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.

Are we really aware of the harm Big Tobacco causes our planet?

Posted by Ailsa Rutter OBE, Director of Fresh and Balance on World No Tobacco Day

The annual World Health Organization (WHO) campaign highlights the many harms of tobacco. This year’s theme explores the growing threat to our environment.

We know that smoking is the worst thing that we can do for our health – 8 million people around the world lose their lives from it each year.

Many of us are already taking action to do our bit in tackling climate change. But do we ever think about how tobacco is polluting our world globally, nationally and here in North East England?

As we face a climate emergency, our fragile ecosystems are being put under even more pressure by the tobacco industry. Tobacco damages the environment, from growing and production, distribution to waste.

Reflecting on my 24 plus years in tobacco control, I’ve seen many appalling tactics from Big Tobacco (the largest global tobacco companies who make billions in profit from killing people and destroying the planet) – including ploys to get kids hooked on a life-long addiction.

It takes a lot to shock me these days, but even I am shocked to read the things that the tobacco industry is doing to our environment.

What we see on the surface is just the tip of the iceberg. Some of the mind-blowing statistics every year:

• 600 million trees chopped down for tobacco.
• 84 million tonnes of C02 released into the air, raising global temperatures.
• 22 billion tonnes of water used to make cigarettes.
• 4.5 trillion cigarette butts not disposed of properly across the globe, generating 1.69 billion pounds of toxic waste and releasing thousands of chemicals into the environment.

Big Tobacco ‘greenwashes’ its impact on the environment through sustainability corporate social responsibility and marketing initiatives, designed to make people and investors think it cares.

Every day we see its impact on our streets and beaches. Cigarettes are the most commonly littered item in the world.

Cigarette butts are made of cellulose acetate, a man-made plastic material, which takes years to degrade and dump a toxic mix of nicotine, arsenic and heavy metals into our water, soil and oceans before turning into microplastic pollution. It makes me so sad to think what this toxic waste is doing to our marine and river wildlife.

Eight out of 10 (81%) North Easterners in a YouGov poll commissioned by Action on Smoking and Health (ASH) want to see plastic in cigarette butts banned. As part of our World No Tobacco Day activity, we’re joining forces with environmental campaigners to protect the region’s beaches from plastic cigarette butts.

Beyond our region, in the developing world, deforestation for tobacco plantations is happening on a vast scale. Around 3.5 million hectares of land are destroyed for tobacco growing each year. That’s the equivalent of over 1.4 million football fields!

The environmental burden is falling on the countries which are the least able to cope with it. Farmers in low- and middle-income countries are left in debt, with widespread poverty and illness among farm workers. Meanwhile the global tobacco companies continue to make billions in profit.

I reflect on when I attended a world conference in 2006 and heard about young children being exploited for child labour by tobacco companies; picking tobacco leaves and exposed to toxic pesticides and hazardous working conditions. The consequences are life-long and this is happening around the world, as shown in the devastating 2016 Human Right Watch report “Harvest is in my Blood”.

As a mother, with children and grandchildren, I am extremely concerned about the future impact.

The question I think we should ask ourselves is – are we really aware of the harm that the tobacco industry is causing to the environment? If the answer is no, then let’s pledge to read some of the fantastic resources on the issue, including those on the WHO website. Talk to people about it, call for action. Learn more about the tobacco industry; the harm it causes.

 

We are supporting national colleagues Action on Smoking and Health in calling for a levy on Big Tobacco, to clean up the harm and to further reduce smoking to reach the Government’s target of a Smokefree 2030 (5% by 2030).

In the North East we’ve seen smoking rates fall faster than anywhere else in the country, thanks to the hard work and dedication of colleagues in the region.

But as the major threat of climate change looms, it’s vital that we go further and faster than ever to reduce the tobacco industry’s destructive impact and make smoking history for the next generation.



Ailsa Rutter OBE, is Director of Fresh and Balance, the North East’s combined alcohol and tobacco programme, working to reduce the harm, the death and disease caused by smoking and alcohol.

Tobacco is still the biggest cause of premature death in the UK, with an estimated 74,000 deaths each year in England and over 113,000 deaths from smoking in the North East since the year 2000.

Planning for a healthier future?

Posted by Tim Townshend, Professor of Urban Design for Health, Newcastle University

Can we plan for a healthier future by intervening in the built environment? You may be surprised to find out this is not a new idea! Indeed, the very concept of Town Planning emerged in the last quarter of the 19^th Century out of a concern for public health and to help prevent the spread of infectious diseases such as cholera.

Ebeneezer Howard - ‘slumless, smokeless’ garden cities

The resulting Victorian terraces, with fresh water supplies and internal toilets may seem unimaginative, but they were a huge improvement on what went before - and did indeed prove a boon to public health. What’s more many still provide decent homes today.

Early planning thinking was also dominated by a vision that the physical health attributes of the countryside – access to open space, clean air and fresh food could be combined with social and economic (mental health) benefits of the city – including opportunities for education, access to culture and wider social contacts. Such thinking is typified by the Garden City Movement associated with Ebenezer Howard and realised - at least in part - in towns such as Letchworth in, Hertfordshire.

Health was at the core of planning for much of the 20^th century, however, in the post-war period it became eclipsed by other issues - particularly the need for economic regeneration. Consequently, the health and well-being impacts of the way our towns and cities were developing was not considered carefully enough.

“...primarily designing around the needs of the private car - rather than humans - has been a disaster.”

In retrospect, primarily designing around the needs of the private car - rather than humans - has been a disaster.  Busy roads now cut noisy polluted swathes through communities; poorer neighbourhoods find themselves served by ‘toxic high streets’ – a deadly mix of nutritionally poor food, subprime financial services, betting shops and other potentially harmful outlets; and vast tracts of poor-quality new build housing - devoid of adequate open space, or local services - have been constructed in the suburbs.  At the same time rates of obesity (and associated health/well-being consequences), respiratory and so-called ‘lifestyle’ diseases have all soared. Moreover, these impacts are not felt equally across all neighbourhoods, and health inequalities unjustly burden the poorest in society.   

 Interlinked themes explored in Healthy Cities? Design for Well-being

It does not have to be this way, however. We can plan for a healthier future and create places that support individuals and communities to take healthier lifestyle choices. In ‘Healthy Cities? Design for Well-being’ I explore five inter-related topics and the ways in which the goal of a healthier future can be achieved.

There is for example a large and robust evidence base around our need for urban greenspace (as was highlighted so graphically during the COVID-19 lockdown period). Green (and blue) spaces in our cities not only facilitate physical activity and socialisation (positive for physical health and mental well-being) but can mitigate against issues such as, air and noise pollution, ‘heat islands’ (the significant heat increases in urban areas as compared to their surroundings) and alleviate flood risk. Crucially, however, greenspaces have also been shown to reduce stress levels and help restore cognitive capabilities - for example concentration levels - just by being there.  

Planning policies can also be used in conjunction with public health goals to tackle specific health issues. A great example of this, is the development of planning guidance and regulation to tackle the further spread of hot food takeaways – a key component of my ‘toxic high street’ concept, which I explore in more detail in the book.  While planning cannot tackle existing businesses it can limit further spread, especially in sensitive areas – for example near schools, as research has proven the link between hot food availability and overweight/obesity in older children. Issues we will explore at the Fuse Research Programme Meeting “Planning for a healthier future: Priorities and Practicalities” on May 18, 2022, at Teesside University (and available online).

Therefore by encouraging those aspects of the built environment that support healthy lifestyle choices, while constraining those aspects we know are linked with less healthy lives, healthier places are within our grasp – but this can only be achieved if we collaborate across disciplines and garner the political support required to make it happen!

Healthy Cities? Design for Well-being is available to order now

Image:

1. Howard, Ebenezer. "Diagram of a group of slumless smokeless cities.". 1898. From Ebenezer Howard, "To-morrow: A Peaceful Path to Real Reform" [London, 1898]. https://www.aaeportal.com?id=40518. Web. 12 May. 2022.

Take it away: a masterclass in healthy takeaways

Post by Scott Lloyd, Advanced Public Health Practitioner at Public Health South Tees and Karen Pearson, Catering Monitoring & Advisory Officer at Redcar & Cleveland Council

Whether it is the Golden Cod or the Taste of India, independent hot food takeaways get a bad rap in Public Health circles. They serve food and drink that is predominantly higher in fat, salt and sugar and may contribute to noise pollution and other environmental ills. Furthermore, they may not be the best option for our beleaguered high streets as they tend to be shuttered up during the daytime.

Up to March 2018, for a variety of reasons (including health), 164 out of 325 Local Authorities (50.5%) have introduced powers through Local Plans or Supplementary Planning Documents (SPD) that aim to restrict the proliferation of hot food takeaways (Keeble et al. 2019)[1].

Watch this video to find out more about how we worked with takeaway owners
(click here if the video doesn't appear above)

But let’s be honest – that horse has already bolted. Analysis by Public Health England has shown that there is an average of 96.1 hot food takeaways per 100,000 population in England (Public Health England, 2018)[2].

Where we work in Redcar and Cleveland, the Local Authority introduced a SPD in 2008 that restricted the percentage of hot food takeaways (A5 class use in planning terminology) in any commercial centre to no more than 5% - but even then, each commercial centre already had more than 5% hot food takeaways.

So we have to accept that hot food takeaways are here to stay – at least for the foreseeable future. Many Local Authorities have implemented interventions such as award schemes that engage these businesses to support them to improve the healthiness of their food offerings, but with limited evaluation (Hillier-Brown et al. 2017)[3]. Indeed, we have a Food4Health award in Redcar and Cleveland, which is open to all out-of-home caterers. We were doing OK in engaging hot food takeaways but we wanted to try something different.

In 2015, the Foodscape team organised a Fuse Quarterly Research Meeting on developing interventions with out-of-home caterers. One of the presentations was by Louise Muhammad from Kirklees Council on the healthy takeaway masterclass that they had developed and delivered to over 20% of the eligible businesses on their patch. The masterclass was described as a three-hour session in which hot food takeaway owners and managers learn about the small, sustainable changes they can make so their food is a little healthier without costing a huge amount or that will actually save them money/generate new custom.

A few months later, we travelled down to Huddersfield to watch a masterclass being delivered. It was clear from the start that this was something that engaged businesses and had potential. The decision to repeat it in Redcar and Cleveland was easy.

Takeaway owners and managers learning about small changes to make their food healthier

We worked with the teams from Kirklees and Foodscape to deliver our first masterclass in May 2016. In line with what Kirklees do, we invited hot food takeaways with a food hygiene rating of three or above – the feeling was that any outlets with less than this really needed to concentrate on food hygiene first. In total, 181 invitations were sent out and 18 attended, representing 10% of those eligible – a figure that we practitioners were happy with (if not all the academics!).

The Foodscape team conducted a mixed methods evaluation to explore the acceptability and feasibility of the masterclass intervention (Hillier-Brown et al. 2019)[4]. The takeaways businesses that attended made a variety of pledges – the ones that required less effort and cost (e.g. reducing salt and sugar in pizza dough) were implemented more so than other more potentially costly or difficult changes (e.g. stocking reduced sugar tomato ketchup).

Pledging to use healthier alternatives

Has this work made the hot food takeaways in Redcar and Cleveland healthy? No it hasn’t. Like the rest of us, businesses owners have a living to make and will cater to what their customers want. But as an example, Carol - the owner of a sandwich shop in Guisborough who stars in the film above - pledged to take 10% of the sugar out of her baking. Did her customers notice? No. Did, this make her flapjacks ‘healthy’? Of course not but they are now a little healthier. Hence, has the masterclass via all the pledges made their food offerings a little healthier? Probably.

We have since delivered a further six masterclasses, with the offer extended to other out-of-home caterers such as restaurants. About 30% of all eligible takeaways in Redcar and Cleveland have now attended a masterclass, with follow up support provided by the Food4Health award.

Engaging with hot food takeaways can be difficult. We are now struggling to attract new businesses onto the masterclass and may hit a saturation point at 35% or 40% of those who are eligible. Some owners have other priorities and some may not accept the healthy eating messages. Also, some hot food takeaway owners are not even resident to the UK so engaging them is nigh on impossible. But we have to continue to try.

Another key learning point is that we need to work more closely with suppliers. The majority of masterclass attendees pledged to start using healthier alternatives, such as reduced sugar tomato ketchup or reduced salt soy sauce but they were unable to source these items from suppliers at a reasonable cost or not at all. Hence, wider work is needed with suppliers which, as one of the other Foodscape projects showed, is possible (Goffe et al. 2019)[5].

But the masterclass is an acceptable and feasible intervention to engage a good proportion of hot food takeaways. We will continue to deliver it once or twice a year as long as there is sufficient demand. We’re hoping to run the next class in September, so lookout for that.

What the masterclass doesn’t do is engage the big operators such as McDonald’s and Just Eat, accepting that the latter works mainly through local independent takeaways (but what requirements can the national corporation specify on their local deliverers?). It’s likely that national work is needed with those corporations, continuing the good work of Public Health England and others.

We also need to be mindful of the potential impact of “dark kitchens” – potentially the “satanic mills of our era”. But I’ll save that for another time…


Read our handy Fuse research brief to find out more about the Foodscape study.


References:

1. Keeble, M., Burgoine, T., White, M., Summerbell., C., Cummins. S., Adams, J. (2019). How does local government use the planning system to regulate hot food takeaway outlets? A census of current practice in England using document review. Health & Place, 57, 171 – 178. https://doi.org/10.1016/j.healthplace.2019.03.010
2. Public Health England (2018). Fast Food Outlets: Density by Local Authority in England. Available at: https://www.gov.uk/government/publications/fast-food-outlets-density-by-local-authority-in-england [accessed 27 May 2019] 
3. Hillier-Brown, F.C., Summerbell C.D., Moore, H.J., Wrieden, W.L., Adams, J., Abraham, C., Adamson, A., Araújo-Soares, V., White, M., Lake, A.A. (2017). A description of interventions promoting healthier ready-to-eat meals (to eat in, to take away, or to be delivered) sold by specific food outlets in England: a systematic mapping and evidence synthesis. BMC Public Health, 17 (1), 93. https://doi.org/10.1186/s12889-016-3980-2
4. Hillier-Brown, F. C., Lloyd, S., Muhammad, L., Goffe, L., Summerbell, C., Hildred, N. J., ... Araújo-Soares, V. (2019). Feasibility and acceptability of a Takeaway Masterclass aimed at encouraging healthier cooking practices and menu options in takeaway food outlets. Public Health Nutrition. https://doi.org/10.1017/S1368980019000648
5. Goffe, L. Hillier-Brown, F., Hildred, N., Worsnop, M., Adams, J., Araújo-Soares, V., Penn, L., Wrieden, W., Summerbell, C.D., Lake, A.A., White, M., Adamson, A.J. (2019). Feasibility of working with a wholesale supplier to co-design and test acceptability of an intervention to promote smaller portions: an uncontrolled before-and-after study in British Fish & Chip shops. BMJ Open, 9 (2), e023441. https://doi.org/10.1136/bmjopen-2018-023441

Is public health ready for complexity?

Guest post by Brian Castellani, Professor of Sociology at Durham University

Public health, presently, is at a difficult crossroads. Its massive success in making the world a healthier place has led to a global embrace of its incredible insights; but still, the challenges currently faced have not given in so easily, as they are deeply entrenched complex problems - or, alternatively, what are more generally referred to as wicked problems!  The global spread of infectious disease; an exponentially growing (or, alternatively, greying) population throughout many parts of the world; the negative impact ecological upset is having on climate and health; urbanisation and the development of mega cities and metropolitan regions; the increasing costs of health and healthcare; air pollution; the opioid epidemic; and so forth.

Still, despite this increasing complexity, public health has been rather resistant to making the shift, falling back on tried-and-true ways of thinking about and modelling public health issues. This is particularly true when it comes to the harsh realities of getting funded or published!  This needs to change! The challenge, however, is how?

Here are, in my mind, six things that public health researchers and practitioners can do to make more effective use of the complexity sciences and advance the use of these ideas across the field:

Six ways to advance the study of complexity in public health

1. Public health is in a difficult position: it realises its work is more complex, but it is struggling to embrace the tools and concepts of complexity science and computational modelling, as it means doing things differently.

• This is particularly problematic in terms of funding streams and publishing in journals.
• The only way forward, then, is to get on with it and actually start funding and publishing such work. High risk can lead to high reward! 

2. Related, the best way forward is for public health to employ a mixed-methods approach, as most public health issues require more than one method, including computational modelling.

• This includes embracing the old and the new, particularly in terms of complex networks, machine intelligence, participatory systems mapping, qualitative comparative analysis (QCA), and agent-based modelling.

3. Public health needs to adopt a critical approach to complexity, as not all methods or theories are equally useful. In other words, the advance of complexity thinking in public health has to be more than the simple application of hard science methods.

• For example, while complex network analysis is powerful, it has significant limits.

4. Public health also needs to develop its theoretical and conceptual understanding of public health topics as complex. This is also true in terms of policy evaluation.

• Not all topics, for example, need to be modelled as overly complex. And there are different ways of modelling complexity.  For an excellent examples, visit the Centre for the Evaluation of Complexity Across the Nexus (CECAN).

5. Public health needs to recognise the important role it plays - both in terms of theory and practical experience - in the development of the complexity sciences, as most of these scholars are trained in other fields. Practitioner expertise, combined with the latest advances in computational methods, will go a long way to improving health. It cannot, however, just be one or the other.

6. Finally, public health needs to adopt a case-based approach to modelling its various complex topics, as health (be it an individual or population) is about cases.

• In turn, it needs to move away from the strict study of variables and variable-based statistics.
• Statistics remains very important for complexity modelling; but variables need to be attached to context and cases and their various path-dependent trajectories.
• Related, the field needs to shift to modelling multiple case-based trajectories, rather than designing a single model.

I want to thank Fuse for the opportunity to present a brief overview of the value of the complexity sciences for public health (and, in turn the value of public health for complexity science!) on 14 February 2019 at Newcastle University.  For those interested, here is a link to the presentation.

What old crisp packets dig up

Posted by Duika Burges Watson, Lecturer at Newcastle University based in the Institute of Health and Society

It appears that I’m an academic litter picker. I like to have hands on experience of topics I write and teach about. Inspired by the new module I’m leading on Global Health in the Anthropocene, and in particular a lecture on plastic pollution and health, I went litter picking. The Anthropocene is a new (ish) term to public health - considered to mark a turning point where “changes to the structure and function of the Earth's natural systems represent a growing threat to human health”[1].

I certainly found a good site for it. In less than 10 minutes from a 2 metre square area, I collected 69 crisp packets amongst the plastic bags and other items. I was intrigued, so I took them home and washed, sorted and ‘analysed’ them. Some use by dates were no longer visible, but of those I could read, 49 of 69 were Walkers crisp packets (parent company Pepsico) with use by dates from between 1996 to 2014. I went back the following weekend to the same site, dug a little deeper, and collected a further 89 crisp packets of which 51 were Walkers. The oldest packet was a Geordie company, Tudor (more on them later), with the use by date 10th January 1992.

Walkers bought out Newcastle
based company Tudor in 1987

There is a lot to be explored on crisp packets including use by dates, ingredients, health labelling and advertising.  Many even listed the time of production, often very late at night. For example, a Walkers smokey bacon use by 23rd June 2012 was made at 10.48pm. The irony of time was not lost on me in terms of the Anthopocene: we can know the exact minute the crisps were made (but not the date), they take about 2 minutes to eat and result in decades of rubbish.

Walkers began using foil bags in 1993 with plastic coatings. Yet people have been finding perfectly preserved plastic Walkers bags from the 80s in litter picking efforts. In September 2018, no doubt inspired by David Attenborough’s shocking profile of marine plastics in the series ‘Blue Planet’, the public started sending their bags back to Walkers. Royal Mail protested that people had to put them in envelopes first.

Walkers took up the challenge created by public protests. They have promised to find alternative solutions to the pesky bags by 2025, and until then have set up a recycling deal with company terracycle across the UK. There are collection points all over the UK.

But it wasn’t just the plastic pollution that concerned me. Crisp consumption is one of those things that people in public health worry about because these are classic examples of the high fat, salt, sugar foods where over-consumption can play havoc with our health. But we’ve been eating crisps for a long time, long before epidemics of obesity, and they have a cultural history to boot. A Brief History of Crisps (2012), suggests they were a British invention that turned up in the English edition of The Housekeeper’s Manual in 1829. The ‘modern’ industrial crisp really found its crunch after the first World War when the Smith’s company enrolled grocers and butchers across the UK to offer crudely made crisps (made in house with lots of fatty smells apparently). In the 1950s it all changed, technologies were imported from the USA and production scaled up. The first company to employ this technology was the previously mentioned Tudor. In 1967 they introduced the first ‘salt and vinegar’ chips to the UK market from their base in Sandyford, Newcastle. Tudor’s 1970s-80s commercials have a distinctly Geordie feel (note the ‘Dunstan Rocket’ in the first ad below – an iconic piece of architecture!). As a more recent immigrant to Newcastle, I had always wondered why every time I got served a sandwich it was with crisps – now I know – they have a proud Northern heritage. Walkers bought out the Tudor company in 1987.

In my ‘analysis’ of crisps, I have been wondering about their continued value as ‘food’. Is there a way we can still enjoy them as cultural icon without creating so much waste and without damaging our health? The one thing I’ve learned about food is that preferences change, tastes change – is the solution to learn to like something else? Last year the Walker’s crisp factory in Peterlee was bought by Heather Mills for her vegan food empire VBites. She is now looking to take over an abandoned factory in Northumberland. If successful, this would be the largest vegan food producing factory in the UK.

One of the sessions I’ll be leading in the Anthropocene module is on food – from source to senses. There is growing international concern about what kind of diet we ‘can’ eat if we want to protect and preserve the planet in the face of the Anthropocene and global climate change. The Eat Lancet Commission produced some rather controversial findings in January that offers their vision of what a ‘sustainable’ diet might involve[2]. Not unexpectedly, it involves cutting back on meat and eating more veg. Most agree that urgent change is required to farming systems and diet, but getting exactly the right mix of dietary components has created tensions. The Sustainable Food Trust, for example, points out that some land is not suitable for vegetable production and that grazing is the best option in some places. So, no simple solutions, and more debate to be had.

Another area of interest that will be covered in the course is new understanding of what it is that makes food ‘delicious’, how we ‘sense’ food, and what promotes ‘satiety’ or feelings of fullness. The ‘flavour’ of food involves a fusion of sensory inputs: smell, taste, colour, sound, trigeminal nerve stimulation[3], and our enjoyment of it is mediated by our culture, our history, our environment. Crisps are not difficult to figure out from a sensory perspective, like many other ‘fast’ foods, they are particularly heavy on salt, fat and sugar: what I would call ‘tongue’ foods. More complex ‘flavours’, particularly those involving smell, have been found to better trigger satiety – that’s why you can keep eating crisps without feeling full. But why do we like these ‘tongue foods’ so much? It’s complex; you’d have to join the course to explore this question.

So what about crisps then? Can we as public health researchers do more with ‘flavour’ to inspire different kinds of food choices? Could we encourage archaeological litter picking to engage the younger folk given so many foods are in single use plastics? People seem willing to give up plastic bags - could we encourage people to stop eating crisps until 2025 when they are in recyclable bags?  I don’t know the answer to these questions, but it will require more than litter picking to know. Food choice is academically interesting from a flavour point of view.  The crisp example throws up other challenges for public health - the Anthropocene creates interesting ethical questions about how we eat ‘beyond’ questions of the food itself. In March we will be running flavour masterclasses for the public where we get hands on to unpack the mystery of the humble crisp, why we like them, and what we should do about it! These questions are also being addressed by the Altered Eating Research Network (AERN) at Newcastle University, a new interdisciplinary collaboration that considers how our relationships with food are diverse, sometimes problematic, and how they intersect with the changing environments we live in and co-create. Keep an eye on the AERN website for details of flavour masterclasses and other upcoming events.

References:

1. Whitmee, S., Haines, A., Beyrer, C., Boltz, F., Capon, A.G., de Souza Dias, B.F., Ezeh, A., Frumkin, H., Gong, P., Head, P. and Horton, R., 2015. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet, 386(10007), pp.1973-2028.
2. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems (Walter Willett et al.). https://www.thelancet.com/commissions/EAT
3. The trigeminal nerve is responsible for sensations in the face and for motor control of biting and chewing. It is how we experience the ‘spiciness’ of food, the ‘coolness’ of mint or the ‘fizziness’ of carbonated drinks. Spence, C., Smith, B. and Auvray, M., 2015. Confusing tastes and flavours. Perception and its modalities, pp.247-274.

The Government’s new Clean Air Strategy – hope or hype?

Dr Susan Hodgson, lecturer in Environmental Epidemiology and Exposure Assessment at the MRC-PHE Centre for Environment and Health, Imperial College London

© 2018 Imperial College London

Air pollution was been high on the agenda at Imperial College London recently, with Environment Secretary Michael Gove choosing to launch the Government’s new Clear Air Strategy at Imperial’s Data Science Institute[1]. To coincide with this launch, Health Secretary Jeremy Hunt announced a new tool, developed by Imperial and the UK Health Forum, to help local authorities estimate the health-care costs due to air pollution - an estimated £157 million from exposure to fine particulates and nitrogen dioxide across England in 2017[2].

Academics and researchers worldwide have worked over many decades to produce an evidence base of high quality research which now clearly links air pollution and health. Globally, 4.2 million deaths are attributed to outdoor air pollution, with 91% of the world’s population living in areas where air quality exceeds health-based guidance limits[3]. Figures for the UK also make grim reading, with an estimated 40,000 deaths per year attributable to outdoor air pollution[4]. While research on this topic makes an unequivocal case for action, Government policy to improve air quality for public health has been found lacking, with the UK (along with France, Germany, Hungary, Italy and Romania) being taken to the European court of Justice for failing to meet EU limits for nitrogen dioxide.

© 2018 Imperial College London

The new Clear Air Strategy[5] outlines how the Government plans to protect the nation’s health. The stated intention of halving the number of people living where concentrations of fine particulate matter are above 10μg/m3 - the concentration of an air pollutant is given in micrograms (one-millionth of a gram) per cubic meter air or 'µg/m3' - by 2025, if achieved, would reap a significant health dividend. However, the focus on a ‘personal air quality messaging system to inform the public…about the air quality forecast [and] air pollution episodes’ places onus on individuals to avoid exposure, rather than creating clean and safe environments within which to live. While there is a place for such messaging, when more than 2000 education/childcare providers across England and Wales are within 150m of a road breaching the legal limit for Nitrogen dioxide pollution (25 of which are in the North East and more than 1500 in London)[6], is it clear that a population based approach is required to tackle this pressing public health issue.

The Strategy also restates the previously announced plan to phase out conventional petrol and diesel cars and vans by 2040, to be replaced by zero exhaust emissions vehicles. This is a positive step, but not sufficient to tackle traffic-related pollution. What comes out of the exhaust represents less than half of vehicle emissions; ‘clean’ vehicles will still generate pollution from tyre and brake wear, and re-suspension of road dust, as explained by Imperial PhD student Liza Selley in her 2016 Max Perutz Science Writing Award-winning essay[7].

The Strategy proposes steps to address not just road traffic pollution, but also shipping, aviation, agriculture and industry, and links health, the environment and economy, marking a welcome move away from silo thinking. There is also mention of ‘appraisal tools and accompanying guidance…to enable the health impacts of air pollution to be considered in every relevant policy decision that is made’ – it is not clear if this extends beyond policy decisions on air pollution, i.e. represents a move towards a coherent ‘health in all’ approach[8], but, if so, would represent a welcome prioritisation of health across Government departments.

© 2018 Imperial College London

Focussing on cleaner vehicles and technological solutions can only offer a partial solution to reducing the impact of air pollution on health, so it is good to see modal shift towards public transport and active transport is mentioned (briefly) in the Strategy. There are funds to support bus and rail infrastructure to improve public transport, and an ambition to double the levels of cycling by 2025 - though this would only raise levels from 2% to 4%, compared to 39% in the Netherlands[9].

If the Government is serious about adopting a more holistic approach to the environment, health and economy, then I feel far more could have been made of the great potential to tackle air quality, sustainability and health collectively. We need ambition and vision to create sustainable cities, and approaches to transport and living that reduce air pollution and additionally tackle inactivity and obesity, which are key drivers of population health. Barcelona’s Institute for Global Health recently launched its #CitiesWeWant initiative[10], which highlights some of the features we need to be prioritising in our cities to benefit future health and wellbeing. We have the research evidence to support these priorities, but Governments will require buy-in from experts and demand from the public to enact bold change. Those passionate about improving our environment for health have the opportunity to voice their views via the Government consultation on this newly launched Clear Air Strategy, which will inform a National Air Pollution Control Programme due March 2019.


The views represented here are those of the author, Dr Susan Hodgson.

Susan is a lecturer in environmental epidemiology and exposure assessment at the MRC- PHE Centre for Environment and Health at Imperial College London. Her research focusses on understanding how interactions with our environment (including air pollution), influences health.

More details at: www.imperial.ac.uk/people/susan.hodgson


References:

1. https://www.imperial.ac.uk/news/186390/michael-gove-launches-governments-clean-air/
2. https://www.imperial.ac.uk/news/186406/air-pollution-england-could-cost-much/
3. http://www.who.int/airpollution/en/
4. https://www.rcplondon.ac.uk/projects/outputs/every-breath-we-take-lifelong-impact-air-pollution
5. https://consult.defra.gov.uk/environmental-quality/clean-air-strategy-consultation/user_uploads/clean-air-strategy-2018-consultation.pdf   
6. https://unearthed.greenpeace.org/2017/04/04/air-pollution-nurseries/
7. http://www.insight.mrc.ac.uk/2016/10/14/braking-perceptions-of-traffic-pollution/
8. http://www.who.int/healthpromotion/frameworkforcountryaction/en/
9. https://ec.europa.eu/transport/road_safety/specialist/knowledge/pedestrians/pedestrians_and_cyclists_unprotected_road_users/walking_and_cycling_as_transport_modes_en
10. https://www.isglobal.org/en/ciudadesquequeremos