Thursday, 22 September 2016

Is the UK an intolerant society for children?

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

UNICEF statistics about child wellbeing among the 29 wealthiest countries in the world made for uncomfortable reading in 2007 with the UK bottom of the league table. Children and young people in Britain were among the unhappiest, unhealthiest, poorest and least educated in the developed world in the early years of the new millennium. Since then many initiatives and policies have been implemented to increase child wellbeing in the UK and when the league table was repeated by UNICEF in 2013 the UK moved up 15 places to a mid-table position of 16th.

However, we are still behind many European countries and with the ongoing austerity measures and continued disinvestment in health and social care services for children we could find ourselves back at the bottom league in the not too distant future. This begs the questions whether ‘simply’ improving health and other services for children is enough?

According to Sir Al Aynsley-Green, Professor Emeritus of Child Health at University College London and former President of the British Medical Association, the problem runs much deeper. He argued at the Fuse Knowledge Exchange Seminar yesterday in Newcastle, titled 'Think Adult - Think Child', that the real problem in the UK is that we are becoming an intolerant society for children. He pointed to the dire straits of politics for children in the UK: not only is the voice of children lacking from national policy making (an argument that he is well positioned to make as the first Children’s Commissioner for England), the policy making itself has often been poor.

The BMA published a damning report in 2013 in which it concluded that “the national focus on children has been short term, inconsistent and untrustworthy”. Specific policies to support children, such as Every Child Matters, have been systematically eroded by consecutive governments; the recent much watered-down Childhood Obesity Strategy is another example of this and Theresa May’s new enthusiasm for grammar schools strikes further fear into the hearts of child rights advocates.

Politicians are not the only ones to blame according to Sir Al: the media regularly publish headlines about children and young people being a nuisance and causing crimes, while shops put up signs in their windows stating that dogs are welcome but that kids can only enter two at a time and, only then, without a backpack and when closely supervised. Most shockingly, public places such as railway stations are increasingly being fitted with high pitched devices that adults can’t hear but which are very unpleasant for young people and deliberately intend to drive them away.

One area where the neglect of children’s needs is particularly visible is bereavement: every 22 minutes a child in the UK loses a parent. While no routine data are collected in the UK on this group, estimates suggest that the majority of young people face the death of a close relative or friend by the time they are 16 years old. In spite of the many services available to families to help them stop smoking, exercise more and eat healthier, there is very little available for children who experience bereavement.

Sir Al presenting at the Fuse Knowledge Exchange Seminar
Specialist service providers attending the Knowledge Exchange (KE) seminar expressed their concern about not being able to cope with the current demand, as school teachers and parents lack basic skills in being able to talk to children about emotional problems, such as bereavement. In spite of this, we know from research that bereavement can have a lasting impact on the life of children long into adulthood. Bereavement in childhood has been linked to educational underachievement, joblessness, fractured adult relationships, adverse psychological and psychiatric consequences, together with poor physical health.

Sir Al’s presentation was therefore more a call to arms. What can we do in and outside Fuse to improve child health and wellbeing in the North East? Firstly, we can act as an advocate organisation to draw more attention to the needs of children and their position in society. Are their voices heard within Fuse? Do we engage with them in our projects?

Secondly, we can bring partners together across public health and related sectors in the North East to focus attention on this topic and bring together evidence and best practice to inform new collaborations. The KE seminar provided a platform for this that could be followed up. We also have a dedicated Early Life and Adolescence Programme (ELAP) within Fuse but does our research link to education and events later in the life course? For example, in Finland shops can rent a grandparent to help them engage with children when they visit their shop.

Thirdly, we need to turn this dialogue into a research agenda for child wellbeing in the North East. How can we mobilise evidence to change the prevailing attitude among politicians and the wider society so that they instead see children as valuable assets and a key policy priority for any government? This also involves challenging popular concepts, such as school readiness, which focus on individual responsibility. As Sir Al suggested at the end of the seminar, we should turn this concept around: are schools ready for children and what do they need to be able to be ready? Are they able to support children’s emotional development and can they help them to cope with bereavement experiences?

Making the UK a better place to live for children requires more than service redesign, it needs political will and consistent pressure from a coalition of organisations to achieve this, supported by actionable research to change hearts and minds.

Thursday, 15 September 2016

Dealing with emotions and breakaway training: reflections on collecting survey data in a prison

Guest post by Jennifer Ferguson, Research Associate (Alcohol Team), Teesside University

“Wear tracksuit bottoms, bring your trainers and be prepared for Judo style moves” – not something you hear every day when trying to set up data collection. Working in a prison has been an eye opener, in ways I expected, and in ways I could never have anticipated. I sit on F wing, the wing that prisoners are brought on to when they arrive. It is in the middle of this wing that I carry out surveys about brief alcohol interventions with each new prisoner for a research project at Teesside University.

When I think back to the phone call I received about “breakaway training” and how I felt on that day, (being told how to physically hurt people should I be attacked, and kicking grown men) it was all very useful and I believe necessary when working on a prison wing. However, what I should have been preparing for was how mentally challenging it is. Prison staff become hardened (through lack of choice) to what happens in there, they have to become emotionally disentangled from each prisoner, and some literally make fun of the inmates. Of course we need to know how to hide our keys, get out of basic holds, locate the alarms and know basic breakaway techniques. But the awful feeling I felt in the pit of my stomach for a vulnerable new prisoner who enquired as to where everyone was going with their towels (they were lining up for the showers), and who was told by another inmate: “swimming mate, you wanna go? Just go up there and ask ‘Mr Jones’”, will stay with me for a long time.

Prisoners don’t expect you to be nice to them, and no one uses first names. It is surnames for prisoners and Sir and Miss for staff. They don’t touch you, even to shake your hand. The language is horrific. This is just the way it is. So in my first few weeks - hearing ‘Thompson’ tell me about how he misses his wife and kids, ‘Scott’s’ emotional breakdown because he is terrified of being inside, and ‘Smith’s’ heartbreak about his childhood and battle with drink and drugs - I soon realised I didn’t need to know how to defend myself against anyone. What I needed to learn, and fast, was how to switch off emotionally in front of these grown men. I am an emotional person and could easily fill up with tears in an instant at some stories. In my time as a researcher, when writing papers, collecting data in various formats and spending hours inputting it into a statistics software package, I have never had to deal with grown men crying. That being said, I am told every day by the peer prisoners not to believe everything I am told. I will learn how to deal with my emotions and what prisoners tell me… and by then be finished data collection. I wonder if my perspective will change the more time I spend in there? 

I guess my point is that I am learning that you cannot understand everything in public health research from articles and text books. A class room cannot prepare for you for the mental challenge of working in prison setting. However, this difficult piece of data collection will be vital to our study and my development as a researcher.

Photo attribution: “Jailed.” by disastrous via, copyright © 2008:

Thursday, 8 September 2016

Stress is a universal experience, but is it unequally distributed across society?

Posted by Dr Joanne-Marie Cairns and Dr Emily Henderson, Durham University and Fuse.

How are you feeling today? Stressed at all?! If so, you are in good company.

Stress is so pervasive in our society that it contributed to a shocking 9.9 million working days lost in 2014/15(1), which equates to an average of 23 days per person. From an evolutionary perspective, stress is useful to animals such as humans to help us react to physical and social threats, commonly known as the ‘fight or flight’ response. According to Danielsson(2) and colleagues, stress can simply be defined as an imbalance between demands placed on us and our ability to cope with them. But if stress continues over a long period of time then a permanent imbalance may arise between the body’s degenerative (reduced growth) and regenerative (regrowth) functions. Stress can also lead to everyday problems including poor performance at work, low mood, lack of motivation, fatigue, sleep disturbance and chest and muscular pain as well as major life-limiting health problems such as high blood pressure, depression and chronic pain.

In light of these concerns, we organised a Health Summit on inequalities-related stress, with colleagues from the Local Area Research & Intelligence Association (LARIA), the Wolfson Research Institute for Health and Wellbeing, and Fuse - the Centre for Translational Research in Public Health. This event was hugely popular and brought together a wonderful mix of delegates and speakers from policy, practice and academia, from the North East and across the UK. The programme, which includes a list of speakers and a description of the talks, can be found here.

While stress can be a universal experience, it doesn’t manifest equally amongst certain population groups. For instance, Thoits(3) conducted a review which highlighted how unequally high exposure to stress by women and people in lower socioeconomic and minority groups lead to inequalities in health outcomes. Moreover, we see health inequalities accumulate over the life course as a result of this unequal distribution of disadvantage, for example Thoits refers to a study conducted by Turner and colleagues(4) that examined the effect of cumulative stressors in adults. These stressors that accumulated over time, explained a significant 50 per cent of the Socioeconomic status (SES) gap in depressive symptoms.

What are health inequalities then? These are differences in health status or determinants of health between different population groups. There are also intersecting inequalities, for example, if you are a lone parent but also on a low income, living in a disadvantaged area. Moreover, coping mechanisms sometimes adopted to mitigate stress can be health-damaging and lead to other forms of health problems, such as smoking or alcohol misuse. John Watson (Deputy Chief Executive, Action on Smoking & Health (ASH) Scotland) quite rightly argues that smoking IS NOT A LIFESTYLE ISSUE; rather in his words it is a form of medication to society’s maladies. Just think of the current global economic downturn as a societal issue that can be at the root cause of individual depression. As well, unequal access to jobs (at least good jobs that aren’t precarious in nature or that might lack autonomy) or good schools, which already limit an individual’s future prospects and may as a result contribute to psychosocial stress and poorer health highlighting the structural factors that are beyond the individual. Furthermore, stress at the population-level can manifest into geographical health inequalities. Data published by the Health and Social Care Information Centre (HSCIC) shows that the North East Strategic Health Authority (SHA) had the highest admission rate due to anxiety of any of England's 10 SHAs (just under 24 per 100,000 of the population), while South Central SHA had the lowest (at nearly 11 per 100,000), mirroring other health outcomes and shows the stark North-South health divide in England.

‘Lifestyle’ is used ubiquitously in current public discourse, and can be understood as a set of factors that describe a person’s daily living. Obesity-related lifestyle often refers to people’s behaviours and apparent food choices(5). These so-called behaviours are ways in which individuals respond to challenging circumstances. They are not choices in the purest sense of the word. Rather, an individual may be experiencing financial difficulties and, feeling the demands in their life which outweigh their ability to cope, may respond to the situation by smoking, drinking or comfort eating. But what is actually causing the financial difficulty in the first place? Are individuals to blame for reacting to the bleak reality of poverty and the social gradient they find themselves in? The seminal work by Sir Michael Marmot tells us that we instead need to consider the “causes of the causes” of inequality, not just the symptoms. Politics is also important, as we have seen in the government’s release of the new obesity strategy which continues to support healthy choices, and maintains the voluntary efforts by industry by suggesting a 5 per cent sugar reduction in children’s food and drink. The chairwoman of the Health Select Committee, Dr Wollaston, told BBC Radio 5 live that “it does show the hand of big industry lobbyists and that’s really disappointing”(6). A key political talking point relates to the fact that what was a 50-page document was shortened to a mere 10 pages which does not do something as complex as obesity justice – it was “weak and watered down”.

To sum up, the discussions from our Health Summit supported the principle of moving away from individualised and stigmatising conceptions of unhealthy behaviours; after all it is not just poor people that behave poorly!

  1. Figures obtained from: [last accessed 17/08/16]
  2. Danielsson M, Heimerson I, Lundberg U, Perski A, Stefansson C-G, Ákerstedt T. 2012. Psychosocial stress and health problems. Scandinavian Journal of Public Health, 40(9):121-134.
  3. Thoits PA. 2010. Stress and Health: Major finding and policy implications. Journal of Health and Social Behavior, 51(s):41-53.
  4. Turner R, Jay and William R. Avison. 2003. Status Variations in Stress Exposure: Implications for the Interpretation of Research on Race, Socioeconomic Status, and Gender. Journal of Health and Social Behavior,44:488–505.
  5. Nettleton S. Lay health beliefs, lifestyles and risk. The sociology of health and illness. 2nd ed. Cambridge: Polity Press; 2006. p. 33-70.
  6. [last accessed 19/08/16]

Tuesday, 30 August 2016

Where you live can kill you

Posted by Clare Bambra, Associate Director of Fuse and Professor of Public Health Geography, Durham University

In 1842, the English social reformer Edwin Chadwick documented a 30-year discrepancy between the life expectancy of men in the poorest social classes and the gentry. He also found a North-South health divide with people from all social classes faring better in the rural South than in the industrial North.

Today, these inequalities persist. People in the most affluent areas of the United Kingdom, such as Kensington and Chelsea, can expect to live 14 years longer than those in the poorest areas, such as Glasgow or Blackpool. Men and women in the North of England will, on average die two years earlier than those in the South. Scottish people also suffer a health penalty with the highest mortality rates in Western Europe.

House for sale in New Orleans
Such geographical inequalities in health exist, to varying degrees, in all high-income countries. People living in more deprived areas fare particularly badly in the casino capitalism of the United States; where gaps in life expectancy between rich and poor areas of some cities, such as New Orleans, are as large as 25 years. Indeed, the US as a whole has a significant health disadvantage in comparison to other high-income countries with, for example, American men living on average three years less than their counterparts in France and five years less than Swiss men.

Understanding and reducing these health inequalities remains a major public-policy challenge worldwide and has garnered significant recent political attention. For example, in her opening speech on the steps of 10 Downing Street, the new British Prime Minister Theresa May highlighted the nine-year gap in life expectancy between the richest and the poorest boys in England. It is not only a moral issue though; health inequalities carry significant economic costs to individuals and society (e.g. NHS costs, lost productivity). But the causes of such inequalities are complex and the solutions contested.

Explaining health and place

Where you live affects how long you live and the health of different places is determined both by the population composition (who lives here) and the environmental context (where you live).

Who lives here? The demographic, health behaviours and socio-economic profile of the people within a place influences its health outcomes. Generally speaking, health deteriorates with age, women live longer than men, and health status also varies by ethnicity. Levels of smoking, alcohol, physical activity, diet, and drugs – all influence the health of populations significantly. The socio-economic status – or social class in “old money” – of people living in a country also matters as those with higher occupational status (e.g. professionals such as teachers or lawyers) have better health outcomes than non-professional workers (e.g. manual workers). So differences in the characteristics of people living in a country, city or neighbourhood will impact on the health of that place.

However, where you live matters. The economic environment of a country, such as poverty rates, unemployment rates, or wage levels can all influence public health. The social environment, including the services provided within a country to support people in their daily lives such as child care or health care and welfare, can also impact on population level health. The physical environment is also an important determinant with research suggesting that proximity to waste facilities and brownfield or contaminated land, as well as levels of air pollution can negatively affect health. So countries, cities or neighbourhoods with worse economic, social or physical environments will have worse health outcomes.

Reducing health inequalities

Even though both composition and context matter, and can be supported by scientific evidence, politics can matter more than science in determining which strategies policymakers pursue to reduce health divides – or if they even care about inequalities at all. After all, some potential solutions are politically easier to implement within existing systems than others.

For example, interventions aimed at changing individual health behaviours are far less challenging to prevailing power structures than those that demand extensive investment in improving the social economic environment. Indeed, by blaming people for their own health problems, such interventions let governments and businesses off the hook for the wider economic, social and environmental determinants of health inequalities.

Such “downstream” approaches only tackle one side of the coin and there is little evidence that lifestyle interventions are effective in reducing health inequalities: more comprehensive measures are needed. Most of the health gains over the nineteenth and twentieth centuries were brought about by far-reaching economic, political, and social reforms which improved the wider environment and also significantly improved the financial position of the poorest people.

It has been clearly demonstrated that more equal societies almost always do better in health terms and the poorest and most vulnerable groups, say in Sweden or Norway, are far healthier and live longer than the equivalent groups in the UK or the US. These countries have done so through the development of a stable, inclusive economy, a supportive welfare system and a high standard of living.

So, where you live matters for how long you live – and changing how we live could reduce health inequalties.

Professor Bambra’s book Health Divides: where you live can kill you is available now from Policy Press.

Clare Bambra
Professor of Public Health Geography, Department of Geography, Durham University, Associate Director of Fuse: the Centre for Translational Research in Public Health and lead of the Health Inequalities research programme
Twitter @ProfBambra

Photo attribution: “House for sale, New Orleans” by K.G. Schneider via, copyright © 2006:

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