robert West, Ashley Gould

Cutting our Carbon Emissions

This infographic explains why climate change is a significant threat to health. It includes facts about climate change and suggests actions we can all take to reduce our impact to help protect human health as well as the health of the planet.

Authors: Ann Jones

Preventing homelessness in care experienced individuals

The number and rate of children in local authority care in Wales has been increasing year on year and care experienced individuals are more likely to experience homelessness than other adolescents.
There are various models of practice to support young people when they leave care to prevent an experience of homelessness. The aim of this study was to identify and analyse Welsh, United Kingdom (UK) and international models of response in relation to care experienced individuals (aged 16-25) and homelessness prevention, and to identify promising practice in this field and further areas for improvement.
This study sought to give a voice to care experienced young people. It summarises the international evidence and the lived experience of care experienced individuals and provides suggestions from service providers on new models of care and how these could best be implemented.
It will be of interest to policy makers and housing and social care practitioners alike.

Authors: Claire Beynon, Laura Morgan+ 5 more
, Laura Evans, Oliver Darlington, Louise Woodfine, Lewis Brace, Manon Roberts

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.

Authors: Timotej Jagrič, Christine Brown+ 6 more
, Dušan Fister, Oliver Darlington, Kathryn Ashton, Mariana Dyakova, Mark Bellis, Vita Jagrič

Communities and Climate Change in a Future Wales

Communities and Climate Change in a Future Wales explores how particular communities feel about the impacts of climate change, and how these impacts might exacerbate existing inequalities. The project was designed collaboratively and involved participants in long-term thinking about climate and inequalities, considering what problems might need preventing, and integrating the findings with other studies and projects in the field.
The project reports not only contain the findings from this work, but also provide resources for policymakers to implement similar creative futuring techniques to involve communities in long-term thinking.
The Storybook is produced by FLiNT under Partnership Agreement between FLiNT and the Office of the Future Generations Commissioner for Wales, and in association with Public Health Wales.

Authors: Genevieve Liveley, Will Slocombe+ 1 more
, Emily Spiers

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

Authors: Mark Bellis, Mariana Dyakova+ 5 more
, Anna Stielke, Abigail Malcolm (née Instone), James Allen, Lauren Couzens (née Ellis), Emily Clark

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.

Authors: Liz Green, Kathryn Ashton+ 4 more
, Lee Parry-Williams, Mariana Dyakova, Timo Clemens, Mark Bellis

What Works in the Prevention and Early Intervention of ACEs at the Community Level? Identifying and Supporting Projects across Wales

Previous research undertaken by ACE Hub Wales indicated that community projects across Wales provide support for community members in respect of a range of adversities. Building on this research, the aim of this project is to identify and map further community projects; to understand the most effective methods of supporting these projects as well as barriers to engagement; and finally to explore the impact of services on community groups

Authors: Samia Addis, Joanne C. Hopkins

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.

Authors: Karen Hughes, Kat Ford+ 2 more
, Mark Bellis, Rebekah Amos

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.

Authors: Sara Wood, Karen Hughes+ 3 more
, Rebecca Hill, Natasha Judd, Mark Bellis

Has Brexit changed how Wales participates in global infectious disease prevention, preparedness and response?

The COVID-19 pandemic has pushed infectious diseases to the top of government agendas around the world. Simultaneously, Brexit has influenced how the UK, and therefore Wales collaborates with international partners on infectious diseases.
Timelines for Brexit and the COVID-19 pandemic overlapped, many post-Brexit arrangements were still in development. The next international public health emergency will test the new systems in Wales/the UK.
Brexit has been shown to have the potential to impact on the health and well-being of the Welsh population and is therefore a consideration in the context of infectious disease prevention, preparedness and response.
This briefing explores how the UK’s exit from the EU has changed its international relationships and processes for dealing with future infectious disease threats.

Authors: Katie Creswell, Louisa Petchey

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.

Authors: Rajendra Kadel, James Allen+ 8 more
, Oliver Darlington, Rebecca Masters, Brendan Collins, Joanna M. Charles, Miqdad Asaria, Mariana Dyakova, Mark Bellis, Richard Cookson

A Service Evaluation of the Delivery and Implementation of a Hospital-Based Violence Prevention Team within the University Hospital of Wales

When it was established in 2019, the Violence Prevention Unit commissioned a new nurse-led intervention at the University Hospital of Wales, with the understanding that Emergency Departments have a unique opportunity to intervene early, and prevent victims of violence from being hurt again. The evaluation of the Violence Prevention Team explores the development and implementation of the service within the Emergency Department, and the nature and level of support provided to patients with violence-related injury. The evaluation included interviews with clinical staff and other professionals, for example, police, as well as analysis of service data.

Authors: Annemarie Newbury

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.

Authors: James Allen, Oliver Darlington+ 2 more
, Karen Hughes, Mark Bellis

International Horizon Scanning and Learning Report: The Cost of Living Crisis

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: Cost of living crisis

Authors: Emily Clark, Anna Stielke+ 3 more
, Abigail Malcolm (née Instone), James Allen, Mariana Dyakova

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.

Authors: Kathryn Ashton, Liz Green+ 4 more
, Timo Clemens, Lee Parry-Williams, Mariana Dyakova, Mark Bellis

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.

Authors: Karen Hughes, Natasha Judd+ 1 more
, Mark Bellis

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

Authors: James Allen, Mariana Dyakova+ 4 more
, Andrew Cotter-Roberts, Oliver Darlington, Rebecca Masters, Mark Bellis

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.

Authors: Sara Wood, Kat Ford+ 4 more
, Hannah Madden, Catherine Sharp, Karen Hughes, Mark Bellis

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.

Authors: Nerys Edmonds, Laura Morgan+ 7 more
, Huw Arfon Thomas, Michael Fletcher, Lee Parry-Williams, Laura Evans, Liz Green, Sumina Azam, Mark Bellis

Resources for Sustainable Health

Helping organisations and individuals to consider the natural environment and the health of the planet and people in everything they do.

The Resources for Sustainable Health e-catalogue gives a brief summary of all the resources produced by the Health and Sustainability Hub.

The resources promoted in the e-catalogue will help teams and individuals reduce their impact on the environment and climate change, and encourage sustainable behaviour in both their work and home life.

The resources are a mixture of e-briefs, reports and toolkits, which bring together research, ideas, suggestions and practical actions. Some are aimed at individual or team level, some at organisation, national, or international policy level, to support sustainability, improve health and well-being, help embed the Well-being of Future Generations Act and reduce our impact on the planet.

Authors: Tracy Evans

WHO CC Scrapbook 2021-22

In 2017 the WHO CC began a special scrapbook, capturing the efforts of all staff in the directorate providing a permanent and easily accessible archive of our mutual activity and achievements. The scrapbook was initiated following feedback from the staff survey whereby as a way to recognise the hard work from across the directorate of all staff and activities; not just those elements visible within the IMTP.

The WHO CC Scrapbook is a way to collect a visual representation of the value and impact of staff achievements. It is a celebration and reminder of the great work we produce as a Directorate each year individually and in collaboration with the wider organisation, stakeholders and partners outside of Public Health Wales – in Wales and around the globe.