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Health inequalities result in poor accessibility to primary, secondary, community and preventative care as well as food sources and other health practices such as exercise and physical activity, across the lifespan1,2. However, globally, we have increasingly ageing population, and the importance of addressing issues related to deprivation in this vulnerable group is crucial. Older people living in deprived communities have reduced access to a range of services, which compromises their health and social-care1. This is often further exacerbated in areas of conflict, political and social unrest.Public Health and Primary Care often adopt top-down approaches, identifying behaviours or individuals as ‘problems’ and developing programmes to target the behaviours or individuals. This can result in programmes that widen rather than reduce inequalities. Our sandpit was designed to explore an evidence-based, bottom-up, community engagement approach3, that enables communities to identify barriers to their health and wellbeing and design sustainable and contextually specific solutions.Our expertise, the urban-rural disparity across GW4 and our global partners uniquely placed us to address the ‘Health, demographic change and wellbeing’ grand challenge and contribute to the GW4 priority areas ‘Inclusive innovative and reflective societies, and ‘Social Justice, Inequality, local and global.’ We worked with research partners in Colombia and Namibia to develop transferable adaptive processes and approaches for these developing countries and the welfare of their older populations.From the outset we identified several key outcomes and benefits from this research sandpit:• To be in a position to inform responses to local, national and international grand challenges to create inclusive communities and promote social justice.• To be in a position to inform government programmes for improving health inequalities of older people.• To develop a, network of researchers, community members and service providers, who can cogenerate ‘community engagement’ approaches, that are underutilised.The focus of our application was to identify new approaches and ways of addressing inequalities in health among older people living in low income / economically disadvantaged communities. In particular we wanted to maximise a community-development, bottom-up approach that is evidenced to have positive effects on health behaviours, health consequences and self-efficacy2. This also aligns with the Healthy Living theme proposed in the GW4, 5-year strategy3.AimTo identify new approaches, based on bottom-up approaches, to address inequalities in health among older people, living in low income and economically disadvantaged communities.6Objectives- Design and deliver a 2-day, international, residential sandpit- Create a network and data base of expertise, including academic, professional and local community members, with expertise in inequalities in older people, from across the GW4 locality and from the two DAC countries of Colombia and Namibia- Form a platform to develop community lead public health education health initiatives, identified by the local communities.- Develop one-two potential research projects in readiness for any future, related calls.How the funds were used ?Funding supported a 2-day, residential sandpit called: ‘Health inequalities in older people: a plan for action’. This was facilitated by a professional facilitator to enable us to achieve our aim and outcomes and ensured that we maximised our productivity. Attendees included stakeholders from relevant service providers and community members as well as academics with expertise in health inequalities in older people. This combined expertise and experience ensured that collective ideas and approaches were focused on grounding any project within the lived experience of economically disadvantaged communities.To advertise the event we designed a poster promoting the two-day, international, residential sandpit titled ‘Inequalities in older people: A plan for action’ (appendix 1). We emailed this to selected, potential delegates from stakeholder organisations, including service providers, community members and academics with expertise in health inequalities in older people, throughout the GW4 locality. We included a link on the poster taking interested applicants to an on-line registration page that we created using the Bristol on-line Survey system (BOS). The application form also asked potential delegates to provide details about their areas of expertise and to state whether they were happy for these to be placed on our database. In addition, we included a draft programme for the event.Approximately three-weeks before the event we circulated a document providing pen portraits from each of the GW4 leads involved in the original application (appendix 2). In the final two weeks prior to the event communication was maintained between organisers and potential delegates and important information, such as the programme for the sandpit was provided (figure 1).The residential 2-day sandpit took place at the Novotel, Victoria Street, Bristol. This was a central location in Bristol. It was a 5-minute walk from the main railway station and on major bus routes. Parking was provided for all delegates, by the hotel, if required.

Research Aim:To assess whether a pedometer based walking program assist standard physiotherapy treatment to decrease pain and improve function in patients who report chronic or recurrent LBP.Research Objectives:To assess whether a walking program will decrease lower back and/or leg pain*.To assess if a walking program will increase function*.To assess the duration, frequency and speed of walking necessary to change pain and dysfunction*.To assess which pain phenotype best matches treatment expectation to outcome.*objectives 1-4 relate to either or both of the CLBP phenotypes

Cardiovascular Disease (CVD) is one of the leading causes of premature mortality and morbidity in the UK with an estimated cost to the NHS of £14.4 billion. The incidence of CVD is projected to rise due to an ageing population and a high incidence of hypertension and Type 2 diabetes. Both of these conditions are associated with obesity, a condition which is reaching epidemic proportions, and is a modifiable risk factor for CVD.The NHS Health Checks programme is a national programme introduced in 2009 as part of a government programme to reduce avoidable deaths and disability. The main aim of the NHS Health Check is to improve the health and wellbeing of adults aged 40-74 years. It aims to do this through the promotion of earlier awareness, assessment and management of major risk factors and conditions that contribute to premature death and disability. Additionally, it aspires to contributing towards reducing health inequalities in England. NHS Health Checks are mainly delivered in GP practices by nurses or healthcare assistants who usually invite patients by letter.However, the method used to invite patients for an NHS Health Check has been shown to influence their likelihood of attendance. A recent study that explored attendance and method of invite for a Health Check found that verbal and telephone invitations resulted in a greater likelihood of attendance compared to a written letter invitation. This has recently been demonstrated by a GP practice in a deprived area of South Bristol. The practice piloted a telephone invitation method for engaging eligible patients for an NHS Health Check. Community link workers telephoned eligible patients, and if the patient consented, they completed selected aspects of the NHS Health Check by telephone. This was followed by inviting the patient to attend their GP practice for the remaining aspects of the NHS Health Check to be completed. This mainly included the physiological measurements for example blood tests and blood pressure. They found that their rate of ratio of invitations made to attendance for the full Health Check increased from 36%, using a traditional letter invite, to 78% using the telephone invitation method.As a consequence of this success, Bristol City Council (Public Health) identified funding to enable this model to be rolled out to all GP practices within the lowest lower layer super output areas (LSOAs) throughout the City of Bristol.We used a quantitative, quasi-experimental approach, to examine the relationship between attendance, or not for an NHS Health Check and age, gender, Index of Multiple Deprivation (IMD) score and ethnicity. We compared and contrasted the types of patients who attended for an NHS Health Check as a result of the telephone outreach initiative, with those who attended for an NHS Health Check as a result of the more traditional letter invite. We also compared and contrasted attendance for an NHS Health Check during the intervention period, with a similar period, prior to the intervention. To try and contextualise our results we explored and described potential confounding influences that may have encouraged or discouraged uptake of an NHS Health Check over the intervention period.The main aims and objectives of this evaluation were:Aims:• To evaluate the effectiveness of the telephone outreach service versus the standard invitation approach on uptake of NHS Health Checks in GP practices located in the lowest lower super output areas (LSOAs) in the city of Bristol.Objectives•Using practices located in the lowest LSOAs in the City of Bristol, compare the rate of uptake of an NHS Health Check in the target population, in GP practices using the telephone outreach initiative, with the rate of uptake in comparison / control practices who were using the traditional letter invite.•Investigate the relationship in the target population of those who attended or declined an NHS heath check, with age, gender, IMD and ethnicity, in both patients who were invited using the telephone outreach initiative and the traditional letter invite. •To explore other possible influencing factors on the uptake of NHS Health Checks, by the target population, during the study period.

A Quantitative Service Evaluation of a Telephone Outreach Initiative to Enhance the Uptake of NHS Health ChecksCoghill N, Research Associate. School of Social and Community Medicine, University of BristolGarside L, Research Associate. School of Social and Community Medicine, University of BristolAimThis study aimed to determine the efficacy of a telephone outreach service for inviting patients for an NHS health Check, in GP practices from the lowest super output areas of Bristol (LSOA). BackgroundNHS Health Checks are offered to patients aged 40-74 who are not on a disease register. The main aim is to assess their risk of developing one of these diseases or conditions and provide support and advice to help them reduce or manage their risk, disease or condition. A recent study found that verbal and telephone invitations resulted in a greater likelihood of attendance for and NHS Health Check, compared to a written letter invitation, particularly in hard to reach groups.Methodology12 self-selected GP practises opted to use the telephone outreach initiative and five practices acted as controls. Rate of uptake, demographics, including IMD for the populations included and predictions for uptake were explored using STATA v13.1.ResultsIntervention practices were more successful at attracting ethnic minority patients to attend and complete their NHS Health Check (25.6%), compared to non-telephone outreach practices (7.2%).However, intervention practices showed a, 24% rate of uptake compared to 36% in control practices. Patients were more likely to attend their GP practice to complete their NHS Health Check, following their phone call if they were female, over aged 70 and less deprived.ConclusionsDespite this initiative being offered only in the lowest LSOA’s in Bristol, it was still more likely to attract those least deprived populations. However, the telephone outreach initiative was more successful at attracting those form ethnic minority groups compared to control practises. Key words: Primary care, NHS Health Checks, Ethnic minorities, low income

NHS Health Checks are currently being offered to patients aged 40-74 years who are not on a relevant disease register. The main aim is to identify those at risk of cardiovascular disease (CVD), kidney disease or diabetes and tackle health inequalities.People from most black, minority ethnic (BME) populations are at greater risk of diabetes and stroke compared to the majority population, yet uptake of health checks is lower in BME communities. Outreach or community based health checks aim to increase uptake within these communities.