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Competing Interests: KF is President of the Faculty of Public Health. GF is President of the UK Association of Directors of Public Health, a member of the gambling related harm strategic steering group for Yorkshire and the Humber, which is funded by a regulatory settlement awarded by the UK Gambling Commission, and a member of the UK National Screening Committee. WR is Chief Executive of the Royal Society for Public Health and an honorary member of the Faculty of Public Health. MR is President of the Public Health and Epidemiology Section, Royal Society of Medicine, and immediate Past-President of the Faculty of Public Health. We declare no other competing interests.

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: MvS is funded by a National Institute for Health Research (NIHR) doctoral fellowship (NIHR3000156) and her research is also partially supported by the NIHR Applied Research Collaboration North Thames. ST has received funding for gambling research from the Australian Research Council, the Victorian Responsible Gambling Foundation, Healthway, and Deakin University. She is a board member for the International Confederation of Alcohol and Other Drug Research Associations and is a member of the Gambling Harm Prevention Advisory Committee of LotteryWest. She does not receive financial payment for these roles. She is editor in chief of Health Promotion International. MM has received funding from NIHR for a doctoral fellowship to research public health aspects of gambling and is president of the BMA (but is writing in a personal capacity). GF is vice president of the UK Association of Directors of Public Health and a member of the gambling related harm strategic steering group for Yorkshire and the Humber, which is funded by a regulatory settlement awarded by the UK Gambling Commission. MD has received funding for gambling research from the Australian Research Council, Healthway, and the Victorian Responsible Gambling Foundation. The views expressed are those of the authors and do not necessarily represent those of their funding bodies.

The conditions in which we are born, grow, live, work and age are key drivers of health and inequalities in life chances. To maximise health and wellbeing across the whole population, we need well-coordinated action across government sectors, in areas including economic, education, welfare, labour market and housing policy. Current research struggles to offer effective decision support on the cross-sector strategic alignment of policies, and to generate evidence that gives budget holders the confidence to change the way major investment decisions are made. This open letter introduces a new research initiative in this space. The SIPHER ( Systems Science in Public Health and Health Economics Research) Consortium brings together a multi-disciplinary group of scientists from across six universities, three government partners at local, regional and national level, and ten practice partner organisations. The Consortium's vision is a shift from health policy to healthy public policy, where the wellbeing impacts of policies are a core consideration across government sectors. Researchers and policy makers will jointly tackle fundamental questions about: a) the complex causal relationships between upstream policies and wellbeing, economic and equality outcomes; b) the multi-sectoral appraisal of costs and benefits of alternative investment options; c) public values and preferences for different outcomes, and how necessary trade-offs can be negotiated; and d) creating the conditions for intelligence-led adaptive policy design that maximises progress against economic, social and health goals. Whilst our methods will be adaptable across policy topics and jurisdictions, we will initially focus on four policy areas: Inclusive Economic Growth, Adverse Childhood Experiences, Mental Wellbeing and Housing., Competing Interests: No competing interests were disclosed., (Copyright: © 2019 Meier P et al.)

Importance: Evidence has linked age-related hearing impairment (ARHI) with cognitive decline; however, very few studies (none in the United Kingdom) explore this link in large well-characterized groups of community-dwelling individuals., Objective: To investigate the link between ARHI and cognitive decline using a cohort of elderly individuals from the United Kingdom and explore untreated hearing loss and social isolation as potential explanations for the observed link., Design, Setting, and Participants: This cross-sectional analysis of wave 7 (June 2014 through May 2015) of the English Longitudinal Study of Ageing (ELSA) sampled men and women 50 years or older and living in the United Kingdom in a community setting. Those with a diagnosis of dementia, Alzheimer disease, or Parkinson disease or with ear infections and cochlear implants were excluded. Data were analyzed from August 1, 2017, through May 25, 2018., Main Outcomes and Measures: Memory and executive function as measures of cognitive function and hearing acuity derived from the HearCheck screener device (Siemens)., Results: Of a cohort of 9666 members in wave 7 of ELSA, 7385 were eligible for analysis after applying exclusion criteria (55.1% women; mean [SD] age, 67.4 [9.4] years). Of these, 3056 (41.4%) had mild hearing loss and 755 (10.2%) had severe hearing loss; 834 (11.3%) used a hearing aid; and 7155 (96.9%) were white. Hearing loss had a negative association with cognition; for those with moderate to severe loss, the score on memory assessment was a full 1 point less (-1.00; 95% CI, -1.24 to -0.76), ceteris paribus, relative to those with no hearing loss. However, this association was seen only in the individuals with untreated hearing loss (ie, those who did not use hearing aids) (-1.16; 95% CI, -1.45 to -0.87). Evidence suggests that social isolation acts as a mediating factor., Conclusions and Relevance: Although hearing loss and cognition are linked, untreated hearing loss drives the association. Social isolation is a mediating factor in the link for those who have untreated hearing loss. Cognitive decline associated with ARHI is probably preventable by early rehabilitation and increased opportunistic screening for the elderly.

Objectives: To investigate the importance of incorporating secondary care input to aid commissioning following National Health Service reforms which will see the replacement of Primary Care Trusts with Clinical Commissioning Groups; to determine barriers that might arise given that this issue had been raised during public consultations and to explore ways to improve this input., Design: Qualitative project with semistructured one-to-one interviews which were audio recorded, transcribed and analysed using thematic content analysis by two investigators. The findings were discussed and organized into a framework., Setting: Bradford and Airedale, UK., Participants: We interviewed 19 participants from primary care, the medical directorship and a range of specialties., Main Outcome Measures: One-to-one semistructured interviews allowed a flexible dialogue to discuss planned questions and any other themes which participants brought up. This elicited a variety of experiences and ideas which provided the basis for in depth theoretical analysis required for our objectives., Results: There was an almost universal agreement that the integration of secondary care advice is important in commissioning. The main perceived barriers were obstacles to good communication and relationships, conflicts of interest and financial pressures. Participants suggested varied and innovative ways to improve communication and integration, and suggestions for organisations., Conclusions: Our results support the importance of secondary care input and highlight communication, organisation and integration as three goals for organisations to work towards. Successful achievement of these objectives could have financial implications for organisations as well as benefits for patient care.

A survey of doctors working in two large NHS hospitals identified over 120 laboratory tests, imaging investigations and investigational procedures that they considered not to be overused. A common suggestion in this survey was that more training was required. And, this prompted the development of a list of core principles for high-quality, high-value testing. The list can be used as a framework for training and as a reference source. The core principles are: (1) Base testing practices on the best available evidence. (2) Apply the evidence on test performance with careful judgement. (3) Test efficiently. (4) Consider the value (and affordability) of a test before requesting it. (5) Be aware of the downsides and drivers of overdiagnosis. (6) Confront uncertainties. (7) Be patient-centred in your approach. (8) Consider ethical issues. (9) Be aware of normal cognitive limitations and biases when testing. (10) Follow the 'knowledge journey' when teaching and learning these core principles.

Background: Within many parts of the country, the NHS is undertaking reconfiguration of services. Such proposals can prove a tipping point and provoke public protest, often with significant involvement of local and national politicians. We undertook a rapid Health Impact Assessment (HIA) of a proposed reconfiguration of maternity services in Huddersfield and Halifax in England. The aim of the HIA was to help the PCT Boards to assess the reconfiguration's possible consequences on access to maternity services, and maternal and infant health outcomes across different socio-economic groups in Kirklees. We report on the findings of the HIA and the usefulness of the process to decision making., Methods: This HIA used routine maternity data for 2004-2005 in Huddersfield, in addition to published evidence. Standard HIA techniques were used., Results: We re-highlighted the socio economic differences in smoking status at booking and quitting during pregnancy. We focused on the key concerns of the public, that of adverse obstetric events on a Midwife Led Unit (MLU) with distant obstetric cover. We estimate that twenty percent of women giving birth in a MLU may require urgent transfer to obstetric care during labour. There were no significant socio economic differences. Much of the risk can be mitigated though robust risk management policies. Additional travelling distances and costs could affect lower socio-economic groups the greatest because of lower car ownership and geographical location in relation to the units. There is potential that with improved community antenatal and post natal care, population outcomes could improve significantly, the available evidence supports this view., Conclusion: Available evidence suggests that maternity reconfiguration towards enhanced community care could have many potential benefits but carries risk. Investment is needed to realise the former and mitigate the latter. The usefulness of this Health Impact Assessment may have been impeded by its timing, and the politically charged environment of the proposals. Nonetheless, the methods used are readily applicable to assess the impact of other service reconfigurations. The analysis was simple, not time intensive and used routinely available data. Careful consideration should be given to both the timing and the political context in which an analysis is undertaken.

Background: Work is being undertaken across a wide range of agencies to ensure a high level of preparedness for pandemic influenza. In England, the Department of Health has published a range of guidance to support this. The impact of pandemic flu on care homes, especially if unprepared may have a major knock on effect on the rest of the health and social care system., Objective: and Methods A rapid survey was undertaken of a small number of care homes in West Yorkshire to assess preparedness. The homes were both local authority and privately owned., Results: It was apparent that little preparation had been done at the time of the survey. A range of readily implementable ideas that may help this sector prepare was identified., Conclusion: Planning for pandemic flu in this sector will require effort and coordination across a range of sectors; it might best be coordinated through Local Resilience Forums.