Postcards from a public heath tourist #2: Boston, Massachusetts, USA

Guest post by Emma Simpson, Research Assistant, Newcastle University

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

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

Here’s the second from Emma Simpson.
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Dear Fuse Open Science Blog,

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



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



Wellness Lab (L-R): Herman Saksono, Lily Stowell, Me, and Andrea Parker
(I also worked alongside Farnaz Irannejad Bisafar who is not pictured here)

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

Beautiful snowy view from Wellness Lab

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

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

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

Glass flower exhibition at the Harvard
 Museum of Natural History

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

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

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

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

Summer is coming

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

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

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?

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

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

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.