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The UK's response to the pandemicThe UK has recorded one of the highest death rates associated with COVID-19 globally, whether measured as deaths that are directly attributable to COVID-19 or by excess mortality. The reasons for this high rate are complex and not yet fully understood, but elements of the UK Government response have been criticised, including delayed implementation of physical distancing measures, poor coordination with local authorities and public health teams, a dysfunctional track and trace system, and an absence of consultation with devolved nations. The role of the National Health Service (NHS) and relevant national executive agencies in relation to testing capacity, availability of personal protective equipment (PPE), the cancellation and postponement of many aspects of routine care, and decisions around discharge from hospital to care homes should also be critically examined. Conversely, aspects of the response by the NHS and relevant national executive agencies deserve recognition. In only a few weeks, capacity for critical care was mas sively expanded, many thousands of staff were reallocated, and services were reorganised to reduce transmission of SARS-CoV-2. The NHS also collaborated with academic institutions to share knowledge about clinical characteristics of the disease and to establish world-leading clinical trials on vaccines and treatments.The response to COVID-19 brings to attention some of the chronic weaknesses and strengths of the UK's health and care systems and real challenges in society to health. Failures in leadership, an absence of trans parency, poor integration between the NHS and social care, chronic underfunding of social care, a fragmented and disempowered public health service, ongoing staffing shortfalls, and challenges in getting data to flow in real time were all important barriers to coordinating a comprehensive and effective response to the pan demic. More positively, the high amount of financial protection that was provided by the NHS and an allocation of resources that explicitly accounted for differing geographical needs have, to some extent, mitigated the already substantial effect of the pandemic on health inequalities. The London School of Economics and Political Science-Lancet Commission on the future of the NHSThis UK-wide London School of Economics and Political Science (LSE)-Lancet Commission on the future of the NHS provides the first analysis of the initial phases of the COVID-19 response as part of a uniquely comprehensive assessment of the fundamental strengths of and chal lenges that are faced by the NHS. The NHS has long been regarded as one of the UK's greatest achievements, providing free care at the point of delivery for over 66 million people from birth to death.Against this backdrop, and considering international evidence, this Commission sets out a long-term vision for the NHS: working together for a publicly funded, integrated, and innovative service that improves health and reduces inequalities for all. This Commission makes seven reco...

Although there is growing recognition that social strain can be a source of considerable distress, few studies to date have examined the ways in which social support may moderate social strain. In this study, social strain was conceived of as a stressor in its own right, whose adverse effects were expected to be alleviated by social support. Participants were 157 pregnant, minority teenagers, all of whom were attending an alternative school for pregnant students. Life events and social strain were positively related to depression. In addition, a significant interaction between social strain and cognitive guidance was found. The pattern of findings suggests that cognitive guidance may intervene between the experience of problematic social exchanges and the onset of depression. Implications of these findings for future research and intervention are discussed.

Mutual help organizations are strongly influenced by the context in which they exist. Therefore, research on mutual help group participation among minority groups must take into account such contextual variables as racial and cultural segregation and the differing roles/attitudes of professionals and local gatekeepers in Black and White communities. To develop this argument, a study of 12-step mutual help group involvement after substance abuse treatment was conducted. One year after treatment intake, African American (n = 233) and White (n = 267) substance abusers were attending 12-step groups at comparable rates, but different factors predicted attendance for each racial group. Among Whites, more severe substance abuse problems and legal problems negatively predicted mutual help group involvement, whereas being treated in a residential setting and being treated for a longer period predicted mutual help group involvement positively. Among Blacks, length of treatment positively predicted mutual help involvement, whereas psychological problems predicted it negatively. For both racial groups, similarity of the individual's race to the predominant race in the area predicted mutual help involvement positively. That is, Whites in predominantly White areas and Blacks in predominantly Black areas were more likely to go to a group than were individuals who were locally in the racial minority. The implications of these findings and the politics of research on African American mutual help organizations are discussed.

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