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Manchester Urban Institute

Photograph an apple and a stethoscope

Health

Our research is addressing inequalities in health outcomes, policies, processes and practice.

Health and social inequalities have been identified by our Faculty of Biology, Medicine and Health as one of the ‘grand challenges’ for health and medicine in the 21st century. We aim to maximise alignment of this cross-cutting theme with our six Faculty Institutes, our five Faculty Schools  and the Manchester Academic Health Sciences Centre – a partnership between The University of Manchester and six NHS organisations, uniting healthcare providers with world-class academics and researchers.  

Our academics have expertise in many aspects of inequalities in health and healthcare, including health promotion/disease prevention, mental health, co-morbidity, resource allocation, service delivery and organisation, health behaviours, public health informatics and health indicators. We are working with staff in our MAHSC partner trusts, local authorities and the voluntary sector to develop these topics and collaborations further. 

We are also leading on Well North, a Public Health England initiative which aims to reduce the widening health gap between the north and the south of England by: improving the health of the poorest, fastest; reducing premature mortality; and reducing levels of worklessness.  

The academic lead for health and social inequalities is Professor Matt Sutton in our Institute of Population Health, who is coordinating the University’s efforts to generate and disseminate evidence on how best to improve the health of the most disadvantaged in society.

Preventing type 2 diabetes

Reducing the risk of diabetes in Salford.

The challenge

Working collaboratively, NHS Salford (now called NHS Salford CCG), the Salford diabetes team and the NIHR CLAHRC Greater Manchester utilised the existing diabetes care call service and developed a six month, proactive lifestyle education and support programme for people with impaired glucose tolerance.

Without intervention, 50% of people with impaired glucose tolerance (the condition that can lead to type 2 diabetes) will develop type 2 diabetes within ten years. Salford, a city with high deprivation and obesity levels, has approximately 7,000 people with impaired glucose tolerance. Analysis carried out at NHS Salford estimated that obesity currently costs the city at least £10m per year and can cost the Salford economy £5,834,314 per year in sickness absence from work. Type 2 diabetes costs the NHS in the UK £8.8billion per year.

Our research

Working collaboratively, NHS Salford (now called NHS Salford CCG), the Salford diabetes team and the NIHR CLAHRC Greater Manchester utilised the existing diabetes care call service and developed a six month, proactive lifestyle education and support programme for people with impaired glucose tolerance.

The telephone service was piloted in seven GP practices and delivered by trained health advisors. Resources included electronic education scripts, a patient information leaflet and a DVD. Participants were encouraged to set and discuss lifestyle goals at each telephone appointment. Blood tests, weight and body mass index (BMI) were recorded in GP practices when participants started, again on completion of the programme (6 months), and then 12 months after the programme had finished.

The impact

We found that after 6 months there were significant reductions in fasting blood glucose, weight and BMI and these were maintained for one year after the programme had finished. Whilst all 55 participants completed the project only those with results from all stages of the programme were included in the analysis.

Participant feedback was overwhelmingly positive with 90% of participants feeling they had received relevant, up-to date advice. And 88% of patients achieved or partially achieved their lifestyle goal. Participating GP practices also reported high levels of confidence in the ability of the impaired glucose tolerance care call project to provide their patients with evidence-based information and motivational support.

Following completion of the impaired glucose tolerance care call project in 2011, additional funding was granted to offer the service to all Salford GP practices making it available to all participants with impaired glucose regulation. 

The project was recognised with a QiC (Diabetes) award and highly commended in HSJ Care Integration awards.

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Key people

  • Professor Ruth Boaden, Director of NIHR CLAHRC Greater Manchester and professor of Service Operations Management
  • Dr Sarah Cotterill, Research Fellow, Centre for Biostatics
  • Linda Savas, NIHR CLAHRC Greater Manchester
  • Katherine Grady, Salford R&D

Access to psychological interventions

Improving access to psychological treatments for depression and anxiety

The challenge

Depression and anxiety are common conditions in the UK. Access to treatment is limited by physical disability, occupational or socio-economic constraints and residency in under-resourced areas.  A recent European health profile survey has shown depression and anxiety to be more frequently reported in Greater Manchester than in many other European cities.

Our research

There is an urgent need to deliver psychological interventions for people with depression and anxiety in a more timely and accessible manner.  However, a range of social, physical and economic barriers may prevent Greater Manchester residents from accessing these services.  We have demonstrated the effectiveness and acceptability of telephone-delivered therapies (T-CBT) for people with depression, anxiety and chronic pain. We have developed and evaluated Guided Self Help (GSH), and established the first GSH clinics across 36 GP practices in Greater Manchester. We have developed culturally sensitive GSH and group interventions for older people and black and minority ethnic (BME) populations. We work closely with user-led organisations including Anxiety UK and Self-help Services in Hulme. 

The impact

Our research has led to reductions in inequalities of access to mental health services across the UK.  

Mental health services have been transformed. National UK mental health policy now increasingly advocates the use of the telephone to deliver help based on our research. GSH and telephone-mediated support have been implemented nationally and are a key component of the Improving Access to Psychological Therapies (IAPT) scheme.  

UK health policy now advocates the use of telephone-delivered and GSH interventions. Our research has influenced current clinical practices in NICE (National Institute for Health and Care Excellence) guidelines on Post-Traumatic Stress Disorder, Depression and Obsessive Compulsive Disorder. These guidelines inform and shape mental health practice in Greater Manchester and elsewhere.

Anxiety UK, a national user charity based in Hulme in Manchester, have implemented telephone-CBT for people unable to access face-to-face therapy. Our GSH book ‘A Recovery Programme for Depression’ is endorsed by Rethink Mental Illness, a national mental health charity, and between 11,000 and 13,000 copies of the book are sold annually. We have written guidelines for T-CBT and have provided GSH and telephone training to over 2,000 UK mental health practitioners and volunteers.

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Key people

European urban health indicators

Urban health monitoring to inform policy and interventions.

The challenge

Trends of population health in urban areas are of increasing importance due to continued rapid urbanisation globally. Urban areas are characterised by an extreme diversity of economic, social and ethnic backgrounds living in close proximity to each other. The juxtaposition of the urban and poor requires monitoring, policies and interventions for individuals and communities. Greater Manchester encapsulates all the issues common to global cities, such as widening inequalities and in some areas, sons born with a lower life expectancy than their fathers.

Our research

The European Urban Health Indicators System (EURO-URHIS 2) gathered data on individual level health indicators across 50 urban areas in Europe and beyond. It included all ten boroughs of Greater Manchester, allowing for direct comparisons for each borough as well as for Greater Manchester as a whole. 

EURO-URHIS 2 identified health features that, whilst not specific only to urban situations, have a major impact on the health of urban residents. We developed instruments to collect data at an urban area level through surveys, routinely available sources, and consultation with policy makers in participating cities.

EURO-URHIS 2 was the largest urban health and lifestyle survey ever carried out in Europe on a range of health and wellbeing issues, in order to inform policy. EURO-URHIS 2 relied on the support of all Greater Manchester primary care trusts, local authorities, communities, voluntary sector organisations, student ambassadors and other volunteers, secondary schools and most importantly, the residents of Greater Manchester.

The impact

The EURO-URHIS 2 project has had a global reach beyond that of a monitoring project. Through the engagement of civil society, we have been able to make strong links to drive change of our own research projects and that of hidden populations and patient groups e.g. Cornishway Patient Group were plenary speakers at the Festival of Public Health in 2014.

The policymakers’ interviews have revealed the changes that have occurred due to austerity and political change. We have been able to adapt the evidence and data from EURO-URHIS 2 into the tools that policy makers want and in the way they want it.

The best output of EURO-URHIS 2 has been the collation of health, wellbeing, social factors and lifestyle data in areas where no systematic data gathering has ever taken place. In these urban areas, we have had the feedback from our partners that our project has led to new monitoring and policy development, the inclusion of civil society into policy making, the development of skills in the local workforce and capacity building including many PhDs.

The results of the study caused great interest and received large coverage from media outlets around the world. The project revealed some astonishing results, particularly in the North West of England where it was found that Greater Manchester and Merseyside had the highest rates of “binge drinking”, particularly amongst teens, as well as higher than average depression, anxiety and obesity.

The quality and amount of data collected during the course of the project has influenced researchers and partners from throughout the world to help ensure the wealth of information can continue to help design and influence policy, contribute to further research in the field, and improve health outcomes in urban areas.

EURO-URHIS 2 has helped to develop a large family of urban health researchers and policy-makers. It has led to new research grants coming to Greater Manchester and major international conferences including the 11th International Conference on Urban Health – the premier non-governmental global forum for urban health issues, attracting delegates from across the world. From this work, we have been able to inform other global processes through the EU, World Health Organisation and the United Nations.

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Key people

The EURO-URHIS 2 project was funded by the European Commission’s 7th Framework Programme and the project collaborated with policy-makers, researchers, NGOs and civil society, involving 17 partners in 13 countries, covering 50 urban areas in Europe and globally.

  • Dr Arpana Verma, The University of Manchester, UK
  • Dr Daniel Pope, Department of Public Health, University of Liverpool, UK
  • Dr Erik van Ameijden, Municipal Health Service Utrecht, GGDUtrecht, Netherlands
  • Dr Chris Birt, University of Liverpool, UK
  • Prof Ioan Bocsan, The Iuliu Hatieganu University of Medicine and Pharmacy Epidemiology Department, UMFCNEPI, Romania
  • Ms Heidi Lyshol, The Norwegian Institute of Public Health NIPH, Norway
  • Dr Peter Achterberg, National Institute for Public Health and the Environment ,RIVM, Netherlands
  • Dr Skirmante Sauliune, Lithuanian University of Health Sciences, KMU, Lithuania
  • Dr Olivera Stanojevic, Regional Public Health and Health Promotion Centre, ZZV MB, Slovenia
  • Dr Monika Mensing, Institute for Public Health North Rhine Westphalia LIGA.NRW, Germany
  • Dr Iveta Nagyova, Slovak Public Health Association, Savez, Slovakia
  • Prof Nesrin Cilingiroglu, Hacettepe University,Department of Public Health, Turkey
  • Dr Jolanta Skrule, Latvian Public Health Agency, PHA, Latvia
  • Prof Murtezan Ismaili, South East European University, IEH-SEEU, Macedonia
  • Dr Andre Ochoa, National Federation of Regional Health Observatories, France
  • Dr the Dung, Pham Ngoc Thach University of Medicine, Vietnam