Over the rainbow: research with an intersectional perspective

Posted by Dr Mark Adley, Research Associate, Newcastle University

LGBTQ+ is an abbreviation for lesbian, gay, bisexual, transgender, queer or questioning, with the "+" sign recognising the multiple permutations of sexual orientation and gender identity.

Intersectionality looks at how social inequities such as racism, sexism, or classism can interact and shape people’s social experiences.

"Reaching Out", pencil and pen drawing and digital collage by artist Sarah Li (2024)

In this Question and Answer blog, Mark shares some of his reflections on intersectionality when working with marginalised groups, and the importance of taking extra steps to make sure that the quieter voices are also heard. LGBTQ+ people are not a single group, and sexism, racism, classism and other social inequities can create unexpected intersections.

What was the focus of your PhD research project?
My PhD examined marginalisation in health and social care services in North East England, specifically looking at multiply marginalised LGBTQ+ people – those who had faced additional experiences of, for example, homelessness, substance use, racism, or domestic abuse. Seventy-two people across the region took part in interviews – 33 with professionals and 39 with marginalised LGBTQ+ people.

How would you explain intersectionality to someone new to the concept?
The shortest explanation would be that 1+1 does not equal 2. Intersectionality examines how different aspects of our identities can interact – creating unique experiences of discrimination. For example, a Black woman's experience isn't simply the addition of being Black plus being a woman. She may experience racism differently than a Black man, and she may experience sexism differently than a White woman. Her experiences as a Black woman are a unique intersection of race and gender. As Zora Neale Hurston perfectly captured in 1928: ‘I feel most coloured when I am thrown against a sharp white background’.

How did your research approach evolve during the study?
I adopted what I call a 'both and' approach. While LGBTQ+ identities remained central to the research, these shifted into the background when necessary, so as to examine broader systems of power. This flexibility became crucial as participants' stories revealed how factors like race, gender, economic status, and social class at times overshadowed their LGBTQ+ experiences.

What challenges did you face in participant recruitment?
One major challenge was ensuring diverse representation. I noticed early on that lesbians and bisexual women were underrepresented, so I paused recruitment to address this. This led to an unexpected complexity – navigating the cultural and political debates around gender identity, particularly around use of the word ‘woman’ – and how to distinguish between cisgender and transgender women without causing offence.

How did you handle the sensitive terminology around gender identity?

It required extensive consultation with five women who held different perspectives on this issue. We eventually reached what I'd call a diplomatic compromise on language – while no one was completely satisfied, no one was seriously offended either. This highlighted the importance of careful navigation in sensitive cultural debates.

Recruitment flyers for lesbian, bi, queer, and pansexual women (left) and LGBTQ+ people of colour (right)

What adjustments did you make to ensure racial diversity in your study?

By March 2023 I had interviewed nine LGBTQ+ people from non-White British backgrounds, but only six were from non-White ethnic groups. After reflecting on the specific experiences of discrimination and invisibility shared by LGBTQ+ people of colour, I paused recruitment again. Following consultation with queer people from ethnically minoritised groups we rebranded the study, including removing rainbow imagery in favour of a brown background, as the rainbow was perceived as ‘very White-presenting’.

What key lessons did you learn about conducting research with an intersectional perspective?
The research required a constant shift in my own focus as a researcher. First, looking inward through reflexivity – examining my own unchecked biases and assumptions and their impact on how the study was conducted. Second, looking outward to understand the broader systems of power that influenced people’s experiences of marginalisation. It's a complex balance that requires both zooming in and out, while avoiding what has been called the ‘fetishization of complexity’.

The other lesson was to avoid ‘Oppression Olympics’ – thinking in terms of which groups experience the most oppression. Intersectionality is not about a hierarchy of minoritised groups. It’s about understanding the complex influences on our social identities, and how they apply to health inequity – the unfair disadvantages that impact on people’s health and their access to services.

The study’s key findings and recommendations

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Findings from the study are available in several formats

PDFs can be downloaded from the project’s website, with videos on YouTube and an Open Access scoping review published in BMC Health Services Research. Mark is involved in ongoing work exploring the experiences of LGBTQ+ people of colour, and collaborations with local organisations in consideration of intersectionality across the North East and Cumbria. To contact Mark or receive project updates via the mailing list click here.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------


This study was funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC) (NIHR200173). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

How our ‘test & learn’ prototypes are strengthening Social Prescribing

Posted by Ang Broadbridge, Head of Implementation at Ways to Wellness, on #SocialPrescribingDay

Evaluation is often something that happens at the end of a project, but what if we built learning into the process from the very start?

At Newcastle-based charity Ways to Wellness, we believe that embedding a culture of learning from the outset helps social prescribing link workers share real-time insights, refine approaches, and ultimately improve support for the communities we serve.

One area where this model has been used is in maternal mental health

Co-designing for impact

A core part of our work is connecting with local communities to shape and refine prototypes that align with our mission:

• Improving health and wellbeing
• Tackling health inequalities
• Reducing demand on NHS services

To ensure our link workers could share learning, develop key messages, and highlight gaps in services, we adopted the Learning Communities model. As described in the Learning Communities Handbook, these are:

"A group of peers who come together in a safe space to reflect and share their judgements and uncertainties about their practice and to share ideas or experiences to collectively improve."

To embed this approach into recruitment and training, we:

• Included an expectation for link workers to actively engage in Learning Communities
• Encouraged participation in ‘test and learn’ approaches
• Provided ongoing support and facilitation to foster a sense of ownership and belonging.

This approach helped link workers collaborate across different host organisations, spanning locations across the North East and North Cumbria.

Extending learning into maternal mental health

One area where this model has been used is in maternal mental health. After eight months of Learning Community meetings, we expanded this approach through a series of external learning events. These events:

• Shared early insights from our maternal mental health prototypes
• Brought in new partners to co-develop next steps
• Strengthened cross-sector collaboration

A key learning was that while social prescribing is well known in GP practices, it was midwives and health visitors who played a crucial role in referring parents to our prototypes - roles that hadn’t previously collaborated with link workers.

By opening up new referral pathways, we helped develop best practices for integrating link workers into maternal healthcare settings.

Turning insights into action

Our Learning Communities aren’t just discussion spaces - they drive change. Link workers use them to:

• Identify barriers in accessing social prescribing
• Test new ways to connect people with support
• Share insights at external events and policy discussions

The impact has been tangible. For example, after testing different approaches, some link workers are now based in health appointment clinics - an innovation that has improved system-wide connectivity and access to services.

Why this approach matters

By embedding a culture of continuous learning, we are:

• Strengthening partnerships across health and care sectors
• Ensuring services are designed with communities, not just for them
• Maximising the impact of social prescribing

At Ways to Wellness, we believe that the voluntary sector, healthcare services, and community organisations must work together to tackle health inequalities.

That’s why we’re committed to testing, learning, and adapting - so that social prescribing continues to evolve, improve, and reach the people who need it most.

Find out more at: waystowellness.org.uk

Image credits: Ways to Wellness Limited company number: 08798423

Bringing dietetics into Public Health

Posted by Alex O'Connor-Sherlock, MSc Dietetic student, Teesside University.

Introduction by Steph Sloan, Senior Lecturer in Dietetics and Course Leader MSc Dietetics at Teesside University.

Practice-based learning (PBL) is a key part of dietetic training, with students required to complete 1,000 hours of hands-on experience in a practice setting. Traditionally, this has mostly taken place in NHS settings, with students working one-on-one with supervisors. However, as healthcare demands grow, diversifying placement opportunities is becoming increasingly important - not just to support student learning, but also to strengthen public health initiatives.

Suited and booted to present to a factory workforce

The Allied Health Professions (AHP) Strategy for England highlights the role of AHPs in disease prevention and health promotion, helping to reduce the burden on already stretched health and social care services. Diet-related diseases remain a major public health challenge, yet dietetic care is still largely focused on treatment rather than prevention. If the profession is to play a greater role in supporting population health, then equipping students with strong public health knowledge and skills is crucial.

To support this, Teesside University’s MSc Dietetics programme now includes public health placements alongside traditional NHS clinical placements. Here, Alex shares her experience of working in a Public Health practice-based learning setting. A must read in National Careers Week for anyone considering a future career as a dietitian!

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

What I worked on

During my placement, I was involved in three projects focused on health improvement and disease prevention. My work involved meeting with stakeholders, conducting research, presenting findings, and engaging with the public. The projects covered a wide range of population groups, including expectant mothers, school-age children, local workforces, and food bank users.

1. Supporting parents with child nutrition

A key part of my placement involved reviewing the nutrition education available to parents of children aged six months to four years.

What I did:

• Conducted a literature and policy review
• Spoke to parents, NHS staff, and school representatives
• Attended a breastfeeding class to hear directly from parents
• Presented my findings to several teams, including the Director of Public Health

Why it matters:

The insights from this work will help shape future research and improve nutrition support for families in the local area.

2. Linking oral health and nutrition

There is a strong connection between what we eat and oral health, but not everyone has access to clear, easy-to-understand information about this link.

What I created:

• Infographics and presentations to educate local workforces
• Materials designed in an easy-read format, avoiding jargon

Why it matters: 

My presentation was really well received, and I was even asked to record it for wider distribution, so it could be shared with professionals working with children and people with additional needs.

 

Infographics to educate local workforces

3. Reducing food waste in a local food pantry

Many food pantry users rely on short-dated products, and without clear guidance, a lot of good food can go to waste.

What I did:

• Designed simple, visual signs with food storage and cooking tips (e.g. "Chop me then freeze me")
• Introduced a ‘Freeze me’ sign for bread and monitored its impact

What happened?

Twice as much bread was sold the day after the sign was put up compared to the previous two weeks combined!

Signs made to reduce food waste

What I learned

• Public health plays a key role in patient care - I saw first-hand how wider social factors impact people’s ability to manage their health and access services.
• Being proactive is crucial - I reached out to stakeholders independently, which helped me build confidence and leadership skills.
• Flexibility is a great learning experience - managing my own projects and working in a less structured environment improved my time management and adaptability.
• Self-care matters - the flexibility of this placement meant I could work in different settings, including from the park on sunny days!

Final thoughts

Introducing dietetic placements into public health settings is a win-win. It helps students gain a broader skillset, supports NHS capacity, and brings dietetic expertise into community settings.

Of course, doing things differently comes with challenges. Expanding placements into public health settings has required commitment from everyone involved - academics, placement providers, and students. But we’re constantly learning and improving, and we’re proud to be making a real impact on the health of our local communities.

Our experience co-producing a zine with LGBTQIA+ young people

Posted by Scarlet Hall, Research Assistant, Durham University and Fuse

We have been collaborating with LGBTQIA+ young people in the North East and South Yorkshire, through Fuse led research funded by the NIHR School for Public Health Research (SPHR) exploring how physical activity spaces could be more joyful and safe. This blog describes how the ‘Moving Spaces’ zine was made and makes suggestions for those wishing to co-produce creative research outputs.

This blog draws from reflective conversations between Caroline Dodd-Reynolds (Fuse), Mary Crowder (University of Sheffield) and Shevek Fodor (Sounds Like Shevek) during the making of the zine. It is written with contributions from Caroline, Mary and Shev.

Seek continuity between research methods and research outputs

At the start of our research project we knew we wanted to host a series of research workshops and then co-produce a physical activity resource with the young people we were working with. After seeing the results of using visual creative approaches in our workshops, we knew we wanted a highly visual and creative resource that would connect and resonate with people.

Shevek Fodor

Working with the right designer and format

We sent an advert out to LGBTQIA+ networks for a graphic designer who would understand the lives of diverse LGBTQ+ people, in particular young neurodiverse people. When Shevek Fodor shared their zines with us our eyes and hearts lit up. We invited Shev to lead on making a collaborative zine. We chose the zine because of its DIY ethos, radical history of self- publishing and as a vehicle for self or group expression of thoughts and feelings.

What is a zine?

Zines originated through people writing letters and sharing information about things they were driven and passionate about. They’ve been used as a way for people who were overlooked within mainstream media to have their voices heard.

Practice reciprocity

We thought the young people would be inspired meeting Shev, a young neurodiverse queer artist. For Shev, this role offered a new opportunity to experiment with collaborative zine-making in a research setting. We offered hands-on guidance (budgeting, finance systems, mentoring) as part of co-production principles of reciprocity. We introduced Shev to the young people prior to the zine session and their curiosity was piqued…’is this person one of us or one of them.…?’

Involving artists at later stages of research is not straightforward. We aimed for a balance between giving Shev space to design and lead the sessions while also sharing our own knowledge, ideas and learning. The trust built in earlier research workshops meant we could also pass on an established  quality of ease in the group when it came to the zine making workshops.

Trust the creative process of each person and the group

Shev laid the zine making table out in a beautiful, organised chaos of found images, stickers, magazines and cards. Young people made creative contributions to the zine, inspired by earlier conversations about physical activity. They found ways to take part and to also hang out in their safe space – which we were encroaching on. Some people chewed and chewed over the right words to express themselves with contributions coming together at the end. One person got stuck and did their piece later with a youth workers’ support. Two zine contributions were made that involved multiple voices, through Scarlet documenting conversations around particular images. Scarlet also made contributions from a researcher’s perspective. Shev took these contributions – writings, drawings and collages – and wove them together into a first draft.

Allowing the time for collaborative editing – it brings difference into conversation

We shared this draft with the youth groups, the SPHR and Fuse communications teams and academic colleagues. We received a lot of feedback – the zine was provoking conversations. The young people gave detailed feedback on what they liked, what was missing, and sequencing of ideas. They spoke the words that became the introduction and expressed their small hopes for a few people to engage with the zine. There was a thoughtful conversation across the youth groups, about whether to personalise individual contributions or depersonalise to show that it could be any LGBTQIA+ young person saying this.

Academic colleagues also read and shared reflections with us, including feedback that policymakers might struggle to engage with the zine’s non-linearity and various people suggested we include a page of key take-home messages and recommendations ‘so things don’t get lost’. The young people responded to this feedback saying that people needed to listen and pay more attention to the messages that were implicitly in there. This dialogue led to the writing of a framing document for the zine. 

Value queer embodied theory and practice 

Another dialogue arose around authorship. Some reviewers found it confusing not knowing who had written what and had a strong wish to know who – a young person or adult – had written different bits – a desire perhaps for a clear identification of distinct voices. For Scarlet, a queer researcher, the ‘queer polyvocality’ (Brice et al., forthcoming) of the zine – many voices that weaved together in to more than sum of their parts – reflected queer practices of overflowing notions of stable identity, disrupting predetermined binaries and unsettling ideas of authenticity (Lescure, 2023).

This somewhat aligned with ideas from the young people. For some, there was a wish for attribution so ‘friends and family would know I made this’, and there was also a wish for zine contributions to be unnamed ‘because any queer young person could have made any piece’ and ‘we made it all together’.

One young person said they appreciated that researchers ‘weren’t butting in with your opinions but also giving your views when right to do so’ and another adding ‘it’s important that the adults’ voices are also in there as you were part of the conversation, and some adults have also had similar experiences’. The young people decided to make creative doodles in place of signatures which were mixed in with academic doodles/logos to show the talking and making and editing together – the polyvocality – of the zine making process.

Through this collaborative editing process (over three months), the young people began to converse indirectly with interested adults who wanted to help, including with the funders. These conversations happened with the young people keeping editorial control. We sense this may open up and shape more generative future encounters between these young people and further influential adults.

Indeed, some of the young people involved have made a plan to hand deliver zines to local venues around town (hairdressers, surgeries etc.). It seems empowerment and co-ownership inadvertently leads to physical activity!

Explore the zine

To find out more about this work, please contact Scarlet scarlet.hall@durham.ac.uk or Caroline caroline.dodd-reynolds@durham.ac.uk 

References

Lescure, R.M., 2023. (Extra) ordinary Relationalities: Methodological Suggestions for Studying Queer Relationalities Through the Prism of Memory, Sensation, and Affect. Journal of Homosexuality, 70(1), pp.35-52.

Brice, S. Marston, K. Wright, R. and Hall, S. (forthcoming). ‘Mycelial Love’ in Harrison, P. Joronen, M. and Secor, A. Love and Catastrophe in Cultural Geography. Edinburgh University Press

When stigma came to town: why a quick fix can never work with a life-long problem

Posted by Ian Treasure, Programme Manager, Changing Futures Lancashire and Cassey Muir, Research Associate, Newcastle University

“When you point a finger, three point back,” a member of our Lived Experience panel said while discussing stigma. Stigma is often invisible, yet it shapes how people perceive themselves and are perceived by others. This saying reminds us that before we judge others, we should first reflect on our own behaviours, actions, and beliefs.

 

The Changing Futures Lancashire Programme and taking a trauma-informed approach

The Changing Futures Lancashire (CFL) programme was one of 15 areas in England chosen to receive funding to test and learn approaches to supporting adults experiencing multiple disadvantage. Anyone experiencing three of the following five conditions were able to access our services:

• substance misuse
• homelessness
• criminal justice involvement
• poor mental health
• domestic violence

CFL was a follow on from Fulfilling Lives which also supported this cohort. CFL was different as it was funded through local authorities in an attempt to gain more traction for system-wide change needed to support a seldom heard group. The funders were Ministry for Housing Communities and Local Government (MHCLG) and The National Lottery Community Fund.

Nationally, we focused on measuring improvements for the people we support, how well services work together, and how decisions are made at a higher level. The aim was to create significant changes in the system so that people with complex needs can access the support they need more easily. We adopted a trauma informed approach in the way we offer and provide support. For example, we understand that individuals who may appear aggressive could actually be scared, confused, or reliving past trauma. This non-judgmental approach not only shapes how our providers assist individuals with complex needs but also affects how the adults we support view themselves.

The majority of beneficiaries (90%+) in the Changing Futures programme face poly-substance use (using more than one substance at a time) as the main condition that developed into multiple disadvantage. Many have shared how chronic drug use often leads to involvement with the criminal justice system, poor mental health, and eventually homelessness. Alongside these challenges, many individuals have experienced parental abuse or neglect. Their negative school experiences, often tied to undiagnosed learning disabilities or other barriers, have also shaped their struggles. Over time, our beneficiaries have developed coping strategies to survive—tools they rely on to navigate a world that often feels unsupportive.

Shining a light on stigma

The CFL Programme has made significant strides in supporting individuals facing multiple disadvantage. However, as we delved deeper into the challenges faced by our beneficiaries, we uncovered an invisible yet pervasive barrier: stigma. This insight shifted our focus and prompted us to ask: 

how can we tackle the stigma that often prevents people from seeking the help they need?

People with lived experience helped shape the CFL model, ensuring that it addresses the needs of those who understand these challenges best. During conversations with our beneficiaries, we found that many initially hesitated to seek help because of the trauma and judgment they felt during comprehensive assessments. We responded by removing this entry barrier, focusing instead on the sharing of information between services followed by a more conversational approach that helps build trust without the fear of interrogation. This small change proved to be a key turning point for many individuals, making them feel more comfortable returning for support.

 

 

Across Lancashire we also have started to shed light on the issue of stigma. We created the powerful and thought-provoking film above featuring people with lived experience and other professionals sharing their stories, which has been viewed thousands of times. One case study highlighted a single mum afraid to visit the pharmacy near her child’s school for fear of being seen picking up methadone by another parent, and the stigma she faces as a result. Another featured a man who is street homeless, sleeping in a public toilet, only to be kicked out by the cleaner in font of commuters. These are painful reminders of some people’s situations and how different they feel from everyone else. It became clear that it wasn’t enough for us to only think about how we tackle stigma across our services, we also had to ask ourselves: what else can be done to prevent stigma and to reduce its impact on individuals?

The CFL board agreed that we should do some credible research into the topic. We sent out an enquiry of interest form and Fuse researchers responded.

Reducing stigma: research findings and key recommendations

The project between the CFL programme and Fuse was to conduct a review of the research into what can be done to reduce stigma for adults who experience multiple disadvantage.

At the heart of our work are the people with lived experience who have been instrumental in shaping our approach. Their first-hand insights have been invaluable not only in designing effective services but also in guiding our research on stigma. Many panel members shared how they overcame their own stigma through achievements like gaining employment, while others still face the stigma of past criminal convictions – something that remains a barrier to moving forward. Their voices are central to the research and the recommendations we’ve developed.

We brought together 51 review papers and found that most focused on reducing mental health stigma. Fewer studies addressed stigma related to drug and alcohol use. There was limited research on stigma linked to domestic violence, homelessness, criminal justice involvement, and poverty. Our panel felt that the findings would be relevant across various forms of disadvantage, reflecting that poor mental health or alcohol and drug use often serve as the primary ways people come into contact with services.

The research we reviewed found that stigma reduction approaches typically focused on:

• individuals experiencing disadvantage and stigma
• practitioners who provide support
• the public

There was little research on system-level changes, such as policy changes, that could address stigma more broadly.

We found that social support, particularly through peer-led or group-based approaches, was highly effective in reducing self-stigma among people facing multiple disadvantage. Peer connections helped individuals build stronger and more positive identities and gain confidence, breaking down feelings of isolation.

Additionally, we discovered that combining educational strategies with contact-based training was a powerful way to reduce stigma amongst practitioners and the public. Educational efforts - such as presentations or information addressing misconceptions about disadvantages - were most effective when paired with opportunities for practitioners and the public to meet and learn from people with lived experience. This combination allowed for a deeper understanding of the challenges faced by those with multiple disadvantages and proved more effective than using either method alone.

We engaged with our Lived Experience panel to discuss and explore recommendations. They came up with eight key recommendations to advance this work into practice:

1. Facilitate peer connections: Provide opportunities for individuals experiencing disadvantage to connect with others who share similar lived experiences. This can help reduce isolation, foster mutual support, and reduce feelings of shame and embarrassment.
2. Promote peer leadership and advocacy: Encourage individuals with lived experience to take on leadership roles or act as advocates within services. This could help challenge stigma and provide role models for others facing similar challenges.
3. Incorporate lived experience in service design and delivery: Actively involve individuals with lived experience in the design, development, and delivery of services to ensure they are relevant, responsive, and inclusive.
4. Embed trauma and stigma informed practices throughout the organisation: Apply both a trauma and stigma informed approach across all levels of the workplace. Training should not only be limited to frontline staff but also extend to managers, supervisors, and directors to ensure everyone is stigma-aware.
5. Ensure long-term commitment to anti-stigma efforts: Integrate anti-stigma interventions into ongoing practice, ensuring they are not one-off sessions. Offer regular refresher courses to reinforce learning and maintain long-term impact.
6. Foster collaboration across services: Promote collaboration between all services to ensure they adopt stigma-aware practices. This includes working together across sectors, such as housing, mental health, and other support services, to create a cohesive approach to addressing stigma.
7. Engage the community: Work on community outreach to raise awareness about stigma and its effects, helping to foster a more inclusive and empathetic environment in the wider community.
8. Implement system-wide change: Advocate for policy changes that address the root causes of stigma, such as social inequalities, and promote fair access to services for all individuals, regardless of their background or circumstances. System-level changes are crucial because stigma isn’t just about individual attitudes; it’s embedded in our systems, policies, and institutions.

We need your help

The insights from the Changing Futures programme and our research are clear: tackling stigma requires a holistic, multi-level approach. By prioritising peer support, lived experience, and trauma-informed practices, we can make real, lasting change. Now, we need your help. Join us in challenging stigma, watch and share our videos, and support this movement. Together, we can create a more inclusive, empathetic society where everyone has the chance to thrive.


Take the next step (useful resources):

• Join the anti-stigma network
• See the presentations from the recent Fuse and Changing Futures Lancashire event - Understanding the impact of stigma and multiple disadvantage, A call to action
• Watch the Changing Futures Lancashire video on stigma
• Watch an animation by Newcastle City Council Adults Safeguarding and Fuse Researchers - Stigma, A Call for Action
• Find out more about Changing Futures Lancashire

Going beyond bricks and mortar to 'Up' awareness of healthy homes

Posted by Natalie Forster, Philip Hodgson, and Alex Kirton from Northumbria University

“It’s just a house”. Words famously uttered by Mr Fredricksen in the much-loved film, ‘Up’. But does this really do justice to the complicated relationships we have with our homes?

There’s a steady stream of evidence now showing that housing characteristics (including issues like overcrowding, poor insulation, damp and mould) can impact on physical and mental health. And far from being just a house, we know that where you live can make a big difference to how socially connected you are, the services you can access and how safe you feel.

This increasing awareness of home as a social determinant of health has led to many local authorities introducing initiatives to address housing-related issues. Yet, evaluations often look at the effects of specific housing enhancements in isolation, and more understanding is needed of how healthy homes services can tackle housing issues in their widest sense.

The Healthy Homes service in South Tyneside is an advice and signposting-based service that aims to address people’s home-related health needs. As Fuse researchers we set out to explore its benefits for residents. We worked with the service to create a data collection tool to help capture the financial benefits of advice given, alongside interviews to explore the experiences of those who used the service.

So, what did we find?

Our analysis showed that the service was reaching people with multiple and complex housing needs, including those related to health conditions, low income and age. We found the personalised approach taken by the service to be especially successful in engaging proactively with older homeowners (like Mr Fredricksen!) who often presumed they wouldn’t qualify for housing improvements, didn’t want to be seen to be asking for help or didn’t want to lose their independence. And without this support they would have otherwise put off seeking help until a crisis hit.

Some participants were keen to swap their bricks and mortar entirely and relocate to a more suitable home or area. For others, longstanding and deep psychological connections to homes and areas meant a move would be too painful. In these circumstances, changes to home environments made through the service (like getting extra bannisters or a stairlift, and support to address cold, damp and mould) helped reduce worries about housing problems and avoided the need for unsuitable coping strategies like coming down the stairs backwards. Participants described how small housing modifications – even getting a different lightbulb when you’re worried about your electricity bills – made a difference both practically and emotionally, helping them resume ordinary and taken-for-granted aspects of life like going to bed upstairs with your partner. Yet, for many, the service also worked on a different level, with the face-to-face interaction and warm and friendly manner of staff helping people feel heard and cared for.

Ultimately, the project illuminates the complex and varied issues and feelings people have around their homes. It underscores the importance of services which see beyond the bricks and mortar of houses and consider the importance of people’s “homes”, such as those offered by South Tyneside Council, but also the crucial role that other (non-home focused) services can play in addressing the interactions between homes, health and wellbeing. Many people we spoke to were unsure of what support they are entitled to and so there’s a need to raise awareness and take up of healthy home enhancements before problems escalate. Finally, both the stories of our participants and Mr Fredricksen demonstrate how our relationships toward our homes can shift and change over time, highlighting a need for long-term and sustainable models of housing care and support.

Natalie Forster, Assistant Professor, Social Work, Education and Community Wellbeing, Northumbria University and co-lead of the Fuse Health Inequalities Research Cluster

Philip Hodgson, Assistant Professor, Nursing, Midwifery and Health, Northumbria University

Alex Kirton, Research Fellow, Northumbria University

Image by Pascal Laurent from Pixabay

Amplifying voices to tackle inequalities in South Asian and Muslim communities

Posted by Zeibeda Sattar, Assistant Professor in Health Policy, Northumbria University

L-R: Greta Defeyter, Humaira Khan and Zeb Sattar 

I recently had the opportunity to chair the Health Inequalities Symposium hosted by the Centre for Health and Social Equity (CHASE) at Northumbria University, in collaboration with Fuse. It was an incredible event that brought together over 100 people, including researchers, policymakers, healthcare providers, and community members, all focused on tackling the pressing health challenges facing South Asian and Muslim (SAM) communities. The main goal was clear: to find ways to bridge the gap between research and real-world impact.

The presentations were enlightening and underscored how critical it is to engage with minority communities effectively to shape public health services. Each speaker highlighted a different, but equally important, health issue impacting SAM communities. Public partner Humaira Khan, who co-chaired the symposium, pointed out that the mental health challenges facing South Asian and Muslim are often misunderstood and stigmatised. Hearing her talk about the need for culturally competent healthcare really hit home. Her words - “researchers are warriors; they don’t fight for themselves - they amplify the voices of the people” - perfectly captured why events like this matter.

“researchers are warriors; they don’t fight for themselves - they amplify the voices of the people” 

Humaira Khan, public partner

Dr Sarah Croke from the University of Manchester spoke about the language and cultural barriers that often lead to untreated health issues. This can leave community members struggling because healthcare services aren’t designed with South Asian and Muslim needs in mind. Dr Saeed Ahmed from Sunderland Royal Hospital took on the tough topic of organ donation disparities. He pointed out the harsh reality: SAM communities are in desperate need of organ transplants but are also among the least likely to donate. His call to raise awareness and educate was powerful, especially when he reminded us that one donor can change up to nine lives.

There were also discussions about everyday barriers that many of us face but rarely see addressed. Professor Defeyter from Northumbria University talked about the lack of culturally appropriate meals, like halal options, in schools. It was a reminder of how even things like food choices can create a sense of exclusion for our children and why legal changes to recognise cultural diversity are long overdue.

I found Simon Luddington’s (SearchNewcastle) presentation about the West-End Befrienders project particularly inspiring. It’s easy to forget how isolating language barriers can be and how vital social connections are for our wellbeing. Their work in bringing people together, especially in helping with access to primary care and breaking down isolation, felt like a model that should be replicated.

One of the more challenging discussions was around drug and alcohol use in our communities. Lydia Lochhead’s (Northumbria University) research laid bare the stigma that prevents so many from seeking help. It’s a tough conversation to have, but hearing about Mushtaq Dakri’s community-led approach to addiction support was a beacon of hope. They offer a holistic service - combining therapy, physical activity, and spirituality - and it’s designed by and for the SAM community. Knowing there’s a women-only support space now available shows their commitment to evolving and meeting community needs.

Fuse Associate Director Dr Floor Christie and Dr Rawand Jarrar from Sunderland University, wrapped up the day with their work on improving cancer screening uptake among Muslim women. Their workshops have reached over 260 women, and it’s encouraging to see how culturally sensitive approaches can genuinely improve health outcomes. This was a reminder of how vital it is to build services that reflect our communities.

As I reflect on the symposium, it’s clear to me that these health inequalities are not just about accessing services - they’re about how these services are designed and delivered. The urgency to address these gaps cannot be overstated. The event reinforced the need for services that truly understand and respect South Asian and Muslim communities, going beyond just offering a service to creating environments where people feel welcomed, understood, and valued.

Leaving the symposium, I felt hopeful. Change is possible, but it won’t happen without consistent engagement with our communities. Trust needs to be built, and community voices must be represented and acted upon. The gap between research and impact can be bridged if we keep pushing for culturally relevant, accessible, and respectful health services.

Plans are already in place for a follow-up symposium in November, focusing once again on the health inequalities that continue to affect SAM communities. I urge everyone to get involved. This is our chance to be part of the change and to make our voices heard in the ongoing fight for a more equitable health system. Sign-up details will be shared soon, and I hope to see more of us there - because turning these conversations into action is how we create a healthier future for all of us.