Search

Coastal communities and their environments are facing unprecedented changes, with climate change driving rising global mean sea level, exacerbating extreme sea level events, and increasing hazards. Whilst adaptations to change have been central to coastal life for millennia, climate change brings a speed and intensity of change not previously experienced. Researchers are noting that adaptations are needed that are large scale and systemic with significant changes to lives and livelihoods – Transformational Adaptations – yet there is little evidence of this in practice, and there remains an operationalisation gap between ambitions and actions. This paper uses a qualitative case study method to assess how existing policy may enable and inhibit local stakeholder involvement in transformational adaptation in English coastal flood and erosion risk management. Through twenty interviews with coastal management stakeholders, the capacity for local coastal management stakeholders to initiate transformational adaptation and the perceived involvement of residents are analysed. The results indicate that transformational adaptation remains a distant aspiration in the English coastal management system, with local stakeholders possessing limited capacity to initiate it. The perceived role for residents in adaptation processes is often focused on their being recipients of adaptation interventions, and there are a range of barriers to their further involvement. The paper concludes that despite the theoretical interest in transformational adaptation, there is limited evidence its implementation in English coastal flood and erosion risk management, and there are multiple priority areas for policy development to support capacity for engaged transformational adaptation practices in coastal management contexts. • There are few examples of transformational adaptation in the English coastal flood and erosion risk management. • The perceived role for residents in adaptation processes is often focused on their being recipients of interventions. • There are a range of barriers for local stakeholders to develop and enact coastal adaptation policy or practice. • There are multiple priorities for policy development to support capacity for engaged transformational adaptation practices. [ABSTRACT FROM AUTHOR]

• Many participants from GRT communities felt coerced into COVID-19 vaccinations. • Healthcare staff inadequately addressed or even dismissed vaccine concerns. • Vaccination decisions were affected by prior discrimination and barriers to care. • The standard 'vaccine hesitancy' model is of limited use in this situation. • Health services for GRT communities need to improve their overall trustworthiness. Many people refuse vaccination and it is important to understand why. Here we explore the experiences of individuals from Gypsy, Roma, and Traveller groups in England to understand how and why they decided to take up or to avoid COVID-19 vaccinations. We used a participatory, qualitative design, including wide consultations, in-depth interviews with 45 individuals from Gypsy, Roma, and Traveller, communities (32 female, 13 male), dialogue sessions, and observations, in five locations across England between October 2021 and February 2022. Vaccination decisions overall were affected by distrust of health services and government, which stemmed from prior discrimination and barriers to healthcare which persisted or worsened during the pandemic. We found the situation was not adequately characterised by the standard concept of "vaccine hesitancy". Most participants had received at least one COVID-19 vaccine dose, usually motivated by concerns for their own and others' health. However, many participants felt coerced into vaccination by medical professionals, employers, and government messaging. Some worried about vaccine safety, for example possible impacts on fertility. Their concerns were inadequately addressed or even dismissed by healthcare staff. A standard "vaccine hesitancy" model is of limited use in understanding vaccine uptake in these populations, where authorities and health services have been experienced as untrustworthy in the past (with little improvement during the pandemic). Providing more information may improve vaccine uptake somewhat; however, improved trustworthiness of health services for GRT communities is essential to increase vaccine coverage. This paper reports on independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or its arm's length bodies, and other Government Departments. [ABSTRACT FROM AUTHOR]

Although much of the existing research on regional airports focuses on their contribution to regional economic development, regional airports in England, as in other deregulated markets, operate in a highly competitive market and not all have been able to sustain commercial flights. This paper examines the factors that have led to the cessation of commercial air services at English regional airports following liberalisation of the European air transport market in 1992. Six factors which have contributed to air service cessation are identified and potential futures for smaller regional airports discussed. [ABSTRACT FROM AUTHOR]

Abstract Advocacy for people using health and social care services is widely promoted but its theoretical foundation is under-developed and its impact poorly conceptualised. This paper explores the liberatory potential of independent advocacy, using Fricker's concept of 'epistemic injustice' as a framework. People experiencing mental distress are particularly vulnerable to epistemic injustices as a consequence of deeply embedded social stigma resulting in a priori assumptions of irrationality and unreliability such that their knowledge is often discounted or downgraded. The mental health service user/survivor movement is at the forefront of validating personal experience and narrative to secure a different ontological and epistemological basis for mental distress. A foundational strand of this is advocacy to enable people to give voice to their experience. The case of independent mental health advocacy (IMHA) services under mental health legislation in England, provides an opportunity to critically examine whether advocacy can promote epistemic justice as a result of the legally sanctioned encounter between clinical assessment and subjective experience, pivoting on judgements about risk. This paper draws on empirical data from a national evaluation of IMHA services, which included 90 individual interviews with people subject to detention and three focus groups with mental health service users. Fricker's concept of epistemic injustice is used as a lens to investigate how this type of advocacy might mitigate forms of epistemic injustice, and thereby promote greater social justice in mental health. The concept of epistemic injustice provides a valuable theoretical basis for understanding the worth of advocacy in addressing testimonial injustice as well as its relative weakness in overcoming hermeneutical injustice. The challenge of independent advocacy to the dominant discourse within mental health is considered and questions raised about the place of advocacy in modern democratic mental health systems. Highlights • Analyses service user accounts of independent mental health advocacy (IMHA). • The concept of 'epistemic injustice' is used to identify if IMHA promotes equality. • The epistemic agency of those detained under MH legislation is compromised. • IMHA promotes testimonial justice but has limited impact on hermeneutic injustice. • Epistemic injustice is helpful in advancing more democratic mental health services. [ABSTRACT FROM AUTHOR]

This paper analyses Active People Survey data (collected 2011/12 to 2015/16) on 789,196 English adults, providing new information on how a range of socio-demographic factors are associated with utility and leisure cycling. Substantial inequalities are found in relation to gender, age, disability, and ethnicity for both types of cycling. For gender and age, and perhaps for disability in relation to recreational cycling, inequalities are moderated by local cycling prevalence such that English authorities with more cycling see less inequality. For education and car ownership, the picture is more mixed. Individuals with higher educational levels are more likely to participate in leisure cycling, but within most English local authorities this association is absent for utility cycling. Car ownership is negatively associated with utility cycling, but positively associated with recreational cycling. The paper’s discussion section puts these inequalities in context, and discusses the significance of the fact that some inequalities seem to be less pronounced or even absent in some contexts. It is argued that more research and a broader conceptualisation of cycling inequalities are needed to better understand and address inequalities in cycling participation. [ABSTRACT FROM AUTHOR]

Objective: To identify attitudes towards pharmacy characteristics and promotional methods for selected pharmacy public health services (lifestyle advice and screening for cardiovascular risk factors) among different sectors of the general public. Study design: Cross-sectional survey, using a previously validated questionnaire. Methods: Three survey methods were used, across 15 areas of England, to maximize diversity: face-to-face; telephone; and self-completion of paper questionnaires. Responses to closed questions regarding characteristics and promotion were quantified and differences among sub-groups explored by univariate and multivariate analysis. Results: In total, 2661 responses were available for analysis: 2047 face-to-face; 301 telephone; and 313 paper. There were strong preferences for a pharmacy near to home or doctor's surgery and for long opening hours, particularly among employed people and nonwhites. Fifty percent preferred not to use a pharmacy in a supermarket, particularly older people, the retired, those of lower education and frequent pharmacy users. Personal recommendation by health professionals or family/friends was reported as most likely to encourage uptake of pharmacy public health services, with older people and males being less likely and frequent pharmacy users more likely to perceive any promotional method as influential. Posters/leaflets were preferred over mass-media methods, with fewer than 30% perceiving the latter as potentially influential. Conclusion: Pharmacists, pharmacy companies and service commissioners should use promotional methods favoured by potential users of pharmacy public health services and be aware of differences in attitudes when trying to reach specific population sub-groups. For personal recommendation to be successful, good inter-professional working and a pro-active approach to existing customers are needed. [ABSTRACT FROM AUTHOR]

The English language term ‘permanence’ is increasingly used in high income countries as a ‘short-hand’ translation for a complex set of aims around providing stability and family membership for children who need child welfare services and out-of-home care. From a scrutiny of legislative provisions, court judgments, government documents and a public opinion survey on child placement options, the paper draws out similarities and differences in understandings of the place of ‘permanence’ within the child welfare discourse in Norway and England. The main differences are that in England the components of permanence are explicitly set out in legislation, statutory guidance and advisory documents whilst in Norway the terms ‘stability’ and ‘continuity’ are used in a more limited number of policy documents in the context of a wide array of services available for children and families. The paper then draws on these sources, and on administrative data on children in care, to tease out possible explanations for the similarities and differences identified. We hypothesise that both long-standing policies and recent changes can be explained by differences in public and political understandings of child welfare and the balance between universal services and those targeted on parents and children identified as vulnerable and in need of specialist services. [ABSTRACT FROM AUTHOR]

• We develop a framework for analysing the role of Science Policy Interfaces in Flood Risk Governance. • We apply this framework to England, France and the Netherlands using policy analysis and stakeholder interviews. • SPIs help diversify FRM; increase their connectivity, facilitate decentralisation of FRM and foster inter-country learning. • SPIs can steer FRG, either along existing pathways, or towards new and potentially transformative change. • SPIs are an underexposed factor explaining dynamics in flood risk governance which merits more systematic empirical study. In the face of increasing threats from flooding, there are growing calls to strengthen and improve arrangements of flood risk governance (FRG). This endeavour requires an appreciation of the multitude of factors stabilising and driving governance dynamics. So-called catalyst flood events, policy champions and advocacy coalitions have tended to dominate this study to date, whilst the potential role played by Science Policy Interfaces (SPIs) has been somewhat neglected and often approached in a reductionist and fragmented way. This paper addresses this gap by drawing from in-depth policy analysis and stakeholder interviews conducted within England, France and the Netherlands under the auspices of the EU-FP7 STAR-FLOOD project. The analysis reveals four prominent ways in which SPIs shape FRG, by i) facilitating the diversification of Flood Risk Management (FRM) strategies; ii) increasing their connectivity, iii) facilitating a decentralisation of FRM and iv) fostering inter-country learning. It identifies different roles of specific interfaces (structures) and interfacing mechanisms (processes) in shaping governance dynamics. This way, the analysis reveals various 'entry points' through which SPIs can steer FRG, either along existing pathways, or towards new and potentially transformative change. The study shows that SPIs are a hitherto underexposed factor explaining dynamics in flood risk governance which merits additional systematic empirical study. [ABSTRACT FROM AUTHOR]

How urban economies evolve has a rich literature. The impulse to discern longitudinal patterns of development can be seen in the body of work on path dependence. However, it has been noted that the drivers of path dependence are under-specified. In this paper we seek to make an association between real estate development in England and the longer term path dependence that has bequeathed an extremely geographically unequally pattern of economic development. In so doing we present empirical research from a major study of 'developer contributions' that associates behavioural aspects of the planning process through which developer contributions are determined and the creation of virtuous/vicious circles of development. It is our contention that these virtuous and vicious circles represent an important but under-researched aspect of the highly varied path dependencies observed in settings such as England that we describe here as poverty and affluence traps. [ABSTRACT FROM AUTHOR]

This paper contributes to the international literature examining design of inpatient settings for mental health care. Theoretically, it elaborates the connections between conceptual frameworks from different strands of literature relating to therapeutic landscapes, social control and the social construction of risk. It does so through a discussion of the substantive example of research to evaluate the design of a purpose built inpatient psychiatric health care facility, opened in 2010 as part of the National Health Service (NHS) in England. Findings are reported from interviews or discussion groups with staff, patients and their family and friends. This paper demonstrates a strong, and often critical awareness among members of staff and other participants about how responsibilities for risk governance of ‘persons’ are exercised through ‘technical safety’ measures and the implications for therapeutic settings. Our participants often emphasised how responsibility for technical safety was being invested in the physical infrastructure of certain ‘places’ within the hospital where risks are seen to be ‘located’. This illuminates how the spatial dimensions of social constructions of risk are incorporated into understandings about therapeutic landscapes. There were also more subtle implications, partly relating to ‘Panopticist’ theories about how the institution uses technical safety to supervise its own mechanisms, through the observation of staff behaviour as well as patients and visitors. Furthermore, staff seemed to feel that in relying on technical safety measures they were, to a degree, divesting themselves of human responsibility for risks they are required to manage. However, their critical assessment showed their concerns about how this might conflict with a more therapeutic approach and they contemplated ways that they might be able to engage more effectively with patients without the imposition of technical safety measures. These findings advance our thinking about the construction of therapeutic landscapes in theory and in practice. [Copyright &y& Elsevier]

Abstract: Binge drinking has been linked to escalating costs of hospitalisation and to premature mortality, and implicated in a range of acute and chronic health problems as well as crime, violence and other negative aspects of the wider well-being agenda. Variously defined, it can be characterised as brief periods of heavy drinking (across one day or evening) within a longer time-frame of lower consumption or even abstinence (across a week or several weeks). In England the current binge drinking epidemic has become particularly salient in the past decade and has been seen largely in terms of excessive consumption by younger people, particularly women in urban centres. It has also been linked to the liberalisation of licencing laws and the promotion of 24 h club cultures. This paper presents an observational study of the regional development of binge drinking between 2001 and 2009 as evidenced in the Health Survey for England. We innovate by using two different definitions of binge drinking within a multivariate multilevel modelling framework, with a focus on the random effects attributable to the year of study and region. We control for age, sex, ethnicity, marital status and individual socio-economic status, and confounding by neighbourhood deprivation and urbanisation. The paper identifies pronounced regional geographies that persist in the face of controls and vary little over time, and strong spatio-temporal gender differences which reflect the definition of binge drinking. [Copyright &y& Elsevier]

Abstract: Development of garden land has attracted political and media attention in recent years, yet there remained uncertainty over whether the issue was nationally or locally significant. Gardens are not a land use in their own right and have no special status in planning law. This enabled them to be considered, until very recently, as previously developed land according to The Brownfield Guide (). This allowed garden sites to be developed for new housing, thereby helping some authorities to meet their targets for residential development on brownfield land as monitored through their strategic housing land availability assessment (SHLAA). This paper reports the findings of a survey of local planning authorities carried out in 2009 and focused on planning applications and permissions on garden sites over a five year period ending 31 March 2008. The results reveal that garden development was a significant issue in only certain regional contexts, South East, London and West Midlands, and its actual and potential contribution to the local housing stock was variable. Where other forms of brownfield land were in short supply, garden sites might be crucial in meeting targets. The paper examines the policy framework underpinning such applications and shows that where local planning authorities had specific policies on the subject in place they were able to reach more robust decisions on garden site planning applications and there was less likelihood of first stage rejection decisions being overturned on appeal. [Copyright &y& Elsevier]

Abstract: England is about to embark on the introduction of an integrated approach to the management of its marine environment, known as marine planning. The management of human activity in the marine environment is a central function of marine planning; therefore, stakeholder involvement will be crucial for the successful development and subsequent implementation of marine plans. The range of stakeholder activities, their connection to the marine environment and interest in its management are likely to vary considerably on a local, regional and national scale. It is realistic to assume that it will not be possible to involve every stakeholder all the time; therefore in order to develop efficient and effective stakeholder involvement during the marine planning process it is sensible to determine who to involve, when to involve them, and how to involve them from the outset. This paper discusses the role of stakeholders in the marine planning process through consideration of the results of a stakeholder analysis, which was informed by primary data collated from stakeholders within the Solent. The paper concludes with a proposed mechanism, comprising different organisational units, for managing stakeholder involvement in the marine planning process. [Copyright &y& Elsevier]

Abstract Geographical deprivation indices such as the English Index of Multiple Deprivation (IMD) have been widely used in healthcare research and planning since the mid-1980s. However, such indices normally provide a measure of disadvantage for the whole population and can be inflexible to adaptation for specific geographies or purposes. This can be an issue, as the measurement of deprivation is subjective and situationally relative, and the type of deprivation experienced within rural areas may differ from that experienced by urban residents. The objective of this study was to develop a Rural Deprivation Index (RDI) using the English county of Norfolk as a case study, but with a view to adopting a flexible approach that could be used elsewhere. It is argued that the model developed in this research gives clarity to the process of populating an index and weighting it for a specific purpose such as rural deprivation. This is achieved by 'bundling' highly correlated indicators that are applicable to both urban and rural deprivation into one domain, and creating a separate domain for indicators relevant to the setting of interest, in this case rural areas. A further domain is proposed to account for population differences in rural areas. Finally, a method was developed to measure variability in deprivation within small areas. The RDI results in more rural areas in Norfolk falling in the most deprived quintile, particularly those classified as 'Rural town and fringe in sparse settings'; these areas also have high levels of heterogeneity of deprivation when using the variability measure created. This model proposed has the potential to provide a starting point for those who wish to create a summary deprivation measure taking into account rurality, or other local geographic factors, and as part of a range of approaches that can be used to allocate, or apply for, resources. Highlights • National indices of deprivation typically poorly represent rural disadvantage. • Paper presents new method to better depict deprivation in rural settings. • Depicts granularity of rural disadvantage better than English deprivation index. • Resulting index valuable for rural health and social service planning. [ABSTRACT FROM AUTHOR]

This paper aims to estimate the causal effect of accidents on traffic congestion and vice versa. In order to identify both effects of this two-way relationship, I use dynamic panel data techniques and open access 'big data' of highway traffic and accidents in England for the period 2012–2014. The research design is based on the daily-and-hourly specific mean reversion pattern of highway traffic, which can be used to define a recurrent congestion benchmark. Using this benchmark, I am able to identify the causal effect of accidents on non-recurrent traffic congestion. A positive relationship between traffic congestion and road accidents would yield multiplicative benefits for policies that aim at reducing either of these issues. Additionally, I explore the duration of the effect of an accident on congestion, the 'rubbernecking' effect, as well as heterogeneous effects in the most congested highway segments. Then, I test the use of methods which employ the bulk of information in big data and other methods using a very reduced sample. In my application, both approaches produce similar results. Finally, I find a non-linear negative effect of traffic congestion on the probability of an accident. [ABSTRACT FROM AUTHOR]

Abstract: There is a move towards large-scale planting of perennial bioenergy crops in many countries to help reduce Green House Gas emissions, whilst still meeting energy demand. However, the implications of such wholesale land use change have yet to be fully understood which raises some concerns over the strategy. This paper identifies, through literature review, that significant social, economic and environmental impacts might be expected from land use change in two different parts of the world, São Paulo, Brazil, where sugarcane is the predominant perennial biomass crop, and England where miscanthus and short rotation coppice are likely to predominate. In order to examine the extent to which these impacts can be addressed in decision-making, the paper develops a framework for testing the effectiveness of environmental assessment practice in these two regions, and applies it to both. The conclusion is that, whilst tools which can address sustainability impacts in decision-making exist, the legal framework in England precludes their application for the majority of land use change, and in Brazil there is incomplete consideration of social and economic impacts at the strategic level. [Copyright &y& Elsevier]

Over the past decade much has been written about the centrality of city-regions to accounts of economic success. But despite a rich and varied literature highlighting the importance of city-centric capitalism, the concept of the city-region remains ambiguous. Defined in economic terms, all too often what is missing from these accounts is how city-regions are constructed politically, and the processes by which they are rendered visible spaces. While recent interventions have done much to advance debates on the former, this paper explores the struggle to define, delimit and designate city-regions through recent endeavours to construct a spatial map of city-regions in England. The aim is to demonstrate how the processes by which city-regions are constructed politically are the mediated outcome of trans-regional economic flows and political claims to territory. The paper concludes by relating these findings to ongoing debates around state, space and scalar geographies, and speculates what they might mean for the future of city-regional debate. [Copyright &y& Elsevier]

Abstract: This paper uses data from the Scottish Health Survey 2003 and the comparable Health Survey for England 2003 to look at whether Scotland''s poor health image and mortality profile is reflected in regional inequalities in prevalence of four risk factors for cardiovascular disease: fruit and vegetable consumption, smoking, obesity and diabetes. It also looks at the “Scottish effect” – how much of any difference between and within Scotland and England remains once socio-demographic factors have been taken in to account. The paper then uses regional analyses to determine the extent to which areas within England and Scotland contribute to their national health advantage and disadvantage. All 2003 strategic health authorities in England and Scottish health boards were compared with Greater Glasgow health board as the reference category. The results showed that significant geographic variation in the risk factors remained once individual economic status was taken into account, but the relationship was complex and varied in strength and direction depending upon risk factor involved and gender of respondent. A small number of areas had significantly lower odds of fruit and vegetable consumption of five portions or more a day in men, compared with Greater Glasgow. In contrast some areas had significantly higher odds of fruit and vegetable consumption for women compared with Greater Glasgow. There was greater geographic variation in the odds of smoking in women than in men. Respondents in the south west and southeast of England (areas which usually show health advantage) did not show significantly lower odds of smoking compared with Greater Glasgow once socio-economic variation, age and urban residence was taken into account. It was respondents from central England that had lower odds of smoking than might be expected. Obesity stood out as the single risk factor that had demonstrated a “Scottish effect” in women only. [Copyright &y& Elsevier]

Abstract: Although it has many merits, the voluminous literature on urban governance gives scant attention to the actual involvement and positioning of business elites and businesses within Public–Private Partnerships. There is also little consensus among academics as to why the private sector become involved in such schemes. This paper begins to address these issues through a critical empirical examination of how and why the private sector is involved with three English Town Centre Management (TCM) partnerships and the Business Improvement District (BID) subsidiaries all three partnerships have recently developed. In order to do this, the empirical study is guided by a conceptual framework that foregrounds the relationship between (a) the opening up and monitoring of ‘institutional space’ by partnerships and the state, and (b) the motivations and ‘constrained agency’ of the business elites. The paper demonstrates that the positioning of the private sector is more multifarious and fractured than previous studies of urban governance have suggested. It also reveals that business elites and businesses view their participation as an ‘investment’ that needs to accrue significant financial returns and that partnership and state officials are highly selective in their choice of ‘who governs’. [Copyright &y& Elsevier]

Abstract: In the past 15–20 years, the rural areas of England have been used by a wide diversity of groups as the stage for their protest activities. Some have argued that this is due the rise of a rural social movement; this paper contends that rural areas have become both available and advantageous as the locale of protest through a range of interlocking factors. Firstly, that the rise of the network society has repositioned the societal importance of rural areas. Secondly, that the governance of rural areas has changed, allowing the social stake of rurality to be more widely contested. Thirdly, that opportunities to protest have shifted in favour of rural spaces, in terms of technology and policing. Through a discussion of recent changes in rural England and three case studies, The Land is Ours, Farmers for Action and the Organic Food and Farming Movement, this paper examines these changes and what they mean for the future of rural England. [Copyright &y& Elsevier]

Abstract: This paper is about the care of babies with confirmed or potential neurological problems in neonatal intensive care units. Drawing on recent ethnographic research, the paper considers parents’ experiences of sharing information and decisions with neonatal staff, and approaches that support or restrict parents’ involvement. There are growing medico-legal pressures on practitioners to inform parents and involve them in their babies’ care. Data are drawn from observations in four neonatal units in southern England, and interviews with the parents of 80 babies and with 40 senior staff. The paper compares standards set by recent guidance, with parents’ views about their share in decision-making, their first meetings with their babies, ‘minor’ decision-making, the different neonatal units, being a helpless observer and missed opportunities. Parents’ standards for informed decisions are summarised, with their reported views about two-way decision-making, and their practical need to know. Whereas doctors emphasise distancing aspects of the consent process, parents tend to value ‘drawing together’ aspects. [Copyright &y& Elsevier]

Abstract: This paper examines hourly wage payments for women who live in the rural districts of England, both in terms of variability within such districts and in terms of comparisons with non-rural districts. Drawing on the Labour Force Survey’s Local Annual Database, the paper argues that, once education, industry and occupation are taken into account, there is little to distinguish wage rates in rural and urban districts. Regionally there are important differences in wage rates, but these apply to rural as well as urban districts and are largely confined to contrasts between South East England and elsewhere. Rural–urban contrasts in wage levels are apparent in pay differences for men and women, although even here distinctions along a rural–urban divide are restricted to managerial workers, with the key distinction for professionals and technicians being between South East England and the rest of the country. For other occupations there is little to distinguish the relative magnitude of difference in men’s and women’s pay along rural–urban or regional lines. It is suggested that more attention to gender relations in wage determination practices within the workplace and within professions are worth exploring to develop a stronger understanding of division lines in wage inequalities. [Copyright &y& Elsevier]

Sight impairment is experienced by approximately 253 million people worldwide, including people of all generations, at all life course stages. Caught between past and present embodiments of the world, people often express feelings of loss with the onset of sight impairment. This paper examines the role of nonhuman nature encounters as a contingent resource amongst individuals navigating these emotional transitions. It responds to recent calls to attend to the life course in both critical disability studies and the growing body of work linking nonhuman nature relations to human wellbeing. The paper draws on findings from a qualitative study that combined in-depth narrative interviews with in situ go-along interviews to explore how 31 people with sight impairment in England describe and experience a sense of wellbeing (or otherwise) with nature across their everyday lives and life trajectories. The data were analysed using inductive narrative thematic analysis. While nonhuman nature encounters were valued by many participants in promoting a sense of freedom, relatedness, pleasurable sensory immersion, opportunities for exploration and 'skilling up', this paper cautions against generalised or overly Romantic tropes of what nonhuman nature can 'do' through key sight loss junctures, and for whom. It highlights the value of providing timely and sensitive social scaffolding and nurturing creativity to open up meaningful opportunities to engage with nonhuman nature and to counter feelings of loss exacerbated by identity-limiting life course narratives and disability stereotypes. Informed by the stories shared by participants to chart and situate their experiences of sight loss, we call for a new identity politics within and beyond the growing movement to 'connect' people to nonhuman nature for wellbeing; a politics that affirms diverse forms of more-than-human embodiment, recognising how and why such relations may weave into – and indeed out of – people's varied, interdependent life course trajectories. • Disabling life course norms can exacerbate feelings of loss with sight impairment. • Care is needed in generalising benefits of nature through transitions of sight loss. • Social scaffolding and creativity can enable supportive nonhuman encounters. • A more inclusive identity politics is needed in nature-wellbeing policy & practice. [ABSTRACT FROM AUTHOR]

This paper examines the impact that the Great Recession had on individuals’ health behaviours and risk factors such as diet choices, smoking, alcohol consumption, and Body Mass Index, as well as on intermediate health outcomes in England. We exploit data on about 9000 households from the Health Survey for England for the period 2001–2013 and capture the change in macroeconomic conditions using regional unemployment rates and an indicator variable for the onset of the recession. Our findings indicate that the recession is associated with a decrease in the number of cigarettes smoked - which translated into a moderation in smoking intensity - and a reduction in alcohol intake. The recession indicator itself is associated with a decrease in fruit intake, a shift of the BMI distribution towards obesity, an increase in medicines consumption, and the likelihood of suffering from diabetes and mental health problems. These associations are often stronger for the less educated and for women. When they exist, the associations with the unemployment rate (UR) are nevertheless similar before and after 2008. Our results suggest that some of the health risks and intermediate health outcomes changes may be due to mechanisms not captured by worsened URs. We hypothesize that the uncertainty and the negative expectations generated by the recession may have influenced individual health outcomes and behaviours beyond the adjustments induced by the worsened macroeconomic conditions. The net effect translated into the erosion of the propensity to undertake several health risky behaviours but an exacerbation of some morbidity indicators. Overall, we find that the recession led to a moderation in risky behaviours but also to worsening of some risk factors and health outcomes. [ABSTRACT FROM AUTHOR]

Illegal waste dumping has been widely regarded as one of the biggest source of environmental damage. Waste facilities management is an important way of combating illegal dumping for environmental protection and sustainability. This paper provides a comprehensive analysis on the determinants of illegal waste dumping based on panel data of England for a period of 7 years (2008–2014) using count data models, to access the effects of different drivers (economic, institution, policy). To be more specific the results show that (1) the increase of landfill cost (including landfill tax and landfill gate fee) have significant negative impact on the occurrence of illegal dumping (2) more waste landfill facilities, income level and intensity of penalty discourage illegal dumping. Such findings are robust using all models. The results indicate the main challenges in combating illegal waste dumping and the respective actions needed from the point of legal factors (i.e., law enforcement), institution factors (i.e., recycling rate, landfill dispersion) and economic factors (i.e., income level). [ABSTRACT FROM AUTHOR]

Like other health care systems, the National Health Service (NHS) in England has looked to new staffing configurations faced with medical staff shortages and rising costs. One solution has been to employ physician associates (PAs). PAs are trained in the medical model to assess, diagnose and commence treatment under the supervision of a physician. This paper explores the perceived effects on professional boundaries and relationships of introducing this completely new professional group. It draws on data from a study, completed in 2014, which examined the contribution of PAs working in general practice. Data were gathered at macro, meso and micro levels of the health care system. At the macro and meso level data were from policy documents, interviews with civil servants, senior members of national medical and nursing organisations, as well as regional level NHS managers (n = 25). At the micro level data came from interviews with General Practitioners, nurse practitioners and practice staff (n = 30) as well as observation of clinical and professional meetings. Analysis was both inductive and also framed by the existing theories of a dynamic system of professions. It is argued that professional boundaries become malleable and subject to negotiation at the micro level of service delivery. Stratification within professional groups created differing responses between those working at macro, meso and micro levels of the system; from acceptance to hostility in the face of a new and potentially competing, occupational group. Overarching this state agency was the requirement to underpin legislatively the shifts in jurisdictional boundaries, such as prescribing required for vertical substitution for some of the work of doctors. [ABSTRACT FROM AUTHOR]

Indoor temperatures during winter conditions play an important role in influencing the comfort and health of households, space heating energy demand and peak heating power. The role that physical dwelling features and household characteristics have on wintertime indoor temperatures has been examined among low-income households, but not across English households in a systematic manner. This paper examines determinants of indoor air temperatures during wintertime conditions to examine how temperature conditions vary with, for example, dwelling age or household socio-economic conditions. Using a cross-sectional survey of English dwellings that included monitoring of indoor air temperatures from January 2011 to February 2012, this study examines the determinants of indoor temperatures during wintertime conditions within a representative sample of English dwellings (N = 821). The study analysed indoor temperatures standardised to outdoor air temperatures of 0 °C, 5 °C and 10 °C within the study sample and the influence of physical dwelling features (type, age, size), household characteristics (tenure, income, composition, benefit receipt) and energy performance (loft and wall insulation, heating system and performance rating levels). The analysis finds that as dwelling age decreased (i.e. newer), so did indoor air temperatures in both the living room and bedrooms, after adjusting for a selection of dwelling and household characteristics. Compared to the lowest income quintile, households with higher incomes kept warmer temperatures, but this was not a linear increase and the highest incomes were not on average the warmest. There appears, however, to be little change in the dwelling temperature trends when looking at lower or higher outdoor air temperature conditions (i.e. 0 °C and 10 °C). In designing policies to improve indoor thermal conditions, policymakers will need to consider underlying energy performance of the dwelling alongside the socio-economic conditions of the household, for example when providing fuel support payments to at risk households. [ABSTRACT FROM AUTHOR]

This paper discusses changes occurring in the field of English forensic psychiatry which appear to be linked to feelings of discomfort amongst medical professionals who manage care in such settings. These changes are neither the result of a sudden ‘shock’ to the system, nor small improvisations at the margins, but instead appear to reflect a growing perception amongst psychiatrists of accepted field practice as inadequate for some types of patients. To understand how feelings and emotions are implicated in these changes we draw on and develop the work of Pierre Bourdieu to suggest that changes must be seen in the context of field tensions, which have implications for habitus. However, we do not view feelings of discomfort merely as a response to these tensions. Instead we suggest a more dynamic process. The habitus plays a key role in structuring what people pay attention to, how they perceive it and therefore, whether they experience particular feelings in the first place. [ABSTRACT FROM AUTHOR]

This paper examines the retail water service market introduced in England in 2017, which allows non-domestic consumers to choose their water retailer. Market competition was intended to motivate service improvement and enhance water-use efficiency. Interview and survey data on the responses of incumbent water companies and the impact on consumers reveal varied strategic responses but no significant change in service quality or bills. High transaction costs linked to market complexity, incompetent data management, asymmetric information, and regulatory restrictions account for the limited impact of market opening. Finally, contrary to expectation, the retail market does not appear to affect water-use efficiency uptake significantly. [ABSTRACT FROM AUTHOR]

Community renewable energy promises to play an important role in reducing the generation and consumption of high carbon sources of power, as well as in demonstrating the viability of novel business models within a transformed energy system built on principles of locality and democracy. The paper argues, however, that community renewable energy, in England at least, remains marginal, undermined by changing government policies and underplayed institutional factors connected with technology and organisational legitimacy. The paper reports on interviews with 29 actors connected with community renewable energy in England. The analysis identifies themes implicating various types of legitimacy with the partial and uneven institutionalisation of community renewable energy. These are bound up with continuing and new institutional rules and the deployment of strategies for (de)legitimising community renewable energy, including associated technologies and organisational forms, adversely impacting on the potential contribution of community renewable energy to energy system transformation. • Novel focus on legitimacy-building in institutionalising community renewable energy. • Identifies legitimacy gaps faced by community renewable energy in England. • Uniquely analyses organisational and technology legitimacy and discursive practices. [ABSTRACT FROM AUTHOR]

This paper investigates how the concepts of clinical specialisation and evidence influence the jurisdictional power of doctors, nurses and therapists involved in stroke care in Sweden, England and Poland. How stroke care has become a distinct specialism across Europe and the role that evidence has played in this development are critically analysed. Five qualitative case studies were undertaken across the three countries, consisting of 119 semi-structured interviews with a range of healthcare workers. The informants were purposively selected and their perspectives of evidence-based practice (EBP) within stroke care were explored. The data were analysed through thematic content analysis. The two key themes that emerged from the data were the health professionals' degrees of EBP and specialisation. The results illustrate how the two concepts of clinical specialisation and evidence are interrelated and work together to influence the different professions' degree of professional jurisdiction. It is concluded that doctors' professional dominance gives them full jurisdiction in stroke care and that nurses' and therapists' degrees of jurisdiction is dependent on their ability to specialise. [ABSTRACT FROM AUTHOR]

Evidence on provider payment systems that incorporate patient outcomes is limited for mental health care. In England, funding for mental health care services is changing to a prospective payment system with a future objective of linking some part of provider payment to outcomes. This research examines performance of mental health providers offering hospital and community services, in order to investigate if some are delivering better outcomes. Outcomes are measured using the Health of the Nation Outcome Scales (HoNOS) – a clinician-rated routine outcome measure (CROM) mandated for national use. We use data from the Mental Health Minimum Data Set (MHMDS) – a dataset on specialist mental health care with national coverage – for the years 2011/12 and 2012/13 with a final estimation sample of 305,960 observations with follow-up HoNOS scores. A hierarchical ordered probit model is used and outcomes are risk adjusted with independent variables reflecting demographic, need, severity and social indicators. A hierarchical linear model is also estimated with the follow-up total HoNOS score as the dependent variable and the baseline total HoNOS score included as a risk-adjuster. Provider performance is captured by a random effect that is quantified using Empirical Bayes methods. We find that worse outcomes are associated with severity and better outcomes with older age and social support. After adjusting outcomes for various risk factors, variations in performance are still evident across providers. This suggests that if the intention to link some element of provider payment to outcomes becomes a reality, some providers may gain financially whilst others may lose. The paper contributes to the limited literature on risk adjustment of outcomes and performance assessment of providers in mental health in the context of prospective activity-based payment systems. [ABSTRACT FROM AUTHOR]

This paper examines potential explanations for recent declines in teenage pregnancy in England. We estimate panel data models of teenage conception, birth and abortion rates from regions in England. Although point estimates are consistent with the promotion of long acting reversible contraception (LARC) having a negative impact on teenage pregnancy rates, the effects are generally small and statistically insignificant. In contrast, improvements in educational achievement and, to a lesser extent, increases in the non-white proportion of the population are associated with large and statistically significant reductions in teenage pregnancy. [ABSTRACT FROM AUTHOR]

Governments world-wide have attempted to use market mechanisms and privatisation to increase the quality and/or reduce the cost of healthcare. England's Health and Social Care Act 2012 is an attempt to promote privatisation through marketisation in the National Health Service (NHS). While the health policy literature tends to assume that privatisation follows from private-sector entry points, we argue that this is more likely if firms expect to make a profit. This paper examines the link between privatisation and marketisation in England drawing on 32 semi-structured interviews with private-sector and public-sector respondents, campaigners, and other experts conducted 6–10 months after the implementation of the 2012 Act. By generating a theoretical framework on the conditions of profitability we seek a better understanding of the conditions under which marketisation leads to privatisation. We find that significant barriers to profit-making remain after the reforms, including a top-down squeeze on prices, uncertainty in market rules, state dominance of funding and provision, and failures to depoliticise the market. These factors restrict private-sector involvement by frustrating profit-making. Where profits are made they are through reduced unit costs and high volumes by a longstanding incumbent in a particular market segment. This, however, restricts marketisation by reinforcing entry barriers. [ABSTRACT FROM AUTHOR]

Understanding the socioeconomic gradient in physical inactivity is essential for effective health promotion. This paper exploits data on over one million individuals (1,002,216 people aged 16 and over) in England drawn from the Active People Survey (2004–11). We identify the separate associations between a variety of measures of physical inactivity with education and household income. We find high levels of physical inactivity. Further, both education and household income are strongly associated with inactivity even when controlling for local area deprivation, the availability of physical recreation and sporting facilities, the local weather and regional geography. Moreover, the gap in inactivity between those living in high and low income households is already evident in early adult life and increases up until about age 85. Overall, these results suggest that England is building up a large future health problem and one that is heavily socially graded. [ABSTRACT FROM AUTHOR]

Summary This paper presents an assessment of the effects of climate change on river flow regimes in representative English catchments, using the UKCP09 climate projections. These comprise a set of 10,000 coherent climate scenarios, used here (i) to evaluate the distribution of potential changes in hydrological behaviour and (ii) to construct relationships between indicators of climate change and hydrological change. The study uses six catchments, and focuses on change in average flow, high flow (Q5) and low flow (Q95). There is a large range in hydrological change in each catchment between the plausible UKCP09 climate projections, with differences between catchments largely due to differences in catchment geology and baseline water balance. The range in change between the UKCP09 projections is in most catchments smaller than the range between changes with scenarios based on the CMIP3 ensemble of climate models (although the shape of the distribution of changes is different), and earlier UK scenarios produce changes that tend towards the lower (drier) end of the UKCP09 range. The difference between emissions scenarios is small compared to the range across the 10,000 scenarios. Changes in high flows are largely driven by changes in winter precipitation, whilst changes in low flows are determined by changes in summer precipitation and temperature. [ABSTRACT FROM AUTHOR]

Obesity has been identified as an independent risk factor for a wide range of health conditions. Therefore, there is a clear need for high quality Bariatric research in order to improve patient selection, outcomes and safety for patients with obesity. We sought to identify and compare the quantitative and qualitative publication output from Bariatric centres in England. We identified 42 National Health Service (NHS) Trusts and 162 surgeons providing Bariatric services in England. A median of 4 (range 1–7) Bariatric surgeons were identified per centre. Eight NHS Trusts (19%) and 75 surgeons (46.3%) had no Bariatric publications during the study period, while 87 surgeons published a total of 432 Bariatric papers. Only 15 surgeons (9%) had ≥10 publications within the study period. However, these surgeons produced >50% of all Bariatric publications. Departments with more than 4 surgeons produced a significantly higher number of Bariatric publications (median 8.5 vs 2, p = 0.01). There is significant variation in research contribution amongst Bariatric centres in England. Academia should be encouraged and promoted across all bariatric services in order to broaden our understanding on Bariatric outcomes by expanding the service and proportional increase in funding. Given that a number of health conditions can afflict individuals living with obesity, bariatric surgery research becomes all the more important. [ABSTRACT FROM AUTHOR]

This paper investigates the link between cannabis depenalisation and crime using individual-level panel data for England and Wales from 2003 to 2006. We exploit the declassification of cannabis in the UK in 2004 as a natural experiment. Specifically, we use the fact that the declassification changed expected punishments differently in various age groups due to thresholds in British criminal law and employ a difference-in-differences type design using data from the longitudinal version of the Offending, Crime and Justice Survey. Our findings suggest essentially no increases in either cannabis consumption, consumption of other drugs, crime and other forms of risky behaviour. [ABSTRACT FROM AUTHOR]

Abstract: This paper reviews the principal marine and coastal policy changes in England since 1999. The key changes identified are the establishment of a strategic national marine and coastal policy direction, new marine legislation and institutions, the emergence of a marine planning framework, the consolidation of Integrated Coastal Zone Management approaches to coastal governance, the establishment of a Marine Protected Area network, and the decline of coastal partnerships. The European Union, UK National Government, and devolved administrations are identified as key influences on the governance evolution and their relative contributions are discussed. It is concluded that the English marine and coastal governance context has evolved significantly since 1999 and that the new framework, if implemented successfully, represents a genuine step towards an integrated governance framework for England's coasts and seas. [Copyright &y& Elsevier]

This paper critically discusses the challenges mental health nurses face in trying to achieve a balance between fulfilling biomedical and social roles. We suggest that dilemmas exist for nurses in attempting to combine both approaches in their practice. We present a specific example of these as occasioned by the advent of the approved mental health professional role in England and Wales. This statutory role requires the adoption of an independent social perspective as a counterbalance to the biomedical perspective brought by psychiatrists. Using the idea of occupational jurisdictions we discuss how nurses embarking on this new role are effectively crossing into territories previously occupied by the profession of social work. We also reveal the tensions for nurses who fulfil the approved mental health professional role whilst simultaneously carrying out work in other areas which demands a more overtly biomedical approach. We review critical accounts of the validity of bio-psycho-social models and concerns about maintaining positive therapeutic alliances alongside making applications for compulsory detention, assessment and treatment. We argue that the new role may become part of the professional project of mental health nursing, but also present challenges in helping redefine nursing's identity and practice. [ABSTRACT FROM AUTHOR]

• Inconclusive reactor (IR)-only surveillance tests represent a future risk of bTB. • Machine learning models identified IR-only tests at risk of an incident at retest. • High-risk IR-only surveillance tests identified in the year 2020 were evaluated. • Severe reinterpretation of these surveillance tests reduced the bTB risk IRs pose. Bovine tuberculosis (bTB) remains one of the most complex, challenging, and costly animal health problems in England. Identifying and promptly removing all infected cattle from affected herds is key to its eradication strategy; the imperfect sensitivity of the diagnostic testing regime remaining a serious obstacle. The main diagnostic test for bTB in cattle in England, the Single Intradermal Comparative Cervical Tuberculin Test (SICCT: also known as the skin test), can produce inconclusive results below the reactor threshold. The immediate isolation of inconclusive reactor (IR) animals followed by a 60-day retest may not prevent lateral spread within the herd (if it is substandard, allowing transmission) or transmission to wildlife. Over half of IR-only herds that went on to have a positive skin test result (a bTB herd 'incident') in 2020, had it triggered by at least one IR not clearing their 60-day retest, instead of by another test within the previous 15 months. Machine learning classification algorithms (classification tree analysis and random forest), applied to England's 2012–2020 IR-only surveillance herd tests, identified at-risk tests for an incident at the IRs' 60-day retest. In this period, 4 739 out of 22 946 (21 %) IR-only surveillance tests disclosing 6 296 out of 42 685 total IRs, had an incident at retest (2 716 IRs became reactors and 3 580 IRs became two-time IRs). Both models showed an AUC above 80 % in the 2012–2019 dataset. Classification tree analysis was preferred due to its easy-to-interpret outputs, 70 % sensitivity, and 93 % specificity in the 20 % of 2019–2020 testing dataset. The paper aimed to identify IR-only surveillance tests at-risk of an incident at the 60-day retest to target them with appropriate measures to mitigate the IRs' risk. Sixteen percent (341 out of 2 177) of IR-only herd tests were identified as high-risk in the 2020 dataset, with 265 (78 %) of these having at least one reactor or IR at retest. Severe-level reinterpretation of the high-risk IR-only disclosing tests identified in this dataset would turn 68 out of the 590 (12 %) IRs into reactors, generating 23 incidents, the majority (19 or 83 %) part of the 265 incidents that would have been declared at the retest. Classification tree analysis used to identify IR-only high-risk tests in herds eligible for severe interpretation would enhance the sensitivity of the test-and-slaughter regime, cornerstone of the bTB eradication programme in England, further mitigating the risk of disease spread posed by IRs. [ABSTRACT FROM AUTHOR]

Primary care management of patients with multimorbidity in the UK is underpinned by clinical guidelines, quality standards and measurable targets which govern practices of risk management and disease control. There is concern that standardised approaches may not always be appropriate for older patients living with multimorbidity. Using a narrative approach, we elicited the voices of older people living with multiple conditions in order to rethink chronicity, and consider what their accounts might mean for reconfiguring care practices. Within an ethnographic study of multimorbidity and polypharmacy, we conducted in-depth interviews, based on the Biographical Narrative Interpretive Method, with 24 participants aged 65 to 94. Participants were recruited from three general practices in England. All had two or more chronic conditions and were prescribed ten or more medicines. Our analysis draws on Bakhtinian theory, tracing the multiple ways in which participants voiced living with multimorbidity. In this paper, we focus on 'keeping in balance' which emerged as a key meta-conceptualisation across our dataset. Adopting the metaphor of the 'multimorbidity tightrope' we explore the precarity of patients' experiences and show their struggle to create coherence from within a deeply ambiguous living situation. We consider how and to what extent participants' narrative constructions co-opt or resist normative biomedical framings of multimorbidity. Our analysis foregrounds the complex ways in which patients' voices and values may sometimes be at odds with those promoted within professional guidelines. Narrative approaches may offer significant potential for reorienting healthcare towards enabling patients to live a flourishing life, even when facing significant adversity. • A voice-centred analytical method illuminates participants' multivocal narratives. • The 'multimorbidity tightrope' illustrates the precarity of patients' experiences. • Managing multimorbidity requires careful balance in order to flourish. • Participants both co-opted and resisted biomedical framings of multimorbidity. • I-poems present the contradictory nature of participants' narratives. [ABSTRACT FROM AUTHOR]

Abstract: Marine spatial planning (MSP) is a new component of the marine governance framework in England. Two MSP pilot studies undertaken on the south of England are evaluated in this paper to obtain key reflections from participants and process organisers. The evaluation was conducted through two phases of personal interviews. Three key reflections emerged related to effective practice in MSP. First was that MSP should be inclusive, which is delivered through adequate participatory opportunities, clear leadership, exploiting trusted pre-existing communication channels, and supporting participants to develop their marine planning capacity. Second, was that the MSP evidence base should maximise the quality and extent of evidence available and offer clarity over data gaps and uncertainty. Third, that adequate resources are critical to successful MSP, particularly to ensure that stakeholder groups should allocate sufficient staff time to fully engage in MSP and that MSP process organisers should allocate sufficient resources to fully support stakeholders throughout the MSP process. [Copyright &y& Elsevier]

Abstract: In a context of ever increasing demand, the recent economic downturn has placed further pressure on decision-makers to effectively target healthcare resources. Over recent years there has been a push to develop more explicit evidence-based priority-setting processes, which aim to be transparent and inclusive in their approach and a number of analytical tools and sources of evidence have been developed and utilised at national and local levels. This paper reports findings from a qualitative research study which investigated local priority-setting activity across five English Primary Care Trusts, between March and November 2012. Findings demonstrate the dual aims of local decision-making processes: to improve the overall effectiveness of priority-setting (i.e. reaching ‘correct’ resource allocation decisions); and to increase the acceptability of priority-setting processes for those involved in both decision-making and implementation. Respondents considered priority-setting processes to be compartmentalised and peripheral to resource planning and allocation. Further progress was required with regard to disinvestment and service redesign with respondents noting difficulty in implementing decisions. While local priority-setters had begun to develop more explicit processes, public awareness and input remained limited. The leadership behaviours required to navigate the political complexities of working within and across organisations with differing incentives systems and cultures remained similarly underdeveloped. [Copyright &y& Elsevier]

Abstract: This study is situated within the international literature on geographic health inequalities between urban and rural areas. Using data from the Office for National Statistics Longitudinal Study (ONS LS), this paper assesses the role of residential mobility within England between 1981 and 2001 in explaining geographic inequalities in all-cause mortality between urban and rural Local Authority Districts at the end of the period (deaths occurring between 2001 and 2005). First, the pattern of directly age-standardised death rates (2001–2005) in urban and rural areas of residence in 2001 is examined and compared with the pattern that would have been seen if the observed death/survival of individuals had occurred in their original place of residence in 1981, or in 1991. Secondly, logistic regression is applied to examine whether individuals'' residential mobility between urban and rural areas predict the risk of mortality, adjusting for people''s socio-demographic characteristics. Findings show that, for this sample, residential mobility 1981–2001 accounts for about 30% of the urban–rural inequalities in mortality observed at the end of the period. LS members who were residentially mobile between urban and rural areas were relatively healthier than long-term urban residents, with better mortality outcomes among rural in-migrants. In age-stratified analysis, LS members of working age (20–64 years) moving out of rural areas, and LS members of retirement age (65 years and older) moving into rural areas, were shown to be healthier. Processes of selective migration in and out of rural areas in England are complex and may partly explain urban–rural health inequalities. In terms of varying mortality risk, findings also highlight the possible marginalisation and disadvantage of sub-groups of the rural population. [Copyright &y& Elsevier]

Abstract: Ever since the United Kingdom published its second sustainable development strategy in 1999, the legitimacy-governing construct of quality of life has been refashioned in the English policy context to accommodate a novel intergenerational dimension. This paper examines the magnitude of this sustainability transformation by examining the operationalisation and reported outcomes of formally established sustainable quality of life data in conjunction with commensurate quality of life information compiled twenty years previously, amongst 63 matched city locations. Conceptually, we find that although the sustainable quality of life data is comparatively more sophisticated in its environmental connotation it has not managed to reconcile this effort with the social and economic domains of sustainability, tending instead to neutralise the distributive, class-based tenor of its predecessor. Empirically, meanwhile, we find that whereas Northern-based city locations perform comparatively worse on the sustainable quality of life rankings Southern ones do much better. We also find that while the lowest scoring localities tend to be afflicted by similar types of quality of life deficiencies the top ones shine on a diverse range of issues. [Copyright &y& Elsevier]

Abstract: This paper seeks to make sense of the sleeping practices of people who are recovering from heroin use. It brings together two hitherto unrelated literatures: the sociology of sleep and studies on heroin use and recovery. Conceptual resources developed within the sociology of sleep are deployed to facilitate the analysis of interview data generated as part of a qualitative investigation into the everyday lives of recovering heroin users living in England. Twenty one men and 19 women were interviewed with 37 of the 40 being interviewed twice, giving a corpus of 77 interviews. Without exception all the participants in the research experienced extensive sleeping problems that were not only exacerbated by the pharmacological effects of heroin, but were made worse by the way of life that accompanied their using. Irregular and anarchic sleeping practices mirrored the study participants’ disrupted and difficult lives. Attempts to establish sleep routines, and normative sleeping patterns, constitutes an important marker of recovery, but after years, and for some decades, of chaotic, intermittent and irregular sleeping, cultivating sleep presents a series of difficult challenges. Their embodied biographies of heroin use constrain the promotion of sleep, and attempts to develop rituals and routines to restore sleeping patterns are confounded by the involuntary aspects of sleep and their recalcitrant bodies. These findings are significant because not only is the quality of sleep critical to health outcomes but it also forms an important but hitherto relatively overlooked aspect of recovery from heroin use. [Copyright &y& Elsevier]

Abstract: Caregiving research has rarely examined the nature and impact of care provision at night. This paper analyses indepth interviews with 24 older people in England whose sleep had been adversely affected by providing care at night. A framework is proposed that illustrates how six aspects of caregiving can disrupt carers'' sleep quality: first, attending to the night-time physical needs of the care recipient; second, anticipation of their night-time care needs; third, ‘monitoring’ their relative at night; fourth, disruption from relatives who are awake for long periods at night, wandering or shouting; fifth, undertaking emotional support, and worries or anxieties related to their relative; and finally, the legacy of caregiving may continue to disrupt sleep after caring ceases, because of painful images of their relative''s suffering or feelings of guilt. Adverse effects on carers'' sleep are greatest for co-resident carers, especially when caring for a spouse or relative with a life-limiting illness or dementia. [Copyright &y& Elsevier]

Abstract: Regions affected by deindustrialisation are often characterised by unfavourable local health profiles. This was the situation in coalfield areas in England, where the scale and suddenness of the job losses in the 1980s and 1990s left these communities experiencing difficult socioeconomic conditions, and associated poor health status. Using data from the Health Survey for England, this paper examines whether poorer health outcomes still characterise coalfield areas today. Findings confirm a ‘coalfield health effect’ related to limiting long-term illness. With regards to self reported general health and mental health outcomes, results are less clear. The population health profile of coalfield communities is not homogeneous, with some coalfield communities faring worse than others, indicating more localised health issues. [Copyright &y& Elsevier]