Against lead poisoning: effectiveness of housing first and counselling in the home Remi Laporte R Laporte 1 , H Barberin de Barberini 2 , E Jouve 2 , K Hadji 3 , S Gentile 2 1 PASS Me ` r-Enfant, Assistance Publique - Ho ˆ pitaux de Marseille, Marseille, France 2 CEReSS - EA 3279, Aix Marseille Universite ´ , Marseille, France 3 De ´ partement Sante ´ Environnement, Agence Regionale de la Sante ´ PACA, Marseille, France Contact: remijulien.laporte@ap-hm.fr Background: Removing lead sources is the main measure against child lead poisoning. Medical treatment is ineffective for most mild cases and particularly against long-term complications in neurolo- gical development. However, the effectiveness of interventions to eliminate sources of lead exposure has not been fully established, mainly because of the diversity of situations. The objective of this study was to determine the influence of several interventions (housing counselling, rehabilitation and reloca- tion) on blood lead levels in two situations (stable unhealthy housing with old flaked lead paints, slums with family recycling practices by incineration). Methodology: A historical cohort of lead poisoning in children has been established in Marseille, France. Medical follow-up followed national guidelines. Environmental interventions followed legal procedures, where available. In slums, counselling was adapted to the exposure. A generalized mixed model was developed to study the kinetics of blood lead levels after the interventions. Results: 151 children were included; age = 5.4 (SD = 7.8) years; 85 (56%) lived in stable unhealthy housing, others lived in slums. Medical follow-up included 492 blood lead levels. For children living in stable unhealthy housing, blood lead level decrease was significantly associated with every intervention: housing counselling, rehabilitation and relocation (respectively p < 0.005; p < 0.05 and p < 0.005). For children living in slums, blood lead level decrease was only associated with relocation in a stable housing (p < 0.005). Conclusions: Several interventions are effective to decrease blood lead levels in unhealthy housing. In slums, access to a stable housing first is a prerequisite for any intervention against child lead poisoning, even when related to family practices. Key messages:  In stable unhealthy housing, several interventions against lead exposure can be effective to raise a strategy.  But, environmental health and access to housing first needs to be addressed for their implementation. 7.R. Health systems and economics The Public Health Implications of Brexit: A Health Impact Assessment Approach Liz Green L Green 1 1 Public Health Wales, Wrexham, UK Contact: liz.green@wales.nhs.uk On March 29th 2019, the United Kingdom (UK) was due to exit the EU in a process known informally as ’Brexit’. This exit and entry into a 2-year transition is a period of unprecedented political and social upheaval - with many unknowns and much uncertainty attached to the outcomes and future impact. In preparation for Brexit, Public Health Wales commissioned the Wales HIA Support Unit to carry out a health impact assessment of Brexit in Wales to support and inform its and other public bodies planning and future work. This paper examines the unique HIA carried out between July and December 2018 on the impact of the UK withdrawal from the EU in Wales. It discusses the robust, participatory process undertaken, the stakeholders involved and the benefits reaped from this. It highlights the evidence gathered and analysed including the collection methods, the complex nature of the work and disseminates the main findings from the HIA including the potential determinants of health and population groups identified. Finally, it describes the challenges faced, how these were overcome, and the huge benefits, impact and influence it has had to date across a wide range of UK and Welsh organisations and public bodies. This work demonstrates continued leader- ship in the field of impact assessment and spearheads the requirement for public bodies to carry out HIAs as part of the forthcoming statutory requirements of the Public Health (Wales) Act 2017 an can inform practice at a global level. Key messages:  HIA can inform and influence action in response to important strategic decisions.  The Brexit HIA is a unique example which can inform international HIA practice. Unpaid carer inequalities: a public health concern Susan Carr S Carr 2,3 , A Woklowski 1 , M Parkinson 2 1 Dove House Hospice, Hull, UK 2 Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK 3 Fuse, Centre for Translational Research, Newcastle upon Tyne, UK Contact: sue.carr@northumbria.ac.uk The number of unpaid carers is rising globally and is anticipated to grow given predictions on life expectancy, morbidities and limitations on care alternatives. The estimated number in England is 5.5 million. Significant international evidence exists of potential negative impact on employment, health and wellbeing which have individual and societal consequences. This presents a major public health concern, especially as much of the experience and health consequences remain a largely hidden issue. Drawing on two doctoral studies undertaken in the UK we expose the potential for significant health and social inequal- ities to be experienced by unpaid carers and offer models to enhance understanding and potentially more effective responses. The presenting author provided supervision and continues to research the topic. Both studies were set in a translational paradigm to maximise timely utility. The experiences of the participants were privileged while attempting to ensure that the clinical, education and policy potential of the research was incorpo- rated. Study participants were care givers for family members with life limiting illnesses, principally cancers and dementia. Qualitative methodologies were employed in both studies; one drawing significantly on realist approaches and the other on grounded theory. There is generally a lack of consensus concerning when and how carers can best be supported. Although some support interventions were valued there are some fundamental tensions in service models which limit their potential. Specifically the centrality of the relationship is needs to be acknowledged and nurtured. Often, professionals often predominately draw on a medical model as the default intervention position when attempt to tackle carers’ health inequalities. These findings suggest that greater attention should be afforded to the 12th European Public Health Conference 2019–01: Poster Walks 349 Downloaded from https://academic.oup.com/eurpub/article/29/Supplement_4/ckz187.140/5623126 by guest on 09 June 2022