Training tomorrow’s Public Health leaders: impact, innovation and prevention

Posted by Liz Morgan, Head of School for Public Health North East, NHS England

The North East Public Health Postgraduate Specialty Training Programme holds an event annually to showcase the work that has been done by trainees over the previous year. This annual showcase highlights how public health trainees in the North East are delivering practical, high‑impact work across the health and care system, demonstrating the value of prevention-led leadership at a time of increasing system pressure. It not only celebrates the tremendous work our trainees have been doing but also provides an opportunity to share that work with public health colleagues in multiple settings During this time, our trainees will have been immersed in communities, health and health-related systems and research environments, identifying challenges, designing solutions and implementing projects that demonstrate innovation and impact. The projects presented at our last meeting ranged from heath protection and health improvement to policy development and healthcare public health. Each one reflected the commitment, curiosity and compassion that defines our public health workforce.

Tackling air pollution through NHS leadership

Most NHS Trusts in the North East employ at least one public health consultant, valuing the broad benefits that this can bring, but also providing greater capacity for public health training. Dr Laura Keast had been undertaking a placement in Northumbria NHS Trust, implementing the Clean Air Hospital Framework and demonstrated the value of collaboration between public health and sustainability teams. Air pollution remains the single greatest environmental threat to public health in the UK, contributing to an estimated 30,000 deaths annually and worsening health inequalities. By making air pollution a tangible and locally relevant issue through accessible monitoring of nitrogen dioxide levels and clear health messaging, the initiative has generated engagement and momentum for action. Importantly, the project highlighted that public health leadership, data expertise, powerful health messaging and alignment with national policy levers are critical in overcoming uncertainty and organisational resistance to change.

Reducing missed outpatient appointments for children

Dr Mark Riley presented a service evaluation undertaken at South Tees NHS Trust exploring why children are not brought to outpatient appointments, an issue with significant implications for health outcomes and system efficiency. Using surveys and follow-up telephone calls, the evaluation identified five key themes:

• appointment timing
• forgotten appointments and reminders
• administrative barriers
• health literacy
• cost of attendance.

Forgotten appointments were the most common reason for non-attendance, with parents strongly favouring clearer and more frequent text reminders. Difficulties rearranging appointments, confusing letters and limited awareness of travel cost reimbursement schemes further contributed to missed care. The findings underscore how relatively small, system-level changes, such as health-literate communications in multiple languages and flexible appointment scheduling to include evenings, can reduce inequalities and improve service use. Finding a champion in the organisation to enable change was also critical.

How leaders make difficult priority-setting decisions

As pressures on the NHS intensify, difficult decisions about how to allocate limited resources are unavoidable. Dr Tom Seasman explored how senior health leaders justified priority-setting decisions. Qualitative in‑depth interviews with leaders across the English health system show broad support for prevention and reducing health inequalities. However, when faced with real-world trade-offs, decisions often favour short-term frontline clinical care over long-term preventative investment and leaders differ in their responses. Clinical leaders often prioritise immediate need and the “rule of rescue”, while those approaching the same problem from a public health perspective place greater emphasis on maximising population health gains through prevention. Political constraints, emotional proximity to patients and fragmented funding structures frequently limit leaders’ ability to shift resources from acute care to prevention, despite widespread recognition that long-term sustainability depends on doing so. These findings raise important questions about how the health system can better support leaders to make transparent and ethical trade-offs.

Policing and public health: prevention in action

Prevention also featured strongly in work exploring collaboration between policing and public health. This is important because of shared commitments to improve lives, reduce harm, reduce unnecessary demand on services, reduce vulnerability, improve equity and maintain public trust. Since the publication of a national consensus statement in 2018, prevention has become more explicitly embedded within policing policy and inspection frameworks. A 2025 review concluded that, while the original vision remained relevant, a refreshed consensus was needed to reflect current challenges and language. Kylie Murrell led on this national project, chairing the policing and public health collaborative, leading on the re-drafting of the document and sign off and associated ministerial briefing. The work highlights both the appetite within policing to engage more fully in prevention and the ongoing need for public health professionals to support cross-sector partners to identify upstream opportunities to reduce harm, vulnerability and demand. It's also an excellent example of how our trainees have led on national initiatives.

Supporting wellbeing within the public health workforce

Alongside the ongoing system-level challenges, attention to the wellbeing of the public health workforce itself is increasingly recognised as essential. Vineeta O’Key reflected on the work the trainees had been doing to support their own wellbeing and on how a Wellbeing Away Day could demonstrate how evidence-based wellbeing approaches could be embedded within training and professional development. Grounded in the “Five Ways to Wellbeing”, the day prioritised connection, learning, physical activity and engagement with nature through volunteering with Durham Wildlife Trust. Feedback highlighted the value of protected time for relationship-building, reflection and compassionate leadership, reinforcing the role of wellbeing as both a personal and professional competency in public health practice.

Julie Lowe presented her experience of travelling to Canada and the Netherlands on a Churchill Foundation fellowship. The Foundation funds approximately 100 Fellows each year to travel overseas to explore an issue of societal importance. This project focused on community interventions to improve the health and wellbeing of unpaid caregivers, who, as a population, experience poorer mental and physical health outcomes known informally as the ‘carer burden’. She shared reflections from her own experience as a young carer and motivation for choosing a career in public health. Findings from her experience included the importance of listening to diverse groups of carers to understand their needs and preferences, and the need for interventions that reduce carer burden rather than responding to health needs as they arise.

Taken together, these projects reflect a common theme: public health impact is maximised through leadership, collaboration and a commitment to prevention, even in constrained systems. Our trainees are already having an impact in their placements and communities by shaping national priorities, supporting workforce wellbeing and building partnerships beyond health. Creating spaces like this conference where recent projects and ideas can be shared, and challenges are explored are vital and demonstrates how public health continues to be pivotal in navigating complexity and working towards more equitable and sustainable futures. I would strongly encourage all of our public educators and senior public health colleagues to attend this event. As Public Health influencers, the task of considering, adapting and altering these ideas and interventions for the benefit of the populations we serve rests with us.

Sparking curiosity with Twinkle, Twinkle Arti

Posted by Nicola Aldridge, Research Associate, and Cassey Muir, Research Associate / Co-lead of the Fuse Early Life and Adolescence Research Cluster, both from Newcastle University

We were recently given the exciting opportunity to showcase the Twinkle, Twinkle Arti project at Discover Festival, a free, one-day festival organised by Newcastle University that brings together families, communities, and researchers through interactive activities and inspiring ideas.

Nicola and Cassey

Discover Festival is designed to spark curiosity, build connections, and encourage people of all ages to explore new ideas. Each year, the university creates a packed programme of family-friendly events, and this year, we were delighted to be part of it as members of the Twinkle, Twinkle Arti research team.

Bringing Arti's story to life

Throughout the day, we invited families to step into Arti’s world through the Twinkle, Twinkle Arti storybook. Developed by Fuse researchers at Newcastle University, with funding from the NIHR School for Public Health Research, the book was created and co-produced with families to support the wellbeing of children experiencing challenging family circumstances, such as drug and alcohol use. While these experiences inspired the story, its themes of feelings, belonging, resilience, and hope resonate with all children.

Visitors to our stall in the Great North Museum had the chance to watch a CBeebies Bedtime Stories style video of it being read aloud by the author. They could also explore puppets and original illustrations from the book, and view artwork created by primary school-aged children who had participated in a pilot study of classroom lessons based on the story.

Families were also able to take home a free copy of the storybook, along with a link to the online read-aloud video and a set of simple conversation prompts designed to encourage creativity, emotional expression, and meaningful family time at home. We handed out nearly 80 copies on the day!

Conversations that matter

Beyond engaging with families, it was equally exciting to see the conversations that the project sparked among professionals attending the festival. We spoke with people from a range of sectors, including teaching, school governance, clinical psychology, and general practice with social prescribing links. Their curiosity about the project and enthusiasm for its potential applications highlighted the broad relevance of Twinkle, Twinkle Arti and the importance of creating accessible resources that support children's emotional and social wellbeing.

One particularly rewarding conversation was with a family who shared their personal experience of the impact of alcohol on family life and how they might be able to use the book. Hearing their reflections was both moving and affirming. It served as a powerful reminder of why the project began in the first place and reinforced the continued need for resources that help children navigate difficult experiences. Moments like these bring the research to life, reminding us that behind every study, storybook, and activity are real families whose experiences matter and whose voices continue to shape our work.

Creating a community star mural

Another highlight of the day was our evolving community star mural. We invited children to create their own star by drawing, colouring, or writing ideas about what they or Arti could do when they felt sad or worried, with 114 stars being created on the day. It was wonderful to see children enthusiastically embracing the activity, and even more special to watch parents, carers and grandparents join in too, talking to their children about the messages in the book. The excitement on their faces as they added their stars to the mural was a lovely reminder of the power of creativity to bring people together.

A colourful celebration of hope and resilience

By the end of the day, the mural had grown into a colourful display of hope, kindness, and imagination. It was a privilege to share the Twinkle, Twinkle Arti project with so many families and to see first-hand how children connected with Arti’s story and messages of hope, resilience and belonging. Events like Discover Festival provide a fantastic opportunity to bring research into the community, and we were grateful to be part of such an inspiring day.

Find out more about Twinkle, Twinkle Arti

• Read this Fuse blog about the development of Twinkle, Twinkle Arti
• Read about Twinkle, Twinkle Arti as a NIHR School for Public Health Research (SPHR) case study
• Read about piloting Twinkle, Twinkle Arti in primary schools
• Listen to this Fuse podcast to hear Cassey discussing her research on social and emotional resilience in children and young people affected by parental substance use.
• Download the book for free.
• Watch a video of the book being read aloud.

How to choreograph a dance between policy makers and academic researchers?

Posted by Peter van der Graaf, Associate Professor in Public Health at Northumbria University and AskFuse Research Manager

Dancing is a key move in public health, particularly if you want to make an impact with your research. Knowledge exchange is not just a science or even an art, but very much a dance between researchers and policy makers about the use of research evidence. To complete this dance successfully and get evidence used in decision making, both partners need to follow certain steps. However, learning the steps (science) or performing them perfectly (art) is not sufficient: it requires instinct and feel for where you are in the dance and why you are doing it.

To develop a dance plan for your interactions between policy makers and academic researchers, Fuse hosted a special session (or dance class) at the European Implementation Event in Basel, Switzerland on 8 June. The EIE2023 brought together over 300 implementation scientists, practitioners and funders from across health, social welfare, education and other sectors in Europe. Over two days through fishbowls, science slams, workshops, inspiring keynotes and oral presentations, participants explored how to create a new normal for implementation science in society.

Our session explored dance challenges (e.g. moving too slow, bad timing, outfit malfunctions, and unsynchronised performances) and new routines in response (see: ‘What did we learn?’ below) that we have developed in Fuse over the last 15 years collaboratively with our partners. In the session, we highlighted examples of creative communication (the art of knowledge exchange), research performance both backstage and frontstage (AskFuse), and dancing together (embedded research) to set the scene for a discussion about what makes a successful dance between policy makers, health practitioners and academic researchers. We invited conference participants to share their own reflections of dance routines they have developed to support knowledge exchange and implementation of research evidence in practice and policy making.

What did we learn? 10 dance lessons

Fuse knowledge exchange model

1. Academic researchers need to learn four basic steps for dancing with policy makers (see the Fuse knowledge exchange model):

• Raising awareness, using creative communication.
• Knowledge sharing through joint events.
• Making evidence fit for purpose (localising and tailoring).
• Supporting uptake and implementation (e.g., capacity, co-production, linking activities).

2. A deviant knowledge broker can help to facilitate backstage conversation and protect policy makers and academic researchers from missteps.

3. Go with the music: as the context and process in which evidence is useful changes constantly, it is an important skill for researchers to be able “to go with the music” based on ongoing relationships with policy and practice partners.

4. Emotional engagement between researchers and policy makers is essential to get a better feel for the music. A heart-to-heart or moaning about bad performances helps you to improve dance routines and hide missteps. Don’t forget the power of cookies!

5. Embedded research helps to develop an instinct for the dance, based on a better understanding of each other’s organisational contexts. Embedded research allows you to be part of solutions, developed with the communities affected, not just report on the effect on interventions and their implementations.

6. Public health is political; lobbying and advocacy are a core part of the embedded research roles.

Choreographing your own dance routine

We presented participants with the following questions to help develop their own dance routines: 

In response, conference participants started to develop their own dance metaphors for describing their experiences with collaborative research between academics and policymakers. Someone referred to their routines as a ‘silent disco’, where academics and policymakers were dancing to different pieces of music without knowing what the other where listening too. Other participants emphasised the need to spend time together first before you start picking music, to get a better understanding of each other’s musical tastes (classical meets punk?).

Overall, participants felt inspired to start to think more deeply about their own dance plans. How would you answer the above questions and what would your dance plan look like? 

Full house at the #EIE2023 @fuse_online Special Session! @pvandergraaf75 and Mandy Cheetham choreographing a dance between policymakers and researchers. Creative communication at it’s best! 💃🏽🕺🏼 pic.twitter.com/7ej4Kr29LG

— Leah Bührmann (@LeahBuehrmann) June 8, 2023

Things I wish I’d known when I started my PhD… (part 1)

Posted by members of the Population Health Interventions Programme at the MRC Epidemiology Unit

“By three methods we might learn wisdom: first by reflection, which is noblest; second by imitation, which is easiest; third by experience, which is the bitterest.” 

Confucius

Like most research groups, ours comprises an ever-changing cast of early, mid and senior career researchers. Our training is in a variety of academic disciplines and we all have different short, medium and long term life and career aspirations. While our experiences of public health research are naturally individual, we have noticed some commonalities. We share these here to provide reassurance to those new to the game that whatever they’re feeling is almost certainly ‘normal’. Challenging experiences are often interpreted negatively, particularly when they are first met. We propose that they can often be reassessed and reframed in ways that make them positive parts of a continuous learning and career development journey. Other people might have different experiences, this is ours…

1. Research is challenging but you’ve got this

"Piled Higher and Deeper" by Jorge Cham www.phdcomics.com

Research is certainly challenging. One of the first hurdles of the PhD will be trying to figure out how your research will contribute new knowledge to the area - this is one of the toughest challenges! Stick with it, because thankfully it does get a bit easier over time as you immerse yourself in the research and build your specialist knowledge. But even the most accomplished still find research hard. All the papers you read are from months (often years) of thinking, hard work, and negotiating multiple barriers - it doesn’t happen overnight. As a PhD student, you have the additional challenge of trying to do this in a short time frame, and it doesn’t always go to plan (which is usually out of your control). But, if good research was easy, anyone could do it.

An obvious interpretation of experiencing something as being difficult is to think that we, as individuals, are not up to it. The cycle of creativity suggests, rather glibly, that all projects are associated with a thought cycle that goes something like: this is awesome, this is difficult, this is terrible, I am terrible, this might be okay, this is awesome. We are not sure that we routinely experience the second ‘this is awesome’ stage. But push through because the ‘this might be okay’ stage always comes.

If you have been selected to pursue the PhD, your supervisors think that you are capable. You wouldn’t be on this journey if there were any real doubts about your ability. Encountering difficulties and making mistakes is normal and expected. Even those researchers you admire the most have moments of self-doubt, numerous journal and grant rejections and bad days when nothing goes right.

2. Comparison can be the thief of joy

Academic research is often experienced as highly competitive. In many ways it is. There is competition for limited research, studentship and fellowship funding; limited space in ‘prestigious’ journals; and limited podium time at conferences. This leads to the tendency to continuously compare your own work, and yourself, to others - and to experience a feeling of falling short.

It’s worth pointing out the selection bias present in the successes others share, and how most of the time we’re not seeing the full picture. Despite knowing this, we understand it is sometimes hard to see everyone else seemingly thriving, while you feel you’re just about surviving! Keep in mind that everyone’s PhD is different, and our successes will run to different timelines. And remember, you bring to your PhD your own unique skills and experiences. We’re confident that others are comparing themselves to you, too…

However, rather than continuously comparing yourself to others, we recommend trying to learn from them. If others appear to be succeeding where we are not, what, if anything, can we learn from their approach? Sometimes this will lead to the conclusion that there are better ways of doing things. Other times it might lead to the conclusion that the sacrifices required to achieve a particular outcome are not something we as individuals are willing to make. Or, indeed, that the outcome is not something we want.

We suggest being clear about what our own success criteria are and trying to stick to judging ourselves by those alone. These criteria can be set alone or with others in the context of formal or informal regular appraisals and personal review. At the risk of getting too SMART*-arsed, they should, at a minimum, be realistic.

Rather than interpreting others’ achievements as indicators of our own lack of success, we propose embracing and celebrating them. Informal and formal research group meetings achieve many things, but we see the sense of community that they build amongst ourselves as one of the most important. By embracing each other’s achievements we can support and build each other up, rather than letting comparison get us down.

 

Channel your inner Arsène - "Le Professeur"

3. Research is a team sport and you’re the boss

Completing a PhD might be seen as a lonely, individual pursuit. But while the end result is your own, you aren’t alone on the journey. In fact, research is a team sport.

Your home team is the one you share with your supervisor(s), and you’ll revel in the highs (and lows) of your PhD experience together. In this team you’re the captain. Lead from the front and manage your supervisors by communicating clearly with them, arranging supervision meetings and keeping them up to speed with your progress. As the captain, you make the final decisions related to your research and you are responsible for defending them. If you don’t agree with your supervisor then you should say so, and explain why. Your supervisor doesn’t want you to nod along, as the idea is to learn from each other and make better research (i.e. win) as a team. This can often feel really hard, especially early on while they’re still the experts, but they expect you to take the lead.

In other teams to which you’ll belong, you might play a different role but still make an impact. For example, you might run a writing group, attend group meetings or present in a seminar series; these are all important aspects of teamwork and becoming a valued member of the research community. You are also a member of teams that are less obvious. You probably aren’t sure now how the Facilities or IT department are going to help you achieve your PhD, but when you need a new chair or an obscure software package installed, be glad that you have them as teammates.

In part 2 next week: learning how not to take things personally, life isn't all about the PhD, bad things may happen that are not okay, and enjoying every step of the journey.

Authors: Catrin Penn-Jones, David Ogilvie, David Pell, Dolly Theis, Emma Lawlor, Hannah Forde, Jean Adams, Jenna Panter, John Rahilly, Kate Ellis, Martin White, Matt Keeble, Nina Rogers, Rich Patterson, Roxanne Armstrong-Moore, Tom Burgoine, Yuru Huang

*SMART Goals: Specific, Measurable, Assignable, Realistic, and Time-related

Images:

1. "Piled Higher and Deeper" by Jorge Cham www.phdcomics.com

2. Mr. Alexander Ottesen, CC BY-SA 2.5 <https://creativecommons.org/licenses/by-sa/2.5>, via Wikimedia Commons

Working together to tackle inequalities and inactivity

Posted by Sophie Phillips, Fuse & NIHR School for Public health Research (SPHR) funded PhD Researcher, Department of Sport and Exercise Sciences, Durham University, and Dr Rachel Mowbray, Insight Coordinator, County Durham Sport, Active Partnership.

In today's Fuse blog post, Sophie and Rachel tell us about collaborating during Sophie's secondment at County Durham Sport between January and March 2021.

It seems obvious that we would work together, right?

I conduct research in an academic institution and Rachel promotes evidence-based working in an Active Partnership which collaborates closely with Durham County Council. Our day-to-day roles are quite different. But, we have a shared goal: to tackle inequalities that stand in the way of physical activity engagement and support children and adults to be more active. By working together, combining knowledge, skills, and connections, we think we can make even greater progress towards improving people’s health and wellbeing.

How is academic research positioned within the physical activity landscape?

Physical activity policy and practice is a large and complex system made up of many different organisations, approaches, and settings. Academia is often positioned as external to the system, trying to create impact from the outside through activities referred to as ‘pathways to impact’. But in reality, academic research could be a crucially important element of the system in its own right (but often doesn’t have that position). Can positioning academic research as part of the system (as opposed to outside the system) make creating impact less of a hurdle and more of an opportunity?

Through my secondment to County Durham Sport, academic research has been embedded into the local Active Partnership. This gave me a huge opportunity to make an impact (on a daily basis!) by simply talking to others in different parts of the system. By sharing my knowledge and passion through conversations, I felt like I could make a real difference. Sharing information and ideas can challenge and influence thinking. This can (and does) influence the way things are done.

What are the benefits of an embedded researcher in policy or practice?

Rachel: Non-academic audiences often cannot access academic publications in meaningful ways because of financial barriers and/or because of the academic format. Having Sophie embedded in our organisation brought academic research to life and into the conversations happening between practitioners, policy makers, and non-academic researchers. These conversations allowed us to access the most up-to-date and robust information about physical activity. In the same way, County Durham Sport were able to offer extensive knowledge of the local physical activity system and inequalities. Working together, we created a stronger evidence-base on which to tackle the challenge of inactivity.

Sophie: I was able to communicate knowledge from academic research papers on physical activity into meaningful insight for County Durham Sport. One of the pieces of work I conducted during the secondment was a report on early years physical activity and movement. This included translating evidence from academic research papers into meaningful and accessible outputs (including reports, overviews in tables, and presentations). I was also able to engage with different stakeholders and physical activity providers across multiple settings, who are involved with local early years provision. This helped to bring together both the research evidence and the current local landscape, to make evidence-based and actionable recommendations about future early years provision.

Take-home messages from our collaborative experience…

Our day-to-day roles are very different, as are the expectations and outcomes of our work. Although this presents some challenges (such as differing timescales and required outputs), ultimately, we share a goal - to tackle inequalities that stand in the way of physical activity engagement, support everyone to be more active, and help to improve people’s health and wellbeing. Finding this common ground can foster true collaborative thinking and drive connections between academic and non-academic players in the physical activity system. Integrating our different perspectives and approaches is beneficial and necessary to create meaningful system change.

Rachel: Tackling big issues (like inequalities in physical activity) requires a collaborative and evidence-based approach. I would encourage other third sector organisations to engage directly with academic researchers - both to learn from their expertise, and to share your own experience of practice or policy. We can achieve more working together than we can alone!

Sophie: My experience of collaboration with County Durham Sport has been invaluable. It has influenced the way I think about conducting and communicating research. I would encourage other public health research PhD students to explore the opportunities of engaging in a short time with policy and practice partners in their field, to help view their work from different angles.

Sophie’s academic research is about measuring the physical activity and movement behaviours of pre-school aged children. Her secondment at County Durham Sport was funded by UK Research and Innovation (UKRI) QR Strategic Priorities Fund awarded through Durham University.

Rachel promotes evidence-based partnership working to tackle inequalities in physical activity through her role with County Durham Sport, Active Partnership funded by Sport England.

Images:

1. Jonathan Greenaway on Unsplash

2 & 3. Photo of Rachel (https://www.countydurhamsport.com/about-us/meet-the-team) and Sophie (https://www.countydurhamsport.com/homepage/news/) with thanks to County Durham Sport.

Four practical steps to increase knowledge exchange between researchers and policymakers

Posted by Peter van der Graaf, NIHR Knowledge Mobilisation Research Fellow, Teesside University

Are you keen to have impact with your research but get lost in all the knowledge exchange frameworks and models that are out there? In this blog, Peter calls upon 10 years’ experience working in translational public health for Fuse to identify four practical steps to develop collaborative research and achieve meaningful change in policy and practice.

We know all about the challenges of using research to inform policy and practice, especially in public health where the evidence base for interventions or programmes is patchy or contested. In response to these challenges, countless models and frameworks have been developed that try to define the knowledge exchange process (how research evidence can be used, in combination with other types of knowledge, to change policy and practice). Practitioners and researchers venturing into the field of knowledge exchange can be bewildered by the options available which don’t go beyond concepts and fail to describe in practical terms what research translation looks like in reality.

Here I want to share practical guidance from our research on ‘how to do’ knowledge exchange by reflecting on a model that has been developed in Fuse over the last ten years. Our approach to achieving practice and policy change has been to engage with practitioners, policymakers and the public through communications and knowledge brokerage, to co-create relevant research, influence policy and practice debates and promote evidence uptake. Below I have broken this down into four practical steps:

• Step 1. Awareness raising: Making evidence users, funders and support organisations aware of our existence, our research and engagement opportunities, including engaging our partners early in setting the agenda for future research.
• Step 2. Sharing knowledge: Creating opportunities for research users and producers to come together to explore opportunities for mutual learning and knowledge exchange through collaborative events, our responsive research service (AskFuse), and patient and public involvement.
• Step 3. Making evidence fit for purpose: Localising and tailoring evidence to context by offering a knowledge brokering service, embedded research, and increasing awareness of the different pressures faced by people in health policy, practice and academia.
• Step 4. Supporting uptake and implementation of evidence: Developing long-term relationships with policy and practice partners to co-create evidence, build capacity for practice change, and change practice and policy.

It is important to link a range of knowledge exchange activities that engage policymakers and practitioners at different levels, intensities and points in their decision-making and development processes.

For example, before meeting with policy and practice partners, we develop tailored research briefs that summarise study findings in an accessible and visual way, and that emphasise recommendations and implications for policy and practice. Involving Fuse researchers in developing these briefs improves their knowledge exchange skills, while providing them with ‘calling cards’ to initiate relationships with policymakers for further collaborative work. These conversations are often followed by requests to AskFuse on how knowledge users can apply the research evidence in a specific context, invitations to engage in collaborative research, or to support capacity building and implementation.

Knowledge exchange between academia and public health practitioners and policymakers can be complicated and at times bewildering. Breaking the process down into practical steps illustrates that knowledge exchange is empirical and relational.

The long and winding (and emotional) road to impact

Posted by Mandy Cheetham, Research Associate, Teesside University

Having submitted written evidence to the Work and Pensions Select Committee inquiry on the impact of the 5 week wait for Universal Credit (details here), I had not anticipated being invited to give evidence by Zoom to a panel of MPs in the midst of lockdown. The evidence submitted (available here) drew on qualitative research into the experiences of claimants in North East England (Cheetham et al 2019) and quantitative research showing the mental health impact of Universal Credit, undertaken by colleagues from Liverpool University (Wickham et al 2019). Dr Sophie Wickham and I were both invited to be part of a panel for the second evidence session. I had watched the first evidence session to see the lines of inquiry pursued, realising (with dismay) it was available live on parliament tv.

As witnesses, we had been given a broad indication of the areas on which MPs would focus their questions. These included the effects of the 5 week wait, its impact on mental health, and our thoughts on what could be done to mitigate the adverse effects. I had read and re-read our research paper, digested more recent reports and published literature and carefully prepared my responses to the anticipated questions. I had emailed colleagues in local advice organisations to see if the issues identified in the research were still relevant. I had a chat with a university colleague who had given evidence to a different committee drawing on our research on energy drinks 2 years previously. A final check that the technology worked in a test call the afternoon before and all was set.

Following advice from the friendly and efficient clerk of the committee, I had moved my laptop away from the background distractions of grandchildren’s Batman costumes and toys. I woke up early on the morning of 17 June feeling nervous with anticipation. ‘Trust you know enough’ were the calm words of advice offered by one committee official.’ ‘Stick to the evidence; be focused and don your cloak of authority’ came texted advice from a senior academic colleague with a good luck message. I have a tendency to talk too much when I’m nervous, and knew I needed to avoid waffling, so this was a helpful reminder. But I wasn’t sure I had a suitable cloak of authority handy.

In the event, the preparation paid off. I stuck to my bullet points and weaved in quotes from participants when I could. It wasn’t perfect and there’s always more to say. I’m not sure it’s possible to do justice to the harrowing experiences which had been shared by research participants, but I tried. There is a big focus in academia on impact, and I sometimes feel limited recognition of the time and multi-layered approaches needed to achieve it. Immediately after the evidence session, which lasted an hour, I was contacted by a journalist from the Independent asking about a paper I had mentioned in my evidence. Within an hour the Sun online quoted our evidence in an article supporting their campaign to make Universal Credit work.

Evidence is clearly not the only, or the most important deciding factor in the messy world of policy making. I believe we need to use a combination of political levers of influence at our disposal to affect changes when opportunities present themselves. This felt like a huge moment. The priorities and timeframes of academia and policy making do not always align. The study I was reporting grew out of embedded research with community members in Gateshead who talked about their fears about Universal Credit being rolled out in 2017, fieldwork was undertaken April – October 2018, written up and paper submitted in November 2018 and published in 2019. Following the select committee, a colleague posted links to the evidence session on the Facebook pages of organisations who had supported the research for community members to see. It felt right to let participants know what had happened.

Since 2018, we have shared the research findings at numerous conferences and with Department for Work and Pensions staff, but with limited effect. COVID-19 has prompted temporary changes to be made to Universal Credit, which will help. My experience in the shielding hub demonstrates how many families claiming Universal Credit, particularly those with children, continue to struggle with the additional costs of lockdown. Last month, Therese Coffey announced the re-instatement of conditionality requirements and sanctions, which will add to Universal Credit claimants’ stress at a time of economic insecurity, rising unemployment, unprecedented job losses, and anxiety about the future. Even a global pandemic can’t halt political will it seems.

In my view, public health is political. Lobbying and advocacy are a core part of our role, particularly when government policy has such a crucial role to play in addressing inequalities. We need to continue to highlight the harmful impacts of policy on particular groups and be part of the process of informing solutions. Researchers need to seek out these opportunities for ‘academic activism’ (Askins 2009) to help shape policy. We need to provide training and support to academics at all levels, and accept the emotional investment these efforts require. After all, the drive to impact is fuelled by emotional as well as scientific engagement with our subject matter.

Reference:

• Askins K. (2009) ‘That’s just what I do’: Placing emotion in academic activism Emotion, Space and Society doi 10.1016/j.emospa.2009.03.005

Images:

1. Screenshot taken from parliamentlive.tv: https://parliamentlive.tv/event/index/5d5e46b8-c323-4a64-8bca-53e2ed17cb4f 16/07/2020
2. Screenshot taken from The Sun website: https://www.thesun.co.uk/news/11883566/universal-credit-wait-12-weeks-severe-hardship 16/07/2020

Covid-19 and the legacy of Edward Jenner: a tale of two pathogens

Posted by Lesley Haley, AskFuse Research Associate, Teesside University 

2020 is going to be a momentous year in world history as the year that the Covid-19 pandemic changed all our lives.

Edward Jenner, English physician who discovered the smallpox vaccine

Coincidentally, this year also marks the 40th anniversary of a significant historic milestone for another deadly disease, but in this case, one which maimed, killed and shaped global history for the past three thousand years (Flight 2011). That disease was smallpox.

On the surface, there is nothing in common between a dead disease and a newly emerging one. But there are some aspects of the history of smallpox that resonate with the unfolding story of the Covid-19 pandemic.

Smallpox was still a killer when I was vaccinated against it in 1967 as part of a routine public health intervention, although it was no longer endemic in the UK. For my mother’s generation, the reality of smallpox was very stark. She experienced the panic of an outbreak in her home town of Glasgow during the war when she was only 10, and again when she was 16, when smallpox killed front-line staff treating infected patients at the local hospital.

Although in 1967 outbreaks in the UK of smallpox were getting rarer, the worldwide picture was very different. Smallpox was still endemic in many countries, maiming and killing an estimated 10-15 million people a year (Baxby 1999). This was despite the fact that Edward Jenner had first introduced a prototype inoculation against smallpox in 1798, had translated his theories and ideas into practice, and had a huge impact during his lifetime (the academic dream!).

One aspect of Jenner’s life and work bears closer scrutiny in light of the current Covid-19 pandemic, and particularly on the emerging debate surrounding the development of a new vaccine. During his lifetime, Jenner made his research, his ideas and his smallpox inoculations freely available to everyone, irrespective of who they were (Baxby 1999). Jenner and his contemporaries appreciated the commercial opportunities of his discovery, but he continued to give free inoculations to everyone who approached him at his surgery, despite the detrimental financial impact this had on his personal and professional life (Britannica 2020). He understood exactly what the implications of his discovery meant for the common good.

So if Jenner’s work was freely available, (and although certainly not perfect), why was smallpox still endemic in some countries in the world in 1967? Millward (2019) proposed that one of the main issues had been the lack of global “joined up thinking” in the approach towards smallpox eradication. It took until 1967 for countries where smallpox was not endemic to realise that they would always be at risk of continual and increasing numbers of smallpox outbreaks, if the disease was still endemic in other parts of the world. Wherever in the world there was smallpox outbreaks, it caused mass panic, strained public health systems to the limit, maimed and killed, and even had economic impacts on national and international trade and travel (Millward 2019). It therefore became in every countries' interest to support a systematic, unified and global approach to smallpox eradication. Under the auspices of the World Health Organisation (WHO), the global strategy of surveillance, containment and vaccination free at the point of delivery and irrespective of ability to pay, worked. In 1980, the WHO declared the world free from smallpox (Baxby 1999) and it became the “first disease to be controlled by immunisation, the first to be eradicated” (Baxby 1999).

So what will historians say about the story of Covid-19? What will be the role of the global community in tackling the Covid-19 pandemic? Will Jenner’s altruistic example of free and accessible vaccinations be consigned to the history books in the 2020 global race to develop a lifesaving Covid-19 vaccine?

On the global front, 4 May 2020 saw world leaders, the UN, research institutions and philanthropic organisations pledge resources to find a vaccine for Covid-19 (albeit with the ominous absence of two major world powers) (BBC 2020). And the race for a vaccine has sparked debates on who, where, and how people would access a Covid-19 vaccine, with speculation for example, that pharmaceutical companies may have to change their business practices (Chu 2020). In the history of smallpox in the UK, vaccine stockpiles were held by private businesses, highlighting “that public health resources were not always in public hands” (Millward 2019, p. 64).

Global businesses have also contributed to an “Open Covid Pledge, “to make intellectual property available free of charge for use in ending Covid-19 pandemic and minimising the impact of the disease” (Open Covid Pledge 2020).

When global powers pulled together for the common good, it took just 13 years to rid the world of a disease that had killed millions across the continents of Africa, America, Australia, Asia and Europe in its 3000 year reign of terror. Prior to that, without global unity and treatment free at the point of delivery, it took 169 years. I wonder what Edward Jenner would have thought?

So as our Covid-19 story unfolds in 2020 and beyond, I wonder how future generations will judge the actions and decisions of our current global leaders and businesses?

References:

1. Flight, C (2011) Smallpox : Eradicating the scourge. BBC History. Last updated 17 Feb 2011. Available: https://www.bbc.co.uk/history/british/empire_seapower/smallpox_01.shtml Accessed: 05 May 2020.
2. Baxby, D (1999) The End of Smallpox. History Today Vol 49 Issue 3. Available: https://www.historytoday.com/archive/end-smallpox
3. Britannica (2020) Edward Jenner. Available: https://www.britannica.com/biography/Edward-Jenner Accessed: 6 May 2020. 
4. Millward G (2019) “Smallpox” Vaccinating Britain: Mass vaccination and the public since the Second World War, Chapter 2. [Internet]. Manchester (UK): Manchester University Press; 2019. Chapter 2. Available: https://www.ncbi.nlm.nih.gov/books/NBK545998/#!po=98.8688 Accessed: 5 May 2020. 
5. BBC News (2020) Coronavirus: World Leaders pledge billions for vaccine fight. Available: https://www.bbc.co.uk/news/world-europe-52525387 Accessed: 5 May 2020. 
6. Chu, B(2020) “To find a vaccine for coronavirus, pharmaceutical companies will have to Adamson the race for profit”. The Independent. Available at: https://www.independent.co.uk/voices/coronavirus-vaccine-uk-pharmaceutical-companies-patent-monopoly-a9467381.html Accessed: 16 April 2020. 
7. The Open Covid Pledge (2020) Available: https://opencovidpledge.org. Accessed: 5 May 2020. 

Acknowledgements:

• Mrs Patricia Hoyland (pers comm)
• BBC Today programme. Thought for the day. David Wilkinson 4 May 2020.

Image: 

1. “Edwar Jenner” by Pan American Health Organization PAHO via Flickr.com, copyright © 2010: https://www.flickr.com/photos/pahowho/9525240640. Attribution-NoDerivs 2.0 Generic (CC BY-ND 2.0)
2. The logo of Open COVID Pledge project, 27 August 2020. Creative Commons, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons (https://commons.wikimedia.org/wiki/File:Open_Covid_Pledge_Logo.jpg).

What fairy tales and pinball machines can tell us about using research

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

Once upon a time... the UK Knowledge Mobilisation Forum 2019 took place in Newcastle at Seven Stories, the National Centre for Children’s Books. The Forum brings together practitioners, researchers, students, administrators and public representatives who are engaged in the art and science of sharing knowledge and ensuring that it can be used. This year I was part of the organising group and we deliberately chose Seven Stories as location for the Forum with its focus on stories, which are an important mechanism for exchanging knowledge.

5 points awarded to Dan Wolstenholme of House Gryffindor 

Knowledge mobilisation wizards are also visiting #UKKMb2019 @fuse_online pic.twitter.com/010WtfEwh1

— UK KMb Forum (@UKKMbF) March 20, 2019

The Centre, spread out over seven floors, provided plenty of exercise to get to the different rooms for interactive poster sessions, knowledge fayres, fishbowls and workshops. The Harry Potter themed conference room also allowed me (not pictured right) to dress up as a Ravenclaw student while serving coffee. But the real highlight of the conference for me were the stories being shared by the key note speakers, Ishbel Smith from Heart in Mouth, who reflected on her practical experiences, and Andree le May and John Gabbay from the University of Southampton, who provided an in-depth research perspective. I will relate two of their stories: the first involves a house made of sweets, the second is about a pinball machine.

The power of stories is often underestimated in research but has gained some traction in academia, particularly for evaluating new interventions and because they make great impact case studies. At the same time, it has proven notoriously difficult to capture any impact in a story: we don’t really know what happens to research findings once they leave academia and trying to trace impact is like Hansel and Gretel clinging onto tiny bread crumbs in a large wood.

This brings me to the first story. Ishbel Smith used the story of Hansel and Gretel to highlight that the siblings missed the blindingly obvious (a house made of sweets is too good to be true and likely to be a trap), because they were too focused on the breadcrumbs and did not see the wider picture or context in which they were walking (a deep dark wood inhabited by a hungry witch). As knowledge mobilisers it is vital to understand where we are in a given situation to be able to unlock the relevant knowledge in that context.

Ishbel reiterated that contextual knowledge is just as important as content. Understanding the context in which research evidence is used and, perhaps more importantly, what happens to that evidence in a practice or policymaking context, is vital for mobilising it. To clarify this, Andree Le May and John Gabbay, told a story about how research evidence is transformed by using the analogy of a pinball machine.

In this second story, research evidence gets batted around across various groups of people within organisations as they interact with it. In each interaction, the evidence is slightly changed: people put their own spin on it and adjust it slightly for their own needs. The evidence literally receives a battering but in this process the evidence is made fit for a particular context and socially reconstructed. Like the pinball getting batted around inside the machine, with every contact the evidence changes shape. Perhaps not noticeably at first but you end up with something quite different and unrecognisable from the research evidence that you put into the dissemination process at the start. This means that, if you don’t understand as a researcher that your research findings will be transformed when it is being used by practitioners and policy makers, then you will never be able to find and follow it for your impact case studies.

Andree and John persuasively pointed out that the craft of knowledge mobilisation is not only using the right skills to get evidence into practice, but also to be able to be part of the story of how evidence is used. This requires not only technical skills (which are mostly studied by implementation science) but also the use of soft skills, such as the striking the right tone and style, being able to get your message across and contextualise knowledge; for example, do we know what the right problem and the right solution is for the context in which we are trying to mobilise knowledge?

Perhaps the most important skills we can develop for mobilising knowledge is how to enable learning: what did work and didn’t work in this context? How can we help others to apply research evidence into their own context? Stories provide a powerful tool for this: not to highlight what we have achieved as research institutions in the next REF submission, but to create a space to reflect on our experiences of using research evidence in different practice and policy context. To make these stories impactful, they have to be told by the people who used the research evidence. And we as researchers have to be willing to listen and be able to reflect on them with the evidence users.

Why I left a full-time teaching role to pursue a passion for school food research

Kelly Rose, Graduate Tutor/PhD researcher at Teesside University, writes about her journey to help young people make healthy food choices in a guest post for National School Meals Week.

‘Why?’ was the question I was asked numerous times when I first announced that I would be leaving my role as ‘Head of health education, and food and nutrition’ teacher in a well-respected secondary school. A job everyone around me knew I had loved; it had provided me with job satisfaction and I was able to make a difference everyday (because that’s what teachers do). To add to the incredulity of those around me, not only was I leaving this hard earned role, I was taking a 50% pay cut to embark on a short-term research contract to complete my PhD with no assurance of job security afterwards!

Here is a little background about why I came to - what was for me - a very easy decision.

As an adolescent I found myself in an extremely confused state about healthy food choices, being the ‘right’ weight and having a positive mental health. Then, when I became a mum, the painful realisation that my girls may be feeling that confusion made me want to make a societal change in whatever way I could. Not really knowing where to start, at 32 years old I threw myself into a degree in Food, Nutrition and Health Science. At this stage my only qualifications were four GCSEs and a BTEC diploma in Travel and Tourism. I still don’t know how I believed I could do it!

Three years later I had become so passionate about the power of food that I wanted to teach it to as many young people as possible. With renewed confidence, my First-class honours, and an award winning third-year ‘school lunch’ poster project, off I went to complete a PGCE in design and technology. In that year I spent more time making a wooden stool than learning about nutrition (approximately three hours) because that’s how we still train food teachers – but that’s a story for another time.

I discovered that I loved to teach and, in addition to my teaching, did all I could to help young people make healthy choices. I researched interventions, registered on courses, spoke at various events including ‘Food Matters Live’ in London and was invited to speak at a dietetic student conference at The Hague, Holland. I was thriving and learning so much about the education system: the teaching leads were happy, the GCSE results were superb, and we were improving the healthy choices and the health education in the school. It was a fantastic opportunity to be in a place where the leadership supported the health agenda. Even so, after a while, it became clear that there were barriers that were much larger than the school environment: policy change had become confusing and the support in implementing food standards had disappeared. The external environment of advertising close to schools, proliferation of fast food outlets and shops offering cheap energy drinks. The social norms around eating behaviour in our teenagers had become a turbulent misunderstood tangle of factors, and this with all of the curriculum changes and budget cuts! It was in my last two years (of seven teaching) that I spent time writing PhD proposals, knowing that to make a change I needed to be able to add research to this field, to inform the decision making processes.

That is why I feel extremely lucky to have been given the opportunity to do research at Teesside University and to have access to inspirational researchers and existing work through the Fuse network, and of course to fulfil the dream of having a positive impact on the school food environment.

I am now 8 weeks into my graduate tutor/PhD researcher post and I am sure that I have made the right decision. I used the library every day in my first week, pinching myself, not quite believing I was here with time to research and learn. Every day I am learning and have so far developed a timeline of policy past-to-present, an ecological framework of everything that impacts school food choice from the macro level (government structure and policy, sustainability focus, food supply, food industry and manufacturing, behaviours etc.) to the external and internal physical settings and the individual students. I know from my time in education that consistency and communication are key components of making sustainable healthy change in schools. I hope that I will be able to provide a clear direction on where that focus should be to contribute to the reduction of the ‘obesogenic’ environment for our young people. I have far to go in understanding the myriad of methodologies required to do this work, but I will delve into past research and attend workshops to learn all I can. As I develop questions and embark on a systematic review I have the feeling that I am at the bottom of a huge mountain, ready to make the climb. It is just the beginning and I am aware that significant patience and discipline are going to be needed to get to the top of that mountain.

I look forward to meeting you on my journey.


#schoolmealsshoutout #NSMW18

Find out more about National School Meals Week here: http://thegreatschoollunch.co.uk

Public health isn’t good politics (part 2)

Knowledge exchange lessons from the spotlight event at the University of Sunderland

Posted by Peter van der Graaf, AskFuse Research Manager, Teesside University and John Mooney, Senior Lecturer, University of Sunderland

In our last blog, we reported on the 4th Fuse international conference on knowledge exchange in Vancouver, B.C. Provocative speakers explained that public health is, at best a hard sell to policy makers and at worst impossible to influence decision making. Luckily, they also presented short cuts for making it more likely that public health evidence would be heard by policy makers.

Sharon Hodgson, Shadow Minister for Public Health, speaking
at the Spotlight on Public Health event in Sunderland

These challenges and the potential short cuts were clearly present at the University of Sunderland spotlight event that we attended, which aimed to increase the visibility of public health research at the university.

Sharon Hodgson, the Shadow Minister for Public Health, opened the afternoon session with a passionate plea for introducing a minimum unit price for alcohol in England, following the example of Scotland. However, she made it clear that the Scottish choice for a 50p unit price would be a hard sell to both her voters and the Labour party. Labour colleagues simply dismissed the policy as a ‘tax on the poor’ and voters would feel the pinch on their already austerity squeezed household budget.

This ignited a lively debate with researchers in the room, who highlighted the research evidence that is available in favour of a 50p unit price. While statistical models consistently demonstrate that this would have the biggest impact on reducing alcohol related harm, such as liver disease, the Shadow Minister was concerned with how the price selected might impact on her voters. Specifically, she felt it was more important that increased costs to people living in more deprived communities were not dismissed, but instead presented as a health improvement incentive.

Having visited various supermarkets in her constituency to check the prices of different types of alcohol in order to work out the impact of different MUP limits, her conclusions sided with the views of the voters and Labour peers: 50p would hit all the different types of alcohol and not just the cheap ciders and therefore penalised not just the heavy drinkers but also the moderate drinkers in deprived communities. Instead, she argued for a 40p unit price, which would mostly affect the price of cheap ciders, and therefore target only the problem drinkers and not the other drinkers in her constituency. What counted as the most important evidence for the Shadow Minister was quite different from what the researchers in the room perceived as the best evidence to inform policy.

When an audience participant also tried to make the economic case by suggesting that the 50p tax would generate a better return for the Government that could be used to finance alcohol addiction services, the Shadow Minister remained unconvinced.

What did start to sway her was another suggestion to change the narrative from a ‘tax on the poor’ (which might be used as a stick by Conservative party members to beat their Labour colleagues), to a ‘tax for the wellbeing of all’. This narrative framed the 50p MUP as a policy that would affect all walks of life and could encourage a change in drinking cultures among all ages and classes, with the money raised being reinvested across a range of policy areas.

Shanon Hodgson agreed that this might make for an ‘easier sell’ and perhaps more importantly serve as the basis of a future health legacy that she could leave for her voters. By reframing the narrative from a small group problem (problem drinkers in deprived communities) to an emotive public issue of damaging drinking cultures, better policy and voter engagement might be secured.

Paul Cairney presenting at the 4th Fuse International
Conference on Knowledge Exchange in Public Health  

The evidence that she really needed were stories to demonstrate meaningful (personal) health gains and cultural change across different sectors of society. This requires a new type of evidence. It does not mean dismissing academic research and all the rigorous evidence it generates, but it does require a careful consideration of the policy system and process in which it is used and a willingness to adapt the messages and narrative to that context and the other types of evidence that are prevalent in that context. This is neatly summarised in the top tips from political science offered by Paul Cairney in his presentation at the 4th international Fuse conference:

1. Find out where the action is (‘actors’) 
2. Learn the rules (‘institutions’) 
3. Learn the language/ currency (‘ideas’) 
4. Build trust and form alliances (‘networks’) 
5. Be entrepreneurs, exploit ‘windows of opportunity’

Public health researchers operating as political entrepreneurs might be a hard sell to academic institutions but they have a world to win when trying to get evidence into decision making where it matters and creates impact.