Postcards from a public health tourist #1: Montréal, Québec, Canada

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:

• "@ChaireCACIS @irspum @ProfBambra @IlonaKickbusch @NCCDH_CCNDS #whs2017 public health is policy: Legacy of the Ottawa Charter" by Louise Potvin (@lsepotvin) via Twitter.com © 2017: https://twitter.com/lsepotvin/status/861693486533410818
• "Island of Montreal" by david brotons (dave13800) via Instagram.com © 2017: https://www.instagram.com/p/BT1zQdRgNYo/
• All other images "Montreal" - Free images on Pixabay.com: https://pixabay.com/en/photos/montreal/

Beyond ownership: a lifetime of housing and health

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?

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:

• 'Anonymous Drinker' by David Goehring via Flickr.com © 2013: https://www.flickr.com/photos/carbonnyc/8686574743
• 'Conundrum’ by Robert S. Donovan via Flickr.com © 2010: https://www.flickr.com/photos/10687935@N04/4854800303

Star Trekkin' across the (research and quality improvement) universe

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

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

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

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.