Thursday, 4 August 2016

Au revoir et bonnes vacances

Posted by Emma Dorée, Fuse Communications Assistant, Teesside University

The blog has spent the last few weeks trying to stay motivated at work whilst watching everyone else share their holiday snaps on social media - enough of the hot-dog legs, already!  It feels as though everyone is enjoying a nice relaxing break except for the blog. However that is all about to change as it is holiday time!

It’s been another busy (academic) year for the blog but the crowning glory has to be winning the award for best blog in the Education category at this year's UK Blog Awards. A fantastic achievement for everyone involved, especially as this was the first time the Fuse blog had been nominated.

So where is the blog going on holiday this year I hear you ask? Well, instead of going abroad it is having an ever so trendy ‘staycation’ and going to the Lake District. This will be a good chance for the blog to get away from its desk, do some physical activity and take in the lovely views. Not to mention, improve its chances of catching some water-type Pokémon - gotta catch 'em all!
Saying goodbye to friends at Teesside University

As well as the blog taking a well-deserved break, this will be my last blog post as a Communications Assistant for Fuse. After having a holiday myself in the sunny south of France, I will be working at West Park Hospital in Darlington as a Communications Assistant.

I have really enjoyed my time working for Fuse and have gained much experience and many skills from being given the opportunity of working in this post. Working as part of a great team to help the blog to victory in the UK Blog Awards has definitely been one of my greatest achievements and something that I will treasure.

So that’s it! It’s farewell from me and happy holidays from the blog.

The blog will return in September with many more exciting posts about public health. Enjoy your summer everyone!


We still need your 500-700 word blog posts so that we can start September in style.

Please email them to Mark Welford (

Here’s how to take part and why you should blog.

Thursday, 28 July 2016

Making an impact with your research: may I have this dance?

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

Early career researchers from the five UK Public Health Research Centres of Excellence met recently (14-15 July) in Norwich to discuss their research and bust out a few moves on the dancefloor at the conference dinner. While some career-focused academics (the conference theme was about career transitions) might frown upon this behaviour, the policy and practice partners participating in the conference made it very clear that, for them, dancing is a key move in public health, particularly if you want to make an impact with your research. 

Before you don your dancing shoes, let me explain what keynote speaker Jim McManus, Director of Public Health at Hertfordshire County, was talking about. He argued that knowledge exchange is not really a science or even an art but very much a dance: a dance between researchers and policy makers about the use of research evidence. To complete this dance successfully and get evidence used in commissioning, both partners need to follow certain steps. However, learning the steps (science) or performing them perfectly (art) is not sufficient: it requires instinct and feel for where you are in the dance and why you are doing it.

You need to understand who you are engaging with and why they are the best partner to talk to. How would you like them to use your evidence and why would it be of interest/ value to them? In other words, as a researcher it is not enough to present your partner with the latest evidence. You need to know when and how to use your evidence and this cannot be gleaned from an internet profile page or academic paper, but is based on an ongoing relationship with policy makers. As the context and process in which evidence is useful changes constantly it is an important skill for researchers to be able “to go with the music”. 
For instance, if a public health commissioner is challenged in a council meeting by an elected member about the lack of progress in bringing down local childhood obesity, it is of limited use to the commissioner to cite a research paper on the complexity of obesity and the need for a long-term, multi-pronged approach, particularly in times of austerity. A better move could be to signpost the commissioner to an existing two-page evidence brief about the most effective way to reduce inequalities in childhood obesity. A more elaborate dance routine could involve suggesting an action research project to identify how to make better use of existing services in a more integrated way, based on in-depth conversations with elected members and other service providers and users.

To get a better feel for the music, Jim McManus emphasised the need for emotional engagement between researchers and policy makers. A heart-to-heart helps you feel the steps and allows you to adapt your steps based on where you are going. This might sound difficult and un-academic but, given what I witnessed at the evening do, the participants at the UKCRC16 conference in Norwich proved that they were more than happy to move around the dancefloor with our public health partners, given the right music.

Thursday, 21 July 2016

What should we do about children and young people’s consumption of energy drinks?

Guest post by Shelina Visram, Fuse Associate and Lecturer in the Centre for Public Policy & Health, Durham University

Did you know that cigarettes are the only product on the market that, when used exactly as intended by their manufacturers, will kill around half of their users? And yet you can buy them legally in every country of the world, with the exception of Bhutan? But you probably knew that already (except maybe the bit about Bhutan). It’s just one example of the type of paradoxical situation that occurs when public health evidence suggests we should do something and this is then contradicted by the actions of government and industry.

Here’s another example: did you know that energy drink consumption by school-age children is linked to hyperactivity, risky behaviours and health complaints such as headaches and stomach aches? And yet children of any age can buy these drinks in a variety of shops? You may have heard that the supermarket chain Morrisons banned sales of energy drinks to under 16s, but this was a trial that ended in early 2015. Some retailers choose not to sell energy drinks to younger children – often in response to pleas from teachers at nearby schools – but they do this on a voluntary basis and have to accept that they will probably lose revenue as a result.

Regular readers of this blog may be aware that Fuse members have been involved in conducting research on youth energy drink consumption over the past couple of years (you can read previous blog entries here and here). You may have read our Fuse brief, seen us present our findings at a seminar or conference, or downloaded our report from the HYPER! study website. So why the renewed call for action? At a time when the Government’s delayed childhood obesity strategy has been described as "pathetic", we need to take every opportunity to push for clear messages around food and health. We have worked with the Food Research Collaboration (FRC) to produce a briefing paper – published today – that clearly sets out the main ingredients of energy drinks, the current market situation, the scientific evidence base, and existing interventions, ranging from school-based educational activities to country-wide bans. The paper concludes with a series of recommendations on what could (and should) be done by policy-makers and others to address this issue.

To go back to the example of cigarettes, we know that sales and marketing restrictions are key factors in preventing uptake of smoking by children and young people, even if they do not eradicate the problem completely. Obviously energy drinks are nowhere near as harmful as cigarettes. They do not kill one in two consumers. But, like all sugar-sweetened beverages, they do contribute to increasing levels of childhood obesity and type 2 diabetes, as well as poor dental health. By law, energy drink labels must include the following warning: “High caffeine content. Not recommended for children or pregnant or breastfeeding women”. So isn’t it time we stopped sending out conflicting messages and made it clear that these drinks are not suitable for children and young people?

Download the briefing paper Energy Drinks: What’s the evidence? written by Shelina Visram (Durham University) and Kawther Hashem (Action on Sugar).

Photo attribution: 06-09-2013 Cathy Wilcox energy drinks, Cathy Wilcox Sydney Morning Herald, via

Thursday, 14 July 2016

Interdisciplinarity – facilitated serendipity?

Guest post by Jane Johnson, PhD student at Teesside University

With Professor Brian Caulfield booked to speak at the European Congress of the World Confederation of Physiotherapy Therapy in November on the topic of ‘the impact of interdisciplinary engagement’, and physiotherapists being encouraged to get out of discipline thinking (1), this is a topic I am coming to think about more and more, not least because my PhD involves supervisors from various fields. There is myself and the Director of Studies, both physiotherapists and from the School of Health and Social Care, a senior lecturer from the School of Computing, a professor of psychology from the School of Social Sciences, Business and Law, plus a Director of Research from the Anglo European College of Chiropractic; input has been necessary from a patenting specialist.

 Interdisciplinarity ‘…involves teams or individuals that integrate information, data, techniques, tools, perspectives, concepts, and/or theories from two or more disciplines or bodies of specialized knowledge to advance a fundamental understanding or to solve problems whose solutions are beyond the scope of a single discipline’ (3). Perhaps because it is …. ‘a term that everyone invokes and none understands’ (2) that I jumped at the chance of attending a free workshop* on this topic, welcoming the opportunity to explore how best to maximise the potential of this collaborative approach.

Asked to consider how we defined our disciplines, it was interesting to discover that whilst myself (physiotherapy), Profession Jane McNaughton (medicine), Andrew Rathbone (pharmacy) and Samuel Azubuike (public health) defined our disciplines in terms of codes of conduct and a sense of rigidity, workshop attendees from the fields of anthropology, theology, sociology, history and english defined themselves according to the methodologies they employed. This in itself was telling and got me thinking about how different disciplines understand and use common words. For example, in my own research, how physiotherapists, psychologists and those from the computing world use the word ‘functionality’ needs clarification in order for us to work together efficiently.

During the workshop we considered how disciplines linked to one another and I reflected that with respect to my own work, linkages came about in both a structured and an unstructured way: some team members were involved from the onset, others have been brought on board as the PhD has evolved. During the first nine months of this project I have come to understand that whilst one must have structure, fluidity is important too, and I am put in mind of the presentation given by Sir Ken Robinson in which he describes how life is not linear but serendipitous (4). I am a planner by nature and came home pondering how one follows a structure whilst leaving space for chance meetings. Some of the most useful contacts I have made in the first nine months of this PhD have been through attending workshops outside of my discipline. There is a need for balancing how many conferences, workshops and seminars one attends, where opportunities exist to meet people from other disciplines who may turn out to be helpful but where this is not guaranteed, against the necessity of following the designated research path. My conclusion is that there needs to be a kind of facilitated serendipity, a contradiction in terms I know.


*Supported by the Welcome Trust, the workshop The Practice, Benefits and Challenges of Interdisciplinarity hosted by the Medical Humanities Department at Durham University.

(1) Hitchcock, G. (2016) ‘Physios must get out of discipline thinking’, Frontline 22, 15 June, p.8.
(2) Cited in Mansilla, V., Lamont, M. and Sato, K., 2015. Shared Cognitive–Emotional–Interactional Platforms: Markers and Conditions for Successful Interdisciplinary Collaborations. Science, Technology, & Human Values, 1-42
(3) Callard, F. and Fitzgerald, D., 2015. Rethinking interdisciplinarity across the social sciences and neurosciences. Palgrave Macmillan. P.4
(4) School of Life & Passion - Ken Robinson - POWERFUL!!

Thursday, 7 July 2016

Keeping up with the pace of physical activity research

Posted by Liane Azevedo, Fuse staff member and Senior Lecturer in Physical Activity and Public Health, Teesside University

The American College of Sports Medicine (ACSM) Annual Meeting takes place at an intense pace with around 20 sessions running in parallel from 8am to 5pm for four days. I have been attending the conference since the year 2000 and at first really struggled to understand the language and content, often returning to my room completely drained and with a thumping headache.

Things are a little bit better now and I was brave enough this year to stand up in quite a few sessions to ask questions. Of course my heart rate was racing but in my early years at the conference just the thought of standing up in front of so many renowned researchers would cause me palpitations.

There were quite a few presentation highlights for me this year, so much so that I’m going to need two blog posts to cover them. Here I’ll talk about the prestigious Joseph B. Wolffe Memorial Lecture, physical activity interventions in children, and an interesting presentation which gave an evolutionary perspective on whether changes in energy expenditure contribute to the problems of obesity.

Liane with her poster at the ACSM Annual Meeting
So let’s start… The Joseph B Wolffe Memorial Lecture (named in memory of the first ACSM President) was delivered by Prof Russell R. Pate from University of South Carolina. Prof Pate is well known by all who do research in physical activity in children. With more than 300 publications in the field, his works mainly concentrate on children, from pre-school to school intervention and policy implementation (he is a member of the US Physical Activity Guidelines Advisory Committee). From all the papers that Prof Pate has written, the articles on pre-school children are those that I am most interested. He showed some data that children spend only 3 per cent of their time in moderate to vigorous physical activity and were sedentary for more than 80 per cent of the time when attending childcare. He then used policy recommendations in US childcare to show that few regulations in childcare are consistent with this recommendation. Surprisingly, no state in the USA has regulations in place for staff joining children in physical activity, and about providing education to carers to increase physical activity. Professor Pate then showed some initiatives that are taking place, for example ABC Grow. This is something that I would be really keen to see in the UK too, having a child that has just recently left the childcare setting and knowing about the limited opportunities and training currently provided here.

In another symposium, I heard about current approaches (and difficulties) to do with helping kids move. There is a great initiative from UNICEF called Kid Power in which by making children active (tracked by an arm band pedometer) it unlocks food packages for malnourished children across the world. The symposium also talked about another initiative running in the United States that is supported by Michelle Obama called The Aspen Institute Project Play. Take a look at this video in which the First Lady talks about the numerous physical activity opportunities for affluent kids and the absence of opportunities for those who are deprived, very thought-provoking….

Finally, I went to a very intriguing presentation, which gave an evolutionary perspective on whether changes in energy expenditure contribute to the problems of obesity. The presenters showed studies from hunter-gatherers and other African rural societies that revealed a lack of association between total energy expenditure and obesity, and that activity energy expenditure is the same between Nigerian and American women but American women are more obese. They also showed that hunter-gatherer populations had surprisingly similar total energy expenditure to adults from developed countries. The presenters suggested that ‘traditional’ lifestyles (without an exercise intervention) may not protect against obesity, and change in diet might be important to reduce the trends of obesity seen in our society (this is a good reading if interested).

In my next blog I will talk about the most recent updates on sedentary behaviour research, interventions to promote physical activity and academic performance, how my own presentation went, and about an interesting debate entitled ‘Who Wins: The Tortoise or the Hare in the Race for Health Benefits?’ which talked about the health benefits of sedentary behaviour, moderate physical activity and high-intensity physical activity. See you then…

Acknowledgment: Liane Azevedo would like to thank Fuse and Teesside University for the support to attend this Conference.

The 63rd American College of Sports Medicine Annual Meeting was held in Boston with around 5,500 people attending from all disciplines related to exercise science and sports medicine.

Thursday, 30 June 2016

Learning to be a researcher

Guest post by Jane Johnson, PhD student at Teesside University

Have you ever had the experience of thrusting your hand into the air, “Oo! Oo! Pick me! Pick me!” and afterwards think, “Uh oh, why did I offer to do that?” Despite being invited to give a poster presentation at CAMSTRAND, the Complementary and Alternative Medicine Strategic Direction and Development Conference hosted by University of Warwick’s Medical School, I felt apprehensive. The topic of the conference was ‘The Application of Qualitative Methods in CAM Research’ and not only is my research mostly quantitative, I have only been doing the PhD for eight months so thought, “how on earth will I hold my own in a room of forty experienced researchers?” My intention to seek out and explore opportunities to learn and to contribute during the limited PhD time frame of 36 months had yet again left me with my hand up, and not in an air-punching Bruce Springsteen Born in the U.S.A. kind of way.

But I was glad to have been brave enough to attend because the experience was invaluable for many reasons. I heard 18 presentations and in addition to learning about the variety and content of on-going qualitative research into complementary therapies, discovered the following:
  • Standing up in front of experienced researchers gave me heartburn but not heart failure.
  • Even experienced researchers don’t always get their point across to the audience in the way they intend.
  • Researchers are curious. They ask questions and reflect on what people say.
  • For the most part, researchers want to share their experiences to help prevent other researchers making the same mistakes.
  • Researchers are solution-focused. They can’t help but start questions with, “have you thought of trying…”
  • Researchers like to network.
  • Everyone presents their posters differently. I made a mental note to make the font size of the title of future posters even larger than PowerPoint’s recommended 24 and to use more yellow.
  • Even as a novice researcher I can contribute. I helped out two attendees who were struggling to understand the concept of ‘coding’, proving that sitting in on Dr Maura Banim’s qualitative methods lessons at Teesside Uni has not been wasted on me.
  • The abstract that got me accepted to CAMSTRAND will be published in The European Journal of Integrative Medicine and the discipline of having to put this together was useful.
Even when you think you are alone at a conference, there are opportunities for surprise and comradery. “Oh you’re that Jane Johnson,” said a woman noting my name badge, “I was looking at one of your books the other day in the library.” I braced myself ready to explain that I didn’t write novels featuring romance in the Moroccan desert. “Posture …something,” she said. I relaxed. “Yes,” I confirmed, “I was that Jane Johnson”, suddenly feeling an affinity for a woman I’d never met and slightly more at ease.

CAMSTRAND is an annual conference organised by the Research Council for Complementary Medicine and I look forward to attending other conferences that provide equally good opportunities for me to learn how to be a researcher.

Thursday, 23 June 2016

‘First, do no harm’: How to think about austerity and public health

Posted by Ted Schrecker, Fuse Associate and Professor of Global Health Policy, Durham University

The current ‘neoliberal epidemic’ of (selective) austerity directs our attention to public health impacts of choices about public finance in several ways. Most fundamentally, anticipated post-2015 public expenditure cuts in the UK will reduce public expenditure as a proportion of Gross Domestic Product (GDP) to the levels of the 1930s, ‘taking the size of the state to its smallest in many generations’, in the words of a 2014 Institute for Fiscal Studies briefing. In fact, on recent projections by 2020 public spending in the UK as a proportion of GDP will be below the figure for the US, despite the latter country’s bloated defence budget. It is implausible that a National Health Service that is free at the point of use can be maintained with pre-World War II levels of public spending. Even a brief conversation with anyone familiar with US health care reminds us just how much that matters.

Meanwhile, the health consequences of social spending cuts that fall disproportionately on the poorest people and regions are beginning to be manifest in rising food insecurity and increased use of food banks – the latter trend probably related to the rising rates at which benefit recipients are sanctioned. Further health impacts, more difficult to isolate epidemiologically but probably at least as significant, are associated with the stresses of chronic insecurity, powerlessness, and lack of ‘control over destiny’.

There is a basic ethical and political point here about the politics of evidence. Sir Michael Marmot and colleagues wrote in 2010 that ‘It is hard to see how even ideologically driven commentators could think that having insufficient money to live on is irrelevant to health inequalities’. Good point.

In a previous blog with Clare Bambra, we demonstrated that politics can make us sick; Clare recently wrote a similar blog highlighting large health divides across Europe, showing that where you live (and the health policies implemented there) strongly affects how long you live. Against the background of austerity and the rising costs of healthy diets, it is indefensible to ask public health professionals and advocates to demonstrate, over and over again, that (for example) inadequate incomes lead to unhealthy diets and poor health. Rather, the burden of proof should be shifted: we must insist on clear and convincing evidence that national governments’ choices about the level and composition of public expenditure first, do no harm to health, except in extraordinary and clearly justified circumstances. This is an important part of the case for (independent, third party, adequately resourced) health impact assessments, especially of policies and programmes outside the health sector. Such a shift in the burden of proof is also congruent with the strong presumption in international law against retrogression (backsliding) with respect to human rights such as the right to health – a presumption that assumes special importance in an era of austerity.
Is corporate tax avoidance a public health issue?
Public finance, then, is a public health issue. This point applies to the revenue side, as well. The publication of the ‘Panama papers’ reminds us of the extent to which cross-border tax avoidance, whether legal or questionably legal, represents one of the ‘fiscal termites’ that can undermine states’ ability to provide everyone with the prerequisites for a healthy life. (Interestingly, the phrase ‘fiscal termites’ was coined by the former director of the International Monetary Fund’s Fiscal Affairs Department.) The question of how maintaining health services free at the point of use and investing effectively in prevention could be financed should be asked as a routine element of public health practice and advocacy – part of a broader strategy of interrogating scarcity. One answer could be using revenues from clamping down on UK corporate taxes avoided by major transnational corporations. In the real world, resources can almost always be found for the purposes of the powerful: think HS2, Trident renewal, and so on.

Choices about public finance are political choices with consequences for health and health inequalities; academics and practitioners must not be shy about pointing out those consequences.

A more extensive list of references is available from the author.  All views expressed are exclusively those of the author.

Photo: Servizi Mediali.  Reproduced under a Creative commons 2.0 licence