B Barr’s research while affiliated with University of Liverpool and other places

What is this page?


This page lists works of an author who doesn't have a ResearchGate profile or hasn't added the works to their profile yet. It is automatically generated from public (personal) data to further our legitimate goal of comprehensive and accurate scientific recordkeeping. If you are this author and want this page removed, please let us know.

Publications (33)


Inequalities in local funding cuts to environmental and regulatory service expenditure in England
  • Article

October 2024

·

5 Reads

The European Journal of Public Health

L Murrell

·

K Fahy

·

H E Clough

·

[...]

·

Background The financial crisis in 2008 has led to governments across Europe introducing austerity measures. England has experienced significant financial cuts to local authority (LA) services. Environmental and regulatory (ER) services provide key functions in public protection such as, Food Safety (FS) and Animal and Public Health Infectious Disease Control (APH), services which are key infectious disease resilience. Here we investigate inequalities in local funding cuts to ER services by socioeconomic deprivation, LA type, and urbanicity, and impact on key ER service indicators. Methods This ecological study uses longitudinal modelling techniques to analyse trends in ER expenditure since the introduction of austerity and the inequalities present. We use Generalised Estimating Equations to estimate the annual percent change of ER service expenditure, and FS and APH expenditure between 2009/10 and 2020/21 in relation to deprivation, LA type and population density. Quasi-Poisson regression is used to assess impact of cuts on ER service indicators. Results Areas of higher deprivation had the largest reduction in expenditure, with ER and FS and APH cuts of 2% and of 23% respectively, compared to a 1% and 8% reduction in the least deprived areas. The share of ER expenditure spent on FS and APH decreased by 13% in the most deprived authorities compared to 6% in the least deprived areas. London boroughs had the greatest reductions in FS and APH expenditure, decreasing by 10%. Both ER and FS and APH expenditure decreased with increasing population density. Preliminary analysis shows inequalities in food business hygiene ratings in addition to other key ER service indicators since the introduction of these cuts. Conclusions The unequal distribution of cuts shows the need for increased and equitable investment into these services to enable resilience to infectious disease threats, and to prevent widening of health inequalities. Key messages • This work provides strong evidence of inequalities in local funding cuts to ER services and highlights where investment should be focused, in order to protect environmental and public health. • This work introduces the impact of local funding cuts on a vital public health service and lays the foundation for future work into the unequal impact of cuts to these services on health outcomes.


System-wide health needs segmentation: innovating integrated care for complex needs households

October 2024

·

1 Read

The European Journal of Public Health

Background Health needs segmentation is increasingly used in healthcare delivery and health policy planning to cater for diverse population groups and develop effective and equitable health policies. But existing models often lack a systemic approach, focusing instead on single conditions or settings. This leads to fragmentation, gaps and inefficiencies in service provision and inequities in health outcomes, particularly when addressing complexity, and specifically for children, as adversity clusters in families. Aims To develop a household health needs segmentation model to identify those households with children with high levels of complex cross-sectoral needs, to plan for integrated care services. Methods Data linkage of primary, secondary, mental, community and social care services, mortality records, residential information, and small-area multiple deprivation measures was used to design a rule-based model to identifying households with children with the most complex needs in the UK region of Cheshire and Merseyside (C&M), with large variation in demography, (human) geography, and deprivation. Results Of 2,645,329 individuals in C&M (97% of the registered population in 2021), 1,022,840 lived in 266,939 households with children aged 0-16: 21,527 households had complex needs. This 8% of families accounted for an estimated 34% of health and social care costs for families, £362 million in total, 42% of which spent on children in care of local authorities. Implications The model identified a specific group of families with complex service use patterns, high mental and physical comorbidity and socioeconomic vulnerabilities. These exhibit potential for improved outcomes through better integration of services and targeting of community building and family support resources. Conclusions Our model represents a significant innovation in health needs segmentation. By using whole system linked data, it provides a pragmatic way of profiling complexity for proactive care. Key messages • Complex health and social problems in children cluster in families with adults also having complex needs, so we need to transform fragmented services to support the whole family to improve outcomes. • Household level segmentation using cross-sectoral, whole system data is an innovation to identify households with complex needs with respect to their locality to improve integration of support.


P04 The public health implications of child poverty targets for England: a modelling study

August 2024

·

7 Reads

Journal of Epidemiology and Community Health

Aim We aimed to investigate the potential population health impacts of targets to reduce child poverty in England between 2024 and 2033. Methods We used English upper-tier local authority level data to simulate the impact of different child poverty policy targets on infant mortality (cases per 100 000 live births per year), children looked-after (cases per 100 000 individuals aged <16 per year), nutritional anaemias (* *), and all-cause emergency hospital admissions (* *). We modelled the relative and absolute changes in outcomes under four scenarios: continued adverse trends, where poverty increased along projections until 2027 thereafter remaining stable until 2033; low-ambition, where poverty cumulatively falls by 15% after a three-year delay; medium-ambition, where poverty cumulatively falls by 25% after a two-year delay; and high-ambition, where poverty cumulatively falls by 35% after a one-year delay. Results were aggregated at national, county, and deprivation level. Results Continued adverse trends worsened all outcome measures, with greater changes in the least deprived areas. All other scenarios resulted in substantial improvements to child health. Between 2024 and 2033, meeting the high-ambition target would decrease infant mortality by 1.2% [or 227 cases, 95% Confidence Interval or CI: 91 to 357], children looked-after by 1.6% [or 3 845 cases, 95%CI: 1 627 to 6 218], nutritional anaemias by 3.2% [or 357 cases, 95%CI: 262 to 448], and emergency admissions by 0.3% [or 25 443 cases, 95%CI 3 134 to 47 633]. Relative health improvements were particularly great in the East Midlands, whereas the largest absolute gains were seen in larger areas (e.g., London). The most deprived local authorities were most likely to experience relative and absolute benefits. Results Implementing and achieving child poverty reduction targets could substantially improve child health and reduce health inequalities in England.


OP58 Impacts of universal credit on wellbeing of low-income households: a natural experiment study of the annual population surveys 2013–2019*

August 2024

·

9 Reads

Journal of Epidemiology and Community Health

Background Income and social security are fundamental determinants of mental health and wellbeing. Universal Credit (UC) was a large-scale reform to the UK’s welfare system, replacing six existing benefits and tax credits, and is currently paid to over 6 million recipients. UC aimed to simplify the claims process and encourage claimants to move into employment. Previous studies have suggested harms to mental health resulting from the new system, via mechanisms such as decreased benefit income, incurred debt and increased stress. Introduction was phased on a geographical basis from 2013 and was available in all areas by the end of 2018 to all new claimants, existing recipients whose circumstances changed and those who chose to switch to the new benefit. We aimed to identify the effect of UC on mental wellbeing on low-income households by treating the phased rollout as a natural experiment. Methods We analysed repeated yearly cross sections of the nationally-representative Annual Population Surveys 2013–2019. The outcome of wellbeing was measured using ‘life satisfaction’, happiness, anxiety, and life rated as ‘worthwhile’. We examined respondents in low-income households (less than £12,000/year household equivalised income; n=249,078), comparing those living in areas where UC had been introduced to those in areas where it had not, using difference-in-difference analyses. In subgroup analyses, we tested for differential effects on under-25s, disabled people, single people, women, non-white ethnicities, people with caring responsibilities, single parents and full-time students (compared to complementary subgroups). We compared effects between Scotland, Wales and England, to take account of differences in the way UC is administered. All analyses were carried out using R. Results Exposure to UC was associated with lower ‘life satisfaction’ (-0.07; -0.10 to -0.04), happiness (-0.06; -0.10 to -0.03) and ‘life worthwhile’ (-0.04; -0.08 to -0.01), and greater anxiety (0.09; 0.04 to 0.13) amongst low-income households. Effects on anxiety were larger among under-25s, disabled people, single people, women, people with caring responsibilities, single parents and full-time students. There were small, additional harms to ‘life satisfaction’ and ‘life worthwhile’ in Scotland compared to England. Conclusion Consistent with studies of the effect of UC on mental health, we found evidence of harmful effects of UC across four measures of wellbeing. Effects on anxiety were exacerbated across multiple axes of vulnerability. This should inform recommendations for the migration of all remaining eligible households onto UC and future adaptations to the UC system to reduce adverse consequences for mental health and wellbeing.


OP01 Trends in inequalities in self-harm in young people over the COVID-19 pandemic period. A population-based linkage study of half a million people in Cheshire and Merseyside between 2018 and 2022

August 2024

·

8 Reads

Journal of Epidemiology and Community Health

Background Covid-19 has impacted negatively on young people’s mental health. Its aftermath compounded pressures on community mental health services and, with wating lists lengthening, monitoring self-harm emergency trends is fundamental to tracking mental health needs in youth. However, few longitudinal studies followed periods beyond immediate pandemic inset. We aimed to quantify changes in self-harm Emergency Department (ED) attendances in children and young people aged 10-24 years old between 2018 and 2022, and whether these changes differed by sex, age, levels of deprivation and preexisting common mental health conditions and self-harm risk. Methods In this cohort study, we analysed routinely collected whole-population linked data of Cheshire and Merseyside, a region in the North-West of England with a population of 2.7 million. The study included 567676 participants: all the people aged 10-24 years registered in the region in 2018-2022.Main outcome was ED attendances for self-harm. We linked Emergency Care records with whole-population individual primary care records, mortality records, and area level indicators of multiple deprivation. We used a multivariable Poisson regression to quantify the baseline self-harm attendance risk, with sex, age group, deprivation, and common mental health diagnosis as exposures of interest. We estimated the changes following Covid-19, using the interaction between the exposures and time trend variables allowing baseline trend variation. Results There were 10230 attendances for self-harm by 7260 people during the study period. As the pandemic waned, there was a marked increase in attendance, concentrated in the most deprived areas, with the highest increases observed in teenage girls, 24% increase every quarter relative to least deprived (RR 1.24, 95% CI 1.07 to 1.45), and young men, 50% increase every quarter (RR 1.51, 95% CI 1.16 to 1.96). While during the pandemic, there was some decrease in self-harm in young people known as at risk to services, for young people already at risk for self-harm, attendances markedly increased after the pandemic, especially in younger girls aged 10-14, with relative risk increasing from pre-pandemic levels at an additional 16% every quarter (RR 1.16, 95% CI 1.01 to 1.33). Conclusion Levels of self-harm in children and young people markedly increased compared to level observed before the pandemic and inequalities in incidence of self-harm episodes in children and young people have widened. Risk accumulated on already vulnerable groups. Urgent action is needed to understand the determinants of these increased risks and to identify appropriate interventions.


OP21 Mental health impacts of local community development funding cuts in England: a longitudinal ecological study

August 2024

·

15 Reads

Journal of Epidemiology and Community Health

Background Community development engages local communities in work for positive social change, such as improving local services and infrastructure. Local government funding for community development has been cut by 26% between 2011/12 and 2019/20, following the implementation of austerity and reduced central government regulation of services. In this study, we investigate the health inequalities impacts of community development budget cuts on mental health and well-being. Methods We used fixed effects regression applied to longitudinal local authority-level data in England between 2011/12 and 2019/20. We assess whether trends in community development spending were associated with trends in mental health and well-being. The exposure was gross community development spending per person, adjusted for inflation. Outcomes were a composite measure of area-level mental health, the Small Area Mental Health Index (SAMHI) sourced from the Place-based Longitudinal Data Resource; the components of SAMHI; and self-reported measures of anxiety and life satisfaction, collected in the Annual Population Survey. We adjusted models for confounders and conducted interaction analysis to examine differential mental health effects of spending cuts based on the level of area deprivation. All analyses were conducted in R 4.0.2. Results The average community development budget cut of 26% was associated with worsening mental health, as measured by a small increase in SAMHI of 0.009 (95% C.I.: 0.004, 0.014) standard deviations, a 0.034 (95% C.I.: 0.016, 0.051) percentage point increase in the prevalence of depression and a 0.67 (95% C.I.: 0.020, 0.113) ADQ per capita increase in antidepressant prescriptions. We found negligible impacts on well-being, as measured by self-reported anxiety and life satisfaction measures. Budget cuts in more deprived areas were associated with larger mental health impacts than those in less deprived areas. Sensitivity analyses excluding unitary authorities, due to differing spending trends and responsibilities, showed similar results. Discussion Local government budget cuts to community development were associated with negative mental health impacts, especially in more deprived areas, widening the existing socioeconomic and geographic inequalities in mental health. A limitation of our study is that the outcome, SAMHI, may be influenced by differing prescribing and diagnosing trends between places and over time. We studied self-reported outcomes as well to address this. Community development should be prioritised as an investment strategy to support public mental health, especially as the government plans to ‘level up’ areas and address worsening mental health trends.


P06 Inequalities in local funding cuts to environmental and regulatory service expenditure in England from 2009/10-2020/21

August 2024

Journal of Epidemiology and Community Health

Background Local authorities (LA) have been subject to significant local funding cuts placing strain on their ability to fund public services. Environmental and regulatory (ER) services provide vital functions in prevention and notification of infectious disease through Food Safety (FS) and Animal and Public Health; Infectious disease control (APHIDC) services. The depth of funding cuts have differed by deprivation level, rural and urban classification, and LA structure. This study aimed to investigate the inequalities in local funding cuts to ER and sub services FS and APHIDC by socioeconomic deprivation, population density and LA structure. Methods This observational longitudinal study used a generalised estimating equation (GEE) model to estimate the annual percent change of service expenditure overtime from 2009/10 to 2020/21 for ER expenditure and FS and APHIDC. Additionally, we analysed FS and APHIDC expenditure change as a share of ER expenditure for this period. Each model analysed how trends varied by deprivation, LA structure and population density. All analysis were carried out on R studio. Results Areas of higher deprivation had the largest reduction in expenditure with cuts to ER of 2.4% (95% CI: -3.5%, -1.3%) and FS and APHIDC of 22.8% (95% CI: -34.9%, -8.4%). The share of ER expenditure spent on FS and APHIDC reduced the most in most deprived areas, falling by 13.4% (95% CI: -21.1%, -5%). Unitary LA’s had the largest cuts in ER expenditure with 1.9% (95% CI: -2.9%, -0.8%) decrease whereas FS and APHIDC expenditure saw the biggest cuts in London boroughs with a 9.9% (95% CI: -16.4%, -2.9%) reduction. Both ER and FS and APHIDC services saw reduced expenditure with increase in population density. Conclusion Here we provide novel insight into the inequalities of local funding cuts to ER services. Despite the importance of ER services in public health protection these services have been cut substantially since the introduction of austerity, with the largest cuts being in the more deprived and highly populated areas. This shows the need for increased and equitable investment into these services to enable resilience to infectious disease threats and to prevent widening health inequalities. This study is descriptive, meaning we cannot confirm why these trends have occurred or what the implications of these findings are. Further research is needed to understand the impacts of these trends, next steps are to understand how these cuts impact ER services and gastrointestinal infection outcomes.


OP56 Inequalities in local authority spending on schools in England. A longitudinal ecological analysis 2014–2022

August 2024

·

24 Reads

Journal of Epidemiology and Community Health

Background Investment in schools is a potentially important determinant of both educational attainment and health. However, little is known about the consequences of the significant changes to school investment in England over recent years, with the introduction of the National Funding Formula in 2018/19 and the additional funding received by schools during the pandemic. In the context of increasing inequalities in child health and educational attainment, we assessed trends in inequalities in education spending, as a precursor to understanding health impacts. Methods We conducted a longitudinal analysis of spending on schools in England between 2014/15 and 2021/22. We used mixed-effects models to assess trends and inequalities using routinely available school-level data aggregated to lower-tier local authority level. We present the estimated relative and absolute changes in total inflation-adjusted school spending per pupil. We assess associations with deprivation and geography, and further consider source, type, and deficits in education spending. Results Spending per pupil declined from 2014/15 to 2018/19 and then increased to 2021/22. There was an overall 4.2% reduction, from £5,629 to £5,394, over the study period. Trends varied by level of deprivation. School spending per pupil in the most deprived and the second most deprived areas declined annually by £40 (95% CI -£54 -£26) and £29 (95% CI -£42 -£16) per pupil compared to schools in least deprived areas. The overall decline in the most deprived quintile was 6.6%, compared to 2.4% in least deprived areas. Spending per pupil was greater in London compared to other regions, and for primary schools compared to secondary schools. Primary school spending returned to 2014/15 levels at the end of the study period, except for primary schools in the most deprived quintile, while secondary school spending declined across all deprivation quintiles. The share of school funding from self-generated sources increased by about 1.2 percentage points to 4.9%, while 24% of the local authorities in 2020/21 had schools with more spending deficits than surplus. Conclusion Funding for schools in England has been cut over the last decade, with clear geographical inequalities. These cuts have particularly impacted secondary schools in deprived areas outside London. While funding for primary schools has increased since the introduction of the national funding formula, inequalities remain. These patterns are concerning in the context of rising geographical inequalities in educational attainment and given recent inflationary pressures impacting school spending. More research is needed to understand the impacts of these spending cuts on attainment and health.


Figure 1.1: Heat maps of mortality, by cause (March 2020 to March 2021)
Figure A5.2 (in the appendix) presents the results for COVID-19 vaccination rates broken down by month.
A year of COVID-19 in the North: Regional inequalities in health and economic outcomes
  • Article
  • Full-text available

September 2021

·

79 Reads

·

25 Citations

Download

HESR innovation in analysis that supports decision making and action

September 2020

·

1 Read

·

1 Citation

The European Journal of Public Health

The European Health Equity Status Report makes innovative use of microdata, at the level of the individual, to decompose the relative contributions of five essential underlying conditions to inequities in health and well-being. These essential conditions comprise: (1) Health services (2) Income security and social protection (3) Living conditions (4) Social and human capital (5) Employment and working conditions. Combining microdata across over twenty sources, the work of HESRi has also produced disaggregated indicators in health, well-being, and each of the five essential conditions. In conjunction with indicators of policy performance and investment, the HESRi Health Equity Dataset of over 100 indicators is the first of its kind, as a resource for monitoring and analysing inequities across the essential conditions and policies to inform decision making and action to reduce gaps in health and well-being.


Citations (12)


... Our participants highlighted insufficient resources, issues with marketing and promotion of creative and cultural courses, and the need for improved feedback mechanisms. While these issues, especially those around staffing and marketing, are closely linked to the post-pandemic climate, particularly the increased pressure on healthcare services in the North since the onset of the COVID-19 pandemic [20], a number of implications arise from the study. First, our findings highlight the importance of teamwork as having a Life Rooms learning facilitator present during online sessions was identified as a factor facilitating effective delivery. ...

Reference:

Re-engaging with arts and cultural activities at the Life Rooms: ‘It’s given me spring’
A year of COVID-19 in the North: Regional inequalities in health and economic outcomes

... Such a case involves the report on the effects of raw milk consumption by people in England and Wales. It was reported that since 2014, seven Escherichia coli outbreaks were reported [3]. In this review, awareness about eating such foods' consequence is studied by microbiological analysis of the streetvended foods. ...

Influence of socio-economic status on Shiga toxin-producing Escherichia coli (STEC) infection incidence, risk factors and clinical features

Epidemiology and Infection

... The positive effect of this parenting approach ranges from childhood to adulthood (Mathew et al., 2017). Residing in resource-constrained environments (henceforth RCE) may negatively affect parenting practices (Gonzales et al., 2011), thus hindering the developmental trajectories of children (Wickham et al., 2018). However, evidence suggests that nurturing care could be a protective factor for child development (World Health Organisation [WHO] et al., 2018). ...

OP64 Impact of poverty trajectories on children’s health and maternal mental health: evidence from the UK millennium cohort study
  • Citing Conference Paper
  • September 2018

Journal of Epidemiology and Community Health

... All of these factors have further increased economic and social insecurity, "reinforcing existing forms of social inequality in the English-speaking nations, compared to Nordic and continental European welfare states" (Deeming, 2017: 414;Toth 2014). In Canada, these interactions have widened economic and social vulnerability for women, racialized populations, those with less education and persons unable to work due to having a disability (Banting & Kymlicka, 2006;O'Connor et al., 1999;Bentley, 2018). ...

Poverty and income support among older people with disabilities and out of work in the UK and Canada
  • Citing Article
  • November 2018

The European Journal of Public Health

... Qu et al. concluded that factors such as economic level, urbanization rate, sex ratio, health resources, education, and living conditions are all key factors that affect the health levels of residents in China [44]. Addison et al. found that in the UK and other high-income countries, factors such as income, education, and health and medical conditions all have a significant impact on people's health levels [45]. Xu et al. showed that family income, education level, and family size all promoted the improvement of residents' health levels [46]. ...

Equal North: How can we reduce health inequalities in the North of England? A prioritization exercise with researchers, policymakers and practitioners

Journal of Public Health

... 12 Previous research has shown that expansions to social security nets and public services have decreased inequalities in life expectancy, 19 IMRs 37 and mortality amenable to healthcare. 38 Robinson et al, 37 for example, found that the English health inequalities strategy (2000-2010) was associated with decreases in inequalities in infant mortality in England. Similarly, Krieger et al 39 found that the 1960s' 'War on Poverty' led to decreases in inequalities in IMR in the USA. ...

OP18 Evaluating the impact of the english health inequalities strategy on socioeconomic inequalities in the regional infant mortality rate

Journal of Epidemiology and Community Health

... 6 8 10 With evidence linking austerity to a range of worsening mortality, health and life expectancy are measured. [26][27][28][29] And, with devolved governments having their budgets cut by Westminster, the negative impact of austerity on health has been recorded in all nations of the UK. [30][31][32] The cuts to welfare and local authority services may then drive privatisation via increased demand on already constrained NHS services, which, in turn, may force commissioners to supplement existing provision with private services. ...

Are austerity measures in England driving rises in homelessness? Evidence from 324 Local Authorities 2004-2012: Rachel Loopstra
  • Citing Article
  • October 2014

The European Journal of Public Health

... This could be due to the increased marginalization of the poorest in society who have not shared equally in post war economic growth. A related explanation for increased inequalities in health by income evidenced in the literature is the increased level of economic inactivity in post-war born cohorts [7,9,10], in part, due to processes such as deindustrialisation [18]. The growth of spatial inequity in public and private investment is also likely to affect the health of those living in the more marginalised areas that have been affected by industrial decline [3,4]. ...

How do macro-level contexts and policies affect the employment chances of chronically ill and disabled people? The impact of recession and de-industrialisation.
  • Citing Chapter
  • January 2014

... Failure to comply can lead to further reductions in benefits. The academic reception of these programs has been largely negative, often citing adverse effects on the health of those that have to undergo these tests and pointing to the fact that work capability assessments tend to shift people from nonemployment to unemployment status, but do not actually activate them into employment (Barr et al., 2016;Cerletti, 2019;Dwyer et al., 2020;Hansford et al., 2019;Hassler, 2016). Other examples include attempts to incentivise people's reintegration into social services by punishing non-compliance. ...

Fit-for-work or fit-for-unemployment? Does the reassessment of disability benefit claimants using a tougher work capability assessment help people into work?
  • Citing Article
  • December 2015

Journal of Epidemiology and Community Health

... One of the few available quantitative studies found that when more WCA re-assessments had taken place on a local authority level, a higher likelihood of suicides, self-reported mental health problems and antidepressant prescriptions was found. 25 So far, however, all that can be concluded from this study is that there are temporal links, for example, between disability assessments and worsening mental health, but such time trends are susceptible to the ecological fallacy. Without individual-level data it is impossible to decide whether these proposed links are coincidental or causal. ...

'First, do no harm': Are disability assessments associated with adverse trends in mental health? A longitudinal ecological study

Journal of Epidemiology and Community Health