Derbyshire County Council

Understanding health information can be difficult, which can limit people’s ability to manage their health and adopt healthy practices, leading to poorer health outcomes. This study aimed to evaluate a verbal health literacy training initiative designed to support clear conversations between health service providers and users. The initiative incorporated Teach-back, Chunk and Check, Simple Language, and Open Questions, alongside implementation support from a health literacy officer. A concurrent mixed-methods evaluation was conducted across two health programmes serving a population of approximately one million people in the United Kingdom: A Pulmonary Rehabilitation Programme delivered by five physiotherapists in a hospital setting, and a Weight Management Programme delivered by 12 health improvement advisors within a regional government authority. The evaluation comprised five components: (1) Surveys of 110 service providers’ perceptions of the training; (2) Observations of 11 service providers before and after training; (3) Two focus groups with 11 service providers six months post-training; (4) Change in 73 service users’ health literacy levels using two domains of the Health Literacy Questionnaire; (5) Change in service users’ health and wellbeing between baseline and programme completion. Service providers found the initiative useful. Changes in communication practice, such as increased use of Chunk and Check and Open Questions, were observed. Both programmes were delivered in group settings. Teach-back was reported to be challenging to apply in this context but beneficial in one-to-one interactions in wider practice. Implementation support from the health literacy officer was helpful but difficult to deliver to busy teams. Service users’ health literacy levels improved by the end of their programme, but there was no evidence that the initiative improved health and wellbeing outcomes. For example, no significant difference was observed in the primary outcome for Weight Management participants in the intervention group compared with controls (0.2 kg, − 2.3 to 1.9; p = 0.84). In this small evaluation, the initiative was well received and enhanced service providers’ communication skills. Further evaluation of a strengthened initiative should focus on controlled before-and-after designs using larger samples to determine the effect on service users’ health literacy and health and wellbeing outcomes.

Background Outdoor air pollution is a major public health concern, exacerbating health inequalities, and causing serious illness and death. A comprehensive evidence synthesis of neighbourhood-level outdoor air pollution reduction interventions was commissioned to inform local decision-making in the UK. Methods We searched 10 databases, reference lists, citations, and UK grey literature. We included quantitative, qualitative and observational studies examining the effectiveness and/or acceptability of neighbourhood-level interventions aimed at reducing human exposure to and health impacts of outdoor air pollution, compared with a separate site or pre-intervention control, on health and wellbeing outcomes and air quality. We applied narrative synthesis and best fit framework synthesis, informed by an a priori conceptual framework, to examine the impacts of interventions designed to prevent, mitigate and avoid air pollution. Results We examined 8912 records and 108 full texts from databases, 103 full texts from grey literature sources, 30 full texts from citation searches, and included 24 studies reported in 26 papers/reports. We identified a range of interventions, almost all traffic-related, implemented by different stakeholders. Low traffic neighbourhood and school streets interventions reduced air pollution levels and traffic counts, with little evidence of traffic spilling over to surrounding streets. Anti-idling messages reduced idling traffic. Walking school bus initiatives encouraged modal shift. Green wall interventions reduced air pollution, possibly depending on wind direction. Street adaptations had mixed effects on air pollution but reduced polluting traffic. A light-touch traffic calming intervention reduced traffic levels. An early warning system had a mixed impact on air pollution. Some studies lacked comparison sites and some may have been confounded by the COVID-19 pandemic. Conclusions A range of neighbourhood-level interventions have the potential to reduce outdoor air pollution locally. The most impactful appear to be low traffic neighbourhoods, school streets, anti-idling messages and green walls.

Hunger, appetite, satiety, and energy intake (EI) are controlled by both physiological and psychological cues, many of which are learned in specific environmental contexts. Appetite is not tightly regulated but has evolved to protect humans and other mammals from energy deficits and so it is relatively easy to overeat in modern affluent environments. Numerous factors influence EI including palatability, other sensory stimuli, emotional state, reward-based responses to food, social and situational influences, dietary energy density, and composition. There are few clearly defined lean/obese differences in determinants of appetite and EI, because the pathways to and from obesity are multiple and heterogeneous.

Water is ubiquitous and vital to life. Though it is recycled naturally through the environment, the water used by people may contain high levels of “natural” pollutants from human and animal wastes, and “artificial” pollutants in the form of naturally derived materials discharged to environment by human activity, and synthetic chemicals produced only by human activity. Pollutants in wastewater and runoff arising from human activity can overwhelm any local natural detoxification ability of the environment. Such wastewater is therefore commonly required to be characterized and treated, for reuse or safe discharge to environment. The degree of treatment required to allow the discharge of a given pollutant is set by legislation, which is in turn a matter for politicians, rather than engineers. There is in many developed countries great political pressure for legislators to set the required standards for any water discharged to environment after use by humans very stringently, even for substances not shown to cause any harm. As each additional increment in the degree of treatment costs more than the last, this has the potential to add very considerably to the cost of chemical processing industry.