No abstract

The Public Health Responsibility Deal (RD) in England is a public-private partnership involving voluntary pledges between government, industry and other organisations in the areas of food, alcohol, physical activity, and health at work, and is designed to improve public health. The RD is currently being evaluated in terms of its process and likely impact on the health of the English population. This paper analyses the RD food pledges in terms of (i) the evidence of the effectiveness of the specific interventions in the pledges and (ii) the likelihood that the pledges have brought about actions among organisations that would not otherwise have taken place. We systematically reviewed evidence of the effectiveness of the interventions proposed in six food pledges of the RD, namely nutrition labelling (including out-of-home calorie labelling and front-of-pack nutrition labelling), salt reduction, calorie reduction, fruit and vegetable consumption, and reduction of saturated fats. We then analysed publically available data on organisations' plans and progress towards achieving the pledges, and assessed the extent to which activities among organisations could be brought about by the RD. Based on seventeen evidence reviews, some of the RD food interventions could be effective, if fully implemented. However the most effective strategies to improve diet, such as food pricing strategies, restrictions on marketing, and reducing sugar intake, are not reflected in the RD food pledges. Moreover it was difficult to establish the quality and extent of implementation of RD pledge interventions due to the paucity and heterogeneity of organisations' progress reports. Finally, most interventions reported by organisations seemed either clearly (37%) or possibly (37%) already underway, regardless of the RD. Irrespective of the nature of a public health policy to improve nutritional health, pledges or proposed actions need to be evidence-based, well-defined, and measurable, pushing actors to go beyond 'business as usual' and setting out clear penalties for not demonstrating progress.

BackgroundMigrants, including refugees, asylum seekers, labour migrants, and undocumented migrants, now constitute a considerable proportion of most high-income countries’ populations, including their skilled and unskilled workforces. Migrants may be at increased risk of COVID-19 due to their health and social circumstances, yet the extent to which they are being affected and their predisposing risk factors are not clearly understood. We did a systematic review to assess clinical outcomes of COVID-19 in migrant populations (cases, hospitalisations, deaths), indirect health and social impacts, and to determine key risk factors.MethodsWe did a systematic review following PRISMA guidelines, registered with PROSPERO (CRD42020222135). We searched databases including PubMed, Global Health, Scopus, CINAHL, and pre-print databases (medRxiv) via the WHO Global Research on COVID-19 database to Nov 18, 2020 for peer-reviewed and grey literature pertaining to migrants (defined as foreign born) and COVID-19 in 82 high-income countries. We used our international networks to source national datasets and grey literature. Data were extracted on our primary outcomes (cases, hospitalisations, deaths) and we evaluated secondary outcomes on indirect health and social impacts, and risk factors, using narrative synthesis.Results3016 data sources were screened with 158 from 15 countries included in the analysis (35 data sources for primary outcomes: cases [21], hospitalisations [4]; deaths [15]; 123 for secondary outcomes). We found that migrants are at increased risk of infection and are disproportionately represented among COVID-19 cases. Available datasets suggest a similarly disproportionate representation of migrants in reported COVID-19 deaths, as well as increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps and labour compounds may have been especially affected. In general, migrants have higher levels of many risk factors and vulnerabilities relevant to COVID-19, including increased exposure to SARS-CoV-2 due to high-risk occupations and overcrowded accommodation, and barriers to health care including inadequate information, language barriers, and reduced entitlement to healthcare coverage related to their immigration status.ConclusionsMigrants in high-income countries are at high risk of exposure to, and infection with, COVID-19. These data are of immediate relevance to national public health responses to the pandemic and should inform policymaking on strategies for reducing transmission of COVID-19 in this population. Robust data on testing uptake and clinical outcomes in migrants, and barriers and facilitators to COVID-19 vaccination, are urgently needed, alongside strengthening engagement with diverse migrant groups.

The RD is unlikely to have contributed significantly to reducing alcohol consumption, as most alcohol pledge signatories appear to have committed to actions that they would have undertaken anyway, regardless of the RD. Irrespective of this, there is considerable scope to improve the clarity of progress reports and reduce the variability of metrics provided by RD pledge signatories.

Summaryobjectives To ascertain the known burden of chronic obstructive pulmonary disease (COPD) in Africa and of spirometry use to indicate the possibility of further unpublished data becoming shortly available.method Literature review. results Screening of 132 articles yielded 22 relevant articles, of which only six used spirometry based data. A total of 106 physicians in 34 countries were contacted and only 23 reported satisfactory use and availability of spirometry.conclusions Current estimates of COPD burden in Africa are based on an unreliably small dataset. Acquisition of further data will require substantial investment in lung function equipment and training.