Fuse blog

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:

      Star Trekkin' across the (research and quality improvement) universe (Fri, 05 May 2017 05:00:00 +0000)


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

      Does improving the quality of care from health organisations need research? This was the question asked at the Annual Network Event of the Clinical Research Network for the North East and Cumbria. The network has been successful over the last four years in bringing together a wide range of clinical staff across the region and promoting and supporting high quality health research, which was celebrated at the event, but the organisers didn’t shy away from asking some tough questions.

      Q (John de Lancie) pictured behind Captain Jean-Luc Picard (Patrick Stewart)
      While the network has put a strong focus on numbers, particularly related to regional recruitment targets for patients in trials, its clinical Director, Professor Stephen Robson, acknowledged that this was only part of the story and that it also ignored what happened later in the research process. For instance, how do we ensure that the research findings get adopted by practice organisations? Brilliant studies are useless if they don’t result in changing clinical practice. But how to change this practice?

      The event therefore put a renewed focus on quality improvement. How can we help health professionals to improve their practice? One of the network’s partners, the Academic Health Science Network for the North East and Cumbria (AHSN NENC), joined forces last year with NHS Improvement and the Health Foundation to play a leading role in the national roll out of the Q community.

      Unfortunately for us ‘Trekkies’, this is not a new Star Trek episode about the famous Q tormenting various Starfleet Captains; instead, the Q community is a force for good that connects health professionals across the UK to improve health and care quality. The community supports members in their existing improvement work and tries to enhance their skills, helps members to share ideas and enable them to make changes in their organisations that benefit patients.

      For this episode, Q came out of the 2013 Berwick report, which followed the publication of the Francis Report into the breakdown of care at the infamous Mid Staffordshire Hospital. The report urged health organisations to make better use of members of staff with improvement expertise and made a case for a system devoted to continual learning and improvement. In response, NHS Improvement (with support from the Health Foundation) developed the Q community in 2015, which now has 236 members in the North East (5000+ nationally) and is expected to grow considerably over the next few years.

      I unashamedly applied to become a member of this network last year and they were crazy enough to accept me, so I was looking forward to the Q workshop at the annual event, led by Suzy Cook. The workshop looked at the link between research and quality improvement but, to my surprise, focused on the differences and argued that they should be viewed as separate activities with distinct aims, following different processes and timescales. Research was described as a linear and long-term process that is mostly concerned with the effectiveness of existing and new services, while quality improvement was pictured as a more cyclic and shorter term process with linked PDSA cycles (Plan-Do-Study-Act) that focus on the sustainability of services.

      This distinction does not do justice to both activities and feels like a rather odd separation: why can’t research inform what practice needs to improve and how? And what about evaluating quality improvement; isn’t research a key component of the PDSA cycle? Luckily, participants in the workshop raised the same objections and an alternative view was provided in the next workshop by Seamus O’Neill, Chief Executive of AHSN NENC.

      He argued instead that there was a clear link between research and quality improvement by looking at the adoption of research in the NHS. Quality improvement needs evidence to select the right intervention in the right context. Just sinking money into an innovation because we think it is going to make a difference will not impress funding and commissioning bodies. At the same time, he warned that many quality improving and cost-saving interventions are not used by health care organisations. They are either not aware of them (clinicians do not read journal articles) or they do not know how to adopt them (how can we make it work here?). According to Seamus, this is where quality improvement can come in: using dedicated health professionals, such as the Q community, and their skills to study, plan, do and act on the research evidence.

      Researchers and quality improvement professionals need each other, not to put more clear blue water between them, but to make both activities more useful and effective. Even Q in Star Trek perhaps saw the wisdom of this when he remarked: “I look at the universe in an entirely different way now. I mean, I can't go around causing temporal anomalies or subspace inversions without considering the impact it'll have”. (Star Trek: Voyager: The Q and the Grey #3.11, 1996).


      North East and North Cumbria - Annual Network Event: Research Matters was held on 26 April at the Stadium of Light in Sunderland.



      Photo attribution: “John de Lancie, Denise Crosby (at back), Patrick Stewart, Star Trek TNG, "Encounter at Farpoint," 1987” by Classic Film © 2015: https://www.flickr.com/photos/29069717@N02/20607700773

      From the office to Eastern Africa: how digital technologies can be used to assess diet (Fri, 28 Apr 2017 05:00:00 +0000)

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

      Life in academia can be tough at times. It can be difficult to switch off, the list of tasks can seem never ending and just when you think things are going to quieten down along comes that call for proposals that you simply can’t miss.

      I’ve worked at Newcastle University for almost 20 years now and throughout that time my research has focused on improving how we measure dietary intake. In the early years this involved going into school and talking to children and parents, which was always good fun. More recently we’ve been working with adults developing online systems for measuring intake along with colleagues at Open Lab. The work is really interesting and I’m enormously proud of the system we have produced but life is predominantly office based now.

      Earlier this year though, my enthusiasm for work was suddenly re-ignited with a slight change in focus for my research. For 12 days in February I left behind my 6 year old son (bad mummy!) and my husband and headed off to do some research looking at how digital technologies could be used to assess dietary intake in Africa. Along with my colleague - research associate Maisie Rowland - I headed to Tanzania to learn about the food environment there, looking at the range of foods available, and the way things are cooked, served and eaten. We also looked at the uptake of technology such as use of smartphones and internet access. We started our visit in Moshi near Kilimanjaro (every time I say Kilimanjaro I still break into a smile). The weather there was lovely and warm and the people were too. We’d been put in touch with a school teacher, Amina who showed us around two primary schools and one secondary school in the area. Seeing the cooking facilities at the schools was really eye opening. The schools all cooked over wood fires.


      I was amazed at the secondary school kitchen; this was what I had expected to find in the homes in poorer rural communities but not in a large (700+ pupils) secondary school. Yet the staff managed to cook enough food to feed all of the students and had taken the time to provide information for us on the common local foods.

      Every day for school lunch the children got maize and beans, one of the schools added oil to the mixture to make sure the children got some fat in their diet. Children brought a bowl, plate or other container (some had margarine tubs) and most ate with their hands. The children ate their food outside. Amina invited us over for dinner one evening. “I thought I’d cook you banana stew and elephant leg” she said, monitoring our faces for a reaction. Politely we said “that sounds lovely” but we clearly looked a bit worried before Amina roared with laughter and told us that elephant leg was a vegetable….it just got its name because it apparently looks a bit like one!

      Before we left Moshi we got to tour the local food markets, where people buy the majority of their food. There was very little in the way of pre-packaged foods consumed.

      Our next stop was Dar es Salaam where we worked with the Tanzanian Food and Nutrition Centre (TFNC). We conducted two workshops, one with nutritionists, dietitians, food technologists and public health workers at the TFNC, which Maisie and I ran in English, and one with a rural community group which the TFNC researchers ran in Swahili. Through the workshops we gathered lots of information about the foods consumed and how these differed between regions, the time of year, celebrations and droughts, and how people would share recipes and consume foods. We learned that African power cuts can last a whole day - the workshop at the TFNC was done in 35 degree heat with the power (and therefore air conditioning) off! We discovered that the foods we were served for breakfast at the hotel were usually only reserved for celebrations for the local population.

      We took our research very seriously and ate at a wide variety of restaurants, cafes and street food stalls. The food over there was really tasty. For breakfast every day we had an amazing beef stew that we got the recipe for. I’ve tried to re-create it but mine isn’t quite up to scratch, I think it’s probably to do with the way that they rear the cows rather than my cooking skills....

      We plan to work with the staff at TFNC to put in a proposal to the Global Challenges Research Fund with the aim to develop a technology based method of assessing dietary intake that will enable them to run what would be the first National dietary survey for Tanzania.

      ….Now back to the office for some proposal writing to get us back out there. Next time I might even take the family with me!

      Sleepless in the slammer (Fri, 21 Apr 2017 05:00:00 +0000)

      Charlotte Randall, Higher Assistant Psychologist and MSc student, Northumbria University

      The current prison population is 85,641 and around 50% of this population suffers from symptoms of insomnia. While this is similar to the general population there are a limited amount of resources to help treat this disorder in prisons.

      Having worked in prisons for seven years, I am all too familiar with the problems that a lack of sleep can have on an offender's ability to engage with the prison regime, and the impact this has on their mental health. Due to the high prevalence of mental health problems, substance misuse and personality disorders in the prison population, the issue of sleep is often side-stepped and the importance of obtaining and having a healthy sleep practice can be forgotten about.

      I am part of the Mental Health In-reach team in a prison in the North East, and have witnessed first-hand the effect poor sleep can have on an offender’s mental health. As this is an under-researched area, I decided it would be interesting and beneficial to conduct research on insomnia in the custodial setting. The aim of the study was to see whether a 60-70 minute session of Cognitive-Behavioural-Therapy for Insomnia (CBT-I) with an accompanying self-help pamphlet was an effective treatment in reducing the symptoms of insomnia in male prisoners.

      As I work in the prison Mental Health Team full time, I thought this would be a simple project to undertake, however there were several hurdles along the way. Firstly I was required to gain ethical approval from several different organisations; NHS; National Offender Management (NOMS); and the University. Offenders are classed as a vulnerable population for research purposes, and therefore there is heightened scrutiny from ethic boards as a result of this. This process was lengthy; I had to complete three separate documents explaining the project’s benefits for each organisation. Once submitted, I was required to attend a full Research Ethics Committee (REC) where the research protocol and IRAS (Integrated Research Application System) form were discussed and additional questions were asked. It was then a waiting game to see whether the study had been granted ethical approval. As with any research project there was a deadline of September 2016, in which my dissertation needed to be submitted. Ethical approval was granted in June 2016, after recommendations had been made by the NHS and NOMS ethic boards and an amendment report was submitted.

      On the other hand, recruitment for the study was relatively easy, which surprised me! Although it also identified the need for insomnia interventions in the custodial setting and confirmed that this research was important. The offenders were keen to engage, due to the lack of pharmacological (drug related) and psychological interventions for insomnia they were eager to find something that helped them sleep.

      Results from this research were positive and highlighted that there was a significant reduction in insomnia related symptoms after completing the 60-70 minute session of CBT-I, with the accompanying self-help pamphlet with category C adult male prisoners. This research is the first of its kind to assess whether an adapted versions of CBT-I is effective in the prison population, where there are limited interventions and resources to help aid sleep disturbances. Although the results were positive, they have to be taken with caution as the prison where this research was undertaken has a unique regime and all prisoners are in single-cells which allowed them to complete certain aspects of CBT-I e.g. sleep restriction.

      My experience of completing this research was positive; I enjoyed the prospect of analysing an undiscovered area and hopefully informing academia and practice within a public health setting. I did however find it hard in the early stages of this project, specifically going through the ethics process and length of time this took. A written report has been disseminated to NOMS highlighting the findings of this research. It also identifies how this research could be taken forward and inform future research opportunities. The single session of CBT-I is being delivered in the prison where the research was completed, more data is being gathered and will hopefully be published in 2017.


      Photo attribution:
      1. “sans horizon” by poirpom via Flickr.com, copyright © 2015: https://www.flickr.com/photos/poirpom/16479845789/
      2. “prison” by erin via Flickr.com, copyright © 2007: https://www.flickr.com/photos/insunlight/1037277952
      3. “Insomnia” by Ben Harrison via Flickr.com, copyright © 2011: https://www.flickr.com/photos/48755144@N02/5564362009

      Life inside foodbank Britain (Fri, 14 Apr 2017 05:00:00 +0000)

      Post by Kayleigh Garthwaite, Research Associate at Newcastle University and Fuse Associate Member

      For the last three years, I’ve been a volunteer and a researcher at a Trussell Trust foodbank in central Stockton, North East England, finding out how a foodbank works, who uses them, and why. My new book ‘Hunger Pains: life inside foodbank Britain’ tells the stories of the people I met inside the foodbank over an 18 month period. The experiences throughout the book offer a serious challenge to persistent myths that foodbank users are simply seeking emergency food as a result of flawed lifestyle choices.

      Every week, I prepared the three days’ worth of food that goes into each food parcel. I dealt with the administration of the red vouchers required to receive food, making sure that anyone who needed further support was signposted to where it could be obtained. I weighed kilograms of food in and out. I volunteered at the collections at Tesco supermarkets, asking people to add an extra tin to their weekly shop. Most importantly, I sat and listened to the stories of the hundreds of people who came through the foodbank doors for emergency food.

      The idea that more people are using foodbanks because there are more foodbanks is a popular one. But, in reality, people are using foodbanks as a last resort, when the benefit delays, sanctions, debt and low pay have finally caught up with them. My research, as well as that of other academics, charities and frontline professionals showed that a major reason for people using foodbanks was the impact of welfare reform. It was common for people to have experienced significant problems with benefit delays and sanctions, which led to lengthy periods without income for themselves and their families. Other reasons that brought people through the foodbank doors were ill health, bereavement, relationship breakdown, substantial caring responsibilities, precarious jobs, and redundancy.

      Although research has repeatedly emphasised the link between foodbank use and welfare reform over the past five years, the Government denies that a connection between the two exists. Instead, it chooses to dismiss foodbank use as a lifestyle choice of those who are unable to budget properly or who would rather spend their money on cigarettes, flat screen televisions, alcohol, and iPhones. Perhaps unsurprisingly, I found that this political rhetoric had a strong influence on beliefs about foodbank use and deservingness, and could lead to stigma, shame, and embarrassment for the people who needed to use them. As a result, people would postpone asking for foodbank support until they were truly desperate.

      The big challenge is ensuring that ‘emergency’ food support continues to be seen by the public as a consequence of food poverty and inequality, rather than a permanent solution. We need to listen to the stories and the voices of people foodbanks so that we can understand who uses them, why, and what it feels like. Perhaps these messages are reaching a wider audience now with Ken Loach’s latest award winning film I, Daniel Blake, which has been called ‘a rallying cry for social justice’ with its depiction of the inefficient and often cruel bureaucracy of the benefits system. It is hard to not feel empathy when watching lead character Katie in the haunting foodbank scene, or in witnessing Daniel’s day-to-day struggles in applying for job after job, despite being unfit for work.

      But it is hugely important to make sure that the messages in the film, as well as the messages of the book, are heard not just by people who are sympathetic to what the research is saying, but also by people who don’t quite believe that the benefits system is really that bad, or who are adamant that poverty is a lifestyle choice.

      Kayleigh’s book ‘Hunger Pains: life inside foodbank Britain’ was placed second in the British Sociological Association / BBC Radio 4 Thinking Allowed Award for Ethnography 2017.

      Passionate Advocacy versus Dry Evidence (Sat, 08 Apr 2017 05:00:00 +0000)

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

      Should public health researchers be passionate advocates of their work when engaging with policy makers or should they present their findings in the most neutral way possible, sticking to the facts only (and preferably economic figures) to encourage take up of their research? This question was the focus of a heated debate at the recent national School for Public Health Research Annual Scientific Meeting, bringing together researchers from eight different centres of excellence across the UK and a selection of senior health practitioners at the Royal Society in London.

      Chris Whitty: academics should present their findings neutrally
      to politicians without making any advocacy statements
      The tone for the debate was set by Professor Chris Whitty, Chief Scientific Adviser for the Department of Health, who challenged the audience to be more ambitious in their public health goals. At the same time, he warned academics to play to their strengths: if they wanted to ensure impact of their work, academics should present their findings neutrally to politicians without making any advocacy statements, as this would deter politicians. Advocacy should be reserved for politicians, who in turn are supported by economic advisors. Therefore, academics would do well to present their data in terms of opportunity costs and trade-offs; without solid economic back-up, any evidence claim would be quickly dismissed by politicians, according to Whitty.

      This provoked strong reactions from audience members and particularly on Twitter, where a lively discussion ensued throughout the rest of the day. People questioned whether it is possible or even desirable to leave advocacy at the door when dealing with politicians. Some argued that, from a social science perspective, there is no such thing as neutral evidence and that it is our duty as public health scientists to take a stand and advocate against increasing health inequalities. Others disputed the need from politicians for dry evidence, stating that purely evidence based approaches can leave politicians cold without a persuasive narrative. Instead, emotionally informed and narrative research was important to persuade local government. Researchers needed to align themselves with local government concerns and cultures and acknowledge the importance of context to have any impact.

      Duncan Selbie: academics should be more ruthless, coordinated and angry
      in the interactions with policy makers to get them to act on the evidence
      Duncan Selbie, Chief Executive at Public Health England, poured oil on the fire in the afternoon by appealing for the exact opposite to Chris Whitty’s call for more neutrality: academics should be more ruthless, coordinated and angry in the interactions with policy makers to get them to act on the evidence that academics have generated. He encouraged public health researchers to make more use of behavioural science to help policy makers take notice and implement their findings. This provoked several reactions, with some participants highlighting the role that advocacy played in the public health fight against the tobacco industry, while others made passionate pleas on soapboxes for the re-politicising of public health science, arguing that it was unhelpful to divide science and politics into two separate worlds.

      The storm seemed to settle towards the end of the day, when Twitter users and audience members started suggesting solutions for the debate, which was dubbed “Passionate Advocacy vs. Dry Evidence”. One suggestion was that public health researchers should develop a ‘horses for courses’ approach: at certain times some people needed to be passionate advocates, while others at different times needed be neutral scientists to get the listening ear of politicians. The different approaches were related to different levels at which politicians operate: local politicians were more persuaded by narratives emerging from research and advocacy, while national politicians valued neutrally presented evidence and data.

      Others suggested the use of intermediates to make the advocacy case for public health, such as voluntary community organisations that represent the will of the people, and by focusing research on the key questions that front line workers are struggling with. Or even better, persuade policy makers to become advocates of research evidence!

      Overall, participants agreed that science needed to be pushed more up the policy agenda, as research is currently losing out to politics and economics. Therefore, in some circumstance researchers need to consider accept that submitting good enough evidence quickly is better than waiting too long for perfect peer reviewed publications. Furthermore, we need to be aware that different kinds of evidence are used in decision making processes.

      My favourite solution was proposed by Professor John Frank, Director of the Scottish Collaboration for Public Health Research & Policy: if you want good policy influencers, you need to change the academic model to produce them. The biggest barriers to knowledge mobilisation are structural and often in academia. As long as we don’t train public health students in engaging with policy and practice partners, fail to teach and reward them in how to use different types of evidence and do not involve them in collaborative research, we will keep returning to this debate for many Annual Scientific Meetings to come.

      Do public health practitioners make good fire fighters? (Fri, 31 Mar 2017 05:00:00 +0000)

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

      Given ongoing budget cuts and diminishing local capacity, one might be forgiven for thinking that soon public health practitioners will only be responding to emergencies, such as disease outbreaks and substance abuse epidemics. Fighting these public health fires would leave little time and resources for prevention and working with other public organisations. An event co-organised by Fuse, Durham County Council and Darlington Fire & Rescue Service recently proved quite the opposite: fire fighters and other public organisations are very capable of ‘doing’ public health.

      Can public health researchers learn a trick or two from fire fighters?
      The increasing focus of the Fire and Rescue Services on prevention over the last 10 years has seen the development of innovative approaches that support public health: from helping people with dementia, to tackling child obesity and getting people active (for some excellent examples, see the Local Government Association (LGA) report Beyond fighting fires).

      In Durham, the Fire and Rescue Service implemented so-called Health and Wellbeing Visits. As part of home visits to check fire safety, fire fighters ask residents questions about their health and wellbeing (e.g. about falls, smoking and alcohol use, heating and loneliness and isolation) and provide them with advice or signpost residents to relevant services to address any health concerns.

      Over the past year (Feb 2016 – Jan 2017), no less than 15,732 Health and Wellbeing Visits have taken place with over 1,800 referrals to various services in Durham and Darlington, accessing vulnerable residents that are often not on public health’s radar. Because of their trusted reputation, the Fire and Rescue Service can get behind the front doors of these people and help them access health services. Perhaps not surprisingly most referrals relate to loneliness and isolation, with an ageing population keen to live at home independently but with a social care system lacking resources to support these people in and outside their homes.

      Even the police is getting in on the act of public health prevention with partnerships being established between health and the police across the UK to support, among others, suicide prevention and reduce alcohol-related harm, as was recently illustrated in a Public Health England paper.

      In turn, public health practitioners are taking on new activities that were previously deemed outside of their scope. For instance, the Durham County Council’s public health team is actively supporting energy efficiency improvement schemes (such as Warm and Healthy Homes), in recognition of the link between excess winter death and cold houses. Poor quality housing, low incomes and high energy costs result in residents having to choose between food or fuel. To prevent residents from having to make that choice, council officers are providing tenants at high risk (e.g. people with cardiovascular and respiratory conditions) with new central heating, boiler repairs, home insulation and energy saving advice.

      This blurring of boundaries between public professionals is not new, but public health moving back into local authorities has created opportunities for linking prevention activities across a wider range or organisations. The event provided many other examples of this, e.g. GPs prescribing boilers to patients with long-term conditions and Citizens Advice providing welfare rights advice to elderly residents.

      This new boundary blurring builds on existing policy initiatives, such as Making Every Contact Count and Health in All Policies, which all involve the wider public health system. Participants at the event made it clear though that this is not a simple cost-saving exercise, allowing councils to pass the public health buck to other parts of the system. Instead, these new partnerships are characterised by a genuine exchange of knowledge and practices between public organisations at the front-line. It highlights a new way of working that recognised joint priorities and the values of other professions to achieve these priorities through the sharing of resources and by taking on new roles. As Professor David Hunter outlined in his presentation at the start of the event, these new partnerships require a different form of leadership, which is less hierarchical and formal, not so much concerned with Key Performance Indicators and commissioner-provider splits, but more focused on the value of relationship building, trust and 'soft' skills.

      The event provided a platform for looking at these new partnerships and the evidence for their effectiveness. If anything, it highlighted a challenge for public health academics to research these new partnerships: how to make sense of the contribution of each partner in a system where boundaries are rapidly blurring? Maybe public health researchers can learn a trick or two from fire fighters.

      Find out more about the event: Creating Healthy Places in the North East: the Role of Fire and Rescue Services and Fuel Poverty Partnerships

      Photo attribution: "Rochdale Fire Station Opening Day" by Manchester Fire via Flickr.com, copyright © 2014: https://www.flickr.com/photos/manchesterfire/13288225965/

      Beyond bricks and mortar: re-thinking home and health (Fri, 24 Mar 2017 06:00:00 +0000)

      Dr Philip Hodgson, Senior Research Assistant, Northumbria University

      In a time of continued public spending cuts, policy drivers to age in place (to grow old in the home or in a non-institutional setting in the community) and an increasing ageing population, the challenge to ensure that people can live longer and healthier in their own homes is growing. Yet, solutions for this, when a host of other factors – the development of housing to meet commercial rather than health pressures, future generations with little equity in housing that can be used to fund future care, the prevalence of a belief in a “forever home” – are difficult to identify.

      That was one of the core messages discussed at the first ‘Home and Health’ research group hosted by Northumbria University and Fuse (via the pump-priming research fund) last month. This brings together researchers, practitioners and policy makers interested in the impact of housing on health. The seminars aim to foster a core working group, culminating in the development of concrete plans for collaborating on further research in this area. Building on insights from previous Fuse Quarterly Research Meetings (‘Creating Healthy Places in the North East’ in October 2015 and ‘Reuniting Planning and Health’ in April 2016), the seminars aim to take stock of existing evidence on how housing conditions can promote or impede healthy ageing, and identify gaps for further research. Our first seminar explored priorities for research from a policy perspective and we were thrilled to welcome Gill Leng (National Home and Health Advisor to Public Health England) to present.

      Gill Leng, Public Health England, presenting at the Fuse research meeting
      Gill highlighted the need to think about ‘homes’ (a term which people identify with and encompasses emotional connections to a place of living) rather than just ‘housing’ (a term used when referring to the workforce and describing bricks and mortar). While evidence and action often focuses on the risks posed by unhealthy homes, little is done to address unsuitable or precarious housing. Although most older people own their homes, these are not necessarily healthy. The challenge we face is to identify an approach to housing which allows its support to develop and mirror our own changing health needs through the life course. This is not just a case of using adaptations and facilities, but reframing how we conceptualise the home as a physical location, a part of a wider social environment and a personal / psychological space.

      The conceptual spaces of home illustration used in the seminars 
      Group discussions focused on this issue (among others). At the personal level, a tension was found between the maintenance of private life and the role of external sources of support. Current policy relies on care delivered by family members, but this can in turn cause problems for individuals without these links. Also, how do we develop mechanisms that initiate people’s thoughts on the best accommodation for them before they reach a point when they’re in crisis / a change is urgently needed and driven by necessity rather than choice (e.g. when people with dementia still have capacity to make an informed choice)? At the level of buildings and services, these problems take on a more concrete form, where the permanence, inconvenience and cost of a housing adaptation to support health is seen more as an obstacle to avoid rather than an enabler in the future. Meanwhile, within social and environmental factors, the current focus of housing policy on volume, rather than quality of public space, and a decrease in social cohesion were both noted as linked factors that could influence health as the population ages. The depth of discussion at each of these levels highlighted the importance of issues of home and health. But to address it we need to move beyond the ideas of bricks and mortar, and consider how we think about and use our homes to facilitate our health and wellbeing as individuals and a wider society.


      Our first seminar explored priorities for research from a policy perspective
      All of these issues will be picked up in future sessions, which will focus on good practice, existing research in the field and funding opportunities. We’ll be continuing to blog about each of these events and their outcomes, so please check back for more information soon.

      If you are interested in joining the group and attending future seminars, please contact Phil Hodgson philip2.hodgson@northumbria.ac.uk

      From left: Peter van der Graaf, Monique Lhussier, Natalie Forster, Phil Hodgson
      and Dominic Aitken; organising team for the home and health research interest group

      Food as a job, life and research: the many meanings of what we eat (Fri, 17 Mar 2017 05:59:00 +0000)

      Posted by Amelia Lake, dietitian and public health nutritionist & Fuse Lecturer in Knowledge Exchange in Public Health, Durham University


      Food is my job. As an academic dietitian and public health nutritionist I spend my time questioning why people eat what they eat, and thinking about what we can do to change behaviours. As a mum, I also spend a lot of time at home wondering why a 4-year-old and a 17-month-old eat what they eat!

      Its nutrition and hydration week, which aims to highlight, promote and celebrate improvements in the provision of nutrition and hydration locally, nationally and globally. So this is an excellent opportunity to explore the many roles of food in public health.
      Top shelf material

      Food is life. We need nutrition and hydration for life and to maintain health.

      Food is a thread that moves through every aspect of our life from the everyday to the special occasion.

      I read somewhere that the origin of culture was when raw ingredients were cooked. The importance of this event was not so much in how food was prepared but in the organisation of individuals around meals and meal times.

      Food has shifted populations and started wars; think of the thirst for sugar, tea and coffee (also known as the ‘hot drinks revolution of the eighteenth century’) and the impact that had on various countries and their populations.

      Food is our culture and identity; it is an intrinsic description of who we are and where we come from. For example, I am a complex mixture of Persian dishes, Indonesian dishes and some Northern Irish wheaten bread and Tayto crisps.

      Food is our comfort. That dish your mother made, it’s a warm familiar blanket; it evokes memories, both good and bad. It is a way in which we show others that we care for them and are thinking of them.

      The party bag horde - a focal point for arguments
      Food is a focal point for arguments: “No you can’t have any more sweets from the party bag…” A conversation every parent has at one point or another.

      Our social media feeds provide us with ‘food porn’, hands that whizz up magical results in seconds. Additionally, social media and the press provide us with self-styled food and nutrition 'experts' presenting us with spiralised courgette and clean eating advice.

      Food continues to dominate our life and the public health agenda on a global scale.

      The World Health Organization’s global targets for 2025 to improve maternal, infant and young child nutrition tackle a range of issues from obesity to stunting and wasting.

      In this country we are familiar with the concept of our obesogenic environment; an environment in which calories are easily accessible and available and with little opportunity to expend that energy. In an attempt to tackle the obesity problem in this country our government will follow Mexico and introduce a sugar levy.

      Despite the issues of over-nutrition and the seemingly endless opportunity to buy food, food poverty is a term we have become more familiar with. Despite it sounding like it belongs to another era, it’s a very real issue for a significant proportion of our population. Oxfam estimates that 500,000 people in the UK are now reliant on food parcels. Foodbanks provide nutrition to those who struggle to feed themselves and their families and have sadly experienced rapid growth in recent years, especially in the UK.

      How can research help to address these global and local problems?

      Free fruit with every purchase
      Within Fuse ‘food’ runs through a number of research themes, from behaviour change to healthy ageing. As part of the national School for Public Health Research, a team of Fuse researchers has evaluated a food training programme run by Redcar and Cleveland Council. To promote the findings from this research we decided to create a short film and this week were filming in a small sandwich shop in the market town of Guisborough, where you were offered a free piece of fruit with every purchase. This small business owner’s focus is food. She provides food to customers every lunch time. This owner had attended the training course run by the Council and decided to make a difference by providing more healthy food.

      This is an important step, supported by research. On this nutrition and hydration week, I am sure you will agree that there is still much to be done on this important and vast topic across many disciplines and on a global scale.

      How I overcame my scholionophobia... a clinical pharmacist in an academic world (Fri, 10 Mar 2017 05:59:00 +0000)

      By Rachel Berry, Specialist Antibiotic Pharmacist, County Durham and Darlington NHS Foundation Trust, and Health Education England (HEE) and National Institute for Health Research (NIHR) Intern 2016/17

      “Scholionophobia* – A fear of school, college or university”

      So, I want you to picture the day ….. It was a sunny September morning and there I was, a clinical pharmacist currently working in hospital, standing by the River Tees at Queen’s Campus Stockton about to enter Durham University. And I was terrified. Honestly, the last time I was this scared walking into a university building was in 2004 and I was about to sit my Registration Assessment to become a qualified pharmacist. I was obviously suffering from scholionophobia.


      Courtesy of mothmediatech & the creators of The adventures of Worrisome Wilf books

      “But why were you so scared?” I hear you ask. Well, the answer is that I was just about to start my Health Education England (HEE) and National Institute for Health Research (NIHR) Integrated Clinical Academic Internship programme.

      The HEE/NIHR funded internship is a programme to enable Healthcare Professionals working in clinical practice to gain research experience and skills by working alongside a university academic. I had ahead of me, 30 days away from my clinical commitments that I could use to gain an introduction into clinical academic research.

      My fear was based on the fact that I didn't know anything about research or universities. Not one bit. And I definitely wouldn't be able to do it myself. In my mind, research was only done by brilliantly clever people who know everything. I was only a lowly hospital pharmacist. I was pretty sure that I would be the most stupid person there!

      Fortunately for me, I was about to meet my amazing academic mentor, and go on an adventure into the unknown world of research. I have gained experience and skills in literature searches and critical appraisal, project design and data collection, statistics, statistical analysis software (SPSS) and writing for publication. I have met so many talented, lovely people who have been interested and willing to help me, even when I probably was the most stupid one there (try explaining Poisson regression and statistics to a person who doesn’t have A-level maths!). It really has opened my eyes to the world of research, and the possibilities for clinical practitioners. My mentor has helped me realise that the skills and experience I have from clinical practice are just as important in clinical research as the skills of doing the research.

      I am now coming to the end of my time. I have completed my project, which will be disseminated to local Clinical Commissioning Groups (CCGs) to enable them to focus on key target areas to improve patient safety within antibiotic prescribing. I am also planning on publishing it, and hopefully this will allow the work to have wider impact. I have been able to take what I have learnt about research and its impact on patients back to my clinical work too. This has meant that I am more reflective and research-aware when doing my job. I have also shared this with the colleagues in my department, and hopefully encouraged them to be more research aware and active, to enable us to provide better care to our patients.

      In the future I would love to do more research in conjunction with the School of Pharmacy as I have realised that blending our skills and experiences, whether they are clinical or research based, can lead to more relevant patient-focussed clinical research being undertaken. I am also trying to get other members of my department to apply for the Internship next year.

      The 30 days spent at Durham University were some of the most challenging, interesting, frustrating and rewarding I have ever spent at work. My scholionophobia has been cured, with no medicines required. If you are a sufferer in clinical practice, I would recommend talking to academics in your clinical speciality and applying for the Internship; there is no need to be scared. And if you are an academic in health research there is a wealth of experience that you could utilise within the clinical teams; they would probably love to be involved, they just might be too scared to ask.


      My thanks go to the team at North West Research and Development who ran the 2016/17 Internship Programme on behalf of HEE/NIHR. Also thanks to my managers at County Durham and Darlington Foundation Trust, and especially to Professor Cate Whittlesea and the School of Medicine, Pharmacy and Health at Durham University.

      *Also known as Didaskaleinophobian or Scolionophobia.


      The challenges (and joys) of evaluating babyClear©: a package of support to help pregnant women to stop smoking (Fri, 03 Mar 2017 06:00:00 +0000)

      Guest post by Sue Jones, Research Associate, Teesside University

      A team of Fuse researchers from Newcastle and Teesside Universities published findings from the babyClear© study a few weeks ago and I thought that I’d put finger to keyboard to share with you the challenges and joys of evaluating the roll out of this innovative intervention.





















      In 2012, I became involved with evaluating babyClear©, a package of support for maternity and stop smoking services, designed to help them to deliver the stop smoking message more effectively to pregnant women. BabyClear© was due to be rolled out regionally across North East England and evaluated throughout, which presented a number of challenges:
      • Challenge 1: different research questions – we wanted to know if this new approach worked and would it help women quit but we knew that this would not be enough; we wanted to understand what influenced those figures, and what healthcare staff need to do to be most effective.
      • Challenge 2: ethical dilemma – ethically we could not deny pregnant women a test like carbon monoxide monitoring that was known to improve outcomes to some degree, so the regional rollout of babyClear© offered a prime opportunity to evaluate the intervention using a natural experiment1.
      • Challenge 3: wide variety of stop smoking delivery models – the extent of austerity measures experienced by the public sector has been far greater than anticipated when the research was envisaged in 2011. At the same time responsibility for delivery of stop smoking services has been moved to local authorities who themselves are under extreme pressure to reduce spending. This has created a wide variety of stop smoking delivery models, all trying to provide a low cost service but with implications for the implementation. For example: babyClear© was designed to be a package that could easily slot into existing services, however it assumed a number of systems were standard when they were not, such as a midwife available at dating scan appointments and a local stop smoking specialist in pregnancy. All those Heinz 57 varieties of stop smoking service delivery models and systems within maternity services, each one different from every other, made it logistically challenging to implement the new pathway, leading to delays of varying lengths in each Trust area.
      • Challenge 4: researching within a changing system – due to ongoing changes largely in the delivery of stop smoking services, but also in maternity, and their impact on the implementation of babyClear©, data collection plans had to be re-thought again ... and again ... and again to reflect what was happening out in the real world! 
      We were greatly helped in approaching some of these challenges by the publication in 2014 of the Medical Research Council (MRC) Guidance on process evaluation of complex interventions. Using this guidance, we were able to start re-shaping our thinking in terms of how the qualitative data could be used synergistically with the numerical data. We set about strengthening the methodology with a retrospective logic model, weaving contextual data into the mix and with an eye on the mechanisms of impact.

      After overcoming these challenges, along came the joys: the findings of our study proved that babyClear© was not only effective but also cost-effective, which was a great achievement in such a short timescale. This new approach, which supported midwives to offer universal carbon monoxide screening and refer pregnant smokers quickly to expert help, nearly doubled quit rates.



      The findings highlighted that we could systematically help women to stop smoking in pregnancy which will result in already well-evidenced outcomes such as:
      • Help mothers have babies who are heavier and healthier than if they continued smoking
      • Help more mothers lead healthier lives
      • Help mothers live longer and see their children grow up
      • Help the children to live and run and grow up surrounded by smoke free air; and 
      • Enable them to not be held back by smoking-related poor health
      So have a read of our paper, this has the nitty-gritty of the statistical outcomes.

      Importantly, soon we hope to be publishing the details about the how, what, when, where, why questions that were the focus of the qualitative process evaluation. Without this it is difficult to know how to implement it elsewhere to best effect and why it works well in one place and not another.

      Celebrate our findings with us; if the maternity and stop smoking services are able to use the babyClear© approach to implement best practice/national guidance it can offer the support that is needed so that more women stop smoking during their pregnancy than did before. So keep your eyes peeled for my next blog – which will focus on the findings from the process evaluation.


      Reference:
      1. “A natural experiment is an empirical study in which individuals (or clusters of individuals) exposed to the experimental and control conditions are determined by nature or by other factors outside the control of the investigators, yet the process governing the exposures arguably resembles random assignment”. (Reference: en.wikipedia.org/wiki/natural_experiment)     More info: Craig P, Cooper C, Gunnell D, Haw S, Lawson K, Macintyre S, Ogilvie D, Petticrew M, Reeves B, Sutton M, Thompson S. Using natural experiments to evaluate population health interventions: new Medical Research Council guidance. J epidemiol commun h. 2012 May 10:jech-2011.
      Related content:

      Two perspectives on arts and public health (Fri, 24 Feb 2017 06:00:00 +0000)

      Andrew Fletcher, PhD researcher, Faculty of Health & Life Sciences, Northumbria University

      Engagement with the arts and/or creative practice benefits wellbeing in multiple ways. I am a musician and relatively new to public health. This post argues that arts and culture should have greater prominence in health and social care.

      Courtesy uk.pinterest.com
      So what of arts-based therapies? Compared to Cognitive Behavioral Therapy (CBT) for example, such programmes are not heavily promoted. Perhaps this is right; CBT is cheap and effective, whereas things like music therapy are often reserved for individuals with more complex needs. But this hierarchy contributes to the idea that arts-based therapies are ‘alternative’ – potentially placing them in the same category as, say, homeopathy. This is not a helpful perception, but anyone who’s tried to advocate for creative therapies will know it exists.

      Then there’s ‘evidence-based medicine’, which is of critical importance, but whose dominance has been challenged.2,3  This is particularly relevant to approaches to health and wellbeing that are seen as ‘alternative’, which still seem to remain the preserve of those who can afford to try more ‘esoteric’ interventions – thereby reinforcing inequality. So what’s the response? Promote holism*; make arts therapies mainstream; emphasise their part in everyday life; make creativity and cultural engagement as vital as exercise, healthy eating or social interaction. The idea that creativity is intrinsic to wellbeing needs to be established in the early years and beyond, and to neglect this idea is missing a trick.

      Courtesy tinybuddha.com
      Why do people do art? Usually to express a political statement, to communicate a specific feeling or sentiment, or to satisfy some intangible ‘urge’. Making a painting to hang on your bedroom wall cultivates a more pleasurable living environment; putting your kid’s collage on the fridge boosts self-esteem; and who never listens to music? Creative practice, in one way or another, feeds into numerous wellbeing outcomes. Artists know this instinctively, yet policy around art and culture focuses on tourism and/or entertainment income, and a vague ‘intrinsic’ social value. Lip service is paid to health, but as Tiffany Jenkins says: “If you’re competing with hospitals, you’ll lose”.4

      But art and wellbeing are significant components of the lived experience. They make us human. They sit at the apex of Maslow’s hierarchy** and most people understand the inherent value of culture to either social or personal wellbeing. If prevention really is better than cure, we must pay attention to the cultural-wellbeing landscape and the atmosphere these concepts exist in. Perceptions are changed through innovative and creative information delivery – so creativity not only has its own wellbeing outcomes, it’s also the key to shifting arts and culture towards being a major pillar in overall wellbeing.

      I can’t help but wonder what the world would be like if the perceptions of arts therapies were different. Stickley (2014)5 outlines one potential scenario as follows:
      The year is 2080. A new textbook has been published. The book is called ‘A Century of Healthcare’ and I would like to quote from this book:

      "For most of the last century it was unusual for people to be treated holistically. Incredible as it sounds today, healthcare systems separated physical interventions from anything they referred to as "mental". Thus a dualism existed and people were treated as divided objects. At the time, there were many attempts at holism, especially by those who practised alternative or complimentary therapies. However, anything that remotely threatened the domination of the medical model was largely side-lined and researchers gave little credence to anything that was not considered scientific.

      We should however give a great deal of credit to those who foresaw the potential contribution that the arts and humanities could make to healthcare and wellness but they operated in a narrow scientific paradigm that gave little acceptance to holism…”
      The contexts in which creative practice occurs are complex, but the benefits are multiple and well-known. The key here is changing perceptions. This takes time, but perhaps Stickley’s vision will bear out. I hope so.


      Footnotes:
      * The idea that the human experience of wellbeing is social, cultural and complex, and extends far beyond medical definitions of health.
      ** 'Self actualisation' appears at the apex of psychologist Abraham Maslow's 'hierarchy of needs' model and includes in its definition (among other things): "expressing one's creativity".

      References:
      1. Various demographic data available from www.theaudienceagency.org
      2. Greenhalgh, T., Howick, J. & Maskrey, N. (2014). Evidence based medicine: a movement in crisis? BMJ g3725.
      3. Stickley, T. (2015). A little rant about evidence, available from: https://ayrshirehealthandarts.wordpress.com/2015/03/31/dr-theo-stickley-a-little-rant-about-evidence/
      4. Jenkins, T. (2015). Front Row debate (23rd Feb, 2015). Are artists owed a living? Online: BBC.
      5. Monologue delivered at ESRC funded Seminar Series on Arts, Health & Wellbeing, 15th September 2014.

      How big food and drink are using sport (Fri, 17 Feb 2017 06:00:00 +0000)

      Guest post by Robin Ireland, Director of Research, Food Active and Healthy Stadia

      You don't have to do much travelling to realise that the unhealthy alliance between sport and the Food and Drink Industry isn't only an issue in the UK.

      I am lucky enough to be visiting New Zealand and Australia at the moment and it's easy to see all the same signs - and very similar marketing campaigns and messaging. Whether it's the All Blacks rugby team being pictured with the product of their "Official Hydration Partner", Gatorade, or the recent Australian Tennis Open full of alcohol advertisements (and I haven't even mentioned cricket), it's clear that the Food and Drink Industry have an international agenda.
      
      Advertising featuring the All Blacks rugby team photographed in New Zealand

      In January, the British Medical Journal published an editorial (Ireland and Ashton 2017)1 that I wrote (with Professor John Ashton CBE) about how Coca-Cola's publicity machine was subverting the Christmas message.

      If anything, it's even more blatant in sport and we have been aware of it for some time from London's "Obesity Games" (Garde and Rigby 2012)2 to Rio's promotion of ultra-processed foods (Loughborough University)3. Even when spectators want healthier food, this choice is rarely made available to them.

      George Monbiot recently referred to "Dark Money" (Monbiot 2017)4 which describes the funding of organisations involved in political advocacy that are not obliged to disclose where the money comes from. In public health terms, we may describe this as Commercial Determinants of Health where industry interests impact on our health. It is often linked to the increasingly sophisticated Corporate Social Responsibility policies being adopted by big corporations.

      The latest of these is of course the deal just announced by the English Premier League and Cadburys criticised by the Obesity Health Alliance in a letter to The Times (Obesity Health Alliance 2017)5. Cadburys no doubt will argue that they are taking an ethical position to help educate people. But can we really take a chocolate company seriously that wishes to advise schoolchildren on nutrition, healthy eating and exercise?

      
      FC Bayern München's branded energy drink
      It is no coincidence that the mantra parroted by food and drink sponsors is that our diets are down to individual choice and that if we simply took more exercise we wouldn't be having the obesity epidemic now prevalent worldwide. This is rubbish. So called energy and sports drinks should have no part to play in the diet of the average member of the public. Kids do not need more sugar (or more protein for that matter) if they are eating a balanced diet with lots of fruit and veg. But of course the food and drink industry do not make their enormous profits in this way.

      It is these concerns - amongst many others - that encouraged myself and colleagues to establish Healthy Stadia in 2005, of which I am a Director. Healthy Stadia takes a holistic and integrated approach to developing sports stadia and clubs as "health promoting settings":
      "Healthy Stadia are those which promote the health of visitors, fans, players, employees and the surrounding community" (from Healthy Stadia website)6.

      Healthy Stadia's Conference which will be held at the Emirates Stadium, London, in April will be discussing food and drink sponsorship in professional sport among other issues. I anticipate that these topics will come under increasing public scrutiny in years to come, as we develop more awareness of the impact that marketing has on our food and drink choices. (Cairns et al., 2013)7.

      Sports fans and public health professionals alike should be questioning how 'Our Beautiful Games' are being manipulated by the Food and Drink Industry to promote ultra-processed food and drink - including alcohol - to audiences, often well populated by impressionable youngsters. Let's see if we can link up the campaigns in different countries to make a louder voice demanding change from the governing bodies of sport.
      References:
      1. Ireland R and Ashton John R. (2017). Happy corporate holidays from Coca-Cola. BMJ 2017;356:i6833. http://www.bmj.com/content/356/bmj.i6833. 10 January 2017.
      2. Garde A and Rigby N. (2012). Going for gold – should responsible governments raise the bar on sponsorship of the Olympic games and other sporting events by food and beverage companies? Commun Law. 2012:356:42-9.
      3. Loughborough University Press Release (2016). Loughborough research calls for change in spectator food and drink provision at sports mega events such as Rio 2016. PR/16/158. http://www.lboro.ac.uk/media-centre/press-releases/2016/december/loughborough-research-calls-for-change-in-spectator-food-and-drink-provision-at-.html. 05 December 2016.
      4. Monbiot G. How corporate dark money is taking power on both sides of the Atlantic. The Guardian. https://www.theguardian.com/commentisfree/2017/feb/02/corporate-dark-money-power-atlantic-lobbyists-brexit. 02 February 2017.
      5. Obesity Health Alliance (2017). Letter to The Times – Cadbury and Premier League Sponsorship. Accessed online at: http://obesityhealthalliance.org.uk/2017/02/06/letter-times-cadbury-premier-league-sponsorship/?utm_campaign=Cadbury%20letter. 06 February 2017.
      6. European Healthy Stadia Network. http://www.healthystadia.eu/about.html
      7. Cairns G, Angus K, Hastings, G and Caraher M (2013). Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary. Appetite 2013: 356:209-15. http://www.sciencedirect.com/science/article/pii/S0195666312001511. 03 March 2013.
      All views expressed are exclusively those of the author.

      The importance of partnership working to improve priority-setting in public health decision-making (Fri, 10 Feb 2017 06:00:00 +0000)

      Guest post by Sarah Hill, Fuse PhD student, Newcastle University

      Last month I attended a workshop in London that explored how local authorities could be supported in setting priorities to improve people’s health and wellbeing. The workshop provided a platform to report the findings of a follow-on study to the Fuse led "Shifting the Gravity of Spending?" project and to explore methods for supporting local authorities in priority-setting.  Watch the video below to find out more about the study.


      As a health economics PhD student looking into methods of evaluating public health interventions, the workshop was of interest to me since the prioritisation tools focused on at the workshop are a part of the evaluative toolkit I am examining. Additionally, as a health economist by trade - who was thrown-in at the deep-end of public health just over a year ago when I started my PhD research - any opportunity to meet those working in the public health field is one that I seize in order to broaden my knowledge and appreciation of the public health context.  Particularly public health officers and those working outside of the academic realm.

      A full report of the workshop can be found here for those who are interested in the outcomes of the event; I will focus here on a few of the key points from the event.

      Small group discussions centred around partnership working
      At the close of the workshop, following small group discussions, each group of delegates was asked to feedback one key point that came out of their discussion regarding how to aid the use of prioritisation tools for public health spending decisions. Interestingly, a number of the points fed back from each group were related to partnership working to make decisions; such as:
      •  “gathering together” with NHS partners to ensure funding for effective interventions is secured when benefits may fall outside of public health’s remit and more under the NHS umbrella; 
      • considering a “place based” approach to seek good outcomes within a place rather than within separate organisations and;
      • working with local politicians to move decisions forward by understanding their objectives.
      The take-home message I got from these points was that for priority-setting to be most successful in public health, a wider viewpoint needs to be considered given the number of stakeholders outside of public health teams that are involved in funding decisions and interventions being successfully implemented. This point echoes a sentiment voiced by Professor Peter Kelly at the recent Fuse meeting on inequalities (see Professor Paul Johnstone’s blog on the meeting here) who emphasised the huge reduction in both alcohol-related hospital admissions and smoking rates in the North-East since a regional approach has been taken to tackling tobacco and alcohol through pooling local resources to invest in initiatives like Fresh and Balance.

      The impetus placed on collaborative working coming out of the workshop has given me something to think about for my PhD research since it appears that being able to evaluate interventions in such a way that incorporates and reflects that way of working is valuable. In fact, this is not necessarily a new thought; incorporating intersectoral costs and consequences has been established as a challenge to be addressed when evaluating public health interventions by health economists previously. A review I recently conducted on existing economic evaluations of public health interventions indicates that there is still a lot of room for improvement when it comes to overcoming this challenge and actually incorporating intersectoral costs and consequences. Often evaluations are conducted from either a health care or provider perspective, thus only considering the costs to those sectors exclusively. Also, of the evaluations I reviewed and those previously identified in the literature, the incorporation of consequences (i.e. benefits or disbenefits) to sectors other than the intervention provider is practically non-existent.

      Perhaps if more evaluations were able to reflect who benefits from an intervention and to what extent this may enable more collaborative working between different partners and sectors in either funding and/or aiding with the implementation of interventions. Of course the availability of appropriate data is a real barrier since an evaluation is only as good as its data, thus a drive needs to be made within public health departments to stipulate the collection of appropriate outcomes data from the very beginning of an intervention being commissioned to build up the database for effective evaluations.

      Shifting the Gravity of Spending? Workshop to explore methods in public health priority-setting was held on the 17 January 2017, and funded by the NIHR School of Public Health Research and supported by the Local Government Association and Public Health England.  The “Shifting the Gravity of Spending?” project is led by Fuse Deputy Director Professor David Hunter at Durham University.

      Mannequin challenge: preparing cancer nurses through simulating emergency situations (Fri, 03 Feb 2017 06:00:00 +0000)

      Guest post by Gillian Walton, Director of Learning and Teaching, Northumbria University 

      Tomorrow (4 February) is World Cancer Day, a day where millions of people across the world unite to raise awareness of cancer. One in two people will be diagnosed with cancer at some point in their lives (cancer research UK), an alarming statistic. Currently, 8.2 million people die from cancer worldwide every year, out of which, 4 million people aged 30 to 69 years die prematurely.

      Of the millions of people diagnosed, a high percentage will receive systemic chemotherapy (anti-cancer drugs that are injected into a vein or given by mouth) as a primary, secondary or palliative form of treatment.

      Students role play chemotherapy induced emergency situations
      As a previous oncology nurse I’m acutely aware that managing chemotherapy and the potential life threatening side effects can be demanding and highly stressful. Management of acute side effects is usually a nursing responsibility which adds extra pressure not only on resources but the knowledge required of the many drugs available to treat over 200 different cancers. Chemotherapy drugs are highly toxic and can have life threatening side effects, so managing severe reactions is essential. This can therefore be a scary environment for both the nurse and the patient!

      Mannequins mimic the symptoms of a deteriorating patient 
      At Northumbria University I run a chemotherapy module and have designed a simulation based interactive educational (SBE) activity to encourage students to engage in scenarios to simulate chemotherapy induced emergency situations. Simulated practice has been described as the "activities that mimic the reality of a clinical environment and are designed to demonstrate procedure, decision making and critical thinking through techniques such as role playing and the use of devices such as interactive manikins” (Jefferies 2005)1. Ongoing qualitative research by my colleague Alan Platt who collaborates with me on this project has shown that the use of simulation informs and improves student performance. His knowledge and findings have facilitated translating the theory into practice. We use high fidelity mannequins, which can mimic the symptoms of a deteriorating patient so the student can role play chemotherapy induced emergency situations in a safe simulated clinical environment. Students are briefed prior to the encounter about the clinical scenario and their role as a nurse caring for a patient in a chemotherapy day unit. They are asked to be themselves and to act as they would if they were at work in the clinical area. A clinical expert assists the learning experience by providing prompts for the nurses to manage the emergency situation. Covert cameras record the scenario in real time and allow the students to review and reflect “on action” and evaluate their performance following the scenario. I then debrief the group which is widely recognised as a critical element of simulation-based education. Debriefing following the scenario allows the students to engage in reflective learning(Fanning and Gaba 2007)2,3 as well as consider decision making, risk management, patient safety and communication amongst the team. Although the students initially find it a bit daunting being filmed and working with dummies that can actually speak, breath and blink their eyes, they also have said that it’s a fun and great way to learn.

      All students complete a questionnaire after the SBE relating to the learning experience. To date, 100% of the students reported that the use of simulation enhanced their learning and that the learning was stimulating and exciting. The majority of the students said that they would recommend the learning experience to a colleague. Comments suggest that they learnt how to react if they experienced the situation again in practice which increased their overall confidence; the main objective of the exercise.

      The use of simulation means students feel much better prepared to manage chemotherapy emergencies. Overall they valued the learning experience and the opportunity to reflect on their practice in a safe environment. This in turn translates to greater safety for students and patients.

      Evaluation and research findings provide support that simulation is an effective learning technique which prepares students to manage the situation should it arise in clinical practice.

      References:
      1. Jeffries, P. (2005) A framework for designing, implementing and evaluation simulation used as teaching strategies in nursing. Nurse Education Perspective; 26: 2, pp96-103
      2. Fanning RM, Gaba DM. (2007) The role of debriefing in simulation-based learning. Simul healthc;2:115Y125.
      3. Gaba DM. (2004) The future vision of simulation in health care. Qual Saf Health Care;13(suppl 1):i2Yi10.

      The first step to an equal North (Fri, 27 Jan 2017 06:00:00 +0000)

      Guest post Professor Paul Johnstone, Regional Director, Public Health England, North of England

      The inaugural meeting of the North of England’s research and practitioner network to address health and social inequalities, hosted by Fuse in Newcastle, was an inspiring beginning. Over 350 people have signed up to ‘Equal North’, including most universities and local practitioners. Judging by the energy and ideas in the room this is going to be an interesting and important development and journey.

      EQUAL North: how can we reduce health inequalities in the North?



      We heard from Professor Dame Margaret Whitehead (pictured left) who chaired the original ‘Due North’ inquiry on health inequality in the north in 2014. Due North had flagged health in all policies as a potential lever and her recent work with the House of Commons All Parliamentary Party Group on Health in All Policies was particularly impressive.






      Professor Peter Kelly (right), Director for the North
      East Public Health England (PHE) Centre reflected on earlier work by primary care trusts and the health authority from which to draw important lessons.


      And I (pictured left) described some of what has happened since Due North was published. In preparing my slides I wanted to go back and look myself at earlier work from Yorkshire and Humber days when we measured health inequalities in life expectancy, a government target 10 years ago.




      What I found was striking: affluent areas, such as York, North Yorkshire and East Riding which had life expectancies above the England average five years ago (78.6 years for men / 82.6 years for women) improved still further to the national trend (which has increased by an average of 0.4 years over five years). Lowest for life expectancy - such as Hull for men and Doncaster, Wakefield and Barnsley for women - made no improvement at all. The increasing gap is the challenge; whether we look at health, education, or the economy. In a highly-centralised country like England such inequalities are hardwired into the fabric of the country from infrastructure investment to schools.

      The seismic shifts following the Brexit vote could change all of this. Theresa May said on the steps of Downing Street that she wants to address the injustice of inequality and the ‘nine year gap’, referring to recent PHE published data on life expectancy. The new Industrial Strategy, launched on 22 January at a regional Cabinet held in an innovation park in Warrington; the RSA* Inclusive Growth Commission; and the early outputs from the National Infrastructure Commission and the Children’s Commissioner for England’s Growing Up North, again address what is needed.

      It is in this context of widening inequality, with new national resolve to address it, that we launched Equal North. As a network of researchers and practitioners across the north this gives us a tremendous opportunity to influence policy:
      • What can we learn from earlier government inequalities polices, from the days of spearheads, for example?
      • How best do we translate complex data on inequalities into simple local actions and how best to influence local devolution deals for elected mayors and local politicians?
      This needs to put communities and individuals at the heart of the action, not graphs and charts. I said earlier that this could be an interesting and important journey. Together we made the first step in Newcastle.


      For more information about this Fuse Quarterly Research Meeting please visit the event page on the Fuse website.  The presentations from the event will be available soon.


      *Royal Society for the encouragement of Arts, Manufactures and Commerce