Category Archives: Public Health Advice to NHS Commissioners

Health Equity in England: The Marmot Review 10 years on

By Institute of Health Equity (Feb 2020)

This report, Health equity in England: The Marmot Review 10 years on, was commissioned by the Health Foundation, to explore what has happened to health inequalities and social determinants of health in the decade since the Marmot Review. We provide in-depth analysis of health inequalities in England and assess what has happened in key social determinants of health, positively and negatively, in the last 10 years. Critically, we set out an agenda for the Government and local authorities to take action to reduce health inequalities in England. This agenda is based on evidence and practical action evidence from the Marmot Review, and enhanced by new evidence from the succeeding decade, including evidence and learning from practical experience of implementing approaches to health inequalities in England and internationally.

Click here to view this report

What good looks like

By The Association of Directors of Public Health (2019)

The Association of Directors of Public Health (ADPH) and Public Health England (PHE) have co-produced a series of ‘What Good Looks Like’ (WGLL) publications that set out the guiding principles of ‘what good quality looks like’ for population health programmes in local systems.

The WGLL publications are based on the evidence of ‘what works and how it works’ including effectiveness, efficiency, equity, examples of best practices, opinions and viewpoints and, where available a return on investment.

Click here to view these publications

NHS long term plan case studies

The NHS Long Term Plan will make sure the NHS is fit for the future.
Find out through our case studies and films about how the NHS is already making significant changes and developing to better meet the needs of patients and their families through every stage of life.

View case studies by topic:
Integrated care
Learning disabilities
Mental health
Personalised care
Primary care
Urgent and emergency care

View case studies by life stage:
Starting well
Better care for major health conditions
Ageing well

Prescribing cannabis based drugs: response from NICE and Health Education England

I thought I would include this response from NICE and HEE as it is an important message. Click the link below to access the letter or read it below.

Further to Hamilton’s recommendation that general practitioners consult Google Scholar and ask their colleagues if they are unsure about prescribing cannabis,1 we write to remind readers in England that they have 24/7 access to reliable sources of evidence to inform clinical decisions.

The National Institute for Health and Care Excellence’s evidence search ( provides access to authoritative evidence on health, social care, and public health. It focuses on synthesised secondary evidence, including content from over 800 sources, including the British National Formulary, Clinical Knowledge Summaries, SIGN, the Cochrane Library, the royal colleges, Public Health England, and GOV.UK. Information and knowledge specialists at NICE add further good quality systematic reviews. This service is openly available to everyone in the UK; here you will find reviews on the use of cannabis in treatment of epilepsy, neuropathic pain, fibromyalgia, HIV/AIDS, and asthma.

Healthcare staff in England can access a vital, core collection of healthcare databases and full text journals for no charge at Purchased by Health Education England on behalf of the NHS in England, these are provided online in partnership with NICE. You simply need an NHS OpenAthens account. Register at

NHS funded librarians and knowledge specialists are skilled in helping colleagues find information and search for evidence. They can offer summarised evidence searches and help teams keep up-to-date.

Health is a knowledge industry. We encourage practices to contact their local healthcare library. Check for details. Health Education England is committed to work with NHS organisations to ensure that all staff can access knowledge for healthcare23 and benefit from the expertise of healthcare librarians. We know that only a third of Clinical Commissioning Groups currently have such arrangements in place for their staff and member practices. For advice on improving your organisation’s access to knowledge services please contact your regional Health Education England library lead.3


Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Steel, et al. Lancet 2018; 392: 1647–61

Click here to view this systematic review


Previous studies have reported national and regional Global Burden of Disease (GBD) estimates for the UK. Because of substantial variation in health within the UK, action to improve it requires comparable estimates of disease burden and risks at country and local levels. The slowdown in the rate of improvement in life expectancy requires further investigation. We use GBD 2016 data on mortality, causes of death, and disability to analyse the burden of disease in the countries of the UK and within local authorities in England by deprivation quintile.


We extracted data from the GBD 2016 to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. We estimated the burden of disease by cause of death, condition, year, and sex. We analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation. We present results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters.


The leading causes of age-adjusted YLLs in all UK countries in 2016 were ischaemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease. Age-standardised rates of YLLs for all causes varied by two times between local areas in England according to levels of socioeconomic deprivation (from 14 274 per 100 000 population [95% uncertainty interval 12 791–15 875] in Blackpool to 6888 [6145–7739] in Wokingham). Some Upper-Tier Local Authorities, particularly those in London, did better than expected for their level of deprivation. Allowing for differences in age structure, more deprived Upper-Tier Local Authorities had higher attributable YLLs for most major risk factors in the GBD. The population attributable fractions for all-cause YLLs for individual major risk factors varied across Upper-Tier Local Authorities. Life expectancy and YLLs have improved more slowly since 2010 in all UK countries compared with 1990–2010. In nine of 150 Upper-Tier Local Authorities, YLLs increased after 2010. For attributable YLLs, the rate of improvement slowed most substantially for cardiovascular disease and breast, colorectal, and lung cancers, and showed little change for Alzheimer’s disease and other dementias. Morbidity makes an increasing contribution to overall burden in the UK compared with mortality. The age-standardised UK DALY rate for low back and neck pain (1795 [1258–2356]) was higher than for ischaemic heart disease (1200 [1155–1246]) or lung cancer (660 [642–679]). The leading causes of ill health (measured through YLDs) in the UK in 2016 were low back and neck pain, skin and subcutaneous diseases, migraine, depressive disorders, and sense organ disease. Age-standardised YLD rates varied much less than equivalent YLL rates across the UK, which reflects the relative scarcity of local data on causes of ill health.


These estimates at local, regional, and national level will allow policy makers to match resources and priorities to levels of burden and risk factors. Improvement in YLLs and life expectancy slowed notably after 2010, particularly in cardiovascular disease and cancer, and targeted actions are needed if the rate of improvement is to recover. A targeted policy response is also required to address the increasing proportion of burden due to morbidity, such as musculoskeletal problems and depression. Improving the quality and completeness of available data on these causes is an essential component of this response.


Cardiovascular Disease Prevention Return on Investment Tool: Final Report

By Public Health England (2018)

This resource has been developed to help commissioners provide cost-effective interventions to prevent cardiovascular disease.

Click here to view this resource

Physical activity and the environment

by NICE (2018)

This guideline covers how to improve the physical environment to encourage and support physical activity. The aim is to increase the general population’s physical activity levels. The recommendations in this guideline should be read alongside NICE’s guideline on physical activity: walking and cycling.


This guideline includes recommendations on:
•strategies, policies and plans to increase physical activity in the local environment
•active travel
•public open spaces

Click here to view this guidance