Fuse blog

Merry Christmas from Fuse (Fri, 22 Dec 2017 06:00:00 +0000)

We would like to wish all of our readers and contributors a very happy festive season. We will return in the New Year - why not make a resolution to blog in 2018 and send us your posts?


Not addicted but still having an impact: children living with parents who misuse drugs and alcohol (Fri, 15 Dec 2017 06:00:00 +0000)

Guest post by Dr Ruth McGovern, Institute of Health & Society, Newcastle University

There is growing political interest in the misuse of alcohol and drugs by parents and its impact upon children. The newly published Drug Strategy 2017 highlights drug and alcohol dependent parents as a priority group with an estimated 360,000 children living with parents who are dependent upon alcohol or heroin.

As a registered social worker, I have often identified ‘dependent parental substance misuse’ as a risk factor in many ‘child in need’ assessments conducted by Children’s Services. Around half of all child protection cases, recurring care proceedings (repeat children removed and placed into local authority care) and serious case reviews (enquiries following child death or serious injury where neglect or abuse is known or suspected) involve parents who misuse substances. However, the impact of parental substance misuse is not limited to addicts. The number of children living with parents who misuse but aren’t dependent upon alcohol and drugs is likely to be substantially more than the number of children living with those who are addicts. As such, greater harm in the population as a whole is likely to be experienced by these children.

I have been part of a group of academics and clinicians who have recently concluded a rapid evidence review funded by Public Health England (PHE). The review found evidence that parents who misuse, but aren’t dependent on substances, can have a significant impact on the physical, psychological and social health of their child. For instance, in early childhood we found that children of mothers misusing alcohol [1] were twice as likely to suffer a long bone fracture and five times as likely to be accidentally poisoned, than children whose mothers do not drink heavily. Children of mothers misusing alcohol or drugs are also more likely to require outpatient care or to be hospitalised due to injury or illness, and for longer. The impact of substance misuse by parents continues into adolescence, with our review showing an increased likelihood of antisocial, defiant and violent behaviour in late adolescence as well as substance misuse by the child. However, many of these children and families are not identified as being affected by the substance misuse of a parent and subsequently do not receive the help they need in the form of an intervention.

Therefore, our review also examined the evidence for effective interventions to help reduce the numbers of parents misusing alcohol and drugs. Family-level interventions, particularly those that offer intensive case management, or those which provide parents with a clear motivation (such as those linked to care proceedings) show promise in reducing the problem. Unfortunately, there was little research examining the effectiveness of interventions for parents misusing but not dependent on alcohol and drugs.

PAReNTS study logo
To respond to this evidence gap, we designed the PAReNTS study (Promoting Alcohol Reduction in Non Treatment Seeking parents). Within this study we are examining the feasibility and acceptability of alcohol screening (using the AUDIT-C questionnaire [2]) and brief interventions with parents involved in early help and statutory children’s social care services. The brief intervention is an adapted version of the ‘How much is too much?’ programme for parents [3] which combines advice and behaviour change activities and is delivered by both social care practitioners and the local alcohol service. Whilst alcohol brief interventions have been found to be effective in adults who misuse alcohol, little is known about the effectiveness of such interventions for parents with additional and complex needs. This presents unique challenges, for instance, parents may be concerned about the stigma of being labelled as having an alcohol problem, particularly if this could be used as a reason to remove their child from their care. There is clearly a need for a sensitive approach. In future blog posts, I hope to update you on the progress we make with the PAReNTS study and whether it is feasible to deliver early interventions with alcohol misusing parents to improve the wellbeing of children, who are often overlooked in public health.

References:
  1. Below the age of 10 years, much of the evidence focuses on mothers with alcohol misuse problems as most caregiving is carried out by mothers during early years. 
  2. The AUDIT-C is a 3-item alcohol screen that can help identify persons who are hazardous drinkers or have active alcohol use disorders (including alcohol abuse or dependence): https://www.integration.samhsa.gov/images/res/tool_auditc.pdf
  3. This programme was highlighted by the National Institute for Health and Clinical Excellence alcohol prevention guidance (PH24): https://www.nice.org.uk/guidance/ph24.
Image credits:

Is it possible to have a research career without being a workaholic? (Fri, 08 Dec 2017 06:00:00 +0000)

Posted by Peter van der Graaf, AskFuse Research Manager, Teesside University

This was one of the burning questions that NIHR trainees put to an esteemed panel of career advisers at their annual meeting in Leeds. Every year the National Institute for Health Research brings together their trainees at a two-day event to network, share experiences, take part in workshops and generally learn more about the largest national clinical research funder in Europe. This year’s theme: Future Training for Future Health.



With all these bright minds in the room and a dedicated session on successful fellowships and grant applications, you would think ‘top tips on surviving an interview’ and ‘what mistakes to avoid in an application’ would be on the top of their list. However, after several inspiring presentations from previous and current award holders who had climbed the academic ladder - including Fuse Director Ashley Adamson a NIHR Research Professor - participants were equally, if not more, concerned about maintaining a healthy life-work balance.

Follow the yellow brick road to academic success
While Brexit questions made a brave entrance (Q: How will Brexit affect future research? A: In the long term, not all all!), they could not knock questions about mental health and wellbeing from the top spot. When Ashley included pictures of her son in a musical-inspired animation of her academic pathway (follow the yellow-brick road!) to explain that she preferred part-time work to spend more time with her family, participants immediately asked “but how do you fit family in with an academic career?”.

New gadget SLI.DO was introduced by the NIHR at the meeting this year: participants could submit questions through a mobile app, which others could vote to be answered by the panel (Bush Tucker Trial for academics). Not having to stand up in front of an audience to say who you are, might have given some participants the confidence to ask uncomfortable questions. The honest and open stories from the presenters about their own struggles and failures in academia (“my new post oscillated between agony and despair”) might also have contributed to this confidence.

Paul McGee emphasises the importance of
 looking after your mental health in academia
Experiences of stress and concerns over mental health in academic careers were acknowledged throughout the conference in various presentations and workshops. This was perhaps most evident in the closing session by Paul McGee (aka The Sumo Guy) who emphasises the importance of looking after your mental health in academia. His four key messages (be kind to yourself; get perspective; hippo time - to wallow - is ok; and keep pushing) resonated with many participants and provoked a strong response on social media.

As public health researchers, we are familiar with these messages. In our studies, we underline the link between physical and mental health, express our deep concern over the lack of mental health services and highlight the importance of resilience training from an early age in schools. However, it appears that we are not very good at applying this evidence to our own life and work.

This was recently confirmed by a systematic review of published work on researchers' well-being featured in the Times Higher Education. The review, commissioned by the Royal Society and the Wellcome Trust, found that academics face higher mental health risk than many other professions. Lack of job security, limited support from management and weight of work-related demands on time were listed as factors affecting the mental health of those who work in higher education.

Given this evidence, is it possible to have an academic career and stay healthy? Despite the questions raised at the annual event, the NIHR trainees were keen to acknowledge positive mental health messages: you can have a life and family outside academia (no need to be workaholic, although being a data geek is acceptable*); it’s ok to be different and carve your own path to develop your intellectual independence; and most of all: the key to success is self-care and not funding.

* An after-dinner presentation by @StatsJen taught us that there is a perfect correlation between eating cheese and death by entanglement in bedsheets. Will midnight cheese feasts be the next public health scare?

When the Coca-Cola truck comes to your town (Fri, 01 Dec 2017 06:00:00 +0000)

Guest post by Robin Ireland, Director of Research at Food Active and Beth Bradshaw, Project Officer at Food Active.

When Coca-Cola announced their 'Holidays Are Coming' truck tour (ironically coinciding with Sugar Awareness Week), our local media in the North West covered the story like it was the first sign of Christmas, the first cuckoo to be spotted in spring.

And in the run up to the big red shiny sugar-laden truck’s arrival to our towns and cities, from Bolton to Liverpool, Manchester to St Helens, the local newspapers will cover the story in page after page of advertorials, telling you where to get your picture taken posing with Coca-Cola's sugary products and even live blogs in some cases.

In previous years, at no time did the reporters consider that not everyone welcomed the truck in their neighbourhood. Many people are concerned that the truck was marketing Coke to children despite the company's protestations that they do not promote their products to the under twelves. Furthermore, in some locations in the North West the truck was allowed to promote their unhealthy drinks to children and families on Council owned landed. 

To demonstrate our concern, last year Food Active drafted a letter objecting to Coca-Cola's tour coming to the North West which was sent to the national and regional media. No less than 108 people signed in support including the current and past Presidents of the Faculty of Public Health, five Directors of Public Health, Professors, Doctors, educationalists and of course parents. If we are honest, we were shocked that the letter was almost entirely ignored. It would appear that Coca-Cola's commercial clout and public relations campaign counted more than the collective voice of those who are having to address the results of diets regularly fuelled by liquid sugar.

Just before Christmas 2016, Professor John Ashton and I (Robin) were in contact with the British Medical Journal concerning these issues and were invited to submit an editorial which was published in January [1]. In contrast to their previous experience the media attention was huge including coverage in over 60 regional and national newspapers and interviews on various channels including Sky News and Wales Today.

This year, the media attention and discussions around the Coca Cola Christmas Tour has continued. Before the tour was even announced, a news story hit the local press in the North West from Liverpool councillor Richard Kemp CBE (also Deputy Chair of the Community Wellbeing Board at the Local Government Association of England and Wales), who raised concerns about its arrival in Liverpool given the city is ‘in the grip of an obesity epidemic’ – although we know this is not an issue only in Liverpool – the whole country is in the grip on an obesity epidemic. Once the tour was announced, including six visits to the North West, we were pleased to see none were on council-owned land (in 2016 the truck visited Williamson Square in Liverpool which is owned by the Council)

Following this came a cascade of news stories from local and national newspapers and radio stations. This year, Food Active joined up with Sugar Smart to encourage Directors of Public Health, Council Leads and Clinical Commissioning Group Chairs across the country to sign an open letter to Coca-Cola opposing its arrival, given the health harms associated with the consumption of their products and calling for more responsible marketing during the festive period. The North West represented one quarter of the 29 areas, cities and towns who signed the letter. This advocacy may have helped to prompt a response from Public Health England and Public Health Wales – there is a sense that the argument against the Coca-Cola truck are now being taken seriously and media coverage of the 2017 Coca Cola Christmas Tour is not just about when and where you can get your photo taken - but also the health concerns. 
Coca-Cola says that it does not promote its products to the under twelves

Following excellent work by Public Health England, by national organisations including Action on Sugar, the Children's Food Campaign and many others, and of course by Food Active in the North West, we know that we must target sugary drinks as part of a strategy to address the tsunami of obesity, type 2 diabetes and dental disease we face in our poorest and most deprived communities. Moreover, as highlighted in a blog by Dr. Alison Tedstone, Director of Diet and Obesity at Public Health England, the truck will be visiting some of our poorest areas which are often disproportionately burdened with higher levels of obesity [2]. As such, a symbol of ill health should not be welcomed nor celebrated within our communities during a season of good will and cheer. 

However, this is not only about high sugar drinks. Protecting children from junk food marketing has been outlined as the number one priority in tackling obesity by the Obesity Health Alliance (a coalition of over 40 organisations committed to reducing obesity – of whom Food Active is a member). We must not mistake the Coca-Cola truck for anything but a very high profile marketing stunt. We do not allow products high in fat, sugar and salt to be advertised to children on children’s TV programmes, so why is the Coca-Cola truck welcomed into our communities year on year with such open arms? Speaking at the Socialist Health Alliance Public Health Conference, we called for junk food marketing controls to be extended to cover family attractions such as the Coca-Cola truck, as well as sports sponsorship and marketing communications in schools. By allowing the truck into our towns and cities, we are allowing Coca-Cola to exploit the festive period to market their products to the community – and to children in particular.

Our experience shows us that public health has to be persistent in ensuring our messages are heard in the current victim-blaming culture. There is little point in local authorities spending their ever restricted funds on promoting healthier eating and drinking if each Christmas we allow Coca-Cola and others to highjack our messages. There is certainly no excuse for local authorities at to allow this truck on their land and it is the responsibility of public health advocates to continue to make the case to Give Up Loving Pop in 2018. 
  
References:
  1. Ireland, Robin, and John R. Ashton. "Happy corporate holidays from Coca-Cola." (2017): i6833. Available at: http://www.bmj.com/content/356/bmj.i6833
  2. Tedstone, Alison. “An update on sugar reduction”. (2017). Available at: https://publichealthmatters.blog.gov.uk/2017/11/14/sugar-reduction-an-update/


Photo © Oast House Archive (cc-by-sa/2.0)


All views expressed in a post are exclusively those of the author or authors.

‘Afore ye go’… across the border for a cheap pint (Sat, 18 Nov 2017 09:00:00 +0000)

John Mooney, University of Sunderland and Sunderland City Council, asks how Scotland’s minimum unit pricing policy would go down in North East England.


Like many former native Scots now living and working in North East England, the geographical, social and cultural parallels are just three areas of overlap that help keep homesickness for my country of origin at bay!

As a public health researcher some less fortunate similarities are often at the forefront of my mind, including a fondness for deep-fried food, an aversion to fresh vegetables and a damagingly long-ingrained culture of heavy drinking.  This is accompanied by an almost Scottish-scale public health burden to match. It will come as no surprise that as a whole, the North East has among the worst health statistics for alcohol related harm in England [1].

Of course it is also no coincidence that both North East England and much of Scotland’s central belt, particularly Greater Glasgow and Clyde Valley, have some of the most longstanding and concentrated areas of social deprivation and economic disadvantage in the UK. As recent research from Glasgow University has highlighted [2], deprivation and alcohol related health damage, present a particular kind of “double whammy”, even after adjusting for alcohol intake and other lifestyle factors such as smoking.

With these similarities in mind, there is an inescapable logic in looking to Scotland for a steer in terms of policy interventions that might reduce the unacceptably high public health burden due to alcohol in this part of the World. I refer of course to the introduction of a minimum unit price (MUP) of 50p for a unit of alcohol, which on the basis of rigorously evaluated international studies combined with sophisticated cost effectiveness modelling from the Alcohol Research Group at the University of Sheffield [3], is one of the best evidenced policies for reducing alcohol harm in the population.

Scotland is also at the forefront of (what may eventually lead to) a much more ‘fit-for-purpose’ legislative framework around alcohol licensing and availability: namely the inclusion of 'health' as a licensing objective (or ‘HALO’). In principle, this has the potential to transform the capacity of public health teams in English local authorities to make much more use of information on health harms as part of the licensing process. This would ensure that challenges to new licence applications - however potentially damaging the new licence may be - no longer need to be based exclusively on crime and public disorder evidence. To explore whether HALOs could also be used in England, our team at the University of Sunderland looked at the practicalities and logistics of using health information in English licensing decisions. The results have recently been published by Public Health England [4].

So what are the prospects for importing MUP and health objective policies to North East England?

Thankfully, on both policy and research fronts, there are also significant grounds for encouragement in the North East! Indeed, some of the most progressive public health policies around alcohol harm reduction, such as cumulative impact zones and late night levies, are now well established in a number of local authority areas. This has been possible thanks to strong political will and high profile regional level advocacy for alcohol harm reduction policies from Balance North East [5], which is funded collectively across most North East local authorities. Balance NE has already been calling for better controls on cheap alcohol availability in the wake of the Scottish Policy decision [6].

There is also no shortage of public health alcohol research effort in the North East, with a long tradition of internationally renowned research from the Universities of Newcastle, Teesside and most recently our own contributions to several national level evaluations (such as HALO mentioned above).

In brief, there are many regional policy drivers already in place for North East England to emulate Scotland’s very progressive approach to the reduction of alcohol harms. With regard to the often raised criticism that price based measures such as MUP are ‘regressive’ due to a disproportionate financial impact on the poorest, it is difficult to rival the response of Scottish novelist Val McDermid on Thursday's (16 Nov) BBC Question time: “it’s actually about preventing people in our poorest communities drinking themselves to death with cheap alcohol”. It is difficult to figure out what particular definition of the term ‘regressive’ that this conforms to…


References:
  1. Local Alcohol Profiles for England [May 2017]: https://fingertips.phe.org.uk/profile/local-alcohol-profiles/data#page/0
  2. Katikireddi SV, Whitley E, Lewsey J, et al. Socioeconomic status as an effect modifier of alcohol consumption and harm: analysis of linked cohort data. The Lancet Public Health 2017;2(6):e267-e76. doi: https://doi.org/10.1016/S2468-2667(17)30078-6
  3. Sheffield Alcohol Policy Model:  https://www.sheffield.ac.uk/scharr/sections/ph/research/alpol/research/sapm
  4. Findings from the pilot of the analytical support package for alcohol licensing: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/620478/Alcohol_support_package.pdf
  5. Balance North East: http://www.balancenortheast.co.uk/about-us/
  6. Balance North East news item: http://www.balancenortheast.co.uk/latest-news/balance-calls-on-government-to-follow-scotland-on-mup 
Images:
  1. 'cheap booze, hackney' (3892082333_943f3cc70e_o) by ‘quite peculiar' via Flickr.com, copyright © 2009: https://www.flickr.com/photos/quitepeculiar/3892082333 (cropped)
  2. Courtesy of Alcohol Focus Scotland: https://twitter.com/AlcoholFocus/status/922822671599054848

Public health, social justice, and the role of embedded research (Mon, 13 Nov 2017 06:00:00 +0000)

Posted by Mandy Cheetham, Fuse Post doctoral Research Associate and embedded researcher with Gateshead Council Public Health Team

On this date (13 November) in 1967, Martin Luther King was awarded an Honorary Doctorate in Civil Law from the University of Newcastle upon Tyne. The speech he gave at the award ceremony is both powerful and moving. It was the last public speech he made outside the US before his assassination in April 1968. You can read it for yourself here or watch it here.


Newcastle was the only UK University to award an honorary degree to Dr King in his lifetime. In accepting the honour, he said “you give me renewed courage and vigour to carry on in the struggle to make peace and justice a reality for all men and women all over the world”. As I listened to the speech, it struck me that the three “urgent and indeed great problems” of racism, poverty and war, which Dr King described in his speech, are just as relevant today as they were then. It made me reflect on our role in universities now and on my role as an embedded researcher in Gateshead Council.

That's me on the left
On Sunday 29 October, I had the privilege of being part of the Freedom City 2017 celebrations held on the Tyne Bridge to mark this significant anniversary, inspire people, and stimulate academic debate about potential solutions. Performances across Newcastle and Gateshead came together to mark different civil rights struggles across the globe, including Selma, Alabama 1965, Amritsar, India 1919, Sharpeville, South Africa 1960, Peterloo, Manchester 1819, and the Jarrow March, Tyneside 1936.

The celebrations were timely, as I am just finishing an embedded research project in Gateshead, undertaken less than a mile from where we stood on the Tyne Bridge. It has been an inspiring year. I’ve learnt a lot, but I have also seen the devastating effects of austerity and poverty on North East families and communities. The research findings demonstrate all too clearly the continuing impact of the social injustices which Martin Luther King talked about fifty years ago.

I believe our role as writers and researchers in public health is not just to highlight the effects of these grave injustices, but to be part of the solutions, developed with the communities affected. If we accept that we are all caught up in what Dr King described as “an inescapable network of mutuality”, then universities have an important part to play in changing attitudes, working with others, facilitating connections, and inspiring efforts to “speed up the day when all over the world justice will roll down like waters and righteousness like a mighty stream”. (Dr Martin Luther King Jr. Speech on Receipt of the Honorary Degree, November 13, 1967).

I believe embedded research affords us valuable opportunities, to work alongside local communities with colleagues in public health and voluntary sector organisations, to challenge injustices and push for the kinds of social and political change advocated by Dr King.


Photo credits:
  1. Martin Luther King Honorary Degree Ceremony: http://www.ncl.ac.uk/congregations/honorary/martinlutherking/. Courtesy of Newcastle University.
  2. Photo by Bernadette Hobby of "the judge", representing the establishment, about to receive the Jarrow Marchers petition. The judge was made by Richard Broderick sculptor.
  3. Freedom on the Tyne, The Pageant: http://freedomcity2017.com/freedom-city-2017/freedom-city-tyne/. Courtesy of Newcastle University.

Spice up your research life: match-making in public health (Wed, 08 Nov 2017 06:00:00 +0000)

Posted by Peter van der Graaf, AskFuse Research Manager, Teesside University

Three years ago, we had a crazy idea: what if Fuse had its own dating service for academic researchers and health professionals? Instead of innovative research findings gathering dust on lonely bookshelves, we wanted to provide a stage for academics and health professionals to meet and discuss how that evidence could be used in practice. We were keen to facilitate early conversations on how to collaborate on research that is useful, timely, independent, and easily understood.

Instead of health practitioners wandering around University campuses, trying to find the right academic to work with, we envisioned an open door leading to a welcoming friendly-faced guide. Someone who could do the matchmaking and help them to find or create evidence for spicing up their policies or interventions.

After checking our idea with various health practitioners in the region to make sure that it would make their hearts beat faster, we launched AskFuse in June 2013: Fuse’s very own rapid responsive and evaluation service with a dedicated match-maker (research manager) in post – that’s me!

Coming from an applied research background in social sciences, this post was certainly a challenge but also an incredibility exiting opportunity to develop something new with the support of an enthusiastic group of people across Fuse. The job has been a steep learning curve, but also a great way to meet a lot of people working in public health across the region, getting to understand their passions and … what keeps them up at night.


I quickly learned that there were many great public health projects and programmes being developed and delivered locally that deserved more attention and research (e.g. My Sporting Chance, Ways to Wellness, Boilers on Prescription).  I was encouraged by a real appetite among academics to support this work but felt the frustrations of health professionals caused by budget cuts and the need to decommission services rather than to develop them. I also noticed the limited research evidence informing some of these decision-making processes and the lack of knowledge among academics about how to influence these processes and mobilise their research evidence effectively.

AskFuse has supported more than 270 enquiries from a wide range of sectors, organisations and on topics ranging from Laughter Ball Yoga to Whole Systems Approaches to obesity. We have helped to develop new interventions and evaluated existing ones, made research evidence accessible and understandable, organised events to explore new topics, and pioneered new methodologies; all in collaboration with our policy and practice partners. We have also made mistakes, misunderstood procurement procedures, were not able to help in time, could not find relevant expertise or did not always follow-up on conversations.

Despite these challenges - or perhaps because of them - we have been able to build a dating service that (I think/hope) is perceived as useful by our policy and practice partners, that has helped us to build relationships (even in times of considerable system upheaval with public health moving to local authorities), and has informed new research agendas for Fuse going forward over the next five years as a member of the national School for Public Health Research.

As the service is expanding and my role is changing (I recently became a NIHR Knowledge Mobilisation Research Fellow, which I will talk about in another blog), we are looking for a new AskFuse Research Associate to work with me on strengthening the service and taking it in new directions. If you are interested in mobilising knowledge, fancy a challenge and want to work with a fantastic team, why not be part of it?

Why are veterans reluctant to access help for alcohol problems? (Fri, 03 Nov 2017 06:00:00 +0000)

Guest post by Gill McGill, Senior Research Assistant, Northumbria University

 
With Alcohol Awareness Week fast approaching, the Northern Hub for Military Veterans and Families Research is busy planning a national conference to share findings from a project on improving veterans’ access to help for alcohol problems. The project was funded by the Royal British Legion and arose from two questions frequently posed by clinical practitioners working within the field of alcohol misuse services: 
  1. Why is it so difficult to engage ex-service personnel in treatment programmes?  
  2. Once they engage, why is it so difficult to maintain that engagement? 
     
In an attempt to test these perceptions, we carried out a systematic literature review of the existing evidence.  We then explored the relationship between being a UK military veteran (ex-serviceman/woman) and alcohol misuse services; and veterans’ experiences of engaging with these services. The research study involved interviews with commissioners and managers of services for alcohol misuse, interviews with veterans who are currently experiencing, or had experienced, problems with alcohol misuse, and focus groups with veterans who had no apparent experience of alcohol misuse.
 
The findings will be discussed in detail at the conference, so please join us there to hear more, but that quick plug aside, we thought we’d give you a sneak preview here!
 
Paradoxically, although alcohol misuse amongst UK veterans is estimated to be higher than levels found within the general population, we found a limited amount of research that specifically considered alcohol problems among UK veterans. Given that there are an estimated 2.56 million UK military veterans[1], this represents an important, but as yet, largely unaddressed public health issue.
 
Commissioners and managers of alcohol services expressed the view that veterans have difficulty navigating available support due to ‘institutionalisation’. Yet, when speaking to military veterans themselves, we found no support for this. Such a view point is also potentially problematic in stereotyping veterans as (at least in part) the architects of their own difficulties.
 
In all cases, it could be said that meaningful engagement with alcohol misuse services was being ‘delayed’ to a significant extent by the veterans involved in our study. They ‘normalised’ their relationship with excessive alcohol consumption both during and after military service and this hindered their ability to recognise alcohol misuse. Yet this was not mentioned by healthcare staff participating in the study. Participants also suggested that seeking help was contrary to ‘military culture’ and that this frame of mind tended to remain with UK military veterans after transition to civilian life. Delay in seeking help often meant that by the point at which help was sought, the problems were of such complexity and proportion that they were difficult to address.

Service commissioners/managers and military veterans highlighted a need for greater understanding of ‘veterans’ culture’ and the specific issues veterans face among ‘front line’ staff dealing with substance and alcohol misuse.
 
As a result of the research, one possible solution identified as worthy of further exploration is a ‘hub-and-spoke’ model of care. At the centre of the hub would be a military veteran peer support worker, with knowledge of local and national services, and experience in navigating existing pathways of care. This solution perhaps offers one way in which UK military veterans experiencing alcohol misuse problems might engage with the full range of existing services in a considered and individually bespoke way.
 
Reference:
  1. Ministry of Defence (2015) Annual Population Survey: UK Armed Forces Veterans residing in Great Britain 2015. Bristol: Ministry of Defence Statistics (Health).

National Conference – Northumbria University and Royal British Legion
Veterans Substance Misuse: Breaking Down Barriers to Integration of Health and Social Care
Newcastle United Football Club (Heroes Suite)
Thursday 16 November
More information on the Fuse website.

The myth of a dangerous ‘underclass’: a real horror story for Hallowe’en (Fri, 27 Oct 2017 05:00:00 +0000)

Guest post by Stephen Crossley, Senior Lecturer in Social Policy at Northumbria University


With Hallowe’en nearly upon us, many parents will be telling their children tales of ghouls and ghosts that can be found in haunted houses. Adults will entertain themselves by watching horror movies and other productions where other-worldly creatures and monsters intrude upon peaceful and civilised spaces to threaten the status quo and the existing order of things. Most of us know that ghosts, spirits, and the like are the stuff of legend and lore and tend not to believe the mythology associated with them. But many people in contemporary society do believe in myths about groups of people that are different to the rest of ‘us’, who exhibit different social norms and values to the mainstream population, and who invoke fear and dread in many of us. Many people watch the behaviour of ‘the underclass’,[1] in the name of entertainment, with a mixture of fear, horror, fascination, and contempt. The ‘underclass’, it is believed, can be found in certain locations. There is a long history to such beliefs.

William Hogarth's depiction of London vice, Gin Lane.
In Victorian times, the middle and upper classes of London spent a great deal of time going ‘slumming’, visiting poorer parts of the East End for various reasons, including their amusement and titillation, and for philanthropic and journalistic purposes.[2] In 1883, George Sims, an English poet, journalist, dramatist and novelist, began his book How the Poor Live by inviting the reader to go a journey with him, not across oceans or land, but ‘into a region which lies at our own doors – into a dark continent that is within easy walking distance of the General Post Office’.[3] Sims hoped that this continent would be:
As interesting as any of those newly-explored lands which engage the attention of the Royal Geographic Society – the wild races who inhabit it will, I trust, gain public sympathy as easily as those savage tribes for whose benefit the Missionary Societies never cease to appeal for funds.
William Booth, the founder of the Salvation Army argued in 1890 that certain areas of London were like parts of Africa that had just been discovered by explorers such as Henry Morton Stanley Africa, and were similarly full of primitives and savages. In 1977, the sociologist E.V. Walter noted that, whilst such beliefs had changed somewhat, traces of them remained:
In all parts of the world, some urban spaces are identified totally with danger, pain and chaos. The idea of dreadful space is probably as old as settled societies, and anyone familiar with the records of human fantasy, literary or clinical, will not dispute a suggestion that the recesses of the mind conceal primeval feelings that respond with ease to the message: ‘Beware that place: untold evils lurk behind the walls’. Cursed ground, forbidden forests, haunted houses are still universally recognised symbols, but after secularisation and urbanisation, the public expression of magical thinking limits the experience of menacing space to physical and emotional dangers.[4]
Indeed, in recent times, the former Secretary of State for Work and Pensions Ian Duncan Smith argued that the television programme Benefits Street offered the middle classes a window into the ‘twilight world’ of neighbourhoods where many people received financial support from the state.[5] The ‘twilight world’ of welfare dependency that Duncan Smith refers to elicits feelings of mystery, anxiety, and the unfamiliar, feelings of nervous excitement that the original social explorers must have felt in the late nineteenth century or what middle class travellers of today might experience whilst ‘doing the slum’ on foreign holidays.

Whilst the words have changed slightly, the myth of a dangerous ‘underclass’ who dwell in ‘dreadful enclosures’ or ‘sink estates’, and who represent a threat to wider society remains. If we want a real horror story for Hallowe’en, we need look no further than how large sections of society view a mythical ‘underclass’ and how they view the places associated with impoverished communities.

Dr Stephen Crossley is a Senior Lecturer in Social Policy at Northumbria University. His first book In Their Place: The Imagined Geographies of Poverty is out now with Pluto Press. He tweets at @akindoftrouble


References:
  1. John Welshman, Underclass: A History of the Excluded Since 1880 (2nd edition), London: Bloomsbury, 2013.
  2. Seth Koven, Slumming: Sexual and Social Politics in Victorian London, Princeton: Princeton University Press. 2004.
  3. George Sims, How the poor live, London: Chatto & Windus, 1883, p1.
  4. E.V. Walter, Dreadful Enclosures: Detoxifying and Urban Myth, European Journal of Sociology, Vol. 18, No. 1 (1977), p 154. 
  5. BBC News online, Benefits Street reaction shows poor 'ghettoised', says Duncan Smith, 23 January 2014, http://www.bbc.co.uk/news/uk-politics-25866259 [Accessed 27 November 2016] 
Images:
  1. William Hogarth [Public domain], via Wikimedia Commons
  2. Generations' (8690911868_23ce2c05a0_z) by ‘Byzantine_K’ via Flickr.com, copyright © 2013: https://www.flickr.com/photos/november5/8690911868

Monopoly money, pitching to the converted, and sending Mr Grumpy away happy: doing home and healthy ageing research differently (Fri, 20 Oct 2017 05:00:00 +0000)

Dr Philip Hodgson, Senior Research Assistant, Northumbria University



Endings are rubbish, right?  Whether it be a great novel, play, film, TV series – there’s always that feeling that no matter how things are pulled together, it will never be as good as you have pictured in your imagination.  And then, you know, it just ends…

It was perhaps with this in mind that we decided to take a different approach in the last of our four workshops on home and healthy ageing.  Rather than guest speakers being invited to share their knowledge and prompt discussion, the project team attempted to summarise and pitch their ideas for future research back to the group (think Dragons’ Den).  This proved to be challenging, as the previous sessions had been so rich that even synthesising them into brief slides was difficult, never mind placing them in a strategic context for the participants to critique and reflect upon.  Yet, three key themes were identified.  These were in addition to the concept of a ‘home’ being more than just bricks and mortar but personal/psychological, physical and social/environment space(s) – an idea that we used as a starting block in week one and illustrated below.

More than just bricks and mortar
'Home' illustration used in the seminars 
The key themes were:
  • Policies and contexts: not only a tension between housing and health policies, but also the need to consider market and narrative factors influencing housing and health decisions;
  • The life course approach: the need to think about housing as an individual pathway, in which preventative measures and services are considered before crisis point;
  • Transitions and soft services: the need for support to be available as and when people experience key housing and life changes, such as reduced physical health, retirement, or the loss of support networks and being able to navigate different services on offer.
However, this is where we’d like to leave you with a cliff hanger: rather than going through each of themes in-depth (fans of this series will have to wait for our spin off…  er, research papers for that!), we’d instead like to reflect on our process at this stage.  These sessions took a slightly different approach as, rather than being a series of open seminars with presentations that people could dip in and out of, we invited several key individuals to attend each session in turn.  The reasons for this were many, but primarily we wanted to ensure that a diverse range of backgrounds were represented throughout (housing providers, architects, academics, local authority workers, homelessness workers, etc.) to go on a learning journey with us as a research team.  This meant that by the time we reached the final session, there was enough of a shared understanding that we could make the most of the group’s commitment to the project – we would be actually able to start to pin down quite complex concepts, practical issues and, hopefully, future projects.

We tried out different formats to structure the discussions: from world cafés, to games (with Monopoly money!) with researchers pitching ideas to mock panels, which worked to various degrees but always ensured a lively debate.

Do not pass Go. Do not collect £200
Pitching ideas with Monopoly money 
There were, of course, some difficulties.  As I’m sure everyone reading this will know, it is a lot to ask of a practitioner to take one morning out of their schedule, let alone for four seminars.  As a result, engagement had to remain a constant focus and I spent much time nervously lingering by the registration desk hoping for just a few more name badges to disappear before we started!  It was also a challenge in terms of managing the conversations during the sessions: you want all voices to be heard in such a diverse group but we all needed to be pulling in the same direction by the end.

Yet, by the final session, the rewards were immense.  Not only were we able to pitch ideas to a group who had already undergone some of the same learning as us, but this gave everybody the confidence to relate the complex theoretical issues to their own practice (allowing us to capture the breadth of what was possible).  It allowed us to discuss concrete projects, and leave the session with a sense of trust that networks were in place to actually deliver on them.  Perhaps most importantly we found that, what started as a broad idea, was something of relevance across the housing and health sectors.  Even the grumpiest of the project group (naming no names) left the day with a spring in their step.  For that alone, everyone who attended deserves some massive thanks…

So, who needs endings, when we can all just sign up to the sequel?

To be continued…



Photo 2: By James Petts from London, England (Monopoly) [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons

From shock to the system, to system map and beyond: evaluating the UK sugary drinks tax (Fri, 13 Oct 2017 05:00:00 +0000)

Guest post by Jean Adams, Centre for Diet & Activity Research (CEDAR), University of Cambridge

Mostly you don’t get to watch TV at work. The day that George Osborne announced he would introduce a tax on sugary drinks in the UK, here at CEDAR HQ we all stood huddled around a computer monitor watching and re-watching the words coming out of his mouth. 

Oh. My. Goodness. I did not see that coming. 

The “soft drinks industry levy”, to give it it’s proper name.

A rather senior professor has since told me that he totally saw it coming.

After we’d got over the shock of the announcement, the conversation turned pretty quickly to research (well, this is a university, after all). We have got to evaluate this!

Colleagues at CEDAR had already written papers about how sugary drink taxes could be evaluated. We had talked with colleagues in other countries about evaluating their taxes – only for those taxes to fall through at the final political hurdle. I have more than one half-written application for research funds to evaluate sugary drink taxes stashed down the back of my computer.

And here it was, all systems go for designing an evaluation for a UK sugary drinks tax! In our back yard!

OK, so we have to work out whether it impacts on diet. But, what about jobs? Will people lose their jobs? Surely we need to know if it changes price and purchasing of sugary drinks. Right, but even if it does people might just shift to other foods – maybe they will just eat more cake instead? We are Public Health researchers, we need to focus on health: does the tax change how many people get diabetes? Or tooth decay? Or the number of obese children? And what about how this even happened? Did you see it coming? Why has this happened? Why now? Why don’t we do interviews with politicians and find out how it happened?

Woah, woah, woah! Ten seconds in and this is getting way more complicated than we (I) had ever thought it might. Before we did anything, we needed to work out what we thought might be going on here. Once we understood what the potential impacts might be, then we could start thinking about how we might evaluate them.

So that’s what we did. We spent 6 months developing a ‘systems map’ of the potential health-related impacts of the UK Soft Drinks Industry Levy (aka sugary drinks tax). The tax is explicitly designed to encourage soft drinks’ manufacturers to take sugar out of their drinks. There are two levels – a higher tax for drinks with the most sugar, a lower one for only moderately sugary drinks. So we started there (at ‘reformulation’) and worked out.

Then we sense-checked our map with people working in government, charities, and the soft drinks industry. They made lots of suggestions for things we’d missed, or needed to clarify. We changed our map and asked people to check it again. We changed it again. Only then did we decide what we should, and could, evaluate.

The current version of our systems map (we still think of it as a work in progress). Larger version here.







Yes, we are going to look at how the price of sugary drinks changes over the next few years. But we are also going to look at the amount of sugar in soft drinks in UK supermarkets, and the range of drinks available. We’re going to use commercial data to look at purchasing of soft drinks, as well as other sugary foods. We’ll use the National Diet & Nutrition Survey to explore whether there are any changes in how many sugary drinks, and other sweet foods, people in the UK eat. We’ll use hospital data to see if the number of children admitted with severe dental decay decreases. We’ll use statistical modelling to predict how changes in how many soft drinks people drink might translate into cases of diabetes and heart disease. We’ll look at the impact of the tax on jobs, and the economy. We’ll explore the ‘political processes’ of why and how this tax happened at this time. And we’ll conduct surveys to find out what people in the UK think of sugar, sugary drinks, and the tax itself – and whether this changes over time.

Obviously it’s going to be a lot of work. We’re going to need some excellent people to join the team to help us actually do this thing. Personally, I’m feeling a little overwhelmed/excited/overwhelmed/excited. It’s going to be brilliant!

Wanna be part of it?

Looking for trouble: deceit and duplicity in the Troubled Families Programme (Fri, 06 Oct 2017 05:00:00 +0000)

Introduced by Peter van der Graaf


Guest post by Stephen Crossley, Senior Lecturer in Social Policy at Northumbria University

Many families facing health problems, limiting illnesses, or with disabled family members have been labelled as ‘troubled families’ under the government’s Troubled Families Programme. Originally established following the 2011 riots to ‘turn around’ the lives of 120,000 allegedly anti-social and criminal families, the programme is now in its second phase and is working with a far larger group of families, many of whom experience troubles, but don’t necessarily cause trouble. In April of this year, the focus of the programme shifted again in an attempt to improve the number of so-called ‘troubled families’ who moved back into employment, despite the majority of them being in work and many of the remainder not being expected to be looking or available for work.

The programme has been dogged by controversy from day one. Research about families experiencing multiple disadvantages was misrepresented at the launch of the programme to provide ‘evidence’ that there were 120,000 troublesome families in England. The government has since been accused of suppressing the official evaluation of the first phase of the programme after it found ‘no discernible impact’ of the programme and also of ‘over-claiming’ the 99% success rate of the first phase. 

David Cameron with Louise Casey, former Director General of Troubled Families

Many health workers will be involved with the delivery of the Troubled Families Programme in their day-to-day work, although there is also a good chance that they will not be aware of it. Many local authorities do not refer to their local work as ‘troubled families’ because of the stigmatising rhetoric and imagery associated with it. Many families are not aware that they have been labelled as ‘troubled families’ for the same reason, and because it would undoubtedly hinder engagement with the programme. They are not always made aware that the data that is collected on them as part of the programme, is shared with other local agencies and, in an anonymised format, with central government.

My PhD research, conducted in three different local authority areas, found that the programme was based on, and relied upon duplicity from design to implementation. Despite government narratives about the programme attempting to ‘turn around’ the lives of ‘troubled families’, the programme appeared to be more concerned with helping to restructure what support to disadvantaged families looks like, and reducing the cost of such families to the state.

For example, support – both symbolic and financial - for universal services, such as libraries, children’s centres and youth projects, is reducing. Direct financial support to marginalised groups is also being cut, with welfare reforms hitting many of the most disadvantaged groups hardest. These forms of support, and many other more specialist services, are being replaced, rhetorically at least, by an intensive form of ‘family intervention’ which allegedly sees a single key worker capable of working with all members of the family, able to ‘turn around’ their lives no matter what problems, health-related or otherwise, they may be facing or causing.

The simplistic central government narrative of the almost perfect implementation of the Troubled Families Programme was not to be found ‘on the ground’, where there were multiple frustrations and concerns about the depiction of the families and the programme, and numerous departures from the official version of events. Despite the rhetoric of ‘turning around’ the lives of ‘troubled families’, in the face of cuts in support and benefits to families, my PhD thesis concluded that the Troubled Families Programme does little more than intervene to help struggling families to cope with their poverty better, despite the efforts of local practitioners.

Put simply, the programme does not attempt to address the structural issues that cause many of the problems faced by ‘troubled families’, but instead encourages them to ‘learn to be poor’. In my previous Fuse blog, I drew on the concept of ‘lifestyle drift’ advanced by David Hunter and Jenny Popay: where the focus of interventions drifts towards attempting to change individual behaviour, despite the wealth of evidence pointing to other solutions. There is no room in the narrative for wider determinants of people’s circumstances. Because of this, the government’s Troubled Families Programme will do little to turn around the lives and health of the families it claims to help.


A summary of Stephen Crossley’s PhD research can be found here. His first book In Their Place: The Imagined Geographies of Poverty is out now with Pluto Press. He tweets at @akindoftrouble


Photograph ‘Almost 40,000 troubled families helped’ (14087270645_3453006d12_c) by ‘Number 10’ via Flickr.com, copyright © 2014: https://www.flickr.com/photos/number10gov/14087270645

Brands, bottles and breastfeeding: sharing stories of early motherhood (Fri, 29 Sep 2017 05:00:00 +0000)


Introduced by Nat Forster


Guest post by Justine Gallagher, Lecturer at Northumbria University

My own story of infant feeding is based in a community where breastfeeding was, and still is, not the norm. I was the first in my immediate family to breastfeed and I struggled with it in various ways. My breastfeeding journey ended much sooner than I had originally planned, when my son was just six weeks old. Two years later, my own sheer determination helped me to feed my second child, a daughter, for nine months.

Justine's first steps into motherhood
Later, in a professional capacity, I worked supporting families in my role as Community Development Worker in Sure Start Children's Centres. I worked with mothers who had similar feeding stories to my own, as well as many women who had never breastfed. They, like most of the people around me, never had any intention to breastfeed.

The guilt I felt for breastfeeding my first child for a short time stayed with me for a long time. I did not understand why it had such an impact. Why did I feel the need to breastfeed when others around me did not appear to give breastfeeding a second thought? When the opportunity came for me to undertake PhD research, my choice of topic was never in doubt.

My research, which is supervised by Dr Deborah James from Northumbria University, is focused on the infant feeding stories of nine women who live in an area where breastfeeding rates are low. All of the women’s stories are equally important however, for the purposes of this blog I would like to introduce you to Claire (names have been changed to preserve anonymity), who formula fed her baby Sophia from birth.

Claire, her parents and grandparents have lived in the same local area all of their lives. Claire was a single parent and lived with Sophia’s grandparents when her daughter was first born. Sophia’s grandmother took an active part in her care. She looked after Sophia for two nights a week when she was first born, reducing this to just one night per week as time passed. Following a biographical narrative approach, which allows participants to tell their stories without interruption, I asked Claire for her story with the use of a single question;

"So, please can you tell me the story of your experiences of feeding milk to your baby?"
"Well I started when I was pregnant, erm, I’ve always wanted to bottle feed her er, cause there was pink bottles that I wanted to get her erm and also knew the milk that I wanted to put on her erm, and just bottle feeding become very easy to us."

Claire’s story was dominated with discussion of branding and consumer goods. The pink bottles and the various brands of infant formula Claire gave to Sophia reveal the way media and advertising can influence infant feeding practice. Claire demonstrates that she was careful with her bottle-feeding choices. These choices were not arbitrary; she made clear decisions between brands and bottles. Claire wanted me to know that she had made the right choices for her and her daughter.

It was also quite clear that Claire’s identity, as the mother of a daughter, was an important part of her story. The ‘pink’ bottles represent this in a very visible way, she could perform her identity as a mother of a daughter with the right choice of bottle. Claire’s relationship with her own mother was important to her and she appeared keen to demonstrate that this mother-daughter bond would continue for another generation.

These stories help us to understand why some women breastfeed and others do not. Upon reflection, for me, I feel that breastfeeding was about being the best mother I could be, which explains the guilt I felt when I stopped. For Claire, feeding her baby was also about the same thing, only for Claire, being a good mother was about making the right consumption choices. In my thesis, I expand on how Claire’s choices were based on the social norms, the unwritten rules of how to be a mother, in the culture around her.

The impact of advice services on health: moving from gut feeling to concrete evidence (Fri, 22 Sep 2017 05:00:00 +0000)

Introduced by Sonia Dalkin


Guest post by Alison Dunn, CEO of Citizens Advice Gateshead

Citizens Advice Gateshead provides independent, impartial, confidential and free advice to people who work or live in Gateshead about their rights and responsibilities. Gateshead is an area of high deprivation. Overall, Gateshead is the 73rd most deprived local authority in England, out of 326 local authorities. Nearly 23,600 (12%) people in Gateshead live in one of the 10% most deprived areas of England. Nearly 49,800 (25%) live in the 20% most deprived areas (Department for Communities and Local Government, 2015).

As a result, our work is predominantly around social welfare issues to include housing, money advice, welfare benefits, relationship and family issues, employment and consumer. In 2016/17 we helped 10,820 people with 71,487 advice issues. We estimate our work has a value to the wider governmental system of £11.5m.

Physical health and mental health are inextricably linked. People with a mental illness have higher rates of physical illness and tend to die 10 – 20 years earlier than the general population, largely from treatable conditions associated with modifiable risk factors such as smoking, obesity, substance abuse, and inadequate medical care (Mykletun et al. (2009). Poor mental health is associated with an increased risk of diseases such as cardiovascular disease (Dimsdale, 2008), cancer (Moreno-Smith et al., 2010) and diabetes (Faulenbach et al., 2012), while good mental health is a known protective factor. Poor physical health also increases the risk of people developing mental health problems.

For us, the link between our advice and health and wellbeing is obvious but persuading commissioners, policy makers and decision makers requires more than a gut feeling. So we feel very privileged indeed for the opportunity to work with Fuse and the research team at Northumbria University to investigate what we have always thought to be true, that our advice reduces stress and anxiety and improves wellbeing for our clients. 

The research constituted of a realist evaluation (the protocol of which is detailed here) of three of our more intensive services – one for those with enduring mental health conditions, one for young people, and one for those referred through their GP. The research indicated that stress was decreased and wellbeing increased as a result of accessing the service, using the Perceived Stress Scale and Warwick Edinburgh Mental Wellbeing Scale. The research also tells us that our intensive advice services increase the options available to our clients, allowing them to be able to participate in more activities to promote wellbeing and reduce isolation. The service also creates trusting relationships with our clients, which was essential in maintaining relationships in order to help clients with their issues. Finally, the service works as a buffer between the client and state organisations such as the job centre and the Department of Work and Pensions, allowing the two to interact more efficiently. 

We plan to maintain our relationship with the research team and we are starting to talk to them about how we can build on this work to learn even more about the link between advice services and the wellbeing of our beneficiaries.

If you would like more information related to Citizens Advice Gateshead, please visit our website: https://www.citizensadvicegateshead.org.uk/ 


References: 
  • DEPARTMENT FOR COMMUNITIES AND LOCAL GOVERNMENT. 2015. English indices of deprivation 2015 [Online]. Available: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/465791/English_Indices_of_Deprivation_2015_-_Statistical_Release.pdf [Accessed].
  • DIMSDALE, J. 2008. Psychological Stress and Cardiovascular Disease. Journal of the American College of Cardiology, 51, 1237-1246.
  • FAULENBACH, M., UTHOFF, H., SCHWEGLER, K., SPINAS, G., SCHMID, C. & WIESLI, P. 2012. Effect of psychological stress on glucose control in patients with Type 2 diabetes. Diabetic Medicine 29.
  • MORENO-SMITH, M., LUTGENDORF, S. & SOOD, A. 2010. Impact of stress on cancer metastasis. Future Oncology, 6, 1863-1881.
  • MYKLETUN, A., BJERKESET, O., OVERLAND, S., PRINCE, M., DEWEY, M. & STEWART, R. 2009. Levels of anxiety and depression as predictors of mortality: the HUNT study. British Journal of Psychiatry, 195, 118-125.
The research was funded by NIHR School for Public Health Research (SPHR) and is supported by Fuse (The Centre for Translational Research in Public Health). The views expressed are those of the research team and not necessarily those of the NHS, the NIHR or the Department of Health.

Postcards from a public heath tourist #2: Boston, Massachusetts, USA (Fri, 08 Sep 2017 05:00:00 +0000)

Guest post by Emma Simpson, Research Assistant, Newcastle University

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A few of our academics are lucky enough to have the opportunity to travel around the world to speak at conferences or explore collaborations - all in the line of work and the translation, exchange and expansion of knowledge of course.

The least we could expect is a postcard, to hear all about the fun that they're having while we’re stuck in the office watching droplets of rain compete in a race to the windowsill…

Here’s the second from Emma Simpson.

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Dear Fuse Open Science Blog,

It’s not just academics who get amazing opportunities, PhD students do too!


I am part of the Engineering and Physical Sciences Research Council (EPSRC) funded Digital Civics programme at Newcastle University and my research lies at the intersection of public health and human computer interaction (HCI) – broadly speaking. As part of this programme, I am are very fortunate to have the opportunity to undertake an exchange at another relevant institution.

Wellness Lab (L-R): Herman Saksono, Lily Stowell, Me, and Andrea Parker
(I also worked alongside Farnaz Irannejad Bisafar who is not pictured here)
Earlier this year, I travelled 2,637 miles to Northeastern University, where I began a three month internship as a research scholar at the Wellness Lab. The Wellness Lab is directed by Professor Andrea Parker and sits within the Personal Health Informatics department in School of Computing and Information Science. After having completed all of my preceding degrees at Newcastle, I was super excited to spend time in a different research institute and it didn’t disappoint! I had such a rewarding experience and because the lab was much smaller than I had anticipated that meant I developed close friendships with the other three students advised by Andrea.

Beautiful snowy view from Wellness Lab
The Wellness Lab has some very interesting research projects (and beautiful views from the office). The research mainly focusses on how digital technologies can alleviate health disparities and improve health and wellbeing across different populations. Some interesting papers here, here and here. I worked specifically on two projects - supporting reflective thinking through family storytelling to encourage physical activity and designing games for encouraging physical activity and social connectedness in Alzheimer’s Disease caregivers. Two very different projects based on gaming and public health, offering very different experiences and skill development and - although not largely related to my projects in the UK - both offered invaluable contributions to my development as a researcher.

I had the opportunity to lead some co-creation workshops with parents, creative writers and health experts to develop stories that could potentially encourage families to reflect on their physical activity behaviours – great fun and insightful, while introducing me to new methods and materials to facilitate important conversations around health, inspired by the value sensitive action-reflection model.

Unfortunately, the second project working with Alzheimer’s Disease caregivers progressed much slower and I didn’t quite get to the data collection stage, but I did design some paper prototype games which made me realise I need to work on my drawing skills!

Glass flower exhibition at the Harvard
 Museum of Natural History
I spent time working alongside Catherine D’Ignazio, Assistant Professor at Engagement Lab and Faculty Chair of Boston Civic Media – both of which are leading the way for collaborative, participatory civic research in Boston. Catherine and I worked together within a team of feminist HCI researchers to organise a 'Hacking Women’s Health' workshop at the Conference on Human Factors in Computing Systems in Denver, Colorado, in May this year. The event was a two-day workshop with a mixture of 25 academics and PhD students from across the world working on projects related to women’s health and technology. It was my first ever experience of organising a hackathon style workshop and it was such a successful (and fun) weekend. You can read another blog about it here.

Boston is a great city and the architecture is beautiful. My favourite and highly recommended leisure activity is to visit the Harvard Museum of Natural History where you can view the glass flower exhibition. It contains over 4000 different glass models representing more than 830 plant species that were made to teach botanicals all year round - super impressive. My inner science nerd was elated. A must see if visiting the city but avoid going in the winter! As beautiful as it was, the -12 degrees and two feet of snow every few days became tiresome.

Thank you to my PhD supervisors Madeline Balaam, for helping organise this opportunity, and to Emma Foster and Ashley Adamson for their continued support.

Please feel free to email me if you would like to know more about any of the projects or Digital Civics research – emma.simpson@newcastle.ac.uk


Summer is coming (Fri, 04 Aug 2017 05:00:00 +0000)

The blog was there at the very beginning, before it became ‘cool’. It’s even read all seven volumes of the book series A Song of Ice and Fire. It’s a self-confessed Game of Thrones geek. But watching the show isn’t enough, so it’s off on an adventure holiday to follow in the footsteps (or flight) of white walkers, wildlings and dragons.

First to Dubrovnik, Croatia and Mdina, Malta to explore King’s Landing, the biggest city in fictional Westeros (with a quick stop off at Lokrum Island - 4kms from Dubrovnik as the dragon flies - to visit the ancient port of Qarth).

Then on to Essaouira, Morocco - Gulf of Grief at Slaver’s Bay (you know, where Daenerys Targaryen - the dragon lady - freed an army of slaves to help her invade Westeros),

Next stop Castle Ward in Northern Ireland - the historic farmyard is the location of Winterfell, the seat of the ruler of the North and the traditional home of House Stark.

Finally arriving in Iceland to see the magnificent Vatnajökull Glacier, the Nordic island nation's largest and most voluminous ice cap to get the full 'North of the Wall' experience.

The blog will return in September.  If you are inspired to write for the Fuse blog in the meantime, please send your posts to m.welford@tees.ac.uk.  More here about who we are and what we're looking for.



Image courtesy of "https://kristina-finds.tumblr.com" via pinterest.co.uk: https://www.pinterest.co.uk/pin/314055773985524526/ 

A week and a day in the life of an embedded researcher (Fri, 28 Jul 2017 05:00:00 +0000)

Posted by Mandy Cheetham, Fuse Post doctoral Research Associate and embedded researcher with Gateshead Council Public Health Team

Standing to deliver my presentation at the UKCRC Centres of Excellence conference recently held at the Royal College of Physicians last week, I felt oddly out of place. I was describing my experiences of embedded research in a community centre in an estate characterised by high levels of poverty, health inequalities and persistently high rates of childhood obesity. The contrast between this setting and the auspicious environment of the RCP was marked. The lecture theatre represented an entirely different world.

Presenting at the UKCRC Public Health Research Centres of Excellence Conference

At the pre-conference dinner, I’d had lively discussions with researchers and practitioners from the four corners of the UK about different approaches to, and experiences of knowledge exchange and about advocacy. Presenters earlier in the day were clear that advocacy was not part of their role. And yet, it felt at the heart of my role as an embedded researcher as a way to affect change.

As my presentation began, photos of the community centre, the events and activities I’ve been involved in, beamed on to the enormous screen, and gave a flavour of the different worlds we inhabit as researchers. One of the slides showed a picture of the international athletics stadium near the estate where I’m based. I explained how during the research, local people said they didn’t feel the stadium was for people like them. Some had never been inside, despite growing up on the estate just across the main road.

Back at the community centre on Monday, I talked about the conference. I had invited the stadium manager for community lunch and was full of anticipation about the possibilities of exploring closer links. He arrived, chatted to community members and staff, and stayed 2 hours. He was really receptive and people shared plenty of ideas. It’s the start of a dialogue. Who knows where it will lead.

Working with the community to involve children in cooking and trying healthy options

I love this aspect of my job, the variety, the networking. The rest of my working week involved a focus group with the steering group of the community centre and another with year 4 children from the local school. My role as a researcher is many and varied. The organisation where I’m embedded, and the public health team who commissioned the research, have been extremely receptive and welcoming, open to scrutiny, feedback and learning. Collaboration requires multiple skills, which are not always taught or easily learned, including sensitivity, diplomacy, tenacity and assertiveness, recognising the nuances of the local context and existing relationships in place. Researchers can contribute by offering new perspectives and working alongside existing stakeholders as equal partners.

If we are to make progress in efforts to turn the tide on entrenched health inequalities, I believe we need to work differently as researchers. Embedded research offers opportunities to engage communities who would rarely volunteer to take part in formal university research projects. It involves co-producing public health research with communities and researcher users, sharing knowledge, identifying and generating solutions together, and including children and young peoples’ views as part of that, as experts by experience. As academics, we are not the experts. Children and adults who have participated in the research process are only too aware of what makes us fit and healthy and the constraints on their choices and decisions. The opportunities to act on that knowledge are limited by their environment and sometimes by the assumptions of others. As researchers, I believe we have a responsibility to challenge some of those limiting assumptions and collaborate with others working proactively in community settings to facilitate positive change where we can. By co-producing and combining different types of knowledge we can create meaningful impact, both in communities experiencing health inequalities and in auspicious academic lecture theatres.


Photo courtesy of the National Children's Bureau (NCB) report (p10): 'Working together to reduce childhood obesity' authored by Emily Hamblin, Andrew Fellowes and Keith Clements (May 2017)

Researching holiday hunger (Fri, 21 Jul 2017 08:43:00 +0000)

Guest post by the Healthy Living Lab team, Faculty of Health and Life Sciences, Northumbria University

“Summer is here and the living is easy ….” well for most people it might be. However, for many families on low incomes, school holidays are challenging times. Over the past few years, the Healthy Living Lab at Northumbria University has undertaken research into the holiday clubs providing support to these families. We have had the privilege of working with clubs right across the UK from Scotland to the South of England. We have visited clubs based within a range of settings including schools, food banks, church halls and community centres. Research by the Healthy Living Lab is providing a significant insight into the location of holiday clubs, and crucially identifying gaps in provision and the outcomes for families and children attending the clubs.


During the school term, free school meals (FSM) act as a safeguard for children from low income families, but there is no additional state provision for these children during the school holidays. The term ‘holiday hunger’ has been used to describe the hardship that children and families on low incomes face during the summer break; when they do not have access to a free school lunch. Moreover, the increase in financial pressures during the school holidays has a more general impact on the quality of children’s lives, as families lack money for entertainment, socialising and educational or developmental activities (Gill & Sharma, 2004; Graham et al., 2016; Kellogg’s, 2015).

School holiday clubs can help to bridge this gap by providing food, activities and support. Many holiday clubs are staffed by volunteers, who have given up their summer to make sure that something important happens; that children have access to nutritious meals when free school meals aren’t available. There is also a good chance there will be activities happening within holiday clubs, and that the children attending are having a great time.

Research from the Healthy Living Lab team ascertained a need for holiday club provision for families on low incomes (Defeyter, Graham, & Prince, 2015). We have spoken to parents and children at holiday clubs, many of whom live below or just above the poverty line. Our findings highlight that, for many low-income families, the school holidays are difficult, especially the longer summer break. A member of staff at one holiday club breakfast club indicated that it wasn’t just children who benefited from the the holiday breakfast club as well, saying:
“Main thing is for the kids, but I think it’s really benefitted the adults as well, so urm yeah just making sure every-one’s getting food, which is really important ‘cause breakfast, the most important meal of the day (Female staff member; Club 5) (Defeyter, Graham, & Prince, 2015, p.5)
Whilst parents strive to ensure that their children are fed, many find it more difficult to manage during school holidays, as food bills increase and thereby the risk of low-income families experiencing food insecurity also increases. Moreover, we have spoken to staff and volunteers from school holiday clubs, who have told us that their clubs provide food, in addition to social, learning and support opportunities (Graham et al., 2016). Our research shows that holiday clubs not only provide financial support to low income families, through the provision of a free meal, but also provide a social outlet for parents and their children, as well as wider benefits for the community (Defeyter, Graham, & Prince, 2015).

Researching this area is challenging as it involves talking to families about sensitive issues such as their food and financial situation. But, this work is also invaluable as it draws directly on the experiences of parents, children, and holiday club staff ensuring their voices are heard.


The Healthy Living Lab Team is:
  • Professor Greta Defeyter, Faculty Associate Pro Vice-Chancellor (Strategic Planning & Engagement), Faculty of Health and Life Sciences, and Director of Healthy Living
  • Dr Pamela Graham - Vice Chancellor's Research Fellow
  • Dr Louise Harvey-Golding - Senior Research Assistant
  • Emily Mann - PhD Researcher
  • Jackie Shinwell - PhD Researcher


References:
  1. Gill, O., & Sharma, N. (2004). Food Poverty in the School Holidays. London.
  2. Graham, P. L., Crilley, E., Stretesky, P. B., Long, M. A., Palmer, K. J., Steinbock, E., & Defeyter, M. A. (2016). School Holiday Food Provision in the UK: A Qualitative Investigation of Needs, Benefits, and Potential for Development. Frontiers in Public Health, 4(April 2014), 1–8. http://doi.org/10.3389/fpubh.2016.00172
  3. Kellogg’s. (2015). Isolation and Hunger : the reality of the school holidays for struggling families. Manchester. Retrieved from http://pressoffice.kelloggs.co.uk/Going-hungry-so-their-children-can-eat-Third-of-parents-on-lower-incomes-have-skipped-meals-during-school-holidays
  4. Defeyter, M. A., Graham, P. L., & Prince, K. (2015). A Qualitative Evaluation of Holiday Breakfast Clubs in the UK: Views of Adult Attendees, Children, and Staff. Frontiers in Public Health, 3(August). http://doi.org/10.3389/fpubh.2015.00199

Photo courtesy of Children in Scotland: http://www.childreninscotland.org.uk

What does a hung parliament hold for the future of Public Health? (Tue, 04 Jul 2017 05:00:00 +0000)

Posted by Fuse Senior Investigator David J Hunter, Professor of Health Policy and Management & Director, Centre for Public Policy and Health, Durham University


The June general election threw a lot of things up in the air but resolved little. We are living in a suspended state awaiting resolution of what is clearly an unstable political landscape and a government hobbled by its own tensions and contradictions. Uppermost among these is of course Brexit. This will continue to consume all of government as it has already done for much of the past year. No part of government will be left untouched by it. The upshot is that other domestic policy areas are likely to receive minimal attention. This includes public health which rarely features high on the policy agenda.


Earlier in June, the Faculty of Public Health President, John Middleton, in a British Medical Journal editorial urged the next UK government ‘to make health central to all its policies’ (BMJ 2017, 2 June doi:10.1136/bmj.j2676). He concluded that just as local government had adopted a health in all policies approach, ‘national government must now become a public health government’. There seems little chance of that happening in the current febrile political climate.

Of course one can argue the merits of putting health into all policies as distinct from putting all policies into health which might hold more appeal for those who are suspicious of, or are opposed to, health imperialism. But the central point is valid. Most, if not all, of what government does impacts on the public’s health. Indeed, much of the support for political parties calling for an end to austerity was driven by a perception that the unrelenting assault on the public realm since 2010 was having unacceptably negative consequences for people’s health and wellbeing. It’s a small consolation that what has happened in regard to widening inequalities was predicted by the public health community.

So if we cannot look to national government for public health leadership in the foreseeable future, and that seems a forlorn hope given that the former public health minister lost her seat in the election and her successor is unlikely to make an impact anytime soon, what does the immediate future hold for public health? And where is the action likely to occur?

Having a disabled or incapacitated national government may not be entirely a bad thing if it allows local government and other agencies to go about their business without being subjected to a constant outpouring of policy initiatives and ministerial announcements and directives which invariably offer only distraction.

This suggests a need for the public health community to engage more vigorously than it has done hitherto in driving the 44 Sustainability and Transformation Plans (STPs) in England. Though flawed, deeply so in some cases, and poorly communicated with minimal public engagement, STPs and related developments like Accountable Care Systems (ACSs) offer an opportunity (perhaps the only one for the time being) to put public health centre stage in developing place-based approaches to improving population health.

STPs are underpinned by the Triple Aim (Berwick et al 2008Health Affairs 27(3): 759-69) which comprises: improving population health, focusing on patient-centred care, and achieving more efficient per capita spending. STPs and many of the other health system transformation activities underway, and being actively promoted by NHS England with back-up as appropriate from Public Health England, are aimed at managing demand on health care services.

This is not a new agenda – the Wanless reports from 2002 and 2004 commissioned by the last Labour government eloquently argued the case for making the NHS a health rather than a sickness service – but the drive for a systemic transformation has perhaps never been so evident.

The opportunity to bring about a much needed shift in health policy should not be lost and public health should be at the centre of STPs. They offer the best prospect of taking on the big beasts of the acute hospital jungle and wresting resources from them to put into public health. Yet, as research being carried out by colleagues in the Centre for Public Policy and Health (CPPH) at Durham examining the public health changes introduced in 2013 demonstrates, with few exceptions Directors of Public Health in Local Government and their teams and Health and Wellbeing Boards are failing to provide the system leadership that is urgently needed1,2.

Since New Labour introduced foundation trust status for hospitals, compounded by the Coalition government’s misconceived and unnecessary Health and Social Care Act 2012, the NHS has been bedevilled by fragmentation and an ethos of competition in place of collaboration. STPs and associated reforms including ACSs are an attempt to mitigate the worst features of the various reforms since the turn of the century.

It is vital that STPs succeed and bring about the whole system, place-based approach to health and wellbeing that they promise. But we are some way from reaching that goal and the risks are considerable especially when budget cuts affecting public health make it less likely that the necessary changes can be realised.

However, we must not make too much of the budget cuts invoking them to argue that it demonstrates how misconceived it was to relocate public health to local government. Had public health remained under the NHS, it is almost certain that it would be in an even poorer state than is the case at present. Those who remember the days of PCTs will recall the frequency of raids on public health budgets to offset overspends and prop up hospitals. At least public health under local government control remains visible and there is evidence despite the impact of austerity of authorities making serious efforts to become public health organisations and take health improvement and wellbeing seriously.


References:
  1. Commissioning Public Health Services - Centre for Public Policy and Health (CPPH), Durham University: https://www.dur.ac.uk/public.health/projects/current/cphs/
  2. Evaluating the Leadership Role of Health and Wellbeing - Centre for Public Policy and Health (CPPH), Durham University: https://www.dur.ac.uk/public.health/projects/current/prphwbs/

Photo attribution: "Exactly." by Sam Rodgers © 2017: https://www.flickr.com/photos/samrodgers/34779376735

Automatic academic: working myself out of a job (Fri, 23 Jun 2017 05:00:00 +0000)

Guest post by Emma Foster, Lecturer in Public Health Nutrition, Human Nutrition Research Centre, Newcastle University

Since I started working in dietary research I’ve been fascinated by how and why people misreport their dietary intake. Lots of excellent research (by others) has gone into understanding how the hassle of recording food intake, problems with memory and attention (if you are busy doing something else at the same time you may not be paying attention to what you are eating) along with social-desirability bias (am I really going to admit to the nutritionist interviewing me how many doughnuts I ate yesterday!) together tend to result in an under-estimate of energy intake and an over-estimate of those foods seen to be “healthy”.

Much of my research has focused on how we can make it less of a burden and perhaps even an enjoyable experience for volunteers taking part in nutrition research studies. I developed food photographs for portion size estimation with children, so participants don’t need to weigh everything their child eats….and more importantly doesn’t eat but ends up wearing!

Food photographs estimate portion size with children, so participants don’t need to weigh everything their child eats (or ends up wearing!)


More recently I’ve been developing an online 24-hr recall system, which sometimes feels like I’m making myself and other nutrition researchers surplus to requirements! In the “olden days”, when I first joined the Human Nutrition Research Centre at Newcastle University, all dietary data was collected by a researcher who went out to people’s homes to interview them about their dietary intake (something I really quite miss). This was followed by day after day sitting at a computer linking the foods and drinks reported to food composition data and weights (which I don’t miss quite as much!). Now with the online recall we are able to collect the data remotely. We send people a URL and login details and the computer system does the rest. It takes them through the previous day, asking for details on foods consumed, getting people to estimate portion size using photographs and checking for forgotten items like butter on toast or sugar in tea. The system automatically does the linking to the food composition data and the weights consumed and the researcher can download the data as soon as the volunteer has submitted their recall.

More beans please. A screenshot from INTAKE24


But surely it doesn’t do as good a job as a highly skilled nutrition researcher such as myself….right? Well it’s not actually that far off! When compared with a traditional face-to-face interview with 180 people the system was found to underestimate energy intake by just 1% on average and average intakes of protein, carbohydrate, fat, vitamins and minerals were all within 4% of the interviewer-led recall. Perhaps most amazingly people reported enjoying completing the system!

So if you would like to measure food intake as part of your research but can’t afford to employ a nutritionist/dietitian as part of your research team (we’re not cheap) then have a look at our demo on https://intake24.co.uk/demo and drop us an email at support@intake24.co.uk and we can set you up a survey straight away – and it really is free.

400 not out (Fri, 16 Jun 2017 05:00:00 +0000)

Posted by Mark Welford, Fuse Communications Officer, Teesside University

This is the 400th post on the Fuse blog and in the spirit of using arbitrary milestones as worthy of note, I thought it was time for some (blog) post-match analysis.

Brian Lara who holds the record for the highest individual score in a Test innings
 after scoring 400 not out against England playing for the West Indies in 2004.

Over the last five-and-half-years, we have had 399 posts, written by 116 authors, and more than 395,000 page views. There has also been a lot of #fuseblog twittering, coffee room chats, and (you surely didn’t think it could be any other way?) blog-related committee discussions.

We even won a UK blog award last year (not that we mention it much!) and were shortlisted in two award categories earlier this year. But shortlisted isn’t winning and on the train back from those awards in April, I contemplated what we could do to improve the blog or - dare I say it - if the blog had run its course, done its job, had its time.

In academia, more than any sector that I’ve worked in (and I’ve worked in a few) you are encouraged to STOP, put down your machete, and climb above the canopy to see if the direction that you’re heading in is getting you to where you want to go. Academics will quite happily interrupt you in mid-flow to ask: ‘so what?’, ‘what impact are we making?’, ‘who are we reaching?’.

Since taking the wheel from blog founder Jean Adams I have enjoyed myself. I have learnt a bit about community and herding cats, I have made some real-life and virtual friends. I have written the odd post, although admittedly not as many as Jean, and I have enjoyed the discipline of having to write 500 -700 words for public consumption (usually when I can’t find anyone else to post).

I think the other writers have enjoyed it too, once they’d got past their initial reservations.

From all of this, I surmise that people value both reading and contributing to the blog. But I don’t have a clear view of who you are. You also seem to be discussing it in some forums. But you aren’t leaving comments on the blog itself. We have had a grand total of 480 comments posted, of which 234 were spam. So that’s 246 sensible comments. From 395,000 views.

So, I would now like to invite you to use the comment box below to post your thoughts on the blog so far. What sort of things do you like? What stuff would you rather we skipped? What would you like more of? Who are you? You don’t need to tell everyone your name, but what got you here? Why are you interested in this blog? What would make you more interested?

It isn’t that tricky:
  1. Depending on how you got to this page, you either start typing straight in the white box, or you need to click the orange link “No comments” at the bottom of the post to get the white box to appear.
  2. After writing your thoughts, click on the “Comment as” pull-down. If you know what any of the branded options mean, select one. If not, just chose “Name/URL” or “Anonymous”. Then do the ‘prove you’re not a robot’ thing and you’re done.
I’ll get an email. If you’re not flogging Viagra or using a barrage of abuse, I’ll approve your comment and you’ll be published.

And, just before you get to work: thanks. Thanks to the writers, the readers, the reviewers, the commenters, the retweeters, and the lurkers. See you all again at the next arbitrary milestone.

Can we achieve a healthy sustainable diet by 2030? (Fri, 02 Jun 2017 05:00:00 +0000)

Guest post by Christian Reynolds, Knowledge Exchange Research Fellow (N8 AgriFood project), Department of Geography, Faculty of Social Sciences, The University of Sheffield.

I recently attended the REFRESH Food Waste 2017 conference in Berlin. In the keynote speech of the conference, Vytenis Andriukaitis, (Lithuania's European Commissioner and designate responsible for Health and Food Safety) closed with the remark that Europe’s target is to halve food waste by 2030, and asked the audience if the goal of halving food waste is feasible or a fairy tale promise? 2030 is only 13 years away after all!


Likewise, the sustainable development goals are aimed for 2030, these include: ending poverty, ending hunger, increasing good health and well-being, climate action, and ensuring sustainable consumption and production patterns – the latter encompassing the aim to halve food waste.

Many of these goals require large changes to production methods and systems, modes of consumption, and general societal shifts on a global scale. This got me thinking about the challenge of shifting populations towards healthy, sustainable diets; is 2030 an achievable and realistic time frame?

Over the last couple of years there have been a few studies discussing how the UK, and global diets need to shift to meet healthy sustainable diets, (I will admit that I also have two in peer review at the moment). Some of my favourite studies currently published are Macdiarmid et al (2012), Green et al (2015), and van Dooren et al (2015). I also recommend reading Dantzig (1990) to get a glimpse of how this field of enquiry began.

These studies use mathematical modelling methods such as linear programming to calculate diets that:
  1. are optimised to be sustainable (for most studies this means low in associated greenhouse gas emissions (GHGE));
  2. meet the current healthy eating guidelines; and
  3. are not ‘unacceptable’ to the population.
This final item is a crucial, as if you do not constrain for palatability, the linear programme will calculate diets that are healthy, but only feature the foods with lowest environmental impacts. For example, Macdiarmid et al (2012) found a diet of 7 foods: whole-grain breakfast cereal, pasta, peas, fried onions, brassicas, sesame seeds, and confectionery to be sustainable and healthy. Stigler (1945) on the other hand proposed the following 7 foods: wheat flour, evaporated milk, cabbage, spinach, dried navy beans, pancake flour, and pork liver. Both of these are very ‘worthy’ but not varied enough diets to pass muster with the general population.

With this acceptability constraint in play, diets that are healthy and have lower GHGE are achievable with as little as 20-40% dietary shift resulting in up to 30% reduction in GHGEs (see Figure 3 from Green et al (2015). The majority of the studies include a reduction in animal products. For instance Macdiarmid et al (2012)’s sustainable diet featured 60% of the current intake of all meat for women in the United Kingdom and 48% of the intake of red meat (see Figure 1 from Macdiarmid et al 2012).

Figure 3. Deviations of optimised diets from current average diet, with associated reduction in greenhouse gas emissions from Green et al 2015
Figure 1. Proportions (by weight) of food groups in the final sustainable diet compared with the average current intake
of women in the United Kingdom (National Diet and Nutrition Survey 2008–2010). from Macdiarmid et al 2012





So are these changes in food consumption and purchase reasonable in a 13-year time period? Can we shift towards a healthy sustainable diet in 13 years?

For a quick check I looked up the rate of dietary change in the historic reports of the Family Food Survey. Looking over 13 year periods from 1945 to 2000, I found differing rates of changes in consumption and purchase for each food item (check out these amazing visualisations of Britain’s diet from 1945-2000, or look at the table I provide below).

Within all the 13 year periods between 1945 to 2000, all food groups have at maximum shifted by over 20%. This is good news, and indicates that change is possible for all food items in the British diet. However, what is less heartening is that total consumption and purchase of meat and meat products has only shifted by a maximum of 40%, while beef and veal consumption has only changed by a maximum of 47%. These rates of change need to be this high - if not higher - if we are to successfully shift toward a healthy sustainable diet.

So are healthy sustainable diets achievable or just a goal? Only time will tell. However, for now, here are some things that we can do to help the shift towards healthy sustainable diets:
  1. Focus on the foods that need to shift for both health and sustainability. Studies are finding that we need to increase fruit and vegetable consumption, increase oily fish consumption and reduce red meat and processed meat consumption. These are the main goals that we can work towards across the population.
  2. Pick our battles: focus on the foods that people have an appetite to change. From the table below we can see there are some foods that are easier to shift than others, for example starchy foods (a core of many British diets) have had much smaller rates of change than fruits and vegetables. Our relationship is already used to changing fruit and vegetable consumption, let’s focus there instead. 
  3. Technology and dietary change is our friend, let’s harness it. As society and technology develops, food consumption changes. Look at the changes in consumption of canned vegetables as better quality fresh vegetables were introduced. Likewise, the reduction in flour consumption as ready-made bread and other starches (rice, pasta, etc.) began to appear in the shops. How can we work with modern technology, such as improved food storage and processing technology, faster food transfer, and the advent of online shopping? Can we make online meal deliveries and food box deliveries lead to healthier and more sustainable diets?
Table: Britain’s diet from 1945-2000

    Maximum 13 year change in food consumption/purchase 1945-2000Minimum 13 year change in food consumption/purchase 1945-2000
    Liquid wholemilk 65.3%4.4%
    Skimmed milk 99.0%0.0%
    Yoghurt and fromage frais73.0%0.0%
    Total milk and cream 27.8%4.5%
    Natural cheese 23.0%0.0%
    Processed cheese44.3%0.0%
    Total cheese 44.1%8.5%
    Eggs 67.1%7.5%
    Oranges and other citrus fruit 74.0%16.1%
    Apples and pears26.9%10.3%
    Bananas64.6%9.1%
    Total fresh fruit 61.0%13.0%
    Fruit juice 88.4%25.0%
    Total other 50.4%9.6%
    Total Fruit 68.3%11.4%
    Potatoes38.8%13.2%
    Fresh green vegetables36.8%15.2%
    Other fresh vegetables24.5%7.8%
    Canned vegetables92.0%11.5%
    Frozen vegetables77.3%0.0%
    Other vegetables and products 42.9%10.5%
    Total vegetables and products22.2%6.9%
    Bread33.9%9.4%
    Flour63.3%18.7%
    Cakes and pastries60.2%12.7%
    Biscuits66.0%4.9%
    Break-fast cereal55.8%11.4%
    Total cereals (excluding bread) 19.9%5.0%
    Bread & cereal products 23.1%6.4%
    Sugar54.0%8.6%
    Preserves 51.9%21.3%
    Tea37.9%9.4%
    Coffee52.3%15.0%
    Total beverages 28.2%6.0%
    Fresh white fish49.0%17.2%
    Fresh fat fish65.3%32.3%
    Shellfish71.7%38.5%
    Cooked fish61.9%29.0%
    Total fish and fish products 46.2%6.1%
    Butter67.5%10.8%
    Margarine82.8%24.0%
    Lard82.1%9.6%
    All other fats 74.0%23.4%
    Vegetable and oils64.1%0.0%
    Low fat spreads53.8%0.0%
    Reduced fat spreads80.0%0.0%
    Total fats 37.4%5.0%
    Beef and veal47.4%19.5%
    Mutton and lamb55.4%17.6%
    Pork95.8%27.7%
    Bacon and ham68.3%7.5%
    Pork, bacon and ham75.9%11.1%
    Poultry90.0%15.6%
    Sausages38.0%8.6%
    Total meat and meat products39.8%8.6%

    Christian Reynolds
    Email: C.Reynolds@sheffield.ac.uk
    Twitter: @sartorialfoodie


    Photo attribution: "2006_04_10 Food waste. Peering into a dumpster at the GI Market." by Taz © 2006: https://secure.flickr.com/photos/sporkist/126526910

    Postcards from a public health tourist #1: Montréal, Québec, Canada (Fri, 26 May 2017 05:00:00 +0000)

    Posted by Clare Bambra, Fuse Associate Director and Professor of Public Health, Newcastle University

    A few of our academics are lucky enough to have the opportunity to travel around the world to speak at conferences or explore collaborations - all in the line of work and the translation, exchange and expansion of knowledge of course.

    The least we could expect is a postcard, to hear all about the fun that they're having while we’re stuck in the office watching droplets of rain compete to reach the windowsill…

    So here’s the first from Professor Bambra.



    Dear Fuse Open Science Blog,

    I spent late April and May 2017 as a visiting Professor at the Institute of Research in Public Health, part of the University of Montréal. I was the guest of Professor Louise Potvin who is a leading international researcher in health promotion and the editor-in-chief of the Canadian Journal of Public Health. She was an amazing and generous host.
    

    Me (bottom right) with Louise Potvin (centre) - an amazing and generous host
    I had a really enjoyable and fruitful time both intellectually and socially at the Institute. It is an exciting place to be as a health equity researcher. They are leading the field in health equity research in Canada and alongside the other Montréal universities and the municipal public health agency, they have set up the joint Lea Roback Centre which examines health equity. There I was honoured to deliver the annual Paul Bernard lecture on social determinants of health – you can watch a video of the talk here.

    I was also an invited speaker at the World Health Summit speaking alongside Ilona Kickbush (World Health Organization Europe) and Connie Clements (Canadian National Collaborating Centre on the Determinants of Health - NCCDH) about the legacies of the Ottawa charter. The NCCDH is tasked with integrating health equity and the social determinants of health into Canadian public health practice. Jane Philpott, the Minister of Health for the Federal Canadian government also gave an inspiring speech at the summit about the importance of the social determinants of health and her journey from being a family doctor to a leading politician.
    
    Montréal experienced unprecedented rain and flooding while I was there
    Montréal is an amazing place to visit, an extremely vibrant multicultural bilingual city with great restaurants and a very welcoming feel to it. It was very exciting to be there in 2017 as Canada celebrates 150 years and Montréal celebrates its 375th year. However, weather wise Montréal experienced unprecedented rain and flooding while I was there with many homes and businesses evacuated and the army required to provide emergency support.












    Montréal is also an interesting place from a public health perspective, it’s a city with a lot of green spaces and a variety of parks and recreation areas. It’s a very safe place to be, and very walkable - unlike other areas of North America. Public transport costs are low with a flat rate on the Metro and the buses of around $3. They also have a shared bicycle scheme called Bixi - which is free for a cycle ride of up to 30 minutes.

    However, Montréal and Canada are of course not without their own public health problems. There was very visible homelessness. The Montréal health gap is 11 years between the most and least affluent neighbourhoods and most significantly, the Inuit and indigenous populations have average life expectancies of only 70 years - 10 years less than the average Canadian. Inuit health is understandably a key focus for health equity researchers in Montréal - including former Fuse associate Mylene Riva. She is now researching the effects of housing conditions and food security on the health of Inuit people in Arctic Quebec.

    So a very useful visit for me and I was able to make good future connections for the Fuse Health Inequalities research theme.


    Photo attribution:

    Beyond ownership: a lifetime of housing and health (Fri, 19 May 2017 05:00:00 +0000)

    Posted by Natalie Forster (Fuse Senior Research Assistant) and Philip Hodgson (Senior Research Assistant), Northumbria University

    Last month saw the second ‘Home and Health’ research interest group meeting hosted by Northumbria University and Fuse (supported through the Fuse pump-priming fund). Building on the key message that a greater emphasis is needed on understanding the relationship between housing and health – particularly in the absence of strong public health messages on the subject (such as 5-a-day) – the focus here was on good examples of practice.

    It's a race to own a “forever home” but circumstances change with age
    Participating in these sessions is continually challenging us to rethink the values that we attach to the idea of ‘home’ in society, and the implications this has for supporting people through housing choices and transitions. The narrative surrounding housing is often singular and fixed – the race to find and own a “forever home”, relocate to a bungalow in retirement and then manage the difficulties of ageing-in-place as ill health and social isolation increase in later life. Yet the reality painted by the examples here posed a more complex problem: how do we identify and sustain a model of housing that allows our homes to reflect and adapt to the wide range of transitions experienced by individuals? The services presented - Safe and Healthy Homes (North Tyneside Council); Housing for older people (Derwentside Homes); Wellbeing and mental health service for adults (Crisis); and Wellbeing for Life Newcastle’s Age-friendly Cities - all reflected the huge range of resources and circumstances people bring to their homes, and the need to be flexible in supporting them. Yet questions remain around how public health approaches can best prepare people to make decisions about the housing which will best support their health in later life, before a crisis occurs. One idea from the meeting was to assess future housing needs alongside the NHS health check.

    The second ‘Home and Health’ research interest group meeting
    Just as the much-publicised difficulties for younger people to get on the “property ladder” are prompting a shift to much less-settled housing patterns in that age group, the transitions faced in ageing are varied enough to suggest the need for more person-centred thinking. Just as retirement and later life can threaten some with social isolation and ill health, for others it can be a period of vibrant reconnection with their communities. Once again, a lifecourse approach which encourages people to engage with these transitions before they occur (e.g. groups organised by employers to maintain social contact after retirement) may help give them the agency to maintain a healthy home environment throughout their lives. Innovations are emerging which propose alternatives to traditional living arrangements (for example, housing schemes where university students live alongside older people for free, in exchange for undertaking voluntary work). The first Home and Health session illustrated how the lack of equity held by future generations can be problematic, as this cannot then be leveraged to pay for care later on. However, discussion in the second meeting prompted thought about whether present forms of home ownership (and even home design) might be too inflexible, and whether other more innovative practices could allow people a more fluid approach to tenancy.

    In focusing on preparing people to make informed housing decisions, it is important not to emphasise individual responsibility at the expense of addressing structural inequalities in the choices people have available to them. Those living in poverty are likely to experience an impoverished range of choices. People are often segregated in housing according to their age and socio-economic status and some groups, such as people experiencing homelessness may ‘settle’ for housing that is inadequate for their needs, as they feel they have no alternative. This led to a ‘lightbulb moment’ for further research from group members – the need to map out the different routes people take through housing options over the course of their lives, and the menu of choices available to them depending on their circumstances at different points in time. Perhaps this will allow services to enable people to have a different form of ownership in housing – the ownership of the housing journey through the transition of our lives, rather than simply owning a building.


    Photo attribution: "Home, health and happiness / Bile Bean Manufacturing Co". See page for author [CC BY 4.0], via Wikimedia Commons

    Alcohol use in retirement: A silent epidemic? (Fri, 12 May 2017 05:00:00 +0000)

    Posted by Roxanne Armstrong-Moore, Fuse PhD student, University of Sunderland

    I was on a course recently and someone mentioned that her parents, since retiring were all about the “three Gs – Gardening, Grandchildren and the Grape”. Laughter ensued from other colleagues, then a sadness dawned on me – she explained that the drinking had gone beyond a social drink with friends and was ingrained in their lives, the glass of wine was getting earlier and earlier and functioning was getting less. It made me think, why is this acceptable once someone has left work? Of course, individuals have worked hard all their lives and they deserve some respite – but should this come at a cost of lessened functioning, higher chance of diseases, premature death and breakdowns in the relationships that have been nurtured over a lifetime?

    My PhD aims to develop a strategy for those in, or about to enter retirement, to avoid what seems to be a downward spiral into ill health.

    In what is a relatively scarce area of literature, myself and my supervisory team have begun this task by conducting a systematic review of current literature. This is to investigate what we currently know about current interventions and how they can help older individuals to reduce negative effects of alcohol. Six papers were included, all of which were in the United States. Individuals in this age group appear to respond well to interventions, with all interventions showing improvements (a reduction in drinking or, in one case study, improvements in quality of life) in at least one area of alcohol consumption or frequency of consumption. These findings were presented at the European Health Psychology Conference in Aberdeen (2016).

    This scarce amount of literature available on interventions shows that older people are currently being neglected in our field. Healthcare professionals may feel it is not their duty to step in and “ruin the fun” but - with predictions that by 2050, 22% of the world population will be aged 60 and over, and that a significant amount of these older individuals will have a “pattern or level of drinking which places them at harm” (Wadd & Galvani, 2014, p. 656)1 - something needs to be done.

    But what can be done? Don’t they deserve to have a drink? Are we spoiling their fun? Would they even want an intervention and how would this work? This is where the hard work begins…

    Older people are more susceptible to the detrimental effects of alcohol, as tolerance to alcohol lowers with age. Drinking more than five standard drinks per week has been found to quadruple the risk of developing psychiatric problems including depression and memory loss (Stevenson, 2005)2. Cognitive impairment as a result of alcohol use can lead to an increased likelihood of falls, and because older people often have weaker bones, this can lead to hip fractures - one of the highest causes of death in the older population (Mukamal et al., 2004; Merrick et al., 2008)3.4.

    While much research has focused on students and younger adults, little has explored the drinking of older individuals. The evidence in this field is growing, however it is still not adequate to inform an intervention in the area.

    So, why retirement? Evidence suggests that those who have recently entered retirement are statistically and significantly more likely to drink almost every day compared to those who are still in work, or those who have been retired for a longer time. At the moment, there is limited support and guidance offered by employers, government and the third sector to those who are retiring in the future. The “Easing the Transition” report from the Drink Wise - Age Well project (Holley-Moore & Beach, 2016)5 suggests that for some individuals, this can be a negative time marred with a loss of purpose, periods of ill health or financial difficulties.

    So this is where my PhD comes in, at the moment very little qualitative data exists in this area. We are hoping to interview individuals – not only those who have retired recently and those who are due to retire, but also their employers. This data will then be analysed to establish core themes using a framework approach and fitted to an intervention map to really find a tool that could be used to help people going through this (at times) difficult transition.

    From data collection, we will use the findings to begin to develop an intervention that can be implemented in the workplace, or after leaving work. This will be the first protocol of its type that uses the information gathered from those who are going through this transition and will hopefully ease the transition between working and retirement and reduce the growing burden on public health.


    References:
    1. Wadd, S., & Galvani, S. (2014). Working with Older People with Alcohol Problems: Insight from Specialist Substance Misuse Professionals and their Service Users. Social Work Education, 33(5), 656–669. http://doi.org/10.1080/02615479.2014.919076
    2. Stevenson, J. S. (2005). Alcohol use, misuse, abuse, and dependence in later adulthood. Annual Review of Nursing Research, 23, 245–80. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16350768
    3. Mukamal, K. J., Cushman, M., Mittleman, M. A., Tracy, R. P., & Siscovick, D. S. (2004). Alcohol consumption and inflammatory markers in older adults: the Cardiovascular Health Study. Atherosclerosis, 173(1), 79–87. http://doi.org/10.1016/j.atherosclerosis.2003.10.011
    4. Merrick, E. L., Horgan, C. M., Hodgkin, D., Garnick, D. W., Houghton, S. F., Panas, L., … Blow, F. C. (2008). Unhealthy Drinking Patterns in Older Adults: Prevalence and Associated Characteristics. Journal of the American Geriatrics Society, 56(2), 214–223. http://doi.org/10.1111/j.1532-5415.2007.01539.x
    5. Holley-Moore, G., & Beach, B. (n.d.). Drink Wise, Age Well: Alcohol Use and the Over 50s in the UK. Retrieved from www.drinkwiseagewell.org.uk

    Photo attribution:

      Systems map
      ‘systems map’ of the potential health-related impacts of the UK Soft Drinks Industry Levy