Thursday, 17 December 2015

The big countdown

Posted by Emma Dorée, Communications Assistant for Fuse

It’s that lovely time of the year again when we count down the days to Christmas. Whilst we are frantically running around trying to complete our Christmas shopping, we are also eagerly waiting in anticipation to see if this year’s X Factor winner will make the number one top spot and whose festive Foxtrot will lead them to become the Strictly Come Dancing winner.

The Fuse Blog however is having a countdown of its own. Seeing as so many great blogs have been written this year, we thought it would be a good idea to have a look at all of the blogs from 2015 and create our very own ‘Top 5 chart’ of the ‘bestsellers’.
So let’s begin….

At number five: No time to run: role overload contributing to physical inactivity in parents? Caroline Dodd-Reynolds’ post looks at how parents find it difficult to fit physical activity into their daily busy routines. With 604 views, this is clearly a subject that lots of people, especially parents, can relate to.

At number four: How active are pregnant women? Measuring the methods. Louise Hayes and Cath McParlin debunk the ‘pregnant pause’ and tell us that guidance recommends that pregnant women should actually be doing at least 30mins of exercise on most days of the week to help reduce the risk of gestational diabetes. This post squeezes into fourth spot by the narrowest of margins, reaching 606 views since publication in May 2015.

In at number three: The troubled families programme: what’s health got to do with it? A guest post by PhD student Stephen Crossley explaining how the Government is helping (or rather not helping) families that need the most help. Stephen goes into great detail about the Troubled Families Programme explaining that health plays a huge role in this issue. This post has had 657 views since it was published in June 2015.

At number two: Bull Sperm and ‘poor parents’: the role of myths in public health practice. Another entry for Stephen Crossley. In this post he takes on the urban myths that surround energy drinks and political myths about benefits and austerity. This post has had close to 750 views.

And finally, time for the top Fuse blog post of 2015. Drum roll please….

Thunder, thunder, thunderclap: when a blog post hits the campaign trail. This blog was written by Fuse Communications Officer Mark Welford and has had an amazing 1575 views. It describes how a Fuse blog post caught the imagination of readers and became a national viral campaign, prompting a campaign page to be set up for people to support the idea that supermarkets should remove unhealthy food from their checkouts. This post followed two other ‘big-hitters’ on the same subject by Mel Wakeman and Amelia Lake: Who’s opting out of responsibility? Battle of the checkouts and Time to chuck the checkout junk? Both have received more than 900 views.

So there you have it, the top five Fuse blog posts from 2015. Let’s see if we can create even bigger and better blogs for 2016!

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Thursday, 10 December 2015

"What should I wear?!" - My first conference as a PhD student

Guest post by Roxanne Armstrong, PhD student at Sunderland University

First of all, let me introduce myself. My name is Roxanne and I am currently doing a PhD at the University of Sunderland and I am part of the Fuse partnership. On the 18 – 20 November I attended my first ever conference, the UKCRC public health conference that took place in Edinburgh. I am going to use this blog to guide you through my experience, not to include the academic research that was presented. Hopefully providing an insight into what the “First Conference” feels like for a PhD student.

I am writing this blog, because despite being surrounded by a really supportive supervisory team, there are some things you just wouldn’t ask. A few examples; “do you think a four inch wedge is too formal for the day events? How about with jeans? Do I wear a dress for the conference dinner? Are flat shoes okay?”. This list goes on… This “fashion anxiety” led me to take a suitcase that could clothe a small town, four pairs of shoes and an array of eye shadow shades that a stylist from London fashion week would be proud of.

I started my journey on the train. A busy, smelly, full train. I had reserved a seat, sure, but due to me being (possibly overly) kind, I let someone take it. I glanced around and saw some other Fuse members that I recognised; I braved going over and introducing myself and ended up having a really nice, chatty trip to Edinburgh. Hurdle one – accomplished!
Professor John Frank, Director of  SCPHRP, got into the Scottish spirit at the conference dinner
Second hurdle, accommodation. Would I have a bed? Would I be sharing with a stranger that was prone to sleepwalking? How about free toiletries? I had no idea what to expect and have heard some fairly scathing reviews about conference accommodation. When I walked into my room I practically had to call someone to pick my jaw up off the floor. My accommodation was bigger than my own house! Bed? Check. Free toiletries? Check. Oh and two double beds, two plasma TVs and a kitchen area. I felt like Kate Middleton; surely this means I have made it in the world….

The third hurdle I faced was being in a sociable environment with people I’d only ever seen in a professional light. This was the most rewarding aspect for me; making connections, talking about normal things with lovely, like minded people. We shared mealtime and a couple of drinks and I finished the first evening with people I now class as friends.
Making connections with lovely like minded people
The conference itself was another challenge; I was full of nerves thinking about all of the other academics that would be there and how I’d act around them, but in truth it was so easy going. I was engaging with lots of approachable individuals with a lot of knowledge to share and exchange. I left the conference sessions feeling excited for my own future and how I was so grateful that I have such a diverse and welcoming community around me for at least the next three years and hopefully many more after that.

If I had to give some advice to someone who had never been to a conference before it would be the following: be open minded – every conference is different and you will find yourself being a social chameleon, adapting to whoever you meet, this is a great skill to develop. Secondly, enjoy it! I enjoyed every minute and really made the most of it. Finally, take as many free pens as your pocket will allow… That’s what they’re there for!

Oh, and I couldn’t end this blog without telling you – I opted for three inch wedge boots, jeans and a neutral shade of eye shadow. You’re welcome.

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Tuesday, 1 December 2015

A day in the life of a 'Pracademic'

Guest post by Natalie Connor, PhD student and Healthy Communities Officer at Groundwork North East

It was at the Fifth Fuse Physical Activity Workshop in Durham a couple of months ago that Istvan Soos, a Reader in Sport and Exercise Sciences from the University of Sunderland introduced me to the term ‘Pracademic’. I had been trying to explain to a delegate what my role was and who I worked for, when Isvtan shouted across the room, "Natalie, you are a Pracademic!" I actually can’t believe it has taken me five years of being a PhD student before finally hearing this term. Cue frantic Googling of the term as soon as I got home, to find a plethora of information on the phrase, which even boasts an entry on the Urban Dictionary website from 2007. I am clearly way behind the times. But maybe it’s because I'm spending so much of my time delivering a PhD intervention that includes scrambling around outdoors in the dirt trying to get rid of some pesky weeds, or building a raised bed in the freezing cold, that the phrase hadn't had time to register.

So I wanted to give you a taste of what it is like to be someone who is still involved in working as a practitioner, as well as studying for a PhD, which qualifies me as a Pracademic.

Gardening selfie!

There are some cons to working out in the field as a practitioner:
  • Always looking like I've been dragged through a bush backwards; 
  • My blood must taste delicious as I am forever being bitten by ravenous midges; 
  • Rogue tomatoes that I find in the car boot two months after being picked; 
  • If I were stopped by the police, my boot containing spades, shovels, rope, duct tape and bin liners would look a little suspicious. Although the rogue tomatoes might actually help me explain myself here. 
Working on the ground delivering community projects can have a number of obstacles that perhaps are not encountered as much in the academic world: payment on result targets, political pressures and economic difficulties for the third sector to name a few. Occasionally, funding will become available at the very last minute. Although this may sound great, the time required to develop and then implement a robust service is lacking. In the academic world, it can sometimes take years to get funding through to deliver a research project. In that time frame, political and organisational objectives have often changed direction. Sometimes, things that sound great in theory are actually nigh on impossible to deliver, whether that’s due to lack of engagement within a community, resources or the lack of a particular skill set. On the other hand, sometimes programmes that are delivered aren't based on any real evidence or theory to justify them. So the two worlds need to come together to try to address these issues. Collaborative practice therefore is a necessity.


Not only are there practical and logistical barriers to navigate, but also the challenge of being an impartial researcher, when I am so heavily involved in the project being evaluated. I have found it very important to reflect after every single intervention session that I have delivered; to think about what has been said by participants, but also to think about what I have said. I need to ensure that I am recognising any potential bias on my part and be mindful of it. I also need to acknowledge that there could be the problem of participants not being completely honest, for fear of upsetting me due to the trusting relationships that have developed. I make sure that when I am collecting data, I remind the participants to be completely honest, as their honest answers are what will ultimately help to shape a better service in the future. I think these are the main issues that a Pracademic will face, but as long as we can continually reflect, and acknowledge that this could potentially affect data, we can do our best to prevent this from happening.

To balance all of this, there are some pretty amazing positives to working on the ground, which allow me to get a real insight into community life. Access to participants does not feel like a barrier to me, and is something that I know other researchers sometimes face. I am able to build a relationship with local people, who will then share their thoughts and views with me, as there is trust. I am not just seen as a researcher, but someone who is working for a local charity that is trying to make a difference to the participant’s local community. Carrying out research in the field means that there is a connection to what is happening in the real world. Getting ‘out there’ to deliver an intervention has been the easier part of this PhD, and for me, definitely the most enjoyable. I also seem to walk away with an abundance of fresh fruit and vegetables. Not a bad perk!

It has been a demanding journey so far as a Pracademic, filled with many ups and downs, many moments of self-doubt, and countless barriers that I've had to dig deep (got to get one pun in!) to overcome. But I’ll take rogue tomatoes in the boot of my car any day.

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Thursday, 26 November 2015

Housing and health: aligning stars or weathering a perfect storm?

Posted by Peter van der Graaf, AskFuse Research Manager

Last Wednesday I attended the annual conference of the Housing Learning and Improvement Network (LIN), which explored how the housing and health sectors can work more closely and effectively together.

The case for this partnership was well made by the keynote speakers: not only are there already strong historic roots but the present day challenges faced by both sectors make them obvious partners. With the recent move of Public Health to Local Authorities, the central message from the Marmot review - improving social determinants is central to improving population health and wellbeing - has taken on a new significance for public health commissioners faced with the needs of other local government departments.

Housing is one of the key social determinants and has received much attention in recent Government policies that seek to redefine the remit of health. For instance, the Care Act outlines an overarching vision for adult social care and emphasises various housing solutions that can help to support the integration of health and social care.

The NHS has also recognised the role of housing and has proposed a new care model around housing in its Five Year Forward View, such as the Healthy New Towns initiative. As Neil Revely from Sunderland City Council and Chair of the Association of Directors of Adult Social Services (ADASS), proclaimed: “the stars seem to align once more to bring housing and health together”. For this reason, ADASS has worked closely with NHS England to develop a Memorandum of Understanding on Housing and Health.

However, the same politics that bring both sectors together could be stumbling blocks for the partnership to take off. As members of the audience pointed out, prevention services have been hardest hit by austerity measures and many local authorities have decommissioned the services that are now most needed. With a growing and ageing population, demand is likely to increase while resources are more likely to decrease with continued budget cuts. Moreover, the ageing population means an increase in complex needs that cannot be addressed by a prevention agenda alone and in which (supported) housing is just one part of the solution.

In short, the current political and financial climate might provide a perfect storm, making it difficult for housing and health to work effectively together. The balance might be decided by the ability of the partnership to access new resources and powers, for instance, by claiming a stake in the North East devolution plans, mirrored on the success of the Greater Manchester Devolution Agreement that includes an MOU on Health and Social Care worth £6bn each year (see also the Fuse blog post by Patrick Vernon on this topic).

To make the business case for these claims, the partnership will need to build the evidence base around the impact of a joint housing and health programme in the North East. An abundance of data is available to highlight the problem areas and populations, supporting the call to arms, but limited evidence was presented at the conference on what housing providers, public health teams and care providers can effectively do to address these problems and populations. Much of the current evidence is anecdotal and in the format of case studies.

The need for more evidence of the impact of the home/housing on health and wellbeing was also reiterated by Gill Leng from Public Health England (PHE) and this is an area where Fuse could provide helpful support. What research evidence do we have available within our Centre to support the North East partnership between housing and heath? What support can we provide in developing the monitoring and evaluation framework for their programme? The recent Fuse Quarterly Research Meeting (QRM) and corresponding research brief on health and housing is a first step in this direction and the upcoming QRM in April 2016 on planning and health another, but more practical evidence is required to align the stars of local policy, practice and research and help the North East health and housing partnership to weather the current political and financial storm.

Photograph 'Incoming Storms No. 2' by Mike Lewinski via © 2013:

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Monday, 16 November 2015

Alcohol Awareness Week: just who are those risky drinkers?

Posted by Dorothy Newbury -Birch, Professor of Alcohol and Public Health Research at Teesside University.

It's national alcohol awareness week and I've been asked to write a blog about it and as I sit and wonder what I would like people to be ‘aware’ of, one thing comes to mind. It’s the thing that I say in every lecture I give and hope that it’s the one thing that people take away with them: “Its not a them and us issue when it comes to alcohol-related harm”. What do I mean by this? Well we know that around 30% of people (any people) who go to the GP will screen positive for risky drinking (an alcohol use disorder). That’s 30% of folk you see walking down the street and in shops – that’s us – not those people over there. If we realise this then we become more aware of how risky drinking is affecting all of us. If I were to screen everybody who is reading this blog then around 30% of you would screen positive for risky drinking and about half of you would have no idea that you had an alcohol use disorder. You don’t believe me do you? Well here is an alcohol screening questionnaire – have a go...

If you score 5 or more than you would be classified as a risky drinker. So, I hear you ask, what is a unit? Well this is a massive problem as a lot of us don’t know what a unit (or standard drink) is. Did you realise that a bottle of wine has around 9 units? Did you realise that a man drinking more than 4 units and a women more than 3 units in one go is classified as a ‘binge drinker’? Did you know that the recommended drinking units are 3-4 per day for men and 2-3 per day for women, with two days free per week? All sounds rather complicated doesn't it?

So what can we do about it if we are drinking too much? Well you've done something already by realising it – remember I said a lot of us don’t realise. Small things make a massive difference. We can keep an eye on what we are drinking; we can think about having a soft drink in between a glass of something; don’t drink in rounds (it’s much easier to drink more when in a round) and remember you can leave some wine in that bottle for another night. 

Alcohol-related harm costs the UK around £21 billion a year. Alcohol is a causal factor in more than 60 medical conditions including cancers, high blood pressure, cirrhosis of the liver and depression. Alcohol-related hospital admissions have increased by 35% in the nine years to 2011/12 when there were 1.2 million admissions related to alcohol. Alcohol is implicated in, or responsible for around 30% of visits to primary health care and around 70% of A&E attendances from midnight to 5am at weekends. These are well known statistics but who do they relate to? The Alcohol and Public Health Team at Teesside University is carrying out research to reduce the harm caused by risky drinking. This includes research with young people in the school setting (SIPS JR-HIGH) and the Accident and Emergency Setting (SIPS JR) and work in the criminal justice system.

If you want more information then have a look at the following websites: 
If you want to find out more about the research, myself and the team that are involved, you can follow TeamAlpha’s research on and @TeamAlphaTees

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Thursday, 12 November 2015

Sublime and ridiculous: the glamorous life of a public health researcher

Guest post by Rebekah McNaughton, Research Associate in Public Health and Lecturer in Research Methods at Teesside University 

They say that variety is the spice of life and that is certainly true in my line of work. When I started my career as a public health researcher I understood that a great deal of my time would be spent reading other people’s research, doing fieldwork and writing numerous reports. That has certainly been true of the last 10 years of my career. What I didn't expect was the huge variety that I would come to love.

Doing fieldwork is by far my favourite aspect of the job. I'm naturally quite inquisitive and I'm really lucky to get paid to do something I enjoy- being nosey! So far, I have worked on projects with children and young people, parents, teachers, public health professionals and patients. You name it: I've probably worked with them. And, to be honest, it has ranged from the sublime to the ridiculous…
Crowd control: Some research participants refused to be quiet for the focus group
Yes, I've done focus groups in schools and community venues. I've sat on people’s sofas having a cup of tea and a biscuit. I've been challenged by young people determined to embarrass me whilst talking about sex and relationships education. All of this I expected as part of the ‘routine’.

What I didn't expect, however, was trying my hardest to concentrate on asking ‘the right questions’ whilst the washing machine was screaming in the background on the extended spin cycle. Or being mauled by a rather ‘licky’ dog and trying to make sense of the tape afterwards. I didn't expect to need crowd control skills when trying to carry out work with 24 new mums and their 28 babies and toddlers, all wriggling on the floor and not one of them being courteously quiet for the tape. However, today took the biscuit. I went to talk to two health visitors, at their place of work. Nothing out of the ordinary, or so I thought. In need of some privacy, I was led into a tiny windowless room (a cupboard), a cupboard lined with patient notes and not enough room to swing a cat. The three of us huddled around a mop and bucket, like women dancing around their handbags in a club circa 1989, whilst I held out the voice recorder. At the same time I was trying desperately not to drop it in the murky water swimming at the bottom of the bucket. Oh, the glamorous life I lead…

Would I change it? Absolutely not! No two projects are the same. Meeting participants is by far the best aspect of my job; it brings obstacles and challenges but most of all it makes my job a lot of fun!

Photo attribution:, Anthony J, 'Six pack', The results of the 'final project' in our childbirth class, (Left to right: Sienna, Maguire, Sophia, Ethan, Claire and Noah)

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Wednesday, 4 November 2015

Too stressed for words? Involving those experiencing stress in research

Post by Fuse members Natalie Forster, Senior Research Assistant, Northumbria University and Sonia Dalkin, Lecturer in Public Health at Northumbria University

On this National stress awareness day, we wanted to take the opportunity to reflect on the ethics of involving those experiencing stress in research.

Fuse researchers are currently undertaking a realist evaluation to understand how, when and for whom, Citizens Advice Bureau (CAB) interventions improve people's health. CAB provide independent, impartial, confidential, and free advice to everyone on their rights and responsibilities. This includes advice on debt, benefits, employment, housing and discrimination.

Changes to physical health take a long time to show, and are therefore difficult to capture in the evaluation timescale. The impact of CAB on stress therefore forms a core focus of the study. As we know already that stress is linked to many mental and physical health outcomes, determining if and how CAB services reduce stress should enable us to project the potential health impact of CAB.

At the point when people approach CAB, they are often under considerable strain. Two in three people accessing CAB services report feeling stressed, depressed or anxious as a result of the problem or problems that they are experiencing, more than one in five people have had to move home or are worried about losing their home, and almost one in five are experiencing difficulties in relationships with other people.
We have had much discussion as a research team, together with CAB staff, around how to design the research in a way that generates sufficient data to assess the impact of the service, but which remains sensitive to what clients are experiencing. Imagine a scenario for example, whereby you approach a service for help already under significant stress, you are anxious to resolve a financial problem, yet before you can start to address the issue you're asked to fill in a lengthy questionnaire about your health. Furthermore, CAB have projects specifically designed to support those diagnosed with cancer. In the case of CAB clients who are currently undergoing treatment for, or supporting a family member with cancer, stress is likely to remain in spite of addressing financial concerns, and to ask if their health has improved would be inappropriate.

These are just some of the issues we've been grappling with and which have informed our decisions about which client groups we invite to participate, when we contact potential participants, and what they can reasonably be asked to take part in. A decision was made for instance, not to include a project for patients and families with cancer among those being evaluated. Baseline questionnaires will not be delivered before, but rather during or just after clients’ initial appointments. The number of questionnaires clients will be asked to complete has been carefully considered and where possible, shorter versions of questionnaires have been used in order to avoid over-burdening participants.

That said, we're also conscious of the risk of excluding people from taking part by making too many presumptions about participant preferences. We have often reflected during involvement with previous research on how generously people have shared their time and experiences even when undergoing difficult circumstances. We therefore continue to consider the balance between participant protection and autonomy when recruiting potentially stressed participants. In research with people experiencing difficult circumstances, involving potential participants and organisations working with them in designing data collection strategies is key to ensuring their appropriateness.

Photo attribution: Photograph ‘Anxious 1’ (File ID #1431663) by Joana Croft via, copyright © 2007:

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Thursday, 29 October 2015

Not just a can of pop: the social meanings of energy drinks

Posted by Mandy Cheetham, Fuse Research Associate at Teesside University

Children and young people can sometimes be conspicuous by their absence in public debates about sugary drinks, so I’ve enjoyed reading the series of blogs posted since September, which describe research and activities involving young people. As children and young people are the predominant consumers of sugary drinks, it is claimed they are one of the groups whose health will benefit most from efforts to control or reduce their consumption (FPH 2015), such as the introduction of a duty on sugary drinks advocated by PHE (2015) and popularised by Jamie Oliver.

Our study on energy drinks showed that cost was one of the major influences on young people’s choices. The mapping exercise we did with Year 6 and Year 9 students in their local area showed walls of cheap, appealing, attractive displays of multiple flavoured energy drinks to tempt young people, with ‘buy one, get one free’ offers to share with friends. As important as the economic considerations are, the social meanings of energy drinks also have a major role to play. These are often misunderstood or ignored by adults planning public health interventions to reduce the risks of obesity.
Young people described the social spaces in which they drink energy drinks, whether consumed at weekend sleepovers, whilst gaming, hanging out with mates in the park, or on the way to or from school. Shared, swapped, and exchanged, energy drinks, and the sponsorship, branding and marketing associated with them, are woven in to the social fabric of young people’s lives. Energy drinks are part of the construction and maintenance of particular gendered identities, associated with extreme sports, alien elimination, looking hard, sophisticated and / or attractive. They offer young people opportunities to conform to certain ideas about what girls and boys like and do, and become part of the currency of young people’s daily interactions. In short, social meanings matter.

In Wendy Wills’ presentation at the Sweetness, Social Norms and Schools seminar in September, (CPPH/Wolfson Seminar - Sweetness, social norms and schools: factors influencing children and young people’s food and drink practices), I was struck by the similarities in young people’s comments about the importance of social relationships, interactions with friends, and the value of friendly respectful exchanges with local retailers, informing their lunchtime decision making. Young people were keen to be involved in efforts to improve the school food environment. Young people in our study were similarly fired up to make positive changes, and questioned why and how energy drinks companies can target young people under 16. They had ideas about what would make a difference and were realistic about the challenges of restricting sales of energy drinks to young people.

In September, Fuse welcomed Professor Helen Roberts, a self confessed fan of evidence informed public health advocacy, to deliver a knowledge exchange seminar prompting debates about our role as academics and advocates. Constrained by restrictions placed on us by funders, some appear nervous about compromising assumed notions of independence. If we want our research to have impact, should we not frame public health debates in ways which make sense to those who participate in our research? Rather than simply highlighting the health risks of energy drinks, this means understanding the social meanings of young people’s food and drink choices and more critical engagement with the industry that promotes them. Our efforts would be further strengthened by encouraging young people and colleagues to connect with other campaigns such as RRED and GULP.

To download the Fuse Energy Drinks report click here, or the Fuse Brief can be viewed here.

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Wednesday, 21 October 2015

Back to the Future: health and housing working together

Guest post by Patrick Vernon, Health Lead, National Housing Federation

The launch of the Due North report in September 2014 was a rallying cry for greater priority around tackling health inequalities with a manifesto in how all stakeholders and system players can recycle effectively the £136 billion in public spend for transforming services. Since May 2015 we have a new Government with a clear agenda on austerity, public sector reform and the revitalisation of the devolution agenda with the mantra of the "Northern Powerhouse". In the middle of this maelstrom has been the Government's approach to tackling the housing crisis with the immediate reduction of 1 per cent in rents over the next four years, the extension of the Right to Buy and the ongoing impact of welfare reforms. These changes have become a major turning point in the history of the social housing sector along with the changes in supported housing.

Although there is an emotional, political, moral and (increasing) evidence base for the links between poor housing and health, the gap between fact and reality still feels light years away. There is a clear role for the social housing sector to work with the NHS, social care and employers in transforming services and care pathways to meet demographic, lifestyle and morbidity changes in the population. A step in the right direction is the Memorandum of Understanding (MoU) to support joint action on improving health through the home which was signed by all stakeholders in the health and housing sector in Autumn 2014. The document highlights at a strategic and national level the key principles and actions around a collective approach around delivery. However, what is currently missing is a regional approach that is embedded in the devolution agenda. This is already happening in Greater Manchester as part of DevoManc (giving greater powers to the combined authority working in partnership with a directly-elected Mayor). In the North East we need to ensure that housing and health are part of the devolution plans.

Thus the Fuse Quarterly Research Meeting (QRM) ‘Creating Healthy Places in the North East: the Role of Housing’ on Tuesday (20 October) in Darlington is the start of another important chapter in the health and housing trilogy (or may be pre-sequel) on how health, social care and housing can work together in meeting the needs of local communities in a period of austerity. All the speakers at the event had - in essence - the same message: a need for strengthening partnerships and system leadership along with collating, translating and communicating the evidence for cost-effective interventions.

The event not only had international examples from the Netherlands and New Zealand but also local case studies from a number of housing associations such as Thirteen Group (Middlesbrough Recovering Together project), Gentoo Housing (Boilers on Prescription), Home Group (social prescribing), Tyne Housing (working with homeless people in the community) and South Tyne side Homes (sheltered accommodation for residents with dementia). The case studies illustrated how better commissioning and service integration can make a difference to the lives of people.

The challenge in a period of reduced budgets and further potential cuts in the forthcoming Comprehensive Spending Review is how we make the business case and get the right people in the room to transform services, building on the spirit and vision of the Due North report in tackling health inequalities and achieving greater health equity.

I think one of the key outcomes of the QRM is for Fuse to act as broker between service providers, commissioners and service users in creating a strong North East dialogue between the health, social care and the housing sector. This can be achieved by networking, sharing good practice, supporting development of the evidence and, finally, an advocacy role in influencing the devolution agenda.

Thus, if Marty McFly and Doc Brown pop out of their DeLorean DMC-12 again in the future, we can share with them the successful journey that we have undertaken in ensuring that the housing sector is a valued, respected and key partner in delivering better health and social care services and an integral agent in tackling the public health agenda.

For more information visit the National Housing Federation website or read the Fuse research brief accompanying this event: Creating healthy places in the North East - the role of housing.

Photograph 'Back to the Future DeLorean Time Machine' by AdamL212 via © 2007:

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Thursday, 15 October 2015

Obesity: How neoliberalism made us fat

Posted by Ted Schrecker, Fuse Associate Member and Clare Bambra, Fuse Associate Director

A 2010 editorial in the Journal of the American Medical Association warned: “If left unchecked, overweight and obesity have the potential to rival smoking as a public health problem, potentially reversing the net benefit that declining smoking rates have had on the US population over the last 50 years”. Obesity increases the risk of developing cardiovascular disease (CVD), certain types of cancer, Type 2 diabetes, and orthopaedic problems. At the end of the 1970s it was estimated that 15% of US adults were obese. By 2012, this had more than doubled, to 35%. Among adolescents the increase is even more striking – from 5% at the end of the 1970s to 20% in 2012. In the UK, it is estimated that obesity nearly tripled between 1980 and 2002, from 6% amongst men and 8% amongst women to 23 percent and 25 percent women respectively. Amongst children in England, obesity has increased from 11% among boys and 12% among girls in 1995 to around 20% today.

In our book Neoliberal Epidemics: How Politics Makes Us Sick we argue that obesity in high–income countries is partly the result of political and economic choices made since the 1980s. Since the early 1980s, neoliberalism or “market fundamentalism” has dominated politics and economics across much of the globe, perhaps nowhere more conspicuously than in the post-Thatcher UK. Obesity is a neoliberal epidemic – one of four, along with austerity, stress, and inequality. They are neoliberal because they are associated with or exacerbated by the rise of neoliberal politics. They are epidemics because they are on such an international scale and have been transmitted so quickly across time and space that if they were a biological contagion they would be seen as of epidemic proportions.
North American contrasts between rich and poor urban areas, less than a mile from one another
Photo: T. Schrecker
Other high-income countries have also experienced increases in obesity. Obesity has no single cause; the many influences include changes in the food environment (including advertising, marketing, accessibility and affordability); the growth of sedentary work occupations and leisure time activity, such as television viewing; changing settlement patterns, notably the rise of a privatised approach to planning organised around driving rather than walking or the provision of public transportation; and changes in the built environment that reduce the safety and attractiveness of physical activity, especially for those who do not live in leafy places. However, countries that have gone farthest down the neoliberal road, the UK and the US in particular, have experienced greater increases in obesity – suggesting that neoliberalism has magnified and accelerated trends that are present to some extent throughout the high-income world.

Obesity is a neoliberal epidemic for several reasons. These include: (1) economic and social policies that have meant fewer people can afford a healthy and balanced diet; (2) increasing time poverty, as when the demands of work (often on unpredictable schedules), transportation, and (especially for women) child care within ‘flexible’ labour markets are combined, there is not much time or energy left for eating a healthy diet and the attraction of a quick stop at the shopping park’s fast food outlet are strong; (3) the role of aggressive corporate marketing of unhealthy, energy-dense foods, notably as multi-national supermarkets, manufacturers of ultra-processed food and fast food chains expand into developing economies with the lowering of barriers to foreign investment. This helps to explain why overweight and obesity are now also rising rapidly in many middle- and some low-income countries, with prevalence in Mexican adults comparable to levels in the United States.
Corporate food systems and time poverty interact at the shopping park.
Photo: T. Schrecker
A fourth connection was addressed at a groundbreaking workshop at the University of Oxford in 2009: political structures such as welfare state regimes. More specifically, higher levels of economic insecurity – associated with neoliberal policies like the rollback of welfare state protections and opening up labour markets to the “creative destruction” that Joseph Schumpeter extolled as a defining virtue of capitalism – are causally linked with a higher prevalence of obesity through both biological (stress-related) and psychosocial (comfort eating) mechanisms, in addition to the more direct effects on time and food budgets.

Public health researchers, who agree on little else, recognize that reducing overweight and obesity is a formidable challenge. A first step is to avoid the lifestyle trap. A recent literature review on policy interventions to tackle what has been called the obesogenic environment produced by the Scottish Collaboration for Public Health Research and Policy provides some useful directions. Its authors do not shrink from arguing the need for large-scale interventions that may be expensive or challenging to vested interests, noting (for example) that the transport mode split in urban areas is 84% by car versus 9 percent walking in the United States, while it’s 36% by car versus 39% walking in Sweden. “Suffice it to say, it has been a concerted combination of infrastructure provision, integrated transport planning and disincentives for private cars which has helped to bring about the higher active travel rates.” We have no easy solutions, but emphasise that neoliberalism and the associated political choices have exacerbated the obesity crisis. Obesity is an example of how politics makes us sick.

Links: Schrecker, T. and Bambra, C. (2015) Neoliberal Epidemics: How Politics Makes Us Sick, Palgrave Macmillan, available at:

Professors Schrecker and Bambra will be discussing their new book 'How Politics Makes Us Sick' at an event at Durham University on 15 October 2015. For more details click here.

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About the authors

In June 2013, Ted Schrecker moved from Canada to take up a position as Professor of Global Health Policy, Centre for Public Policy and Health, Durham University (UK). Since 2002, most of his research has focused on the implications of globalization for health; he also has long-standing interest in issues at the interface of science, ethics, law and public policy. A political scientist by background, Ted worked as a legislative researcher and consultant for many years before coming to the academic world, and co-edits the Journal of Public Health. Among his publications, he is editor of the Ashgate Research Companion to the Globalization of Health (2012) and co-editor of a four-volume collection of key sources in Global Health for the Sage Library of Health and Social Welfare (2011). Ted is also an Associate Member of Fuse. Ted can be followed on Twitter @ProfGlobHealth.

As well as being an Associate Director of Fuse, Clare Bambra PhD is Professor of Public Health Geography and Director of the Centre for Health and Inequalities Research, Durham University (UK). Her research focuses on the health effects of labour markets, health and welfare systems, as well as the role of public policies to reduce health inequalities. She has published extensively in the field of health inequalities including a book on Work, Worklessness and the Political Economy of Health (Oxford University Press, 2011). She contributed to the Marmot Reviews of Health Inequalities in England (2010) and Europe (2013); the US National Research Council Report on US Health in International Perspective (2013); a UK Parliamentary Labour Party Inquiry into international health systems (2013), as well as the Public Health England commissioned report on the health equity in the North of England: Due North (2014). She is a member of the British Labour Party and can be followed on Twitter @ProfBambra.

Saturday, 10 October 2015

End of life care: looking through a different lens

Guest post by Joanne Atkinson, Director of Programmes, Northumbria University to coincide with World Palliative Care Day 2015.

When reflecting on my professional journey I often ask myself how did I get where I am today? The thing is your personal story has great resonance for you as a professional; this is an insight into my doctoral journey.

I have worked in palliative care for many years, firstly as a Macmillan Nurse in the acute sector, and then at Northumbria University teaching palliative care. Commencing a professional doctorate I had a stuttering start, but eventually arrived at where I am now with my research which is a study using Foucauldian discourse analysis. My research explores the influence and impact of emerging, competing and overlapping discourses on practice in end of life care, and provides insight into the discursive tendencies impacting on end of life care practice in the hospital setting.

Recent years have seen unprecedented media interest in end of life care, and the emergence of powerful discourses that influence health care professionals delivering care. My research focusses on the tensions, challenges and possibilities that emerge from this intersection.
You may recall some time ago the tragedy that occurred in Greater Manchester when Harold Shipman, a GP, killed his patients. The media coverage that occurred as a result of this has had a significant impact on the way in which doctors and nurses caring for people at the end of life. The public and other professionals questioned the prescribing of opiates for pain and symptom relief. This cultured the germ of a research idea. So my research journey started.
As I commenced my professional doctorate the media frenzy related to end of life care and the Liverpool Care Pathway developed, and I found myself at the cutting edge of end of life care. It is fair to say that I was taken aback by some the media outputs. 

I undertook an analysis of artefacts from journalistic press not tabloids (although this did include the Daily Mail!) and terrestrial television (factual outputs). Initially this was to be over a period of six months, but this was extended due to the profile of end of life care at the time. In addition tape-recorded narratives were taken from four consultants and six clinical nurse specialists working in palliative care, and a cancer centre. Participants recorded the narratives over a two-week period.

The media artefacts and narratives have reaffirmed the metaphorical language utilised when discussing end of life care, and highlighted the impact that the sensationalisation of end of life care has on practice, instilling a moral panic that both disables and fuels the need for change. Prominent discursive formations have emerged related to the power of representation and the impact on practice when caring for people at the end of life.
Back to my personal story which is inextricably linked with the research journey, having life happen throughout this research has no doubt enriched my understanding, but holding a very old man’s hand when he thinks he is going to be killed because he is so ill makes the impact discussed above so real especially when that very old man is your father.

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Photograph (5138623107_b05613223b_o) by More Good Foundation via © 2009:

Thursday, 8 October 2015

Animation designers…'the day in the life of a researcher'

Guest post by Megan and Glen (TeamAlpha)

TeamAlpha (The alcohol team at Teesside University: Professor Dorothy Newbury-Birch, Dr Emma Giles, Dr Grant McGeechan, Dr Victoria McGowan, Gillian Waller, Lisa Anderson, Robert Sayer) were joined by two young people from local schools - Megan and Glen – who helped the team to develop the groundwork for an animation video. This video is part of the SIPS JR-HIGH trial, a multi-centre individual-randomised controlled trial of the effectiveness of brief alcohol intervention for 14-15 year olds in a school setting. This animation video is currently being developed to show to young people in the school setting, and will be used to provide advice on how to complete the questionnaire component of the trial. This animation replaces the need for individual researchers to enter all the schools in the trial to inform the young people about the study process.

In order to develop the animation Megan and Glen spent two days drawing storyboards, drafting scripts, searching for background music, and even thinking of examples of voices for the characters. This blog was drafted by Megan and Glen to highlight their thoughts on being a researcher and graphic designer for two days.

Day one

Brainstorming and initial storyboards were created as we worked hard all morning. We had a jolly start to the day and thought it was quite interesting and fast going, however more tiring than anticipated!

Individual tasks were completed as we both researched ideas for the animation, even though we had to overcome difficulties associated with having to think of our own ideas for the initial designs for the animation. We definitely thought it was more hands on than we thought it would be, given the number of tasks planned throughout the day. We developed character images and screen shots for the video and really liked the process of doing this.


We felt that we worked hard during the first day at the University but we really enjoyed ourselves. This is partly due to the fact that we’d both like graphic design careers, and so a ‘taster’ of the process was really helpful. We were busy most of the time throughout the day; this was tiring, but also stopped the boredom setting in. This project showcased our skills in graphic design and our use of technology that we have learnt from school. Our experience of drawing, researching pictures and mood board designs really impressed TeamAlpha. As the day went by we described our visit to TeamAlpha as interesting but “full on” given that we did a 9-4 job!

TeamAlpha was very welcoming and Dot (the Professor!) helped us with our ideas and team work. Emma also mentored us throughout the two days, helped guide our ideas, and helped us to showcase our skills as designers. Initially it was hard to build a rapport with each other, since we came from different schools, but by the end of the first day we worked as a duo much better.

Day two

The second day was more relaxing since we knew who we were working with in terms of TeamAlpha, and we were also getting used to each other. Additionally, the environment felt more relaxing since we had been there before; this helped us to interact better with each other and helped us to work on our tasks much more quickly. The day was very interesting, particularly when we found out what the animation script was – basically what each character says during each scene. We enjoyed editing this script to make it relevant for the target audience, which will be Year 10 students. It was good to see all of the different components coming together to become the animation.

Overall reflections

The two days were interesting for us both and I think our experience with TeamAlpha was brilliant. We thought the team were really cooperative and they communicated very well with each other – particularly during our ‘picnic’ lunches. We feel that the work that we created and produced on these two days will enhance our CVs and help inform the work that we will be doing in school and college next year. We were really surprised by the range of tasks that researchers undertake, and the amount of thought and research that has to go into making such a short (2 minute!) animation. We really feel that we have learnt the basics of research, working independently and as part of a team, and overall we really enjoyed being in such a creative environment. We’re really excited to see the finished animation later in the year, to see how our thoughts and work have helped shape the final video.


Thursday, 1 October 2015

Green and blue commuting

Guest post by Dave Berry, Lecturer in Pharmaceutics, Durham University

How do you get to work? Like most people, I personally use a car. Sometimes I run, more often than not though, I use a bike. However, I was asked to blog about the times I do none of these things and still get to work.

As I’ve said I regularly cycle to work, I do this for a number of reasons: 

1) I have a bike and walking past it in the morning makes me guilty
2) It saves money
3) I’m lucky enough to live within 6 miles of work
4) It’s good for the environment
5) It keeps me happier
On the way to work
The last point may not seem like a particularly pertinent one, but exercise has a significant benefit on my mood and leads to positive outcomes across the rest of my life. Without exercise everything has a tendency to get a bit black for me. This was made worse by a move of job two years ago to the North East where the darkness in winter becomes quite oppressive for the uninitiated. Despite the cold and dark I enjoy cycling in winter, coming home cold and wet to then become warm and dry, gives me a feeling of taking winter head on and most of the time it feels like I’m winning. I do however sometimes get bored. It’s still just cycling repeatedly down a road when it boils down to it.
I love being outside and our move to the North East, from the Peak District, makes getting to wide open spaces feel hard at times. I do happen to live near a river, with a lovely path down to it very close to my house. I’m also very lucky to work even nearer a river, specifically three metres from the same river, so one bored day I made the logic leap and decided it would be quite nice to try and canoe to work.
This would have been very simple if:

a. I owned a kayak/canoe
b. I had any real experience (since scouts) of paddling. 

By this time though I’d become excited, so these small obstacles seemed less relevant, especially since I’m a strong swimmer. I bought a kayak on Ebay, a paddle (having heard tales of problems without one) and a spray deck.
Nearly at work
I did a bit of homework before setting off on my maiden voyage, as I/my wife were unsure of many practical points. These included:

  • What happened if I fell in? Emergency clothes stashed at work.
  • How would I get the Kayak from home down to the river? Kayak trolleys can be bought (£25-80) for the 800m trundle. Got some strange looks from the neighbours though.
  • How long will it take to get the six miles? I picked a day where I had no specific time to get to get to work and discovered I moved at about five and a half miles an hour (which is pretty average).
  • What happened if I fell in, how clean is the Tees? Quite clean actually, there are salmon living in it.
  • Showers? Gym at work (I’m lucky enough to work for a University)
  • Where would I store my kayak? I’m lucky enough to work at a University with a boat house - otherwise it would have been funny looks with it locked in the bike shed.
  • What are the rules for navigating a river? Very basics are drive on the right, if it’s bigger than you- get out of the way to the right of it.

One practicality that I hadn’t really considered was the need for a license to travel on the water. This can be purchased from the canals and rivers trust on an annual or day rate basis.

There was a little bit of a splash on the first attempt and the emergency clothing was called for, but it did get me the seclusion, exercise and general feeling of adventure I was looking for. So I’d recommend it.

I appreciate that I’m incredibly lucky to be able to do this and have a fairly unique set of circumstances, but in the UK we all live near a river and many of them are managed by the Canal and Rivers Trust, so there probably is a river or canal near you that could be used. Go on, make a splash.

A map of the canals and managed water ways can be found here:

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Monday, 21 September 2015

Shielding against the impact of the dementia time bomb

Guest post by Mark Parkinson, Postgraduate Researcher, Department of Public Health & Wellbeing, Northumbria University

Today (September 21) marks the anniversary of World Alzheimer’s Day which aims to raise public awareness about this most common form of dementia.

Dementia represents one of the main causes of disability in later life. Current estimates indicate that someone is diagnosed with the disease every 68 seconds. Alzheimer’s affects 44 million people globally with this figure predicted to triple over the next 35 years - a phenomenon aptly named 'The Dementia Time Bomb'. Advances in health mean many more people are surviving life-threatening diseases such as cancer, but susceptible to life limiting diseases such as dementia.

By 2030 more than 20 million people in the UK will be aged 60 or over. For people familiar with dementia it is one of the diseases most feared as they approach 60 years of age, a fear justified given the increased prevalence of the disease once we reach this milestone, a fear heightened by the fact that it is irreversible and terminal.

The impact of all this truly hit home during a recent conversation with my mother. Renowned for her ability to trounce all-comers at Scrabble, she struggled to recall the word ‘padlock’ prompting her to quip, with mock seriousness, that perhaps she was succumbing to the disease. My mother’s perception of Alzheimer’s still follows a traditional and mistaken one that Alzheimer’s disease is a typical and therefore ‘normal’ part of ageing. She is not alone: it is estimated that around 60% of people worldwide also incorrectly believe this, while 40% of people mistakenly think it is not fatal. I on the other hand stopped dead in my tracks. The sudden realisation that my mother’s uncharacteristic memory block might genuinely be a precursor to the more serious cerebral ‘padlocks’ associated with dementia. As a researcher involved in dementia I was only too well aware that Stage 2 of the disease is generally represented by very mild cognitive decline, including deficits to semantic memory that can include a sudden inability to recall everyday words. Much worse though was my knowledge that the later stage of Alzheimer’s can be marked by far more severe symptoms as part of a terminal degenerative process that can endure for 15 long years. A key question ran through my mind at this point: who would care for my mother if she did develop dementia?

In the vast majority of cases it is a family member who will elect to take on this role. One in eight of the UK adult population already provides such an unpaid but invaluable service. However, a central problem with our continued reliance on unpaid care is that, in general, family carers of people with dementia experience greater health inequalities due to the chronic stress commonly associated with long-term caregiving. This threatens carers' health whilst also undermining their ability to continue to provide care. A key question therefore is, ‘who will care for the carers?’ This question was the springboard for the research project I am presently engaged in which seeks to investigate, ‘What works to support family carers of people with dementia?’ While myriad resources exist that might potentially be made available, what is noticeably absent is any agreed ‘gold standard’ of support that might be put into place, tailored according to the different stages of Alzheimer’s. Unlocking this particular dementia challenge will not prevent the ‘time bomb,’ but it can offer families a much needed protective shield if and when that time does come. The need to raise awareness of dementia and the challenges associated with it has never been more urgent - the disease lies on all our doorsteps. 

Mark is currently engaged in a project concerned with several key questions related to Alzheimer’s disease: (i) which factors remain crucial to resilience-building for family carers of people with dementia (PWD) in order to maintain and sustain informal caregiving and which hinder it (ii) how can tailored support best be targeted to address the needs of specific carers? (iii) how can the inherent health inequalities faced by family carers of PWD be reduced? 

UK Dementia Awareness Week 2015 took place 17-23 May. If you wish to find out more about Alzheimer's please visit the Alzheimer's Society website.

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Tuesday, 15 September 2015

Savour the flavour! Expanding young people's experience of food & eating

Posted by Duika Burges Watson, Fuse staff member and Lecturer in Evaluation and Policy Interventions in Centre for Public Policy & Health, Durham University

Food and drink that is high in fat, sugar and salt (HFSS) is disproportionately marketed and promoted to children and young people in the UK. Public health practitioners have long cried that excessive consumption of HFSS foods is detrimental to health but, overall, the health statistics show that globally, people are consuming more HFSS foods and have less healthy diets[1]. So, is there another way?

Chef Sam Storey applies blue colouring to a teacher's tongue
We decided to test an idea with a group of 14 year 9 students from Whitley Bay (a seaside town on the North East coast) to see how they would respond to a workshop exploring the science and gastronomy of ‘taste’ and ‘flavour’. The idea came from work in the NIHR/RfPB funded project, ‘Resources for Living: Exploring the potential of progressive cuisine for survivors of head and neck cancer’. In the course of doing this research we’ve expanded our own understanding of what is ‘good’ to eat. The multi-disciplinary team includes a research chef, Sam Storey, and with him we’ve been playing with food and flavour to try to improve cancer survivor’s experience of food and eating. We used teaching resources available from the Institute of Food Research[2] alongside ‘food play’ ideas developed in our project.

Our workshop involved students from Whitley Bay High School who were participating in a local Enquiry Based Learning (EBL) event. All 300 year 9 students were involved in one of 24 projects – a three day activity in the local community. Our group of 14 spent their three days exploring the senses; this involved a food play workshop, building a raised sensory bed in the local community garden, and talking with the chef and users of New Prospects, a centre for people with learning difficulties, about their experience of food and the senses.

In our two-hour food play workshop we demonstrated how taste and flavour are not the same thing. Salt, sugar and, some scientists now say, fat as well, are largely experienced through taste – that is, via receptors on the tongue and around the mouth; but flavour refers to a much broader ‘multi-modal’ experience[3] of food that includes the very powerful element of aroma. We know that we have around 350 different types of odour receptor that stimulate thousands of flavour experiences. Chewing a flavoursome sweet whilst holding their noses, the students could experience sweetness, but it was not until they let the nose go mid chew that they could identify the flavour of strawberry, blueberry, lime etc. We explored more about aroma on a tour of the Whitley Bay Station Master’s Community Wildlife Garden – rubbing herbs and other edibles to release the volatile compounds and experience numerous delicious smells.

There were many elements to our playful explorations of multi-modal flavour perception. In one experiment we gave the students three coloured jellies and asked them to tell us what the flavours were – red, green, and yellow. Uniformly they responded with colour recognition flavours – red was raspberry, green: lime, and yellow: lemon. When we ‘revealed’ that in fact, all the jellies were identical other than the colour – all flavoured with lemon – they were astonished.

If you think about the experience of food in a contemporary UK supermarket, the only ‘smell’ that really stands out is that of baking bread. Students noted that supermarket shopping while on summer holidays abroad was different – French or Italian supermarkets had more diverse smells. Could critical food awareness challenge their taste for HFSS foodstuffs and make them notice the over-use of piped bread smells? In the school evaluation of the EBL project, our senses workshop rated the highest of all programmes. Students highly valued the experience, which suggests that more could be done. Could flavour appreciation workshops change how young people eat?

Coming up: Flavour masterclass: with Dr Rachel Edwards Stuart, part of the Wolfson Research Institute's Special Interest Group on Culinary Innovation, Senses and Health Seminar Series. St Cuthbert’s Society, Durham - Monday 5 October 12-1pm.

Thursday, 10 September 2015

Energy drinks: Don't believe the hype

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

When asked where the idea for our study on energy drinks came from, I usually say it was through discussions with colleagues as part of another project I’m leading on in County Durham. But that's not strictly true. The original spark came from my experience a few years ago of lecturing at Northumbria University in the dreaded Tuesday 9am slot (student night in Newcastle is on a Monday), where I noticed some students regularly downing a couple of energy drinks throughout the lecture. This was my first encounter with these drinks being consumed during daylight hours and I was fascinated by the idea that some people might have them for breakfast. So this got me wondering - why would young, seemingly healthy students feel the need to use an artificial source of energy to get them through the day? Or was it just my lectures sending them back to sleep? (That is if they had even been to sleep).

Over the years I noticed more and more of these drinks appearing in shops, on TV shows, in adverts and as litter on the streets, and assumed that they were used primarily by adults to stay awake. Most cans and bottles state that these products are not recommended for children, given that they contain high levels of caffeine which children are advised to consume in ‘moderation’ [1]. But then I overheard a couple of external partners discussing energy drinks in the context of them being seen as a growing 'problem' in primary and secondary schools in County Durham. They were looking for support in scoping the evidence base and exploring what types of interventions or educational materials could be developed locally. Around the same time, a call was circulated via Fuse for research proposals to The Children’s Foundation [2]. Colleagues from Fuse and the Wolfson Research Institute for Health and Wellbeing at Durham University [3] were keen to collaborate on an application. We developed our proposal, were awarded funding, and the HYPER! (Hearing Young People’s views on Energy drinks: Research) study was born [4]. 

Since June 2014, the HYPER! study team has been busy: reviewing the published literature on children and young people’s use of energy drinks; conducting a series of focus groups and interviews with students, parents and staff from four local schools; and involving young people in a mapping exercise, drawing on their knowledge of the area around their school to identify local energy drink vendors. Here are some of the things we’ve learned:

  • If you come across a paper that says ‘energy drinks are good for you’, check to see if the work has been funded by Red Bull or conducted by someone with shares in PepsiCo.
  • Most papers that say ‘energy drinks are bad for you’ are based on expert opinion, rather than robust research.
  • Young people in the UK drink more energy drinks than those in other European countries, yet there are no published studies from the UK.
  • Sales restrictions might seem like a sensible option; they would help to send a clear message but our study participants had concerns that they would be difficult to enforce.
  • The strong influence of the marketing activities of energy drink companies should not be underestimated.
  • Any interventions should ideally involve children and young people, as well as parents, schools, retailers and the industry.
  • There is a lot of confusion around whether energy drinks are safe for children, and parents, teachers and young people need help to make more informed choices.  At least one young person in all but one of our focus groups thought that energy drinks contained bull or horse sperm [5]. They don’t.
There are still lots of unanswered questions. For example, if the government requires energy drinks to carry warnings stating that they are not recommended for children, why are manufacturers allowed to market them so obviously towards young people? What are the long-term health and other effects? Is there a link to health inequalities? And why would anyone knowingly drink something that they thought contained bull sperm? We’re hoping to answer some of these questions by conducting further research so please get in touch if you’d like to collaborate with us or if you’re already involved in work on energy drinks. We would love to hear from you.

You can find out more about this study by reading the new Fuse Brief here.

Shelina spoke about the HYPER! study at the CPPH/Wolfson Seminar - Sweetness, social norms and schools: factors influencing children and young people’s food and drink practices (9 September)

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Tuesday, 8 September 2015

Translating local action to national policy

Guest post by Robin Ireland, Chief Executive, Health Equalities Group and Director, Food Active

North West England (NWE) has some of the worst health statistics in the country calling for transformative and challenging approaches by its local public health community. Merseyside-based social enterprise, the Health Equalities Group (HEG) including heart health charity Heart of Mersey has worked with and supported NWE’s Directors of Public Health since 2003.

Obesity and maintaining a healthy weight present huge problems both now and in the future. Balancing the need for a population-based prevention approach whilst government policy focuses on targeting individuals with expensive weight management programmes is particularly difficult. At the same time individual stigmatisation is both unhelpful and particularly damaging. Somehow we have to work towards changing cultures so that junk food is less easily available, that healthier food is the popular choice and walking and cycling are positively encouraged.

The NWE Directors of Public Health asked HEG to develop a collaborative approach to healthy weight in 2012 and the Food Active campaign was eventually launched in November 2013. It calls for policies to:
  • Control the marketing of junk food to children and young people
  • Place a duty on sugar sweetened beverages
  • Enforce 20mph speed limits in urban areas (lower traffic speeds make cycling, walking and play safer)
In the same way Liverpool and the NWE played an important role in the development of smoke free policies, Food Active hopes to bring local pressure to bear on government in calling for a more upstream approach to addressing obesity.

We began by building the evidence base around attitudes towards sugary drinks and modeling the effects a tax on such drinks may have on consumption. This in turn can be compared with the prevalence and cost of type 2 diabetes, and bariatric surgery etc. As data show teenagers are the highest consumers of sugary and ‘energy’ drinks, we established a media-friendly campaign called ‘Give Up Loving Pop’ to raise the debate and heighten the pressure for action. In the same way that regional tobacco control organisations have worked closely with national charities such as Action on Smoking and Health (ASH), Food Active has developed relationships with the Children’s Food Campaign and Action on Sugar.

In 2014, learning from ASH and the excellent work of local government on the Local Authority Declaration on Tobacco Control, Food Active started to develop a similar declaration on healthy weight. A regional meeting followed by workshops with three North West authorities showed that such a declaration could:
  • Raise with elected representatives and the public that local authorities have a role to play in addressing obesity
  • Help to show a wide range of policies (such as transport, planning and leisure) all have a part to play in promoting healthy weight
A Local Authority Declaration on Healthy Weight is more complex than its tobacco control equivalent and it is being developed in two parts; the first with some generic commitments (such as agreeing that obesity and overweight are a priority), the second more locally focused and aligning with local policies and priorities (for example Local Transport Plans).

As previously, the North West’s health needs will help to make the call for more concerted and resourced national action.

Robin will be speaking about the Food Active campaign tomorrow (9 September) at the CPPH Seminar - Sweetness, social norms and schools: factors influencing children and young people’s food and drink practices 

Robin Ireland

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