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Search Results: 1 - 10 of 1811 matches for " Tony Blakely "
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Poverty, inequality and health. An International Perspective
Woodward Alistair,Blakely Tony
Bulletin of the World Health Organization , 2001,
Trends in absolute socioeconomic inequalities in mortality in Sweden and New Zealand. A 20-year gender perspective
Sarah Wamala, Tony Blakely, June Atkinson
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-164
Abstract: The New Zealand Census Mortality Study (NZCMS) consisting of over 2 million individuals and the Swedish Survey of Living Conditions (ULF) comprising over 100, 000 individuals were used for analyses. Education and household income were used as measures of socioeconomic position (SEP). The slope index of inequality (SII) was calculated to estimate absolute inequalities in mortality. Analyses were based on 3–5 year follow-up and limited to individuals aged 25–77 years. Age standardised mortality rates were calculated using the European population standard.Absolute inequalities in mortality on average over the 1980s and 1990s for both men and women by education were similar in Sweden and New Zealand, but by income were greater in Sweden.Comparing trends in absolute inequalities over the 1980s and 1990s, men's absolute inequalities by education decreased by 66% in Sweden and by 17% in New Zealand (p for trend <0.01 in both countries). Women's absolute inequalities by education decreased by 19% in Sweden (p = 0.03) and by 8% in New Zealand (p = 0.53). Men's absolute inequalities by income decreased by 51% in Sweden (p for trend = 0.06), but increased by 16% in New Zealand (p = 0.13). Women's absolute inequalities by income increased in both countries: 12% in Sweden (p = 0.03) and 21% in New Zealand (p = 0.04).Trends in socioeconomic inequalities in mortality were clearly most favourable for men in Sweden. Trends also seemed to be more favourable for men than women in New Zealand. Assuming the trends in male inequalities in Sweden were not a statistical chance finding, it is not clear what the substantive reason(s) was for the pronounced decrease. Further gender comparisons are required.Historically, both New Zealand and Sweden have had a long tradition of universalism and welfarism, and targeted policies for equity. However, in the late 1980s and beginning of 1990s there was a substantial economic recession in both countries. New Zealand responded by considerable reductio
Correction: what potential has tobacco control for reducing health inequalities? The New Zealand situation
Nick Wilson, Tony Blakely, Martin Tobias
International Journal for Equity in Health , 2006, DOI: 10.1186/1475-9276-5-16
Abstract: In our article [1] there was an error in the calculation of population attributable risk percents (PAR%) for 1996–99 shown in Table 1 (bottom row). The corrected Table is in this correction article (see Table 1). This correction has also required revising Figure 2 (see Figure 1 in this correction article). In the process of making these corrections, we have extended our presentation of the contribution of smoking to mortality gaps by ethnicity and education to include a more explicit acknowledgement of the choice of counterfactual assumption. Figure 1 now shows the estimated 'never smoker rate' plus the 'smoking attributable rate' for each ethnic and educational group. Note that the 'smoking attributable rate' as a percentage of the total rate is equivalent to the relevant PAR% shown in Table 1. 'A' and 'B' signify two alternative counterfactual scenarios that can be used to estimate the contribution of smoking to ethnic or socioeconomic gaps in mortality. Scenario A for ethnic gaps is whereby the non-Māori non-Pacific (nMnP) population adopt the smoking rates of Māori, calculated using direct standardisation as given elsewhere [ref 27 of the original paper]. Scenario A for education gaps is whereby each educational group is given an 'average' smoking rate, calculated using Poisson regression as given elsewhere [ref 75 of the original paper]. Scenario B is more extreme (and arguably somewhat unrealistic) whereby we assume there had never been smoking in New Zealand, with the area labelled 'B' in Figure 1 being that for Scenario B over and above that for Scenario A. The contribution of smoking to gaps under Scenario B is calculated using standard population attributable rate methods, that is the difference in "attributable smoking rates" between Māori and nMnP or between nil and post-school qualifications. Thus estimating the contribution of smoking to mortality gaps depends on how extreme the counterfactual assumptions are [2]. Halving total population smoking rates
What potential has tobacco control for reducing health inequalities? The New Zealand situation
Nick Wilson, Tony Blakely, Martin Tobias
International Journal for Equity in Health , 2006, DOI: 10.1186/1475-9276-5-14
Abstract: In New Zealand smoking prevalence is higher amongst Māori and Pacific peoples (compared to those of "New Zealand European" ethnicity) and amongst those with low socioeconomic position (SEP). Consequently the smoking-related mortality burden is higher among these populations. Regarding the gap in mortality between low and high socioeconomic groups, 21% and 11% of this gap for men and women was estimated to be due to smoking in 1996–99. Regarding the gap in mortality between Māori and non-Māori/non-Pacific, 5% and 8% of this gap for men and women was estimated to be due to smoking. The estimates from both these studies are probably moderate underestimates due to misclassification bias of smoking status. Despite the modest relative contribution of smoking to these gaps, the absolute number of smoking-attributable deaths is sizable and amenable to policy and health sector responses.There is some evidence, from New Zealand and elsewhere, for interventions that reduce smoking by low-income populations and indigenous peoples. These include tobacco taxation, thematically appropriate mass media campaigns, and appropriate smoking cessation support services. But there are as yet untried interventions with major potential. A key one is for a tighter regulatory framework that could rapidly shift the nicotine market towards pharmaceutical-grade nicotine (or smokeless tobacco products) and away from smoked tobacco.As for other countries, the distribution of disease burden in New Zealand is far from equal [1-4]. In particular, there are much higher rates of premature death and of serious chronic diseases for the poorest New Zealanders, for Māori (the indigenous people of New Zealand), and for Pacific peoples living in this country. Māori adult mortality rates are at least twice those of non-Māori in New Zealand. Such inequitable patterns are a concern for the government and the health sector for the ethical reason of ensuring justice but also because the New Zealand Government is c
Effects of childhood socioeconomic position on subjective health and health behaviours in adulthood: how much is mediated by adult socioeconomic position?
Sarah K Mckenzie, Kristie N Carter, Tony Blakely, Vivienne Ivory
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-269
Abstract: Data came from 10,010 adults aged 25-64 years at Wave 3 of the Survey of Family, Income and Employment in New Zealand. The associations between childhood SEP (assessed using retrospective information on parental occupation) and self-rated health, self-reported psychological distress, current smoking status and binge drinking were determined using logistic regression. Models were adjusted individually for the mediating effects of education, household income, labour market activity and area deprivation.Respondents from a lower childhood SEP had a greater odds of being a current smoker (OR 1.70 95% CI 1.42-2.03), reporting poorer health (OR 1.82 95% CI 1.39-2.38) or higher psychological distress (OR 1.60 95% CI 1.20-2.14) compared to those from a higher childhood SEP. Two-thirds to three quarters of the association of childhood SEP with current smoking (78%), and psychological distress (66%) and over half the association with poor self-rated health (55%) was explained by educational attainment. Other adult socioeconomic measures had much smaller mediating effects.This study suggests that the association between childhood SEP and self-rated health, psychological distress and current smoking in adulthood is largely explained through an indirect socioeconomic pathway involving education. However, household income, area deprivation and labour market activity are still likely to be important as they are intermediaries in turn, in the socioeconomic pathway between education and health.The influence of childhood and adult socioeconomic position (SEP) on a wider range of adult health outcomes, other than mortality and cardiovascular disease, is becoming a major research focus internationally. There exists three potential mechanisms whereby the socioeconomic environment in childhood can affect health and disease risk in adulthood. Firstly, experience and socioeconomic environments during early life and at subsequent points in the life course may 'accumulate' to influence adult
Ethnic and socioeconomic trends in breast cancer incidence in New Zealand
Ruth Cunningham, Caroline Shaw, Tony Blakely, June Atkinson, Diana Sarfati
BMC Cancer , 2010, DOI: 10.1186/1471-2407-10-674
Abstract: Five cohorts of the entire New Zealand population for 1981-86, 1986-1991, 1991-1996, 1996-2001, and 2001-2004 were created, and probabilistically linked to cancer registry records, allowing direct determination of ethnic and socioeconomic trends in breast cancer incidence.Breast cancer rates increased across all ethnic and socioeconomic groups between 1981 and 2004. Māori women consistently had the highest age standardised rates, and the difference between Māori and European/Other women increased from 7% in 1981-6 to 24% in 2001-4. Pacific and Asian women had consistently lower rates of breast cancer than European/Other women over the time period studied (12% and 28% lower respectively when pooled over time), although young Pacific women had slightly higher incidence rates than young European/other women. A gradient between high and low income women was evident, with high income women having breast cancer rates approximately 10% higher and this difference did not change significantly over time.Differences in breast cancer incidence between European and Pacific women and between socioeconomic groups are explicable in terms of known risk factors. However no straightforward explanation for the relatively high incidence amongst Māori is apparent. Further research to explore high Māori breast cancer rates may contribute to reducing the burden of breast cancer amongst Māori women, as well as improving our understanding of the aetiology of breast cancer.Breast cancer is the most commonly diagnosed non-skin cancer and the leading cause of cancer death for New Zealand women [1]. Rates of breast cancer in New Zealand are similar to other developed countries, with an age-standardised rate of around 80 per 100,000 women [2]. The incidence of breast cancer has been increasing in New Zealand, with rates nearly doubling in the second half of last century. This increase is likely to be due to changes in both risk factor patterns and methods of diagnosis [3,4].Breast cancer incidenc
The global distribution of risk factors by poverty level
Blakely,Tony; Hales,Simon; Kieft,Charlotte; Wilson,Nick; Woodward,Alistair;
Bulletin of the World Health Organization , 2005, DOI: 10.1590/S0042-96862005000200012
Abstract: objective: to estimate the individual-level association of income poverty with being underweight, using tobacco, drinking alcohol, having access only to unsafe water and sanitation, being exposed to indoor air pollution and being obese. methods: using survey data for as many countries as possible, we estimated the relative risk association between income or assets and risk factors at the individual level within 11 medium- and low-income subregions of who. who and the world bank data on the prevalence of risk factors and income poverty (defined as living on < us$ 1.00 per day, us$ 1-2.00 per day and > us$ 2.00 per day) were analysed to impute the association between poverty and risk factors for each subregion. the possible effect of poverty reduction on the prevalence of risk factors was estimated using population-attributable risk percentages. findings: there were strong associations between poverty and malnutrition among children, having access only to unsafe water and sanitation, and being exposed to indoor air pollution within each subregion (relative risks were twofold to threefold greater for those living on < us$ 1.00 per day compared with those living on > us$ 2.00 per day). associations between poverty and obesity, tobacco use and alcohol use varied across subregions. if everyone living on < us$ 2.00 per day had the risk factor profile of those living on > us$ 2.00 per day, 51% of exposures to unimproved water and sanitation could be avoided as could 37% of malnutrition among children and 38% of exposure to indoor air pollution. the more realistic, but still challenging, millennium development goal of halving the number of people living on < us$ 1.00 per day would achieve much smaller reductions. conclusion: to achieve large gains in global health requires both poverty eradication and public health action. the methods used in this study may be useful for monitoring pro-equity progress towards millennium development goals.
Food Pricing Strategies, Population Diets, and Non-Communicable Disease: A Systematic Review of Simulation Studies
Helen Eyles ,Cliona Ni Mhurchu,Nhung Nghiem,Tony Blakely
PLOS Medicine , 2012, DOI: 10.1371/journal.pmed.1001353
Abstract: Background Food pricing strategies have been proposed to encourage healthy eating habits, which may in turn help stem global increases in non-communicable diseases. This systematic review of simulation studies investigates the estimated association between food pricing strategies and changes in food purchases or intakes (consumption) (objective 1); Health and disease outcomes (objective 2), and whether there are any differences in these outcomes by socio-economic group (objective 3). Methods and Findings Electronic databases, Internet search engines, and bibliographies of included studies were searched for articles published in English between 1 January 1990 and 24 October 2011 for countries in the Organisation for Economic Co-operation and Development. Where ≥3 studies examined the same pricing strategy and consumption (purchases or intake) or health outcome, results were pooled, and a mean own-price elasticity (own-PE) estimated (the own-PE represents the change in demand with a 1% change in price of that good). Objective 1: pooled estimates were possible for the following: (1) taxes on carbonated soft drinks: own-PE (n = 4 studies), ?0.93 (range, ?0.06, ?2.43), and a modelled ?0.02% (?0.01%, ?0.04%) reduction in energy (calorie) intake for each 1% price increase (n = 3 studies); (2) taxes on saturated fat: ?0.02% (?0.01%, ?0.04%) reduction in energy intake from saturated fat per 1% price increase (n = 5 studies); and (3) subsidies on fruits and vegetables: own-PE (n = 3 studies), ?0.35 (?0.21, ?0.77). Objectives 2 and 3: variability of food pricing strategies and outcomes prevented pooled analyses, although higher quality studies suggested unintended compensatory purchasing that could result in overall effects being counter to health. Eleven of 14 studies evaluating lower socio-economic groups estimated that food pricing strategies would be associated with pro-health outcomes. Food pricing strategies also have the potential to reduce disparities. Conclusions Based on modelling studies, taxes on carbonated drinks and saturated fat and subsidies on fruits and vegetables would be associated with beneficial dietary change, with the potential for improved health. Additional research into possible compensatory purchasing and population health outcomes is needed. Please see later in the article for the Editors' Summary
Taxes on Sugar-Sweetened Beverages to Curb Future Obesity and Diabetes Epidemics
Tony Blakely ,Nick Wilson,Bill Kaye-Blake
PLOS Medicine , 2014, DOI: 10.1371/journal.pmed.1001583
What is behind smoker support for new smokefree areas? National survey data
Nick Wilson, Deepa Weerasekera, Tony Blakely, Richard Edwards, George Thomson, Heather Gifford
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-498
Abstract: The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) derives its sample from the NZ Health Survey (a national sample). From this sample we surveyed adult smokers (n = 1376).For the six settings considered, 59% of smokers supported at least three new completely smokefree areas. Only 2% favoured smoking being allowed in all the six new settings. Support among Maori, Pacific and Asian smokers relative to European smokers was elevated in multivariate analyses, but confidence intervals often included 1.0.Also in the multivariate analyses, "strong support" by smokers for new smokefree area laws was associated with greater knowledge of the second-hand smoke (SHS) hazard, and with behaviours to reduce SHS exposure towards others. Strong support was also associated with reporting having smokefree cars (aOR = 1.68, 95% CI = 1.21 - 2.34); and support for tobacco control regulatory measures by government (aOR = 1.63, 95% CI = 1.32 - 2.01). There was also stronger support by smokers with a form of financial stress (not spending on household essentials).Smokers from a range of population groups can show majority support for new outdoor and smokefree car laws. Some of these findings are consistent with the use of public health strategies to support new smokefree laws, such as enhancing public knowledge of the second-hand smoke hazard.Legislation that bans smoking indoors in public places is now commonplace in developed countries. There is extensive scientific evidence to support these bans being effective in protecting non-smokers from second-hand smoke (SHS) and in contributing to advancing tobacco control in other ways [1-4]. There are a range of other domains for which some jurisdictions have passed smokefree laws, including cars with children; settings where smoke can drift from outside to inside (eg, entranceways and near windows); and various other outdoor settings (eg, outside eating areas of hospitality venues, stadiums, beac
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