Punishing the poor, killing the poor: punitive political responses to economic decline deepen health inequalities in the United States

Elias Nosrati, Michael Ash, Michael Marmot, Martin McKee and Lawrence P King

Nosrati authors

Health inequalities are on the rise in the United States: the gap in life expectancy between those at the top and the bottom of the income spectrum has increased rapidly since the dawn of the century, to the point where the lives of the poor are cut short by up to a decade and a half compared with those of the wealthy. Moreover, while the rich tend to live longer everywhere, life expectancy among the poor varies significantly by geographical region.

In our article recently published in the IJE, we show that these patterns of health are the product of powerful political and economic forces. Over the past few decades, neoliberal politics, the decline of unions and economic globalisation have resulted in rapid industrial restructuring and economic dislocation in the US. Organised labour has been eroded in the industrial heartland, and manufacturing operations have been shifted to the non-unionised south and to foreign countries.

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Asthma and type 1 diabetes in childhood: new insights into their association

Johanna Metsälä, Jaakko Nevalainen and Suvi M Virtanen

Metsaela_authors

Traditionally, asthma and type 1 diabetes have been considered distinct immune-mediated diseases in which the underlying immune responses counteract each other, resulting in an inverse association between the diseases. In our study, recently published in the IJE, we explored the association between asthma and type 1 diabetes in childhood in a novel way, and observed that the direction of the association is dependent on the order of appearance of the diseases.

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Having more frequent social contact is associated with better cognitive performance

Andrew Sommerlad and Marko Elovainio

Sommerlad Elovainio

Dementia is the most feared aspect of ageing and is a major global health challenge, so identifying lifestyle factors that can reduce memory decline, and possibly prevent dementia from occurring, is a research priority. In our study, recently published in the IJE, we explored whether having more frequent contact with friends and family, or being married, is linked to better memory and language in older age.

We found that having more social contact and being married in mid-life were both linked to having better cognitive performance over the next 20 years. In particular, we found that verbal fluency was the cognitive area with the strongest link to social contact.

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Deaths of despair? Recent trends present a more complicated picture of mortality among White Americans

Daniel H Simon, Andrea M Tilstra and Ryan K Masters

Simon authors

Rising mortality among young and middle-aged White Americans has alarmed researchers, public health professionals and the broader public. These concerns were amplified by a 2015 study in which the authors attributed rising mortality rates among White Americans to increases in deaths from chronic liver disease, suicide and drug overdoses. The authors argued that increased mortality from these causes of death is likely a result of the “same underlying epidemic” that is affecting a “lost generation” of Americans. The underlying epidemic was said to be “deaths of despair”, originating from rising distress, economic insecurity and chronic pain.

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“Not-so-good-anymore” cholesterol linked to vision loss in the elderly

Joe Maranville, Qiao Fan, Tien Yin Wong, ChingYu Chen and Heiko Runz

Maranville authors

Only a few years ago, doctors would advise their patients that elevated blood levels of high-density lipoprotein cholesterol (HDL-C), then termed the “good cholesterol”, were beneficial and would protect them against coronary heart disease. This belief has been called into question, however, as neither genetics nor clinical trials could demonstrate that raising HDL-C levels would protect against cardiovascular disease. Our study, published recently in the IJE, casts further doubt on this “not-so-good-anymore” cholesterol by showing that genetic variants that cause higher HDL-C levels also increase the risk for age-related macular degeneration (AMD).

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Can women talking save lives? Reducing inequalities in newborn mortality in India, Nepal, Bangladesh and Malawi

Tanja AJ Houweling, David Osrin, Kishwar Azad, Dharma S Manandhar, Prasanta Tripathy, Tambosi Phiri, Joanna Morrison and Anthony Costello

In low- and middle-income countries, the odds of surviving the first 28 days of life are grossly unequal between infants born in deprived and better-off families, even among children living in the same community. In our study, recently published in the IJE, we have shown that women’s groups are able to address this problem. Under the guidance of a facilitator, women came together every month to discuss problems during pregnancy, delivery and the newborn period, and then designed and implemented strategies to overcome these problems with the help of the entire community.

Ekjut
Ekjut women’s group in rural India

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The relevance of a local cohort: the case for generalisability over representativeness

Eleonora Uphoff, Neil Small, Rosie McEachan and Kate Pickett

For some years, our research has been based in the city of Bradford in northern England. We are often asked to justify our research setting. There seems to be a concern that a cohort population that is not representative of the nation as a whole or of the ‘average person’ cannot produce valuable insights beyond its local setting.

While such concerns are not new, they now seem more present, perhaps due to the rise of Big Data or the increased sharing of and access to data from national surveys and cohorts. Do these reservations represent a push for representativeness and generalisability in epidemiology? If so, this might come at the expense of research aiming to paint a more detailed picture of population health.

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Could pre-gestational weight status affect children’s cognition?

Vicente Martínez-Vizcaíno, Celia Álvarez-Bueno and Iván Cavero-Redondo

Our study, recently published in the IJE, looks at the relationship between pre-gestational weight status and children’s neurodevelopment. It shows that children born to mothers who were normal weight before pregnancy scored better on cognition tests than children born to obese women. An original aspect of our study is that it summarises the evidence provided by 15 previous follow-up studies, including samples from seven different countries, and provides information for both cognition tests and general intelligence scores.

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It only takes a minute, girl: women who run for just 1 minute per day have better bone health

Vicky Stiles, Brad Metcalf, Karen Knapp and Alex Rowlands

Victoria_StilesBrad_MetcalfKaren_KnappAlex_Rowlands

We don’t yet know whether it’s best to do it all at once, or little and often, but what we do know is that if a woman’s day-to-day activity contains 1–2 minutes of weight-bearing, high-intensity activity, similar to a medium-paced run for pre-menopausal women or a slow jog for post-menopausal women, she will have better bone health than women who do less. The benefits of high-impact activity on bone health are nothing new. What is novel about our findings is that better bone health is linked to such a short amount of daily activity, albeit at an intensity of the running variety.

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Varenicline produces enduring smoking cessation when prescribed in primary care regardless of patients’ socioeconomic position

Gemma MJ Taylor, Amy E Taylor, Kyla H Thomas, Tim Jones, Richard M Martin, Marcus R Munafò and Neil M Davies

cigarette-2383191_1280

Tobacco is the world’s leading cause of premature disease and death. One in two smokers will die from their addiction unless they quit. Smoking is also a major contributor to health inequalities between the richest and poorest in society. Evidence from the Health Improvement Network in the United Kingdom indicates that smokers from more deprived groups are just as likely as those from less deprived groups to receive advice to quit from their GP. However, evidence from observational studies suggests that smokers from disadvantaged backgrounds are much less likely to quit, even after accessing treatment from specialist stop-smoking services.

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