The Lancet. Public health最新文献

Globally, billions of hours are spent on unpaid labour every year, a burden that is disproportionately carried by women. However, the potential health effects of unpaid labour have largely been unexplored. This Review examines the gendered association between unpaid labour and mental health among employed adults. We did a search of six databases and examined the association between different forms of unpaid labour and mental health. 19 studies (totalling 70 310 participants) were included. We found substantial heterogeneity, and low-to-moderate methodological quality, in the existing research. Our Review indicates substantial gender differences in exposure to unpaid labour and confirms persistent inequities in the division of unpaid work. Overall, our findings indicate that, among employed adults, unpaid labour is negatively associated with women's mental health, with effects less apparent for men. Globally, women spend a greater number of hours on unpaid labour; this review suggests that inequities in the division of unpaid labour expose women to greater risk of poorer mental health than men.

The health of those who care for someone with a health condition or advanced age is poorer, on average, than non-carers. However, the health of young carers (<18 years of age) has been under-researched, especially in quantitative studies. This systematic review aimed to summarise studies assessing the mental and physical health of young carers. 1162 unique studies were screened and 14 associations between being a young carer and health were identified (two studies were treated as a single unit of analysis as they had information from the same sample). Most of the included studies were done in the UK, with the remaining studies done in the USA, Canada, Australia, and Austria. A cross-European study of 21 countries was also included. Five of the included studies investigated both mental and physical health outcomes, seven studies investigated only mental health outcomes, and one study investigated only physical health outcomes of being a young carer. All of the included studies, except one, were cross-sectional in design. Most studies found that young carers had poorer physical and mental health, on average, than their non-caregiving peers. However, the evidence is relatively weak and more quantitative research is needed, particularly research that is longitudinal in design and assesses physical health outcomes.

The abolition of Public Health England (PHE) during the COVID-19 pandemic has raised concerns about the future of the public health system in the UK, particularly in England. The two new bodies established in haste to replace PHE prompt reflection on the executive agency's fate and the need to identify any lessons to ensure that a public health system is put in place that is fit for purpose. The UK COVID-19 Inquiry provides an opportunity to make recommendations, but it will need to act quickly to avoid recommendations being ignored. Two areas of concern are highlighted in this Viewpoint: the respective remits of the new bodies and their governance arrangements. Both issues demand urgent attention if the new structures are to succeed and avoid a similar fate to that which befell PHE. But underlying these concerns is a much larger challenge arising from the UK's broken political system. The political system in the UK suffers from several systemic weaknesses, including departmentalism, poor implementation, an inability or unwillingness of those in power to listen to the truth, and chronic short-termism at the expense of long-term planning. Overhauling the UK's dysfunctional political system is a prerequisite for successfully improving the public health system.