Air pollution, deprivation and health: understanding relationships to add value to local air quality management policy and practice in Wales, UK.

Background: Air pollution exposure reduces life expectancy. Air pollution, deprivation and poor-health status combinations can create increased and disproportionate disease burdens. Problems and solutions are rarely considered in a broad public health context, but doing so can add value to air quality management efforts by reducing air pollution risks, impacts and inequalities. Methods: An ecological study assessed small-area associations between air pollution (nitrogen dioxide and particulate matter), deprivation status and health outcomes in Wales, UK. Results: Air pollution concentrations were highest in 'most' deprived areas. When considered separately, deprivation-health associations were stronger than air pollution-health associations. Considered simultaneously, air pollution added to deprivation-health associations; interactions between air pollution and deprivation modified and strengthened associations with all-cause and respiratory disease mortality, especially in 'most' deprived areas where most-vulnerable people lived and where health needs were greatest. Conclusion: There is a need to reduce air pollution-related risks for all. However, it is also the case that greater health gains can result from considering local air pollution problems and solutions in the context of wider health-determinants and acting on a better understanding of relationships. Informed and co-ordinated air pollution mitigation and public health action in high deprivation and pollution areas can reduce risks and inequalities. To achieve this, greater public health integration and collaboration in local air quality management policy and practice is needed.

Tackling teenage pregnancy in the UK.

PIP: The deleterious social and health outcomes of unplanned pregnancy have been recognized internationally for some time. In UK, birth rates among teenagers have not decreased; every year about 90,000 teenagers in England become pregnant. Of these, 7000 are under 16 years old. A report from UK government's Social Exclusion Unit sets out a comprehensive analysis of the problem and offers far-reaching recommendations on how the extent and consequences of the problem can be reduced. The recommendations cited take a determined multisectoral approach. As part of a national campaign, parents will be encouraged to talk with their children about sex, young men are motivated to be more responsible in their sexual behavior, and those who father children of teenage mothers are pursued vigorously to ensure the provision of continuing financial support. At the local level, local authorities and health authorities will have to develop a local strategy involving the wide range of groups that have an interest on the issue. Efforts must also be made to refute the idea that sex education lowers the age at first intercourse. In addition, it is suggested that the sexual health in UK adopt the integrated approach to produce an effective sexual health service.^ieng

Environment and health.

There is a clear connection between environment and health. This article outlines the importance of the quality of the environment and the role of the public health function in working across the NHS and local government to improve population health.

Public health medicine in a new era.

The health service reforms in the United Kingdom have posed significant problems for the carrying out of the public health function. The increasing size of populations for which health authorities are responsible makes the formation and maintenance of strong community links difficult. An attempt to broaden the membership of the Faculty of Public Health Medicine beyond members of the medical profession has failed to achieve consensus support, and academic departments are highly variable in their working links with the NHS. The creation of a separate public health service for the country has become a possibility. Behind these structural problems lies the lack of a commonly understood and agreed theoretical basis within the specialty. It is argued that an understanding of the role and functioning of the specialty as well as the real determinants of health is important to the achievement of improvement in the health of the population. The NHS reforms have created an opportunity for public health practitioners that if not seized may not be recreated for some time.

Management knowledge and skills required by U.K. and U.S. medical directors.

A survey was undertaken of the medical directors of National Health Service trusts in the South Thames Regional Health Authority of the United Kingdom. The purpose of the survey was to ascertain medical directors' views regarding the importance of various areas of administrative practice, their preparedness in these areas of administrative knowledge prior to taking up their roles as medical directors, and their views as to the body of knowledge required for future medical directors. The study was compared with a similar study undertaken in the United States. While there were many areas of agreement between the English and the American medical administrators, there were also areas of significant differences of opinion. The need to develop a recognized training program in medical administration is acknowledged.

Accessibility of sexual health services for young people: survey of clinics in a region.

Describes the approach and results of a regional survey to assess the accessibility of sexual health services for young people in the south-east Thames region. Outlines the practicalities of performing such a survey and what can be achieved through this approach.

Sodium, potassium, body mass, alcohol and blood pressure in three United Kingdom centres (the INTERSALT study).

Standardised data on blood pressure, 24 h urinary electrolyte excretion, body mass index (BMI) and alcohol intake were collected as part of the INTERSALT study in 598 men and women aged 20-59 years, selected randomly from three population groups in the United Kingdom. For the three centres combined, mean systolic blood pressure was 121.4 mm Hg and diastolic pressure 72.1 mm Hg, urinary sodium excretion 152.1 mmol/24 h, urinary potassium excretion 61.0 mmol/24 h, urinary sodium/potassium ratio 2.64 and BMI 25.2 kg/m2. Prevalence of heavy alcohol drinking in men (greater than or equal to 300 ml/week) was 27.5 per cent. Applying overall INTERSALT regression coefficients to the United Kingdom data suggested that modest changes in average sodium and potassium intakes, together with reductions in the prevalence of obesity and (in men) of heavy alcohol drinking could lead to important reductions in average population blood pressures and the prevalence of hypertension. The potential of this multifactorial approach to blood pressure control was illustrated by stratifying individuals within each of the United Kingdom centres by sodium and potassium excretion, BMI and alcohol intake. The 20 (out of 299) men considered at 'lower risk' for high blood pressure with respect to the above variables had systolic pressure lower by 11 mm Hg (P less than 0.01); for the 27 (out of 299) 'lower risk' women, systolic pressure was lower by 5 mm Hg (P = 0.06). These non-pharmacological approaches towards more favourable blood pressure levels could be accompanied by reductions in mortality from stroke and coronary heart disease.

Sources of fat in the northern Irish diet.

The Belfast MONICA Project carried out the joint European Economic Community WHO MONICA Project nutrition study (EURONUT) in 1985-1986 in 401 males subjects (45-64 years) using 3-day weighed records. This resulted in 356 reliable records which were analysed. The mean energy intake was 2369 Kcals (9.9 MJ) with 38% of energy (including alcohol) derived from fat (16.5% from saturated fat, 14.0% from monounsaturated fat, 4.8% from polyunsaturated fat), 14.2% from protein, 43.2% from carbohydrate and 4.0% from alcohol. The mean total fat was 100.3 g (saturated fat 43.5 g, monounsaturated fat 36.9 g, polyunsaturated fat 12.5 g), with a P:S ratio of 0.32. The sources of the different kinds of fat and cholesterol are presented as cumulative percentages of the total. This is a useful way of identifying those foods which contribute chiefly to fat in the diet, and it should have important implications for the monitoring of progress towards meeting dietary guidelines.