Happy New Year from everyone at Fuse

We would like to wish all our readers and contributors a very Happy New Year - why not make a resolution to blog in 2020 and send us your posts?

Image (adapted with thanks):
The original uploader was Rsabbatini at English Wikipedia. [CC BY 4.0], via Wikimedia Commons.

Scaling the mini Matterhorn - risk and adventure with a disability

Posted by Llinos Jehu, Research Associate with AskFuse, Teesside University

Llinos introducing the blog and speaking about her experience of epilepsy

Happy ‘International Day of Persons with Disabilities’! That day set aside by the United Nations to ‘promote the rights and well-being of persons with disabilities in all spheres of society’.

There’s a lot to be happy about. When I was diagnosed with epilepsy in the 1970’s, the world was a very different place. I got used to being treated as a fire and safety hazard (so not allowed into some buildings or events), a risk (so refused insurance), and a liability (excluded from school trips ‘just in case’). Given all the gloom and doom, it’s amazing that I turned out to be such a boringly average sort of person, never knowingly causing anything to spontaneously combust.

Roseberry Topping has been compared to the Matterhorn in the Swiss-Italian Alps

And generally I am happy living as someone with epilepsy, identifying as a disabled person. But then I attend something like the launch of the NIHR Applied Research Collaboration (ARC) in North East & North Cumbria, and get told that I’m going to die 10 years before everyone else. OK, they didn’t actually say that, they didn’t necessarily mean me. But people living with a disability or long term condition are at risk of premature mortality, and that risk isn’t always linked with their condition. For me, good epilepsy management is dependent on taking medication like clockwork. Seizures don’t stop me from taking my medication, but having to remember to order a repeat prescription just might: not more than 10 working days before I run out, but not less than 8 working days as it takes time to process. Good epilepsy management requires a good standard of physical and mental health: managing the weight-gain that the medication can cause, managing stress and anxiety, getting a good night’s sleep. Most people want to achieve some of the things on that list. Epilepsy doesn’t stop me from travelling with my job or going out to see friends; that’s caused by poor public transport. Unless I actually drop down with a seizure (and there’s no reason that I should), epilepsy won’t stop me from doing a 16 mile hike across the Moors. Barriers are more likely to be caused by people asking me, ‘Are you sure you should? Is it safe? Is it wise?’.

Speaking to Steph Kilinc about her research on the experiences of people living with adult-onset epilepsy

So what would make me happy, and possibly live a bit longer? Good, accessible, affordable public transport for starters. And a text from my pharmacist to say that my meds are ready to collect – after all, they know I’m a responsible person who takes them as instructed. They also know I’m not the sort of person who will stock-pile meds to sell on the internet or feed to my goldfish! The text wouldn’t just make sure I had the meds to take, it would make an enormous contribution to reducing levels of stress and anxiety. It would make me feel that I was viewed as an adult with a range of competing demands on my attention, rather than an old child with nothing else to think about.

Phil and Llinos on how technology helps them to navigate both walks and public transport

What already makes me happy is that I’ve had a life filled with friends who’ve supported and encouraged me. They’ve helped to keep the stress and anxiety levels down, to get the good night’s sleep, to manage the risks and have the adventures. There’s still lots to be unhappy about. Sometimes I’m really, really angry. Hate crime targetting disabled people, increasing levels of inequality: sometimes there can seem little to celebrate. But for this year’s event I’ve walked up Roseberry Topping on a glorious day, accompanied by two great friends: Phil Jeffries who’s a very experienced walker and happens to be partially sighted, and Steph Kilinc, a member of Teesside University’s Behaviour, Health and Resilience Research Group who happens to be a somewhat less experienced walker. We’ve compared Steph’s research findings with our own experiences of living with a disability. Phil’s shown how technology can help someone with a visual impairment to read maps (actually how to interpret maps, he was good at orienteering before his sight loss and there’s only so much technology can achieve). Together we’ve managed to navigate the public transport system and arrived at the same place and at the same time. I’m not stressed, I’m not anxious, I’ll take my meds and have a good night’s sleep. I’ll leave being angry until tomorrow, when I might follow up on those ARC presentations and find out what’s to be done to address that premature mortality risk.

References:

• Stephanie Kılınç a,. The experience of living with adult-onset epilepsy, Kilinc S, van Wersch A, Campbell C, Guy A, Epilepsy & Behvious 73 (2017) 189-196

• Thomas R & Barnes M, 2010, Life expectancy for people with disabilities NEUROREHABILITATION Volume: 27 Issue: 2 Pages: 201-209

• Epilepsy Action: https://www.epilepsy.org.uk

• Epilepsy Research UK: https://www.epilepsyresearch.org.uk/

• NHS: https://www.nhs.uk/news/neurology/people-with-epilepsy-have-higher-risk-of-early-death/

Bridging the research industry 'Valley of Death'

Posted by Peter van der Graaf, AskFuse Research Manager / Fuse Knowledge Exchange Broker, Teesside University

I was recently invited to attend a meeting in the British Library of the Bloomsbury SET. Not a group of subversive English writers, intellectuals, philosophers and artists but an Advisory Council for an innovative collaboration between four partner Colleges of the University of London. Namely, the Royal Veterinary College; London School of Hygiene and Tropical Medicine; School of Oriental and African Studies; and the London School of Economics and Political Sciences.

Death Valley, Eastern California

The partnership is funded by Research England and aims to bridge the ‘Valley of Death’: supporting research projects that get stuck between university and the market place. It does this by creating a knowledge exchange platform between the four Colleges that accelerates the delivery of innovative scientific and technical solutions in the field of infectious disease and antimicrobial resistance.

Pronouncing pathogen emergence, zoonotic disease and antimicrobial whatsit was hard enough, let alone my hope of making a meaningful contribution. I thought I would feel completely out of place as a public health researcher and the only social scientist in the room, but to my surprise I quickly discovered that the collaboration faces very similar challenges to Fuse.

For example, the project is trying to pool their commercialisation expertise across the Colleges and create a ‘single open door’ for government agencies, big pharmaceutical companies, small and medium sized enterprises, and overseas partners particularly in Africa. So, similar to our AskFuse service but with industry. In spite of their best efforts to engage researchers from the different Colleges, the project leads found that not all academics are keen to engage in partnership working outside their immediate area of expertise and that interdisciplinary partnerships, particularly with social sciences and humanities colleagues, proved challenging, as they speak a different language and have different cultures for sourcing funding.

It also proved challenging to develop trusting relationships with industry partners: academics don’t know how to find these partners and engage them in their projects, while industry partners allege that academics are ignorant of innovate technologies that have been developed in-house. This is akin to public health researchers not being aware of different types of knowledge that are being used in local government. It takes time to develop these relationships and exchange knowledge within them, for which the three-year grant funding is not long enough to show full results.

While the partnership is keen to engage with social scientists about the social aspects of the commercialisation process (e.g. work with local non-governmental organisations on engaging communities and identifying cultural and societal perceptions around vaccine use and human health), Research England is more interested in the commercialisation of ‘hard’ intellectual property through licensing or spin-out. Hence, the key performance indicators are all skewed towards these outputs. In other words, the incentive structure set by the funder is not encouraging the very thing that the partnership is trying to achieve. This sounds very similar to the lack of incentives and career opportunities within universities for engaging in knowledge exchange in public health.

Group photo (me, furthest right)

During the meeting, the need for creating an infrastructure within the Bloomsbury SET that can facilitate conversations between academics across the Colleges and broker relationships with industry partners was acknowledged by the Advisory Council members. Dedicated funding to develop collaborative proposals between industry partners and academic researchers that address this need was suggested as a useful knowledge transfer mechanism. Similar to the Public Health Practice Evaluation Scheme (PHPES) operated within the NIHR School for Public Health Research.

In summary, even if you don’t have any expertise in a particular scientific field (and can’t even pronounce their topics), chances are that you have more in common and face similar struggles when moving research findings outside academic institutions, whether that involves industry or policy and practice partners. The Colleges study transmittable diseases from animals to humans but to have impact with their research equal attention is needed to the transmission of knowledge from one human sector/ academic discipline to another.

A tale of two families: diabetes and rugby

Posted by Ruth Boocock, Senior Lecturer in Dietetics, Teesside University

The rain is coming in sideways, the mud is three inches and counting, a Sunday afternoon somewhere in the North of England. My rugby family. Amongst the rain, probably beneath four or five bodies, my seventeen year old daughter is having fun.

A whistle goes and a rain sodden, mud covered monstrosity jogs towards her family on the touch line. An upper arm extended, a mobile phone waved at a discreetly protected sensor and a blood glucose level read. Sometimes it’s an insulin pen to compensate for the adrenaline, other times a sports drink to refuel, such is the trial and error process of educating herself on what management routines work for training and matches. Blood glucose responses to physical activity for this recently diagnosed teenager with type 1 diabetes are highly variable based on activity type and timing and require different adjustments (Colberg et al, 2016)1. There are looks of course. Some parents are confused but a hurried whisper and the confusion is quickly replaced by respect. No mess, no fuss, just ordinary life. There are more important and more exciting things to do. Opponents to fell, tries to be scored. Rugby here, really has no barriers. A progressive, modern, attractive, dynamic and inclusive sport played by all (World Rugby, 2017-2025 vision)2.

Today is World Diabetes Day and the theme for 2019 is ‘The Family and Diabetes’. The aim, to raise awareness of the impact that diabetes has on the family and support network of those affected, as well as promoting the role of family in the management, care, prevention and education of diabetes.

On the rugby pitch my personal and professional life comes into sharp focus. I have spent the last twenty years as a dietitian sharing the journeys of people with diabetes. From the familiar insulin dose adjustment which offers greater freedom to eat and exercise while minimising glycaemic excursions (changes in blood glucose levels), to the battle of weight management and diabetes polypharmacy (the use of multiple medications). Weight loss for those with type 2 diabetes unlocking a future without diabetes or at least the ability to rationalise the use of diabetes medications.

Willowy wings take to the pitch alongside broader hardier oaks. At its best they complement each other wonderfully. From helping to prevent and manage medical conditions to reducing the risk of type 2 diabetes, the benefits of sport and activity on a person’s physical wellbeing are huge. But only 63% of adults are physically active for the recommended 150 minutes weekly, with figures lower still for children (Department of Health and Social Care, 2019; Sport England, 2019)3,4.

Rugby helps to maintain or improve aerobic capacity (the ability of the heart and lungs to get oxygen to the muscles), strength and balance and bone health and contributes to meeting the physical activity guidelines. Other benefits to exercise include reduced stress and improved self-esteem. Rugby reminds these girls that nobody’s self-worth comes from how they look or the perfect make-up or beautiful hair or high fashion clothes of online celebrities. There is a wonderful freedom here but also a challenge. Obesity. There is a fine line between giving girls and women confidence in their bodies and shape while also encouraging those patterns of healthy eating that will allow them to play at their best and get the most out of their training and their life. We do not always get the balance right. Push come to shove however they are out there two-to-three-times a week, come rain or shine working incredibly hard, growing as team mates and women, and reducing their risk of developing type 2 diabetes by 30-40%. That has to be an excellent beginning.

On the pitch there is just the team, on the side lines the wider rugby family. Sometimes also the diabetes family. Nicknames abound. Banter flows. Yet there are no labels. There are no diabetics, no 'fat girls', just a team and its friendships, its victories and losses, its celebrations and of course, lots and lots of mud.


Ruth’s current doctoral studies seek to identify barriers and enablers to the implementation of diabetes remission strategies for adults with type 2 diabetes recently diagnosed within general practice in one of the most deprived local authority districts in England.


References:

1. Colberg et al. (2016). Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care; 39(11): 2065-2079. https://doi.org/10.2337/dc16-1728
2. Accelerating the global development of women in rugby 2017-25. https://www.world.rugby/womens-rugby/development-plan?lang=en 
3. Department of Health and Social Care (2019). UK Chief Medical Officers' Physical Activity Guidelines. https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report
4. Sport England (2019). Active Lives Adult Survey: May 18/19 report. https://www.sportengland.org/media/14239/active-lives-adult-may-18-19-report.pdf

Images:

1. 'Logo for the World Diabetes Day' by International Diabetes Foundation via Wikimedia Commons: https://commons.wikimedia.org/wiki/File:World_Diabetes_Day_logo.svg
2. Published by: West Park Leeds Girls Rugby ‘Meet your #innerwarrior’ event, with thanks to Kurt Nutchey

Can Scottish inventiveness curb the nation’s alcohol habit?

Posted by John Mooney, Senior Lecturer in Public Health, University of Sunderland

 Churchill is defeated by a Temperance movement MP - Dundee election result in 1922

“Of all the nations of this earth, perhaps only the ancient Greeks surpass the Scots in their contribution to mankind…” 

Sir Winston Churchill

This often cited sentence from the great orator’s canon of memorable expressions, frequently (in social media posts at least), is accompanied by a story of the number of times in a normal day ‘the typical Englishman’ is obliged to thank his Northern cousins for gifts bestowed:

From the spreading of ‘Dundee marmalade’ in the morning to his whisky night-cap it is easy to lose count of those almost innumerable causes for daily gratitude. In these days of Prophet Greta, perhaps the less said about ‘TarMacAdam’ and the internal combustion engine the better… but in our defence there is always Kirkpatrick MacMillan’s bicycle to offset that carbon footprint!

It’s no accident of course that pride of place be afforded in the above account to Scotland’s national drink of distilled and malted barley – renowned the World over for its unparalleled quality and distinctive dalliance on the palate. Scotland’s broader relationship with alcohol however, has not traditionally been a reputation to which one might raise a glass and is perhaps better summed up by the lovable and tragic Rab C Nesbit (right). The real tragedy of course being the excessive and abiding toll of alcohol related illness and premature death for which Scotland is infamous and also near the top of the World league table, for all the wrong reasons...

And yet, the nation’s pioneering spirit (of the non-liquid variety!) and very inventiveness in the face of a challenge may yet serve up another exemplar for others to follow. In May 2018 Scotland became the first country in the World to introduce legislation that set a minimum floor price for a unit of alcohol (MUP). While other fiscal mechanisms have been tried and tested for tackling cheap alcohol, MUP has consistently shown the greatest promise in modelling studies, since it cannot be “absorbed” by the retailer [1].

Sure enough, the first evaluation of the population level impact of MUP has found the policy to be associated with reduced alcohol purchasing. In line with model predictions, the reductions were largest for those households purchasing the most alcohol and for those drinks with the cheapest alcohol content [2, 3]. The very modest impacts on household budgets and the effect of reducing alcohol purchasing / consumption the most for those at greatest risk of harm also in line with predictions [4], helps counter any serious criticisms that the policy represents a regressive measure by unfairly targeting the economically disadvantaged. In the words of the Glaswegian novelist Val McDermid, on BBC Television’s Question Time in 2017: “There is nothing regressive about preventing people in Scotland’s poorest communities drinking themselves to death with cheap alcohol”.

Returning to the bigger picture, Scotland’s appetite for policy innovation to tackle alcohol harms is by no means restricted to minimum pricing. Rather, MUP is seen as only one component of a ‘whole system’ approach to tackling this most intractable and culturally embedded of public health problems. Bringing drink driving levels into line with the lower threshold in place across the rest of the EU [5] and incorporating health outcomes as a long overdue legitimate alcohol licensing objective [6], being two potential ingredients in the mix…

The Scottish ‘double edged’ relationship with alcohol can be best summed up by another snippet of Churchillian wisdom, a man who by all accounts was not unaccustomed to enjoying a ‘brandy before breakfast’:

"Whisky has killed more men then bullets, but most men would rather be full of whisky then bullets." 

Sir Winston Churchill

Perhaps the pragmatic recognition of a population’s natural affinity for a risky behaviour responsible for such a significant health burden is the first step towards realising that only meaningful restrictions in access mediated through price and availability, as well as legislative sanctions, might yet constitute the best defence against our worst excesses. Most Scots, myself included, know only too well of the devastating impact alcohol can exert on friends, families and communities. Maybe that is why we are most responsive to the remedies!


References:

1. Meier PS, Holmes J, Angus C, Ally AK, Meng Y, Brennan A: Estimated Effects of Different Alcohol Taxation and Price Policies on Health Inequalities: A Mathematical Modelling Study. PLoS Med 2016, 13(2):e1001963-e1001963.
2. Mooney JD, Carlin E: Minimum unit pricing for alcohol in Scotland. BMJ 2019, 366:l5603.
3. O’Donnell A, Anderson P, Jané-Llopis E, Manthey J, Kaner E, Rehm J: Immediate impact of minimum unit pricing on alcohol purchases in Scotland: controlled interrupted time series analysis for 2015-18. BMJ 2019, 366:l5274.
4. Holmes J, Meng Y, Meier PS, Brennan A, Angus C, Campbell-Burton A, Guo Y, Hill-McManus D, Purshouse RC: Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: A modelling study. The Lancet 2014, 383(9929):1655-1664.
5. Haghpanahan H, Lewsey J, Mackay DF, McIntosh E, Pell J, Jones A, Fitzgerald N, Robinson M: An evaluation of the effects of lowering blood alcohol concentration limits for drivers on the rates of road traffic accidents and alcohol consumption: a natural experiment. Lancet 2019, 393(10169):321-329.
6. Mooney JD, Sattar Z, de Vocht F, M Smolar M, Nicholls J, Ling J: Assessing the feasibility of using health information in alcohol licensing decisions: a case study of seven English local authorities. In: Lancet Public Health Science: 2016; Cardiff: The Lancet; 2016: 78.

Image:

1. Election result in Dundee in the 1920s when Churchill was defeated by a Temperance movement MP. With thanks to Eric Carlin, Director of the Scottish Health Action on Alcohol Problems (SHAAP).

The hardest thing was admitting that I was stressed at work...

To coincide with International Stress Awareness Week Annabel Gipp writes about workplace stress and shares her personal experience of working in the NHS.

Stress is something we all experience at some point in our working life, academic studies and at home. It’s almost become a standard for measuring how our day has been. I can recall many a time when I have exclaimed ‘That day was pretty unstressful!’, where this has really been code for ‘I’ve had a really great day’.

Being in employment has been found to have a beneficial impact on the health and wellbeing of a person, and helps to reduce workplace inequalities. Sadly however, being in low paid, insecure employment can actually contribute more to stress than being unemployed according to the National Institute for Health & Care Excellence. In non-manual workers, the most common cause of workplace absence was stress.

Workplace stress in defined as a harmful reaction people have to undue pressures and demands placed on them at work. Stress can manifest in a variety of mental and physical symptoms. Mentally, this includes:

• Trouble concentrating
• Negative feelings towards yourself, others and situation 
• Difficulty processing information or thinking logically 
• Constantly worrying something awful might happen 
• Forgetfulness 

This can also manifest in physical symptoms:

• Dizziness/ hyperventilating
• Trouble sleeping 
• High blood pressure 
• Chest pains 
• Tension and muscle pains 
• Fatigue 
• Digestive problems 

All of these can make it very difficult to focus on work or study, or even just keeping your home and socialising. This can result in a vicious circle which can worsen stress: 

A paper written by the Health and Safety Executive in October 2019 estimated that there were 602,000 workers across the UK suffering from work related stress, depression and anxiety. This resulted in 12.8 million working days lost and 54% of all working days lost to ill health were as a result of stress, anxiety and depression. The biggest cause of a build-up of stress was due to increasing workload, tight deadlines, too much responsibility and lack of managerial support.

It is also acknowledged that stress, depression and anxiety are more prevalent in public sector industries such as education, health and social care and public administration. Sadly, trends of reported workplace stress seem to be increasing slowly year-on-year, with 1,800 per 100,000 workers reporting work place stress in 2018/2019.

Stress has been linked with increased risk of many chronic health conditions, including heart disease, high blood pressure and depression. It has also shown to have links with immune system suppression, including in the progression of cancers, gastrointestinal disorders such as irritable bowel syndrome, skin conditions, neurological and emotional disorders.

So, stress is a very serious condition that needs to be reduced wherever possible, and organisations have a part to play to help manage it as much as possible.

Sadly it is not always possible to remove stress completely. I work in the NHS, and the nature of working in this organisation can potentially increase stress. Using this as one example, workers within the NHS are often faced with increasingly large workloads, stretched budgets, emotionally distressing situations or challenging patients - which can all increase stress.

I have had to take some time off work due to workplace stress. For me this was caused by a number of factors but what helped me return was a very supportive manager and team, and adjustments at work to help manage my caseload.

For me, the hardest thing was admitting that I was stressed at work. I felt guilty for letting the team down and that I should be able to manage. However, reducing the stigma around workplace stress is essential, as seeking support allowed me to return more quickly and stay in work.

So what can we do? The NHS Employers Website has a great tool to assess how you are feeling today, and it’s essential to check in on yourself. Having space to reflect and allowing yourself to voice worries or anxieties can help and give you time away from the stressful environment.

Trying to connect with people around you and with meaningful activities can all be helpful as well. But the key message is to seek support when you need it, from whoever you feel able to seek this from. Be it a colleague, friend, GP or charitable service, talking is essential and no-one is an island.


Annabel is a Floating Dietetic Clinical Specialist at Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV). Practitioner of Public Health, Faculty of Public Health, Trade Union Representative for the BDA (Association of UK Dietitians) and Staff and Dietetic Wellness Champion.


Good sources of information:

• Health and Safety Executive: http://www.hse.gov.uk/statistics/causdis/stress.pdf
• NHS Employers: https://www.nhsemployers.org/howareyoufeelingnhs
• NICE Guidance: https://www.nice.org.uk/guidance/ph19/chapter/1-Public-health-need-and-practice
• Psych Central: https://psychcentral.com/lib/the-impact-of-stress

Image:

1. "According to HR you haven't had any stress-related illnesses yet." by Grizelda Grizlingham via University of Kent, British Cartoon Archive (Reference number: GGD1406, Published by: Prospect, Sep 2017, with thanks to Copyright holder: Grizelda Grizlingham): https://archive.cartoons.ac.uk/Record.aspx?src=CalmView.Catalog&id=GGD1406&pos=11

Research on the go with women in walking groups

Posted by Stephanie Morris, Research Fellow, University of York

In this blog Steph reflects on the use of mobile ethnography in a recent study of the place of walking groups in the lives of women in deprived areas of north-east England.

Ethnography’s signature method, participant observation, or ‘hanging out’, provides rich data inaccessible by other forms of qualitative research. Mobile ethnography, as the name suggests, uses this methodology in the context of mobility. It can involve ‘go-along’ interviewing (See Carpiano 2008, Kusenbach, 2003) and participant observation as researchers travel and converse with participants.

When conducting research with women in walking groups, I found that mobile ethnography facilitated inclusivity and openness. For example, some women were interested in participating in the study, but uninterested in having a formal ‘sit down’ interview. So this approach opened up the study to those who might not usually opt to take part in research. Walking with study participants also enabled me to build rapport in a more ‘natural’ way than in a one-off interview, when the research and participant go in ‘cold’. Walking and talking, what the women did on the walks, encouraged free and open conversation: participants talked a lot to me about the intricacies of their lives, as they did with each other.

Mobile ethnography produces data which I feel is not likely to be created in static interview interactions. In ‘go along’ informal interviews, objects and embodied experiences along the route are often talked about. Conversations ranged from discussing fly tipping and historical features in the landscape, to sharing experiences of bodily sensations whilst walking in all weathers! Walking with the groups also provided a first-hand experience of the sense of safety and solidarity that comes with group walking. The following excerpt from my fieldnotes* shows an example of how this happened:

"As we walk along, Ashley who is in front of us by a few metres, points out that there is a hole in the path. She puts her stick down it and shouts to us to be careful of the hole. We do the same for the people behind us. Less than a minute later, Lisa says ‘step’, as there is a slight step in the hard soil and she is warning me about it. I do the same for the people behind me, and I get the feeling that I am being watched out for, and that I am instantly doing the same for the others."

Acts like this also quickly make the researcher feel part of the group, an insider participant-observer.

Despite its broad affordances, mobile ethnography is not without its challenges. The logistics of note taking when walking are tricky to say the least! I used the note function on a smartphone to take notes and took photographs along the route to remind me of encounters noteworthy of description. I walked with a Nordic walking group, which was even more difficult as I often had to carry the Nordic poles in one hand or clip and unclip at the group’s brief stops to quickly take notes of conversations or observations. However, as it was usual for people to walk alone for moments during walks, these times provided me with opportunities for note-taking. Conducting ‘go along’ formal interviews with a voice recorder was for the most part unproblematic; however, external noise was an issue at points near busy roads.

As with all ethnography, doing it well requires a lot of time and emotional labour. For instance, as transcribing fieldnotes is time intensive and needs to be completed as soon as possible after participating in the activity/group being studied, this task can clash with life’s other responsibilities. Likewise, as participants can become friends, research relationships and boundaries need to be carefully negotiated. And lastly, when using a method that helps to build rapport and relationships valuable for research, at the end of a project it can be difficult to say goodbye (and it was particularly hard to say goodbye to the many pleasures of group walking!).

There are many other contexts where mobile ethnography could contribute to health research, including but not limited to other physical activity and sustainable travel interventions. Why not give it a try?!

*Anonymised using pseudonyms

Eradicating poverty through empowerment: what’s the responsible thing to do?

Posted by Stephen Crossley, Senior Lecturer in Social Policy, Northumbria University

On this day, 17th October, in 1987, at the instigation Father Joseph Wresinski, the founder of ATD Fourth World, an anti-poverty movement, around 100,000 people congregated in Paris to honour victims of poverty, hunger, violence and fear. Five years later, and following the death of Father Wresinski, the United Nations announced the day as the International Day for the Eradication of Poverty, and published a resolution by the General Assembly that, amongst other things, ‘invited all states to devote the day to presenting and promoting, as appropriate in the national context, concrete activities with regard to the eradication of poverty and destitution’.

This year is the 27th anniversary of that resolution and the theme of this year’s observance is ‘Acting Together to Empower Children, their Families and Communities to End Poverty’. Themes such as this matter. How people in poverty are spoken about has consequences for how they are viewed, and the solutions that are put forward to address poverty. Discourses of empowerment are often used by governments and service providers to encourage people to view themselves as active agents with the ability, if not the responsibility, to change their circumstances for the better. This reflects attention away from what governments themselves can do.

In an examination of ‘dimensions of family empowerment’ within the ‘troubled families’ discourse in England, Sue Bond-Taylor (2014) highlights the merging of empowerment talk with encouraging families to take responsibility for both their situation and the improvement of it. This occurs not only in the ‘troubled families’ discourse, but also in the practices of family workers, suggesting that families are empowered ‘only in so much as they are compliant and accept the normalising discourses of the services through engagement with their agendas for change’ (2014: 12). She argues that families’ participation in the programme ‘merely legitimates existing power relations under a veneer of empowerment discourses’ (2014: 8). 

In another similar research project examining how education services engaged with disadvantaged families, Fretwell et al (2018: 1056) highlight how a project exhorted parents to take greater responsibility for the educational performance of their children and to take measures to address it. Notions of empowerment were deployed, particularly when discussing employment:

This aspect of the programme was couched in a discourse of empowerment. The parameters of choice are firmly circumscribed, though. Parents can choose which activities to pursue, but they are not free to choose just anything; they must make the right choices. Empowerment is thus restricted to making choices within conditional limits and is itself a strategy of government; a sanctioned means for producing the kind of active citizen demanded by neoliberalism (2018: 1056).

One of the most powerful organisations in the world
is encouraging us to 'act together' to end poverty 

It is therefore interesting, perhaps even worrying, to note that one of the most powerful organisations in the world, made up of over 190 national governments, is encouraging us to ‘act together’ to ‘empower children, their families and communities to end poverty’, as if the responsibility for ending poverty lies primarily with ‘us’ as individuals or with the people experiencing poverty. Not only are impoverished groups expected to deal with and be ‘resilient’ about their own hardship, and the problems that come with it, but they’re now also expected to be the solution. Nelson Mandela argued powerfully that overcoming poverty was an act of justice, not a gesture of charity, and John Veit-Wilson (2000, 144) has noted that the responsibility for ending poverty ultimately rests with governments:

“Ensuring that all the members of society, residents in or citizens of a nation state, have enough money is a clear role which governments can adopt or reject, but they cannot deny they have the ultimate power over net income distribution.”

It is shameful that this is where we are at in 2019. Poverty continues to exist because of political and economic decisions, by powerful groups, regarding the allocation of resources, both nationally and globally. Impoverished communities lack political power because they lack economic power. Nobody feels the need to empower millionaires or politicians to take greater control of their lives. Perhaps if we increased the economic power of those living in poverty, we might find that they were more fully able to participate in society and there might be less need for ‘empowering’ projects and services. That would be the responsible thing to do.


Stephen is currently working with Kayleigh Garthwaite (University of Birmingham) and Ruth Patrick (University of York) on an online project exploring representations of people living in poverty in the UK. This blog also appears on their website www.whatstheproblem.org.uk



References:

Bond-Taylor, S. (2015) Dimensions of Family Empowerment in Work with So-Called ‘Troubled’ Families, Social Policy and Society, 14 (3): 371-384. DOI: https://doi.org/10.1017/S1474746414000359

Fretwell, N., Osgood, J., O’Toole, G. and Tsouroufli, M. Governing through trust: Community‐based link workers and parental engagement in education, British Educational Research Journal, 44 (6): 1047-1063. DOI:  https://doi.org/10.1002/berj.3478

Veit-Wilson J (2000) Horses for Discourses: poverty, purpose and closure in minimum incomes standards policy. In: Gordon D and Townsend P (eds) Breadline Europe: The Measurement of Poverty. The Policy Press, Bristol, pp 141-164. https://policy.bristoluniversitypress.co.uk/breadline-europe

The website for the International Day for the Eradication of Poverty can be found here:
https://www.un.org/en/events/povertyday/

Images:

1. Courtesy of the United Nations Department of Economic and Social Affairs: https://www.un.org/development/desa/socialperspectiveondevelopment/international-day-for-the-eradication-of-poverty-homepage/2019-2.html
2. 'I like the campaign so far, Bob- I've already made my poverty history' by David Austin via University of Kent, British Cartoon Archive (Reference number: 86494, Published by: The Guardian, 02 July 2005, with thanks to Copyright holder: Janet Slee): https://archive.cartoons.ac.uk/Record.aspx?src=CalmView.Catalog&id=86494

Research journey for hospice evaluating its innovative dementia care

Posted by Nicola Kendall, Namaste Lead, St Cuthbert’s Hospice and Dr Sonia Dalkin, Senior Lecturer in Public Health and Wellbeing and Lead of the Fuse Healthy Ageing Research Programme

To celebrate World Hospice and Palliative Care Day, we wanted to share part of St. Cuthbert’s Hospice’s research journey, in collaboration with Northumbria University. Specifically, we wanted to share some of the innovative activity that has been taking place in practice surrounding ‘Namaste Care’ and the evaluation of it with Fuse funding.

What is Namaste Care?

As dementia progresses, family carers describe a changing relationship and sense of loss, which can cause significant distress. Finding new ways of communicating is important to help the family carer and person with dementia to maintain a good quality of life. ‘The End-Of-Life Namaste Care Program for People with Dementia’ (Namaste Care) challenges the perception that people with advanced dementia are a ‘shell’, a ‘living death’; it provides a holistic approach based on the five senses. Early evidence suggest that it can improve communication and the relationships families and friends have with the person with dementia.

How has St. Cuthbert’s Hospice used it?

St Cuthbert’s Hospice in Durham has started to provide Namaste Care in the person’s own home, as opposed to its more traditional use in care homes. We train volunteers who are then matched with a person with dementia, in terms of personality, abilities and interests, for example. Volunteers visit the person, usually weekly for two hours and try to build a bond with the person living with dementia and the family.

Why did we want an evaluation?

Evaluating Namaste Care has proved challenging for many organisations. It is straightforward to measure reduced number of falls, less infections and reduced agitation, but teasing out the nuances of why the approach works requires more detailed study. Also, we were aware that our use of Namaste was somewhat novel, with only one other hospice in the UK implementing Namaste Care in people’s own homes. A team at Northumbria University, led by Dr Sonia Dalkin applied to the Fuse Pump Prime fund and was successful in attaining a small pot of funding to do some preliminary evaluation of our use of Namaste Care.

What did the evaluation find?

The preliminary research found that when used in people’s own homes Namaste Care has positive outcomes, such as increasing engagement and social interaction. Previously, social interaction had potentially been overlooked in the literature as an important outcome of Namaste Care. This was particularly important for carers who felt that their loved ones with dementia often didn’t have any interaction with others, beyond those living with them. The importance of matched volunteers was also highlighted, and special relationships were built between volunteers and the person with dementia. Family members would often use the time when the volunteer was present as respite as opposed to taking part in the session, and this highlighted interesting perspectives on their involvement in Namaste. The evidence suggested that those who care for a person with dementia at home provide continuous care and have little input from other services, therefore provision of two hours contact with a trained Namaste Care volunteer allowed them to concentrate on other things, knowing that the their loved one was in safe hands. This is in contrast to the usual delivery of Namaste Care in care homes, where family members may feel more able to get involved as they do not provide continuous care.

What next? 

Book for organisations and carers
interested in using the approach

• Delivery of Namaste Care in various settings
The ethos of the Namaste Care approach has proved transferable into various care settings at St Cuthbert’s hospice. We now run a Namaste inspired ‘Potting Shed’ Men’s Group and we deliver Namaste Care at the bedside in an acute hospital. We are also in the early stages of discussions about taking Namaste Care into prisons, either via staff training or training prisoner buddies. We are very proud to say that due to this and other work we have been shortlisted as finalists for ‘Best Team Award’ in the 10th National Dementia Care Awards 2019.

• Spreading the word
The Hospice has developed a training programme which is steadily gaining popularity. Nicola Kendall (Namaste Lead) has also written a book as a guide for other organisations and carers who are interested in using the approach: ‘Namaste Care for people living with advanced dementia - A practical guide for carers and professionals’. The book is now available from Jessica Kingsley Publishing.

• Research
Nicola has just attended the Namaste Care International Conference and continues to take Namaste Care from strength to strength at St Cuthbert’s Hospice. We are now planning to further evaluate our work, building on the findings of the preliminary evaluation and the guide book… Watch this space!

Policy, procedure, practice and plate-spinning - how to achieve a work-life balance

Posted by Susanne Nichol, Better Health at Work Award Programme Coordinator, Northern TUC

I regularly wish for an extra hour in the day, or a day in the week and I even more regularly feel like my frenetic movement from place to place whilst grabbing various coats, bags, children, laptops, papers and other extraneous articles is accompanied by the Benny Hill theme tune. And I know that I am absolutely not alone in this daily plate-spinning, multi-tasking blur that is reality for the vast majority of parents, carers – and well, everyone else!

However, I am fortunate to work for an employer that has a raft of measures in place to help me restore some balance. For example, having flexi-time means I can get a much needed hit of endorphins by going to the gym or out for a power-walk on my lunch hour, or before I have to sprint through the school gates lest my youngest child becomes an accidental boarder.

The Better Health At Work Award (BHAWA) is a regional flagship public health programme that is the result of a long-standing (currently celebrating a decade of making workplaces healthier), progressive partnership between 11 of the regional local authorities. This was evaluated in 2012 by Durham University, received a RAND Europe award in 2018 for its impact on health and wellbeing, and due to cross-organisational working between Local Authority specialist public health practitioners, academics and Fuse, was a featured element in the Prevention stream of the recently awarded regional NIHR Applied Research Collaboration (ARC) funding.

As BHAWA Coordinator I have contact with literally hundreds (currently over 400) workplaces across North East England and Cumbria, who cumulatively employ nearly a quarter of a million workers. One of the mandates of the BHAWA is that participants survey their staff biennially (at a minimum) and ask them what topics/ issues they’d like to see addressed or get more information/ support on and more often than not, work-life balance is ubiquitous in the top 5.

To me, this presents more of a challenge for both employer and employee than some of the other regular top 5 entries such as healthy eating, physical activity and mental health. Work-life balance encompasses all of those things and more, and whilst the application of all health topics is subjective, this even more so, as we all have our fulcrum in a different place – with a large measure of economics thrown in. Most of us would like to work less time for the same pay, but currently business demands and finances often make this unviable; conversely, whilst going to 3 days instead of 5 might give you perfect work-life balance, most of us wouldn’t be able to sustain a 40% reduction in salary.

Unfortunately, there is no quick fix or magic wand. However, there are multiple ways and means to mitigate work-life imbalance and to actively facilitate a redress in the right direction. The BHAWA takes a holistic approach to workplace health that emphasises making positive changes to all aspects of the workplace, from the infrastructure and logistics, to the pervading culture of staff and management engagement and interaction – and everything in between.

So, how do they do it and what does ‘good’ look like? Well, based on my six years of experience I can safely say that the best employers take a wholesale approach and embed health and wellbeing into the holy workplace triumvirate of policy, procedure and practice.

It all starts with having fit for purpose policies in place, specifically such as Flexible Working; one of our workplaces operates a best practice ‘Adult Working’ policy, which is uber-flexible, employee-led and based around a mutually trusting relationship, so if Costa is a conducive place for them to deliver their work in between school-runs or meetings, then so be it. More and more participants are also introducing ‘stuck not sick’ policies that allocate a bank of ‘reserve’ hours that people can use to deal with unexpected issues, such as an ill child or a flooded kitchen.

Then there are underpinning procedures like regular and supportive line management, meetings/1-2-1s that start with the question ‘How are you?’ which allows for an open dialogue and an easier conversation around any issues and hopefully a subsequent resolution. But, what is of paramount importance is the active implementation of policy and procedure. If an employer has the best policy in the world, yet nobody actually knows about it, then it’s not worth the paper it’s written on. Awareness, buy-in, good communication/training and a practical approach is imperative here.

Having managers who are properly supported to understand and apply the policy in practice is fundamental. They can do this in various ways; by advertising jobs as flexible from day one, supporting a range of flexible working options such as home-working, flexi-time, or compressed hours; reminding colleagues that they can (and should) take their lunch break/leave and can attend medical appointments or workplace campaigns or activities like on-site flu jabs, or a lunch-time yoga class, without it being detrimental to pay.

One thing is for certain - work-life balance is for life and not just for a week



Image:

1.  'plate spinning' by Clancy Mason via Flickr. Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0): https://www.flickr.com/photos/clancy123/1805082629
2. 'I'm working through my lunch hour. Work - life balance survey' by David Austin via University of Kent, British Cartoon Archive (Reference number: 84983, Published by: The Guardian, with thanks to Copyright holder: Janet Slee): https://archive.cartoons.ac.uk/Record.aspx?src=CalmView.Catalog&id=84983

This is my truth, now tell me yours

National Poetry Day was launched in 1994 with the aim of inspiring people to enjoy, discover and share poems.

To mark this year's event on the theme of Truth, we issued a challenge to our followers on Twitter @fuse_online to write a poem about public health research.

Below are the literary masterpieces we received!



Wordsworth's Work-Balance

Mark Green, Senior Lecturer in Health Geography, University of Liverpool
@markalangreen

I wondered lonely as a cloud,
Over the summer where I found,
That working was not always for me,
Papers and grants failed to bring me glee.

So I chose to work a little less,
And I admit I must confess,
I’ll write a little less this year,
But be happier, and smarter, without that fear.



Changing the story

Emma Halliday, Senior Research Fellow, Lancaster University
@halliday_e

Illustration © Joe Decie 2018

We were ranked deprived,
left behind, always maligned;
that place - nobody moved to.
Public health called time
on booze and smoking islands.
Newspapers traded fears of
crime and wild west violence -
no one counted the human cost
or listened to the local voice.
When did reality get so lost?

So, the community took control
of a more powerful story -
it started with a conversation
about the decisions they’d make
to improve their place;
what they wanted to change
to reclaim this space.
Now, carnivals attract crowds,
lanterns of hope light the town;
residents fight back with pride.

These days, when they label us;
we don’t believe what they say.

A poem inspired by the Communities in Control study



Buckfast Free Zone

John Mooney, Senior Lecturer in Public Health, University of Sunderland
@StandupforPHlth

Once upon the Tyne, there was disorder, there was crime,
Cos’ everyone was pickled on the bevvy,
But that all came to grief,
When the Police and the Council Chief,
Introduced a top-up charging late night levy!

Now stags and hens all go tae Durham
Cos’ there’s nothing left here ‘fur them’
An all-night drinking parties have been banned!
They've installed the impact zone on their google map and phone
And the Toon’s the safest city in the land!



A poetic reflection on Public health alcohol policies in Newcastle, which have included the introduction of a late night levy and a cumulative impact zone for alcohol licences. 

Extract from my Stand-up comedy set: ‘Buckfast Free Zone’ performed at The Stand Comedy Club as part of Bright Club Newcastle. 

Actions bring risks

Posted by Llinos Mary Jehu, Research Associate with AskFuse, and Pat Watson, Research Fellow, Teesside University

We all know that. At a time when many of us are returning from holiday (or conference), we can reflect on the risks we took, like driving to the airport or eating sea-food.

So it’s no surprise that participatory action research brings risks. Co-researchers may be exposed to the risks that academics frequently anticipate, such as risks arising from lone-working or the emotional impact of data collection and reflection. There are also risks associated with research being carried out by people who have not been trained to the level of an academic, such as confidentiality, informed consent or interviewing techniques.

I’ve been involved in participatory action research at two universities, as well as within the NHS and local government. I’ve been through university ethics and NHS ethics, jumping through hoops as we’ve recruited and trained co-researchers, often re-submitting so we can finally start collecting and analysing data. I’ve also spent a fair amount of time getting to grips with systems for paying co-researchers expenses and honoraria. It’s amazing how complicated getting agreement to give out some supermarket vouchers can be, as both the ethical risks and financial risks are apparently enormous.

For all these projects, risk was removed, reduced or managed through our training and support systems. The training sessions allowed potential co-researchers to build their understanding of what the research involved, giving them an opportunity to opt-out should they choose. The sessions also built open, trusting relationships which, very occasionally, allowed us to identify and counsel people away from the project and signpost them to other opportunities. These relationships were vital during data collection periods. We may have drunk gallons of coffee and eaten far too much cake, but frequent, informal meetings with co-researchers ensured we kept a handle on what was happening in terms of ethics, finance and lone-working.

Consequently, I was a bit thrown when AskFuse - the responsive research and evaluation service run by Fuse - received a query from Pat Watson at Teesside University. Pat’s been commissioned by Sunderland City Council to carry out a piece of participatory action research involving pregnant mums in the design, development and implementation of a project looking at how expectant mums make decisions on how to feed their babies. The university Ethics committee had asked about insurance for co-researchers, and we had to admit that no one in the AskFuse team had any examples of formal arrangements. I also had a slight concern that, given the risk-averse nature of many large organisations, such a requirement might pose an insurmountable barrier for the research proposal. Undeterred, Pat went on the hunt, with a meandering email trail that eventually reached the University’s Deputy Director of Finance and the Liability Underwriter for the University’s insurers, UMAL. To my absolute surprise and delight, they confirmed ‘that the Teesside University Employer Liability/Public Liability/Public Indemnity covers apply to all University authorised research activity’. If Ethics approve participatory action research, then the co-researchers are insured.

It’s a huge relief that we now have a tick to put in the required box, and we have an example to cite should another researcher be asked the same question. I am really impressed with the approach of the insurance company: as their website states, they ‘never shy away from difficult risks’. However, managing risk in participatory action research requires far more than ticking boxes, regardless of how important these boxes may be. An equally important tool for identifying and managing risk is the strong relationships that successful co-research depends on. These relationships require time and investment, going to where people are and being prepared to share their space. They require trust and respect; possibly not asking people to show you a receipt before you pay their bus fare and not assuming that they’ll use their supermarket voucher to buy cider.

Research tools, data collection and analysis will be different, and often better, when the research process involves or is led by people who share the same standpoint, or even are, the research subjects. Hopefully universities will continue to recognise the benefits of participatory action research, recognise that the relationships it generates are a valuable asset and tool for managing risk, and not shy away from any ‘difficult risks’ it may present.


Image: 'victorian risk assessment cartoon' by John C Bullas BSc MSc PhD MCIHT MIAT via Flickr.  Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0):
https://www.flickr.com/photos/johnbullas/7788230372

Why we need to celebrate our PostDocs

Annette Bramley, Director of N8 Research Partnership

It is no exaggeration to say that without our PostDocs, research in the UK would not be what it is today. PostDoc researchers go out into our businesses, charities and government as well as into lecturing positions in this country and internationally. However, given the increasing numbers of PostDocs in research, not matched by increasing numbers of permanent academic positions globally, there is a clear mismatch between hopes and expectations of a career in academia, and the reality. This can lead to frustration and pressure to deliver high impact outputs while at the same time having to build a life on the precarious foundations of short term contracts.

This week is National PostDoc Appreciation Week, a social campaign running from the 16th to 20th September, and an opportunity for research institutions and figures to thank those who are essential figures to their cause. With a reported four PostDocs out of 30 securing permanent academic posts with a significant research component, what does tweeting appreciation for a PostDoc prove?

Of course, saying “thank you” to our PostDocs will not solve the structural issues for this group in the sector but, I hope, it will go some way to ensuring that our colleagues across the N8 Research Partnership feel more valued and recognised for their hard work and dedication to research.

Public recognition, in particular, is important. A clear demonstration of our gratitude and appreciation, because Postdoctoral researchers make up a crucial part of the research and academic body in our universities. Nurturing and developing this talent is vital to generating new knowledge and innovation – for the N8, that means a focus on the Northern universities of our Partnership, as well as encouraging future generations of researchers in the Northern Powerhouse. We want to highlight the diversity within our PostDoc population and the vast range of contributions they make to ensuring that the N8 is a vibrant and successful research powerhouse in the North of England.

Professional researchers in their own right, these highly skilled individuals also turn their hands to mentoring, knowledge exchange, public engagement and training junior researchers and students.

Multidisciplinary research teams, like N8AgriFood, tend to have PostDoctoral researchers from a range of subject backgrounds working alongside each other. This is a fantastic career development opportunity for a PostDoc and leads to much better research outcomes for the Programme. The research benefits from bringing different perspectives and knowledge to bear on a problem; the PostDocs benefit from learning about other areas of research and the peer support that working in a larger team can bring.

One look at the #N8PostDocs hashtag on Twitter gives you some idea of the range of skills and projects that this diverse group undertakes; simply too many to list here.

But movements like this are just one aspect. This support needs to be just one stream leading to improving career structures and we have been looking at how we can tackle this for PostDocs within our universities. The ‘Prosper’ programme led by the University of Liverpool is looking at how to equip the first-time PostDoc with skills and experiences that will open up a wider range of potential careers. In time we intend for this to be rolled out across the N8.

Although more steps need to be made, we believe this is one great first step onto that ladder. But we need your help to reach out and show appreciation to the thousands of PostDocs who work in the N8 universities.

Here’s how to get involved:

• Download the Thank You poster and Thank You graphics from the N8 website: www.n8research.org.uk/celebrate-national-postdoc-appreciation-week-n8postdocs
• Fill out the poster with details of some outstanding work or contributions made by one of your team, and post a photo to Twitter 
• Or just simply post the Thank you graphic to Twitter, with a message of gratitude 
• Don’t forget to use the hashtag #N8PostDocs, and tag your postdocs!

Health inequalities in rural and coastal areas

Last November we, a team of Fuse academics, were successful in winning competitive funding from Public Health England (PHE) and given just four months to complete a rapid evidence review investigating health inequalities in older populations in coastal and rural areas. The team from Northumbria University and led by myself, consisted of Professor Katie Brittain a Social Gerontologist and Dr Sonia Dalkin Co-lead of the Fuse Healthy Ageing Research Programme (HARP). Read a case study about the review on the HARP pages of the Fuse Website.

The short timescale and vast quantity of literature made this a challenging project from the outset but the evidence was urgently needed to provide recommendations for taking an asset-based approach to reducing inequalities and promoting productive healthy ageing in rural and coastal areas. We worked closely, consulting and collaborating, with stakeholders including PHE Centre leads, Knowledge and Libraries Service, the Health Inequalities Team and Director of Public Health representatives from rural and coastal authorities. Key partners were approached from the start to recommend grey literature and case studies.

One hundred and eleven studies later the report is finally published and launched by our colleagues at Public Health England with this great blog showing how we age is strongly influenced by our environment, including where we live.

Katie Haighton, Associate Professor in Public Health, Northumbria University

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How we age is strongly influenced by our environment, including where we live

Helen Brock - Programme Manager for Adults & Older Adults at Public Health England
Dr Rashmi Shukla - Director, Midlands and East of England at Public Health England

The impact of where we live

The long-term trend in life expectancy in the UK has been upwards; however, our experience of getting older varies across the nation. Some people have good physical and mental health well into old age, whereas others become frail or ill.

How we age is strongly influenced by our environment, including where we live. For both men and women, there is a 19-year difference in healthy life expectancy between those living in the most and the least deprived areas of the country.

Whether or not we live in an urban setting can also make a difference. While many of our country’s rural and coastal areas are picturesque, they can present significant challenges to protecting the health of the local population.

Our new evidence review builds on the existing evidence and suggests that older people living in rural or coastal areas may experience specific inequalities in their physical and mental health.

With almost 10 million of us living in rural areas, and older people making up a growing number of this group, it is important to understand why these health inequalities exist so that we can help to tackle them.

The evidence review aims to provide a synthesis of the evidence to support leaders in local areas in their efforts to reduce health inequalities.

Why are there public health inequalities in rural and coastal areas?

There are several drivers of health inequalities in rural and coastal areas.

One significant factor is social exclusion and isolation. Research suggests that loneliness can increase the risk of premature death by 30%.

Rural and coastal areas can face infrastructure challenges, with many villages and small towns lacking frequent and reliable public transport and high-speed internet. Having sufficient numbers of healthcare workers and carers in certain areas is an additional problem.

However, living in a rural or coastal area also has benefits. Rural places often have a strong sense of community, easier access to green space and lower crime rates than urban areas. ONS figures indicate that a higher proportion of people living in rural areas feel a sense of belonging and safety in their neighbourhood compared to people living in urban areas. Coastal environments may also provide benefits, through increased opportunities for physical activity as well as the restorative and stress-reducing impact of blue space (water).

What can we do to reduce these inequalities?

Local government and NHS partners, alongside the voluntary and community sectors, play a key role in taking action to improve the health and wellbeing of their populations.

PHE and NICE recognise that local interventions which bring communities together are some of the most valuable in addressing rural public health challenges.

Good social relationships and engagement in community life are necessary for good mental health and can help people become more resilient. By providing and maintaining community areas, green spaces and promoting public and community transport, councils can help to create a positive local environment and tackle social isolation.

Creating communities

Community activities such as lunch clubs can encourage older people to socialise and participate in community life. Bringing groups together in a village hall or other community space also provides the opportunity to reach older people with services, helping them to look after their wellbeing.

It is important to encourage social connections and contact for those in marginalised groups, who may be particularly affected by social exclusion. Involving older men who often find it harder than women to make friends later in life and may be reluctant to engage in community activities or social groups can also be a challenge.

Men’s Sheds is a programme that provides a place for older men in rural communities to participate in physical activities and projects such as gardening, woodwork and model-building. The initiative helps older men to meet, socialise and learn new skills, alleviating social isolation and creating a sense of purpose. With over 480 Sheds open in the UK, and more than 100 in development, it’s estimated that over 11,000 ‘Shedders’ are benefitting from Men’s Sheds across the country.

Promoting physical activity and making use of natural assets

There is potential for coastal and rural areas to use their natural assets to promote physical activity and reduce social isolation, for example, through volunteer-led walking groups or outdoor activities.

‘Stepping into Nature’ is a project led by Dorset Area of Outstanding Natural Beauty using Dorset’s natural and cultural landscape to provide activities and sensory-rich places for older people, including those with dementia and their carers. It seeks to increase physical and mental wellbeing, to reduce social isolation and loneliness, and to increase confidence and motivation for people to access the countryside.

Promoting and normalising physical activity as part of the experience of daily living for older people living in sheltered housing or residential care settings can result in further benefits.

In rural Norfolk, Active Norfolk – a partnership of organisations working to encourage people to participate in sport and physical activity – trialled Mobile Me, a physical activity programme for older people funded through Sport England.

For ten weeks, Mobile Me visited 65 sheltered housing and residential care homes to encourage them to get moving through games such as bowls and table tennis. The programme helped to reduce older peoples’ sedentary behaviour and fear of falling as well as increasing overall wellbeing.

Harnessing technology

Technology can be useful for providing care services to older people in the country’s most remote areas.

NHS Highland recently trialled video conferencing in remote care homes to allow doctors to speak to dementia patients in a familiar setting without the need for extensive travel.

The technology enabled care home residents to be assessed and reviewed more quickly and monitored more regularly. Video conferencing also helped care home staff to access specialist knowledge and advice more easily, helping them to feel more confident and actively involved in their residents’ care.

However, it’s important to find a balance between remote and direct face-to-face contact that many older people value.

Supporting local areas

With advances in healthcare and a greater understanding of how healthy lifestyles, supportive communities and environments can help us to live longer, enabling older people to lead fulfilling lives for as long as possible is more important than ever.

Recognising the health inequalities faced by people in different areas of the country, including rural and coastal places, is a crucial step to ensuring that all older people have the opportunities and care relevant to their needs, no matter where they live.

PHE’s evidence review seeks to share what is known about these issues, so that through Locality Plans, local Health and Wellbeing Strategies and other mechanisms, local authorities and the NHS locally are supported to prioritise work to address the health inequalities that exist within and between coastal and rural areas.

To find out more you can read the full report: An evidence summary of health inequalities in older populations in coastal and rural areas. You can also read our rural health report produced with the Local Government Association: Health and wellbeing in rural areas, and our recent health inequalities report: Place-based approaches for reducing health inequalities.


Reproduced with thanks to Public Health England and Exposure: 
https://publichealthengland.exposure.co/health-inequalities-in-rural-and-coastal-areas


Images:

• 2,3,4 courtesy of EXPOSURE: https://exposure.co/?source=story-footer-word-mark
• 5 courtesy of Sigismund von Dobschütz [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)]