DR

AFT

November 2015

Transforming young lives across Wales: the economic argument for investing in early years 2 Day Short Course - Health Economics for Public Health Practice and Research, 14-16 March 2016 New Research – Physical ACtivity monitors in an Exercise Referral Setting (PACERS) Anti-bullying as an example of the wider remit of public health research across Wales Outcome of ‘The Impact of Housing on Health and Well-being’ Symposium, March 2015 THRIVE—Tenant’s Health Research: Improving Vitality through (home) Environment Update on Wylfa Newydd Recent publications Placements at CHEME

TOPICS IN THIS ISSUE...

Welcome to the second Spotlight newsletter produced by The Centre for Health Economics and Medicines Evaluation (CHEME) at Bangor University. This issue focuses on health economics research for public health across Wales.

Health economics is the study of how we use scarce health care resources to meet our health care needs in society. Public Health Economics is the study of how society uses scarce resources, within the health care sector and right across government (e.g. housing, education and environment), to improve the health of the whole population.

There is growing political interest in public health, often referred to as population health, resulting in a palpable shift away from the traditional “medical model” of patient-centred behaviour change interventions towards promoting healthy environments and legislation of health harming products and behaviours.

Health economists can bring to the table a toolbox of methods for economic evaluation of individual Public Health programmes; methods for priority setting such as Programme Budgeting and Marginal Analysis (PBMA); and methods such as Social Return on Investment (SROI) to explore the wider social benefits of investing in promoting better health for the population.

Spotlight on Health Economics Research for

Public Health Across Wales

SPOTLIGHT ON RESEARCH...

The Public Health Wales Executive Board, via the Public Health Wales academic research division, led by Professor Mark Bellis, asked Professor Rhiannon Tudor Edwards to lead a team of researchers to produce an independent report setting out the economic case for investment in early years across Wales. As health economists our role is to bring to the policy, the debate about services for families and children, evidence relating to how we might best use scarce public resources to best achieve societal objectives. It is, therefore, our task to bring to the table robust international and UK evidence on the relative return on investment of devoting levels of public sector services to different life course stages and the relative cost-effectiveness of specific programmes. Our intended audience range from Public Health Wales, our Public Health colleagues in England, Scotland and Northern Ireland; colleagues working across the seven Health Boards across Wales; colleagues from local government across Wales and those working in the third sector who all potentially have an important impact on families and young children living across Wales.

This report sets out the economic case for investing in early years. In Wales early years is defined as conception to age 7, though we do refer to effects on older children and impact later in life along with areas for investment before children are born, at the pregnancy and preconception. Ultimately, the economic case is based around breaking an inter-generational cycle of poverty, economic inactivity due to lack of jobs and poor health, and an acknowledgement that the first few months and years of a child’s life, living in Wales will have a large impact on their life chances, health and wellbeing, edu-cational attainment and income ability.

There is much to be learned from international efforts to reduce malnutrition in developing countries, which have, through the first 1000 days campaign, begun to concentrate resources on women during pregnancy and for babies up to the age of 2. In Wales, our focus may not primarily be on nutrition, but rather on establishing healthy lifestyle choices and reducing the impact of poverty - the evidence seems to point towards the greatest economic returns being during these first 1000 days. Investment in early years offers a means for government to generate simultaneously social and economic returns, and reduce lifetime inequalities.

The report is intended to be helpful to Welsh Government, proposing a way forward to guide future investment deci-sions, providing robust evidence rather than prescriptive policy recommendations. Wales already has significant invest-ment programmes and policy direction relating to families and young children. This report is intended to complement and strengthen the argument for investing in babies born today in Wales, and by doing this, investing in future generations.

The report is due for completion, peer review and bilingual distribution March 2016.

Transforming Young Lives across Wales: The Economic Argument for Investing in Early Years

Lucy Bryning and Huw Lloyd-Williams presenting their “Investing

in Early Years“ work at the 2015 WHEG conference held in

Bangor.

Rhiannon Tudor Edwards presenting

the welcoming speech at the 2015

WHEG conference held in Bangor.

SPOTLIGHT ON RESEARCH...

2 Day Short Course - Health Economics for Public Health Practice and Research, 14th—16th March 2016

We are pleased to announce CHEME will be running its annual residential short course “Health Economics for Public Health Practice and Research” in 2016 from 14th—16th of March.

This course offers those working in public health, the NHS, local government, MPH students and Public Health trainees an opportunity to learn about Health Economics and methods of economic evaluation; specific challenges of applying these methods to the evaluation of Public Health interventions; the role of economic modelling; and current guidance from NICE advocating a wide multi-sectoral perspective of analysis. The course is run by Professor Rhiannon Tudor Edwards with Public Health Wales input from Professor Robert Atenstaedt and guest speakers, such as Dr. Emma McIntosh (Institute of Health and Wellbeing, University of Glasgow), leading sessions on their particular topic of expertise.

The course is priced at £775 which includes meals and accommodation from 4pm on the 14th to lunch on the 16th.

There are 5 subsidised places available for Public Health Wales staff at £325. These will be allocated on a first come first served basis. Registration closes 12th February 2016. To register for the event or for further information visit: http://cheme.bangor.ac.uk/health-economics-course.php.en or contact Mrs Ann Lawton Tel: 01248 382153 Email: cheme@bangor.ac.uk

New Research – Physical ACtivity monitors in an Exercise Referral Setting (PACERS) The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) at Cardiff University has received funding from Health and Care Research Wales for a pilot trial aimed at enhancing the long-term uptake of regular physical activity in adults. The study is led by Dr Jemma Hawkins at DECIPHer with co-investigators from Cardiff University, Bangor University, University of Bristol, Durham University and University of Glasgow. Professor Rhiannon Tudor Edwards and Lucy Bryning of CHEME are contributing health economics expertise. The majority of adults in Wales do not currently achieve public health recommendations for physical activity. Interventions to increase individuals’ physical activity levels, such as exercise referral schemes, have had mixed successes to date and have often only demonstrated effects in the short term. The researchers will evaluate the feasibility of introducing activity monitoring devices, alongside a web-based support system, within the National Exercise Referral Scheme [NERS] in Wales. The study will enhance understandings of how to integrate such technologies into existing exercise programmes. NERS was launched in Wales in 2007 and was evaluated using a Randomised Control Trial, led by Prof. Simon Murphy of DECIPHer. The evaluation showed that the scheme demonstrated small but significant impacts on physical activity at 12 month follow-up, though effects were limited to patients referred with coronary heart disease risk factors.

Uptake and completion were higher among older patients, and those already engaging in some activity prior to the study.

Anti-bullying as an example of the wider remit of public health research across Wales The Social Research Unit at Dartington is implementing and evaluating the KiVa Anti-bullying programme, which originated in Finland, for primary schools in Wales. This evaluation is being conducted in partnership with the Centre for Evidence Based Early Intervention at Bangor University and the Children’s Early Intervention Trust, and with support from the programme developer, Professor Christina Salmivalli. Professor Rhiannon Tudor Edwards and Dr Joanna Charles from CHEME will be conducting micro-costing analyses alongside the evaluation to provide the costs of implementing KiVa in Wales in its first year. The project, funded by the Big Lottery Innovation Fund for Wales will benefit approximately 2,000 pupils aged 7-11 years who will receive the programme in its entirety. It will also benefit an additional 1,000 pupils aged 5-6 in participating schools who will be exposed to the whole-school element and KiVa team.

For more information about the KiVa programme please see http://www.kivaprogram.net/wales

SPOTLIGHT ON RESEARCH continued...

THRIVE—Tenant’s Health Research: Improving Vitality through (home) Environment

Eira Winrow, a Health and Care Research Wales funded PhD student at CHEME, is working collaboratively with Ynys Mon and Gwynedd councils to assess the health impacts of housing and the cost-effectiveness of home improvements.

It is estimated that at least £600 million is spent by the NHS every year to treat illnesses that are directly attributable to poor housing. The aim of this PhD is to consider the cost-effectiveness of preventing ill-health through home improvement, evaluate the cost impact of a suite of home improvements and evaluate the effect on health & well-being of these improvements. The study will also consider the effects on health due to household expenditure trade-offs in North West Wales and the current debate around preventative economic outlay from the NHS to social housing provision to achieve cross-sectorial savings.

This is a natural experiment cohort study with pre and post measurements of self-reported health and spirometry lung function testing of families receiving a suite of home improvements in council-owned social housing or privately rented social housing. Quantitative measures include HQol and wellbeing measures for adults and children; NHS service use, household income, and attribution of health status to the home improvement.

Qualitative, semi structured interviews will be conducted with a subsample of tenants with the aim of hearing their lived experience.

An update on Wylfa Newydd

In conjunction with BCUHB, Mr. Huw Lloyd-Williams (CHEME) is contributing to a BCUHB scoping exercise of the economic and public health impacts of Wylfa Newydd. We are helping to scope the likely work that has been done in describing the socio-economic profile of Anglesey, using local area statistics. The profiling looks at population structure and change, migration, Welsh identity and language, economic activity and business, productivity and earnings and qualifications and skills. The conclusion is that Anglesey’s socio-economic profile is fairly complex: unemployment is low and the population is growing; earnings are high and the workforce seems to be highly skilled by all-Wales standards. Yet its GVA per head, the bedrock of measuring economic performance, is the lowest in any region in the UK. The make up of Anglesey’s offering is such that there seems to be a structural impediment to retaining its young talent. Hence, we are witnessing a high outflow of young people - a problem shared with many rural areas within Wales and the U.K. in general. This work is ongoing as part of the wider project of assessing the economic and public health impacts of the proposed Wylfa Newydd site.

Outcome of ‘The Impact of

Housing on Health and

Wellbeing’ Symposium, March

2015

Over 20 delegates attended the symposium ranging from external researchers (The London School of Economics, Gentoo Green, Health Impact Assessment), local authorities (Gwynedd Council, Lancaster Council), Public Health Wales, and housing associations and charities (TPAS Cymru, Care and Repair Cymru). The event provided an opportunity for those interested in exploring the impact of housing upon health and well-being, to share their work, experiences and network with others interested in the topic. The event highlighted that housing is a complex issue. There is also a great need for communication and the right language to engage tenants, landlords, local authorities, the housing sector, the social care sector, policy makers etc. There is clearly an interest in this area and a need to widen the evidence base. We hope that the symposium created points of contact and introduced delegates to potential untapped resources and new contacts. Following the event an e-mail list was created to share progress and keep in touch with the delegates. We are also aware of a local “Housing and Health” alliance group of health professionals, Public Health Wales staff and council housing staff who meet to discuss topics such as tackling avoidable health inequalities in North Wales health and housing.

THRIVE logo created by Eira Winrow for

use in her PhD study.

Recent Publications

Berry V, Axford N, Blowers S, Taylor RS, Edwards RT, Tobin K, Jones C and Bywater T. The effectiveness and micro-costing analysis of a universal, school-based, social-emotional learning programme in the UK: A cluster-randomised controlled trial. School Mental Health (2015) (IN PRESS). Quinn C, Toms G, Jones C, Brand A, Edwards RT, Sanders F and Clare L. A pilot randomized controlled trial of a self-management group intervention for people with early-stage dementia (The SMART study). International Psychogeriatrics (2015) (In Press) Charles JM, Brown G, Thomas K, Johnstone F, Vandenblink V, Pethers B, Jones A, and Edwards RT. Use of programme budgeting and marginal analysis as a framework for resource reallocation in respiratory care in North Wales, UK. Journal of Public Health (Oxford, England) 2015; DOI:10.1093/pubmed/fdv128 Edwards RT, Jones C, Berry V, Charles J, Linck P, Bywater T and Hutchings J. Incredible Years Parenting Programme: Cost-Effectiveness and Implementation. The Journal of Children’s Services. (2015); DOI: 10.1108/JCS-02-2015-0005 Edwards RT, Yeo ST, Russell D, Thomson CE, Beggs I, Gibson JN, McMillan D, Martin DJ and Russell IT. Cost-effectiveness of steroid (methylprednisolone) injections versus anaesthetic alone for the treatment of Morton's neuroma: economic evaluation alongside a randomised controlled trial (MortISE trial). Journal of foot and ankle research 2015, 8, pp. 6-015-0064-y. eCollection O'Brien TD, Noyes J, Spencer LH, Kubis H, Edwards RT, Bray N and Whitaker R. Well-being, health and fitness of children who use wheelchairs: Feasibility study protocol to develop child-centred ‘keep-fit’exercise interventions. Journal of Advanced Nursing 2015; 71(2): 430-440. Stanciu MA, Morris C, Makin M, Watson E, Bulger J, Evans R, Hiscock J, Hoare Z, Edwards RT, Neal RD and Wilkinson C. A pilot randomised controlled trial of personalised care after treatment for prostate cancer (TOPCAT-P): nurse-led holistic-needs assessment and individualised psychoeducational intervention: study protocol. BMJ Open 2015; 5(6): e008470-2015-008470. Sivaprasad S, Prevost AT, Bainbridge J, Edwards RT, Hopkins D, Kelly J, Luthert P, Murphy C, Ramu J, Sarafraz-Shekary N, Vasconcelos J, White-Alao B and Hykin P. Clinical efficacy and mechanistic evaluation of aflibercept for proliferative diabetic retinopathy (acronym CLARITY): a multicentre phase IIb randomised active-controlled clinical trial. BMJ 2015; 14:5(9):e008405. Nollett CL, Bray N, Bunce C, Casten RJ, Edwards RT, Hegel MT, Janikoun S, Jumbe SE, Ryan B, Shearn J, Smith DJ, Standford M, Xing W and Margrain TH. High prevalence of untreated depression in patients accessing low-vision services. Ophthalmology 2015; DOI:http://dx.doi.org/10.1016/j.ophtha.2015.07.009. Edwardson CL, Harrington DM, Yates T, Bodicoat DH, Khunti K, Gorely T, Sherar LB, Edwards RT, Wright C, Harrington K and Davies MJ. A cluster randomised controlled trial to investigate the effectiveness and cost effectiveness of the Girls Active intervention: a study protocol. BMC Public Health 2015; 4;15:526. doi: 10.1186/s12889-015-1886-z. Williams NH, Hawkes C, Din NU, Roberts J, Charles J, Morrison V, Hoare Z, Edwards RT, Andrew G, Alexander S, Lemmy A, Woods B, Sackley C, Logan P, Hunnisett D, Mawdesley K and Wilkinson C. Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR): study protocol for a Phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture. BMC Pilot and Feasibility Studies 2015; 1:13 doi:10.1186/s40814-015-0008-0. Watt H, Harris M, Noyes J, Whitaker R, Hoare Z, Edwards RT and Haines A. Development of a composite outcome score for a complex intervention - measuring the impact of Community Health Workers. Trials 2015; 16:107-015-0625-1. Clare L, Nelis SM, Jones IR, Hindles JV, Thom JM, Nixon JA, Cooney J, Jones CL, Edwards RT, Whitaker CJ. The Agewell trial: a pilot randomised controlled trial of a behaviour change intervention to promote healthy ageing and reduce risk of dementia in later life. BMC Psychiatry; 2015: 15:25.

How to find us CHEME is based on the Normal Site situated between Bangor and the Isle of Anglesey along the A5

Centre for Health Economics & Medicines Evaluation Ardudwy, Normal Site, Bangor University,

Bangor, Gwynedd, LL57 2PZ

cheme.bangor.ac.uk Follow us on Twitter @CHEMEBangor and @ProfRTEdwards.

SPOTLIGHT ON RESEARCH continued...

Placements are available at CHEME for Public Health Wales Staff and Trainees. Please see our website for details - http://cheme.bangor.ac.uk