The world diabetes population quadrupled between 1980 and 2014 to 422 million and the enormous impact of Type 2 diabetes is recognised by the recent creation of national Type 2 diabetes prevention programmes. There is uncertainty about how to correctly risk stratify people for entry into prevention programmes, how combinations of multiple ‘at high risk’ glycemic categories predict outcome, and how the large recently defined ‘at risk’ population based on an elevated glycosylated haemoglobin (HbA1c) should be managed. We identified all 141,973 people at highest risk of diabetes in our population, and screened 10,000 of these with paired fasting plasma glucose and HbA1c for randomisation into a very large Type 2 diabetes prevention trial. Baseline discordance rate between highest risk categories was 45.6%, and 21.3–37.0% of highest risk glycaemic categories regressed to normality between paired baseline measurements (median 40 days apart). Accurate risk stratification using both fasting plasma glucose and HbA1c data, the use of paired baseline data, and awareness of diagnostic imprecision at diagnostic thresholds would avoid substantial overestimation of the true risk of Type 2 diabetes and the potential benefits (or otherwise) of intervention, in high risk subjects entering prevention trials and programmes.

BackgroundThe English National Health Service NHS Stop Smoking Services (SSS), established in 2001, were the first such services in the world. An appropriate evaluation of the SSS has national and international significance. This modelling study sought to evaluate the impact of the SSS on changes in smoking prevalence in England.MethodsA discrete time state-transition model was developed to simulate changes in smoking status among the adult population in England during 2001–2016. Input parameters were based on data from national statistics, population representative surveys and published literature. The main outcome was the percentage point reduction in smoking prevalence attributable to the SSS.ResultsSmoking prevalence was reduced by 10.8 % in absolute terms during 2001–2016 in England, and 15.3 % of the reduction could be attributable to the SSS. The percentage point reduction in smoking prevalence each year was on average 0.72%, and 0.11 % could be attributable to the SSS. The proportion of SSS supported quit attempts increased from 5.5 % in 2001, to as high as 18.9 % in 2011, and then reduced to 8.2 % in 2016. Quit attempts with SSS support had a higher success rate than those without SSS support (15.1% vs 11.3%). Smoking prevalence in England continued to decline after the SSS was much reduced from 2013 onwards.ConclusionsApproximately 15% of the percentage point reduction in smoking prevalence during 2001–2016 in England may be attributable to the NHS SSS, although uncertainty remains regarding the actual impact of the formal smoking cessation services.

These results suggest that both social causation and social selection processes operate concurrently. This raises the possibility that people could get trapped in a vicious cycle in which poor socioeconomic conditions lead to depression, which, in turn, can cause further damage to their economic prospects. This study also suggests that modifiable factors such as income, employment and treatable depression are suitable targets for intervention in the short to medium term, while in the longer term reducing inequalities in education will be necessary to address the deeply entrenched inequalities in South Africa.

The UK government has committed to improving the nation's health. It has set itself a 'grand challenge' of enabling people to live an extra 5 years of healthy life by 2035 while narrowing the gap between the richest and poorest. Bolder action is needed to make progress towards this goal. •The transition to a new public health system needs to be managed carefully, to ensure that the reorganisation does not disrupt the pandemic response or lead to a weaker system in future.

The RSA (royal society for arts, manufactures and commerce) is committed to a future that works for everyone. A future where we can all participate in its creation. The RSA has been at the forefront of significant social impact for over 260 years. Its proven change process, rigorous research, innovative ideas platforms and diverse global community of over 30,000 problem-solvers, deliver solutions for lasting change. The RSA invites you to be part of this change and join its community. Together, we'll unite people and ideas to resolve the challenges of our time. Find out more at www.thersa.org About Demos Helsinki Demos Helsinki is a globally operating, independent think tank that conducts research, practices consultancy, and runs the UNTITLED initiative. The Demos ethos is: "Only #together can we fight for a fair, sustainable, and joyful next era". Demos Helsinki works with curious governments, cities, companies, universities, and other partners who aim to make an impact on ongoing societal transformations. Demos are 50 kind individuals from diverse backgrounds, based in Helsinki and Paris.

BackgroundThe English National Health Service (NHS) Stop Smoking Services (SSS), established in 2001, were the first such services in the world. An appropriate evaluation of the SSS has national and international significance. This modelling study sought to evaluate the impact of the SSS on changes in smoking prevalence in England.MethodsA discrete time state-transition model was developed to simulate changes in smoking status among the adult population in England during 2001–2016. Input parameters were based on data from national statistics, population representative surveys and published literature. The main outcome was the percentage point reduction in smoking prevalence attributable to the SSS.ResultsSmoking prevalence was reduced by 10.8% in absolute terms during 2001–2016 in England, and 15.1% of the reduction could be attributable to the SSS. The percentage point reduction in smoking prevalence each year was on average 0.72%, and 0.11% could be attributable to the SSS. The proportion of SSS supported quit attempts increased from 5.6% in 2001, to as high as 19.3% in 2011, and then reduced to 8.4% in 2016. Quit attempts with SSS support had a higher success rate than those without SSS support (15.1%vs11.7%). Smoking prevalence in England continued to decline after the SSS was much reduced from 2013 onwards.ConclusionsApproximately 15% of the percentage point reduction in smoking prevalence during 2001–2016 in England may be attributable to the NHS SSS, although uncertainty remains regarding the actual impact of the formal smoking cessation services.

We were hoping for something bold and ambitious. In the end, it’s a missed opportunity

In this article, Rita Ranmal and Tim Elwell-Sutton look at recent trends in population health, the conditions needed for healthy lives and some effective actions that can be taken to secure the public's health in the long term