An update from the Cochrane Public Health Group

Our work within Public Health Insight aims to generate evidence-informed solutions for decision makers. Public Health Insight incorporates the Cochrane Public Health Group (CPHG) and we thought it was time to provide an update on the work of CPHG and highlight the scope of our Cochrane reviews.

By way of background, in 2005 the World Health Organisation (WHO) convened the Commission on Social Determinants of Health to determine the available evidence globally on health inequities. The ultimate goal of the commission was to identify strategies to curb the increase in inequities.

The results suggested that inequities were not naturally occurring and could be avoidable by improving policy choices, i.e. acting on the social and structural determinants of population health.

In 2008, the Cochrane Public Health Group (CPHG) was registered as an editorial group with the international Cochrane Collaboration to address these challenges. Our mandate is to produce systematic reviews of interventions that seek to support decision-making involving the upstream determinants of health. Our group filled a crucial gap in the existing coverage of Cochrane review topics relevant to global population-level health evidence.

CPHG authors, guided by our editorial team, have utilised contemporary systematic review methods to identify not only whether interventions work, but the ability of these interventions to reduce inequities. Our reviews also seek to identify pointers to potential ineffectiveness or harm (including inequities) due to implementation or resource issues. We understand the need for decision-makers to have access to information about how to implement effective interventions in their own contexts. Review authors are also asked to highlight issues for low and middle income countries, often in the absence of good quality evidence in these countries.

The CPHG works with the Campbell and Cochrane Equity Methods Group to encourage authors to utilise the PROGRESS (Places of residence, race/ethnicity, occupation, gender, religion, socioeconomic status and social capital) tool for extracting data and reporting outcomes.

We currently have a wide range of reviews published or underway (see below). If you are interested in learning more visit our website and please join us on Twitter (@CochranePH), where you will be notified of exciting new reviews published and other news items of relevance to evidence-informed public health. If you are interested in being involved in any of the topics (for example, by commenting as a content expert) contact our Managing Editor (Jodie Doyle: jodied@unimelb.edu.au).

Education

  • Later school start times for supporting the education, health and well-being of high school students
  • Interventions for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease
  • Interventions for enhancing the implementation of policies or practices supportive of healthy eating, physical activity, and obesity
  • prevention in child care settings
  • Education support services for improving school engagement and academic performance of children and adolescents with a chronic health condition

Employment & the Work Environment

  • Flexible working conditions and their effects on employee health and wellbeing
  • Workplace-based organisational interventions to prevent and control obesity by improving dietary intake and/or increasing physical activity

Food Supply/Access and Public Health Nutrition

  • Staple crops biofortified with increased micronutrient content for improving vitamin and mineral status in populations
  • Interventions for preventing undernutrition in children (0-5 years) living in slum environments Portion, package or tableware size for changing consumption of food, alcohol and tobacco
  • Policy level and environmental interventions for reducing the consumption of non-alcoholic sweet drinks among children
  • Interventions for preventing obesity in children
  • Interventions for preventing obesity in children: an overview of systematic reviews
  • Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders
  • Nutritional labelling to promote healthier food purchasing and consumption
  • Fortification of condiments and seasonings with iron for preventing anaemia and improving health
  • Community-level interventions to improve food security in developed countries
  • Community-level interventions for improving access to food in low- and middle-income countries
  • Fortification of rice with vitamins and minerals for addressing micronutrient malnutritition
  • Fortification of staple foods with vitamin A for preventing vitamin A deficiency
  • Wheat flour fortification with iron for reducing anaemia and improving iron status in whole and at-risk populations
  • Fortification of maize flour with iron for preventing anaemia and iron deficiency in populations
  • Fortification of wheat and maize flour with folic acid for population health outcomes
  • Population-level interventions in government jurisdictions for dietary sodium reduction
  • Food fortification with calcium and vitamin D: impact on health outcomes
  • Fortification of staple foods with zinc for improving health outcomes in the general population
  • Food fortification with multiple micronutrients: impact on health outcomes

Housing and the Built Environment

  • Housing improvements for health and associated socio-economic outcomes
  • Built environment interventions for physical activity in adults and children
  • Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children
  • Slum upgrading strategies and their effects on health and social outcomes
  • Interventions to reduce ambient particulate matter air pollution and their effect on health

Income Distribution and Financial Interventions

  • Welfare to work interventions and their effects on the health and wellbeing of lone parents and their children
  • In-work tax credits for families and their impact on health status in adults
  • Unconditional cash transfers for assistance in humanitarian disasters: effect on use of health services and health outcomes in low and middle income countries
  • Unconditional cash transfers for reducing poverty and vulnerabilities: effect on use of health services and health outcomes in low and middle income countries
  • Livestock development programs: effects on indicators of livelihood and health status for families in low and middle income countries

Natural Environment

  • Interventions for reducing adverse health effects of high temperature and heatwaves
  • Participation in environmental enhancement and conservation activities for health and well-being in adults
  • Participation in outdoor education programs in natural environments and children’s health

Public Safety

  • Interventions for preventing abuse in the elderly

Social Networks/Support

  • Social cohesion and community building interventions in local communities for improving health and quality of life
  • Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people
  • Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations
  • Individual-, family-, and school-level interventions for preventing multiple risk behaviours in individuals aged 8 to 25 years
  • Population-level intervention for preventing multiple risk behaviours in 8 to 25 year olds

Systems for Health

  • Interventions implemented through sporting organisations for increasing participation in sport
  • Policy interventions implemented through sporting organisations for promoting healthy behaviour change
  • Interventions for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease
  • Interventions for enhancing the implementation of policies or practices supportive of healthy eating, physical activity, and obesity prevention in childcare services
  • Portion, package or tableware size for changing consumption of food, alcohol and tobacco
  • Collaboration between local health and local government agencies for health improvement
  • Service brokerage for improving health outcomes in ex-prisoners (previously entitled, Population level interventions for improving health outcomes in ex-prisoners)
  • Community-based, population level interventions for promoting child oral health
  • Knowledge translation strategies for facilitating evidence-informed public health decision making among managers and policymakers
  • Interventions for improving the use of the oral healthcare services by adults

Transport, Active Transport and Physical Activity

  • Legislative and engineering interventions for preventing road traffic injuries and fatalities among vulnerable road users (nonmotorised road users and motorised two-wheel road users) in low and middle income countries
  • Community wide interventions for increasing physical activity
  • Environmental and behavioural interventions for reducing sedentary behaviour in community dwelling older adults
  • Public health interventions for increasing physical activity in adults, adolescents and children: an overview of systematic reviews
  • Workplace based organisational interventions to prevent and control obesity by improving dietary intake and/or increasing physical activity
  • Interventions for enhancing the implementation of policies or practices supportive of healthy eating, physical activity, and obesity prevention in child care settings
  • Built environment interventions for physical activity in adults and children
  • Incentive-based interventions to increase physical activity
  • Interventions for preventing obesity in children
  • Interventions for preventing obesity in children: an overview of systematic reviews
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On the conference circuit – from Melbourne to Thailand and back again

In an academic work environment you could say that one of the ‘perks’ is representing your work, or collaborative work, at academic and topic-focused conferences (However in comparison to my days working in the private health industry, business travel in the University signals a more economically responsible mode, namely frequenting the back of the plane rather than the upper deck on long haul flights!). This year has been no exception for me, being fortunate to attend a range of conferences on topics of public health, health promotion, knowledge translation and exchange, and obesity prevention.

So we pack our bags, roll up our posters and prepare our presentation slides at the eleventh hour – but what for? What motivates researchers and practitioners to scramble to find funding so we can run laps of the conference circuit? What benefit does our research and its end-users gain from us attending these forums?

Recently I attended with colleagues what might be considered seminal conferences in public health research/practice/policy: The World conference on Health Promotion by the International Union for Health Promotion and Education (IUHPE) – in Pattaya, Thailand, followed by the Public Health Association of Australia annual conference – in Melbourne. We’ve also attended emerging conferences in our field of interest: The “FUSE 2nd Conference on Knowledge Exchange in Public Health: How to get practice into science” – in Noordwijkerhout, The Netherlands; and the “2nd Annual NHMRC research translation symposium: from Bench to Bourke” – in Sydney. Note the similar style of the long-winded titles on the last two conferences on knowledge translation… For people interested in communicating and doing ‘real world’ research, you’d think we’d have more succinct event titles!

Aside from enjoying a working week near a sandy beach or among fields of tulips, I believe that conference attendances (and active participation obviously) are a necessary perk if we want our research to be useful and utilised, and if we want to link our ideas to a broader national and international dialogue. At these conferences, I took away a few points about the issues being explored and debated, as well as some reflections on what we gain from attending, and thus what we offer as research practitioners. Here’s a wrap-up, fresh from my suitcase.

Salient issues that resonated for me as a conference participant:

  1. Social justice concerns are high on the agenda in public health and health promotion.
    All the policy, practice and research communities represented at theses conferences appear to be very dedicated to chipping away at the systemic barriers to attainment of good health. Good thing.
  2.  Public health and health promotion decision-makers, advocates and researchers need to better articulate what we do, and what good it does.
    What is public health and health promotion anyway? Sure, we all know that the sum of our parts is more than water sanitation and quit-smoking campaigns, but try explaining that to a new acquaintance at a backyard barbeque. And what are the benefits of investing Government dollars in preventive health? Can anyone tell me the economic return on investment of health promotion partnership meetings, or the productivity gains from banning junk-food ads in kids TV viewing hours? Either way, a strong theme that continued to emerge for me was the sheer lack of public outrage when public health research funds are cut, or when a health promotion unit is shut down.
  3. Working across sectors means singing from the same song-sheet.
    I often go to conferences realising that I’m preaching to the converted. It’s not a new concept that public health and health promotion decision-makers need to be working with other sectors like planning, transport and education – this message has continued to come through, but more focused on tweaking our agendas and language, to make it easier to work together. Finding processes to allow cross-sectoral work are getting more focus too – like embedding health impact assessments into local government’s power. We might be a long way away from that but in the meantime we can at least coordinate the message.
  4. We keep on with research to know that we are doing the right things, and doing things fairly.
    Not all of the conferences I went to had an ‘academic’ or scholarly focus, but thankfully, I walked away from each and every session knowing that the majority of attendees valued the role of research and evaluation, rigorous methods, or evidence-informed decision-making – all of this is achieved by furthering research and academic inquiry.
  5. It takes specific skills to advocate, and without advocacy, our concerns won’t be heard.
    Like me, you might not always feel comfortable with the term advocacy so let’s call it leadership, or whatever you like – either way, see points #2 and #3 above. We need to find smarter ways of communicating evidence and knowledge to influence decision-making.
  6. We all love a framework!
    I think every conference session I went to had a ‘framework’, ‘model’ or ‘tool’ which was ‘guiding’ or ‘underpinning’ or ‘informing’ their approach. Hopefully this is more than jargon, and actually means rigor and systematic ways of conceptualising and working – whether you’re in research, practice, or somewhere in between. So I think it’s a good thing, as long as we don’t get lost in translation!

What I think we gain and can offer from active participation at conferences:

  1. Disseminating research and practice.
    This is an obvious benefit, and the one most often used by conference organisers to lure you into spending $900 of your precious budget to be out of the office for two days, subjected to death-by-powerpoint, and forced to catch up on all your emails late at night after the welcome reception. But in order to ‘keep it real’ and stay connected to the broader health and wellbeing dialogue, attendance and active participation at conferences are actually an efficient way to communicate your work. Ok, so I might not feel that way when I’m standing next to my poster watching conference delegates walk straight past, making a bee-line for the coffee stand without an interest in my glossy artwork and data. But if you’re proactive to network, interact, present and tweet, it really is an chance to build the profile of your/your team’s work, and get others to know who you are and what you do.
  2. Networking and engagement.
    By signing up for conferences, we open ourselves to public scrutiny of our work, and let’s not forget those awkward moments of introducing yourself to that esteemed Professor or Policy-maker who has no idea who you are. But this is almost always a positive outcome. We meet new people with similar passions, discuss different contexts and ways of working, and maybe even score a new collaboration, friend, or new LinkedIn connection. The use of social media is really growing at public health conferences, engaging both participants and those who couldn’t attend in person. I’ve come away from every conference with lots of new follows and followers, which also boosts engagement of the research group and links in our other collaborators.
  3. Broadened thinking, new perspectives.
    Sitting in an early morning plenary deciding what to tweet really makes you think about what you think about the topic. In my early days at conferences I probably didn’t reflect much, and was more focused on staying awake and when the next coffee break was. But as a more experienced practitioner, I find that I am continually thinking, appraising, analysing and reflecting on what’s being said. I ask more questions, and use the breaks to chat (to anyone who’ll listen) about the perspectives emerging at the conference.
  4. Confidence.
    After meeting such a range of different people from different contexts, doing different jobs and working in different ways – you realise that you’re all doing good stuff and sharing the goal to promote public health. It’s a nice confidence boost to have your work verified in an international or national context, and helps you feel like you’re on the right track.
  5.  A break from routine.
    I work in an office, and I can’t say I get regular tea-breaks with cake and tropical fruit, nor am I offered a selection of mini-baguettes for lunch. Conferences are good for this. But I do think it is good to get away from the desk and reflect on your practice within a broader context. I always enjoy catching up with colleagues old and new, who are equally as nerdy and equally keen to get out of the office for a few days. Another emerging trend at conferences which is a very welcome break in a workday routine is tea-break flash-mob dances. Enough said.

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Repost from DECIPHer Blog: Improving the evidence base on adolescent health

This blog is a repost from DECIPHer  http://blog.decipher.uk.net/

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Improving the evidence base on adolescent health.

Dr. Ann Hagell from the Association for Young People’s Health (AYPH) looks at the implications of the latest ‘Key Data on Adolescence’ for research into adolescents’ health and health needs.

AYPH firmly believes that we need better, more accessible information about adolescent health.  We also believe that we need to do this by focusing on adolescents as a standalone age group, rather than merging them together with all children.  The experiences of young people are likely to vary according to age, and their health needs might also be different. To help professionals working with young people, AYPH publishes a compendium of statistics about young people’s health every two years.  We draw on data from government departments and other large representative surveys.  The latest edition (Key Data on Adolescence, 2013) has just come out.  What’s new about adolescent health data this time round?

First, in the last couple of years there has been a huge growth in interest in the social determinants of health, as well as in health outcomes.  Since the 2012 Marmot Review for the World Health Organisation, there has been an ongoing debate about reducing health inequalities and improving equality of access to services. Without equal access to resources and support, some young people are at a disadvantage, and we need to know how this affects their health.  Lack of access to services may be because of low income, living in temporary accommodation, or underachieving in education, all of which are associated with health. Data on under-25 unemployment rates are notable – young people have been disproportionately affected by economic recession. In 2011, the average proportion of ‘economically active’ under-25s (those looking for, or in, employment) in the EU was 21.4%, up from 19.7% in 2009. 

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Second, there’s been an increased interest in adolescent accidents and mortality.  Adolescence is generally a healthy age but young people aged 10-24 do die, often from preventable causes.  The main causes of mortality are external, rather than diseases or other natural causes. The most common preventable, external causes of death in this age group include traffic accidents, intentional self-harm and violence.

Common preventable, external causes of deaths among young people aged 10-24 years in the UK

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Source: Patton et al. (2012) ‘Health of the world’s adolescents: a synthesis of internationally comparable data’
Lancet 379(9826):1665-1675
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Third, many health trends are very positive for this age group.  Smoking rates among those aged 11-15 have halved in the last 10 years.  More young people abstain from drinking alcohol now than several decades ago. The proportion reporting that they have used illegal drugs in the last year has also been falling for at least a decade.  Teenage conceptions have fallen too, and in England and Wales they are at the lowest level since records began in 1969.

Proportion of 11-15 year olds who were regular smokers in England by gender, 2001-2011

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Source:  ‘Smoking, drinking and drug use among young people in England in 2011’  Health and Social Care Information Centre.

Fourth, we attempted for the first time to pull together the available data on health promotion and use of health services.  This proved to be quite a challenge, as there is little directly relevant data for this age group. On the other hand, it is clear that young people form a substantial group of users of primary health care, particularly young women.  They also draw on a wide range of other community based services. Tailoring services to their needs, and supporting clinicians in understanding issues of confidentiality, are both very important.

Finally, there are a number of other topics where we desperately need new, robust data.  One example is mental health. The last Office of National Statistics survey of child and adolescent mental health took place in 2004.  Those data have been incredibly useful and are still widely cited.  We need to know what has happened since then.

So the picture is nuanced.  Many overall trends are very positive, but within this we need to keep the focus on sub-groups of young people who may be at a disadvantage compared to their peers.  All young people deserve the support they need to be healthy.  Good data allow us see where help might be most important.



Dr. Ann Hagell is Research Lead at the Association for Young People’s Health (AYPH).

This blog is based on AYPH’s recent publication, ‘Key Data on Adolescence 2013’, which is available to download free on the AYPH website