Learning to be a researcher

Guest post by Jane Johnson, PhD student at Teesside University

Have you ever had the experience of thrusting your hand into the air, “Oo! Oo! Pick me! Pick me!” and afterwards think, “Uh oh, why did I offer to do that?” Despite being invited to give a poster presentation at CAMSTRAND, the Complementary and Alternative Medicine Strategic Direction and Development Conference hosted by University of Warwick’s Medical School, I felt apprehensive. The topic of the conference was ‘The Application of Qualitative Methods in CAM Research’ and not only is my research mostly quantitative, I have only been doing the PhD for eight months so thought, “how on earth will I hold my own in a room of forty experienced researchers?” My intention to seek out and explore opportunities to learn and to contribute during the limited PhD time frame of 36 months had yet again left me with my hand up, and not in an air-punching Bruce Springsteen Born in the U.S.A. kind of way.

But I was glad to have been brave enough to attend because the experience was invaluable for many reasons. I heard 18 presentations and in addition to learning about the variety and content of on-going qualitative research into complementary therapies, discovered the following:

• Standing up in front of experienced researchers gave me heartburn but not heart failure.
• Even experienced researchers don’t always get their point across to the audience in the way they intend.
• Researchers are curious. They ask questions and reflect on what people say.
• For the most part, researchers want to share their experiences to help prevent other researchers making the same mistakes.
• Researchers are solution-focused. They can’t help but start questions with, “have you thought of trying…”
• Researchers like to network.
• Everyone presents their posters differently. I made a mental note to make the font size of the title of future posters even larger than PowerPoint’s recommended 24 and to use more yellow.
• Even as a novice researcher I can contribute. I helped out two attendees who were struggling to understand the concept of ‘coding’, proving that sitting in on Dr Maura Banim’s qualitative methods lessons at Teesside Uni has not been wasted on me.
• The abstract that got me accepted to CAMSTRAND will be published in The European Journal of Integrative Medicine and the discipline of having to put this together was useful.

Even when you think you are alone at a conference, there are opportunities for surprise and comradery. “Oh you’re that Jane Johnson,” said a woman noting my name badge, “I was looking at one of your books the other day in the library.” I braced myself ready to explain that I didn’t write novels featuring romance in the Moroccan desert. “Posture …something,” she said. I relaxed. “Yes,” I confirmed, “I was that Jane Johnson”, suddenly feeling an affinity for a woman I’d never met and slightly more at ease.

CAMSTRAND is an annual conference organised by the Research Council for Complementary Medicine and I look forward to attending other conferences that provide equally good opportunities for me to learn how to be a researcher.

‘First, do no harm’: How to think about austerity and public health

Posted by Ted Schrecker, Fuse Associate and Professor of Global Health Policy, Durham University

The current ‘neoliberal epidemic’ of (selective) austerity directs our attention to public health impacts of choices about public finance in several ways. Most fundamentally, anticipated post-2015 public expenditure cuts in the UK will reduce public expenditure as a proportion of Gross Domestic Product (GDP) to the levels of the 1930s, ‘taking the size of the state to its smallest in many generations’, in the words of a 2014 Institute for Fiscal Studies briefing. In fact, on recent projections by 2020 public spending in the UK as a proportion of GDP will be below the figure for the US, despite the latter country’s bloated defence budget. It is implausible that a National Health Service that is free at the point of use can be maintained with pre-World War II levels of public spending. Even a brief conversation with anyone familiar with US health care reminds us just how much that matters.

Meanwhile, the health consequences of social spending cuts that fall disproportionately on the poorest people and regions are beginning to be manifest in rising food insecurity and increased use of food banks – the latter trend probably related to the rising rates at which benefit recipients are sanctioned. Further health impacts, more difficult to isolate epidemiologically but probably at least as significant, are associated with the stresses of chronic insecurity, powerlessness, and lack of ‘control over destiny’.

There is a basic ethical and political point here about the politics of evidence. Sir Michael Marmot and colleagues wrote in 2010 that ‘It is hard to see how even ideologically driven commentators could think that having insufficient money to live on is irrelevant to health inequalities’. Good point.

In a previous blog with Clare Bambra, we demonstrated that politics can make us sick; Clare recently wrote a similar blog highlighting large health divides across Europe, showing that where you live (and the health policies implemented there) strongly affects how long you live. Against the background of austerity and the rising costs of healthy diets, it is indefensible to ask public health professionals and advocates to demonstrate, over and over again, that (for example) inadequate incomes lead to unhealthy diets and poor health. Rather, the burden of proof should be shifted: we must insist on clear and convincing evidence that national governments’ choices about the level and composition of public expenditure first, do no harm to health, except in extraordinary and clearly justified circumstances. This is an important part of the case for (independent, third party, adequately resourced) health impact assessments, especially of policies and programmes outside the health sector. Such a shift in the burden of proof is also congruent with the strong presumption in international law against retrogression (backsliding) with respect to human rights such as the right to health – a presumption that assumes special importance in an era of austerity.

Is corporate tax avoidance a public health issue?

Public finance, then, is a public health issue. This point applies to the revenue side, as well. The publication of the ‘Panama papers’ reminds us of the extent to which cross-border tax avoidance, whether legal or questionably legal, represents one of the ‘fiscal termites’ that can undermine states’ ability to provide everyone with the prerequisites for a healthy life. (Interestingly, the phrase ‘fiscal termites’ was coined by the former director of the International Monetary Fund’s Fiscal Affairs Department.) The question of how maintaining health services free at the point of use and investing effectively in prevention could be financed should be asked as a routine element of public health practice and advocacy – part of a broader strategy of interrogating scarcity. One answer could be using revenues from clamping down on UK corporate taxes avoided by major transnational corporations. In the real world, resources can almost always be found for the purposes of the powerful: think HS2, Trident renewal, and so on.

Choices about public finance are political choices with consequences for health and health inequalities; academics and practitioners must not be shy about pointing out those consequences.


A more extensive list of references is available from the author.  All views expressed are exclusively those of the author.

Photo: Servizi Mediali.  Reproduced under a Creative commons 2.0 licence. 

Being critical of how bodies are ‘sinking’ the NHS: Lessons from the University of Wollongong (Part 2 of 3)

Guest post by Stephanie Morris, PhD Candidate at Durham University

My time at The University of Wollongong has been one of the biggest learning experiences so far on my Overseas Institutional Visit to Australia. My conversations with scholars there have led me to think more critically and question the status quo regarding physical activity, health and obesity. I had many conversations with Professor Jan Wright that made me realise the way in which physical activity is often promoted may have some unintended consequences for the health and wellbeing of those whose behaviours public health initiatives constantly seek to change.

The University of Wollongong

Many academics and practitioners stress the importance of understanding the political economy of health and health inequalities yet it appears that the media and other discourses in our neoliberal society remain focused on stigmatising individual bodies and their behaviours. I came across an article in The Spectator (a conservative magazine) recently entitled, Our NHS will sink under the weight of Britain’s fatties. The title alone got my blood curdling but one paragraph written by Dr Dawn Harper stood out in particular. It went as follows:

If you are a woman with a waist greater than 32in (80cm) or a man with a waist greater than 37in (94cm) you are at risk of type 2 diabetes. If you are a woman with a waist circumference greater than 35in (88cm) or a man with a waist greater than 40in (102cm) then your risk is very high… For your sake and for the sake of our beloved NHS, take this as a warning shot across your bow and get yourself on a healthy living plan.

Now, the first thing I thought about this extract was how fear mongering and morally loaded its tone was. The emphasis is put on the individual for being a bad citizen, immorally and self-indulgently sinking the NHS. Yet, causations and prevalence of obesity and diabetes is much more complex than a waist circumference category. The key question that I wish to raise here stems from the work of two critical scholars, Gard and Wright (2005), whose work is part of the literature critiquing the ‘obesity epidemic’, the link between body size and diseases like diabetes, and health education curriculums. They ask whether the prevalence of such obesity discourses are actually more connected with the morality included in cultural attitudes concerning fatness than about the clear communication of objective and conclusive scientific knowledge. I am not suggesting that there is no reason for some focus on body weight and size, nor am I attempting to condemn all quantitative research in this area. However, I am questioning what implications such a focus on the body might have for people, and future research and policy. First, many have argued that focusing on the individual body distracts us as researchers and citizens from looking at wider structural issues and health inequalities that need to be researched and addressed. Second, others show obesity discourses and 'Healthism' (a term coined by Crawford (1980) to describe a discourse where individuals are held morally responsible for their own health. Individuals then self-monitor and manage their health by objectifying the body.) fuel body dissatisfaction, feelings of guilt and eating disorders, thus negatively impacting on the wellbeing of children and young people.

Positive vibes from a hostel in Sydney

Due to these negative consequences on people's wellbeing I ask what we as scholars, practitioners and third sector workers in the field of public health really consider ‘health’ to be? Do we consider 'health' to be “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” (The WHO definition)? Or do we view ‘healthy’ as appearing as an active and slim body? There are movements away from focusing on weight and body size, including Health at Every Size (HAES) – which Peter van der Graaf also writes about in this blog post – that focuses on promoting happiness in eating and an enjoyment of movement in life. Although HAES has been critiqued by many I wonder if some of its elements can be valuable. I do not think continually worrying about one’s body or fat composition is a ‘healthy’ way to grow up or live, as I don’t think it helps achieve “physical, mental and social wellbeing”. Moreover, perhaps if we stop fixating on the body and move away from changing individual behaviours we might consider societal inequalities more and help reduce inequalities that constrain people’s daily lives. What do you think?

Aspiring to new lows in North West waistlines

Guest post by Naoimh McMahon, Postgraduate student, NIHR CLAHRC NWC

In theory weight management is a ‘simple’ balance between consuming enough energy to adequately fuel ourselves and moving enough to ensure that extra energy is used up. However, in reality there is a complex web of influences that determine our eating and activity habits. We are becoming increasingly more sedentary and are prone to consuming more energy-dense foods. This combination is making the energy balance harder to achieve. When it comes to weight management interventions, what works for one individual is rarely guaranteed to work for the next and so there are real challenges to understand what the right mix of actions are to enable people to achieve and maintain a healthy weight.

Last summer, when preparing a doctoral fellowship application I met with providers and service users from a range of local health improvement initiatives in the North West of England. I was really intrigued by one initiative in particular called Aspire. Aspire is a weight loss programme delivered by a local charity. The design of the programme was unlike any other weight loss programme I had encountered and there was a real sense of personal investment in the programme from both the providers and participants. The thinking behind Aspire is that for individuals who have a lot of weight to lose, intensive and ongoing support is needed to make a positive and sustainable change. The programme runs for 26 weeks and each group has 12 participants. Aspire includes all the traditional elements that you would expect to find in a weight loss programme such as advice and education on food and healthy eating. It also supports participants, many of whom have a body mass index (BMI) of over 35, to engage in graded physical activity.

I think what I found most intriguing about this programme was the emphasis it placed on the person, trying to build confidence and esteem to really convince people that they could achieve their weight loss goals. For example one of the activities that participants spoke about with most feeling was a step climb in a local park at the beginning of the programme. The Aspire providers discussed how this activity served two purposes: (i) to act as a ‘shock to the system’ by allowing the participants to really reflect on their current fitness levels and (ii) to provide a goal to work towards and make a commitment that it will never be that hard again. The group returned to this step climb at the end of the 26 weeks with smart phones in tow and there is some really fantastic footage that captures the excitement and pride at the progress they had made along with the disbelief at how it had once taken hours to complete.

There is never a ‘one size fits all’ and any programme will work for some but not for others. It certainly seems like now it is less about finding a single ‘effective’ or ‘perfect’ programme and more about trying to understand what it is about programmes that enable different people to make positive and sustainable changes. I think we will all know people personally who have taken control over their weight by stumbling upon park runs and ‘getting the bug’ or by using commercial weight loss programmes such as Weight Watchers or Slimming World - finding a system that really works for them. Like other weight loss programmes, there were Aspire participants who did not achieve their goal weight and there were participants who regained the weight that they had worked so hard to lose. What is important is not to write-off such efforts as ‘ineffective’ but to get a better understanding of how and why these outcomes came about. Aspire is only one example of a novel approach to enable people to lose weight but there are certainly elements that have been particularly effective for some participants.


Find out more about the programme and how participants felt about what worked for them.

Boring to Baywatch

Guest post by Jane Johnson, PhD Researcher at Teesside University

The title of this post is perhaps not what you’d expect to hear at an academic conference but then again not all conferences broach the tricky subject of ‘sexy communication’.

The Hoff

This month I was invited - and funded thanks to help from Teesside University and the Royal College of Chiropractors (RCC) - to present an outline of my PhD at the Researchers’ Day of the European Chiropractors’ Union (ECU) Convention in Oslo. The theme for researchers was Down from the Ivory Towers: Breaking Down the Barriers Between Research and Clinical Practice.

As a clinician-turned-researcher and someone who has sat through countless presentations by researchers, this was a theme close to my heart. It felt like a win-win because not only was the RCC getting to see where its money was being spent but - as a fledgling researcher - I gained a valuable insight into the world of research and particularly into the opportunities and challenges presented to us in disseminating what we are doing and what we discover.

President of the ECU Executive Council, Øystein Ogre opened the conference by saying that research has always been a priority for the ECU, not least because chiropractors need a sound evidence base; a concept which, as a physiotherapist, drew me to apply for the PhD on which I am now engaged.

Two speakers from whom I took home important messages were Alice Kongsted and Jørgen’s Jevne. Firstly, Alice suggested that, when presenting our message to clinicians, we should “decide on a clear message” and “drop the details”. She gave examples of PowerPoint slides where the message was unclear and the details many, contrasted to the same information presented in a pared down format. The second take home message was from Jørgen, whose claim to fame could be that he managed to get the word ‘sexy’ into a British Medical Journal publication when they published his article The Sexy Scalpel: unnecessary shoulder surgery on the rise. He said that in getting our message across to clinicians we need to be ‘message brokers’, maximising the use of social media and including images, videos, catchy quotes in our delivery.

Having previously felt anxious about presenting my own work in a highly visual and often interactive way for fear of being criticised as lacking gravitas, I suddenly felt an immense sense of relief. These were experienced researchers and skilled presenters advocating not that we dumb down the content of what we say, but that we change the way we say it. For the first time I felt like I was being given permission to present in a manner that I was drawn to even if it didn’t match the majority of presentations I have sat through. Jørgen’s said that we need make the way we communicate sexy: we need to go “from boring to Baywatch”. I may not have the skill to incorporate images of David Hasselhoff or Pamela Anderson into my slides, but I’m inspired to think more creatively about communication to clinicians.

Photo attribution: flickr.com, Geoffrey Chandler, "David Hasselhoff": https://www.flickr.com/photos/hotrodhomepage/53065807

Why England could get knocked out in the quarter finals

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

If Euro 2016 was based on how healthy each nation is, there would be some surprising results. England would get knocked out in the quarter finals of Euro 2016 if the tournament was based on how healthy each nation is. Based on health statistics, Switzerland would walk away as European Champions for the first time in the competition’s history, narrowly beating Iceland on penalties in the final. 

Click here to see more Country Health Fact Files‌

Our analysis of differences in life expectancy for men in the 24 countries taking part in the forthcoming football tournament shows huge health divides across Europe and highlights the links between where you live and how long you live.

The European Health Championship is an accessible way to shed light on these stark differences. It scores each nation’s football team based on the country’s male life expectancy at birth for 2013. From these scores, the winners and losers of each group are decided as well as the results of the games in the knock out stages.

England, with a male life expectancy of 79 years, would be winners of their group by beating Russia (63 years), Slovakia (72 years) and Wales (78 years). England would then beat Czech Republic (75 years) in the round of 16 knockout stage but would lose to Iceland (81 years) in the quarter-finals. Likewise, Wales and Northern Ireland, with a male life expectancy of 78 years each, would be beaten by Austria and France (79 years each) in the round of 16 knockout stages. Switzerland and Iceland both with male life expectancy of 81 years meet in the final, with Switzerland winning on penalties because female life expectancy there is 85 years compared to 84 years in Iceland.

The European Health Championship also reveals a clear east-west gap with worse health in the countries of Eastern Europe compared to those in the West. For example, in the host country France (the runners-up in group A), baby boys are expected to live up to 79 years old whilst in Ukraine, who finish bottom of group C, it is just 66 and in Russia (bottom of group B) it is a mere 63 years. Spain and Italy also fare well with men expected to live up to 80 in those countries.

But what explains these differences in health across European countries? Why do some countries perform so much better in health terms than others? Geographical research suggests that the answer is twofold: the health of places is determined by the population composition (who lives here) and the environmental context (where you live).

Who lives here? The demographic, health behaviours and socio-economic profile of the people within a place influences its health outcomes. Generally speaking, health deteriorates with age, women live longer than men, and health status also varies by ethnicity. Levels of smoking, alcohol, physical activity, diet, and drugs – all influence the health of populations significantly. Indeed, research has strongly linked Russia’s comparatively low life expectancy amongst men with the high levels of alcohol consumption in the country particularly since the collapse of communism. The socio-economic status – or social class in “old money” – of people living in a country also matters as those with higher occupational status (e.g. professionals such as teachers or lawyers) have better health outcomes than non-professional workers (e.g. manual workers). So differences in the characteristics of people in the countries of Europe will contribute to these country level differences in life expectancy.

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

Infographics

• ‌European Health Championship – final round of 16 to final‌
• Group results A-F‌
• Country health fact files‌

The underlying research to the European Health Championship and these links between health and place are explored further in Professor Bambra’s forthcoming book Health Divides: where you live can kill you. Reducing health inequalities between and within the countries of Europe is also the focus of HiNEWS, an international project led by the Department of Geography at Durham University. It is funded by the New Opportunities for Research Funding Agency Co-operation in Europe (NORFACE) which is a partnership of European research councils including the Economic and Social Research Council (ESRC).

Dementia: not drowning but waving

Posted by Mark Parkinson, Post Graduate Student at Northumbria University

It's Dementia Awareness Week in England as part of Alzheimer’s Society’s ongoing campaign to raise public awareness of this disease. It also affords us the opportunity to take stock of just how far we have progressed since the dark days of the 1980s. Back then a mood of extreme pessimism surrounded dementia amid stark warnings that this ‘rising tide’ represented an unstoppable tsunami-like force that would engulf the UK. Attempts to avert the coming disaster were seen as futile and hopeless, akin to King Canute holding back the sea. The prevailing mood of despondency was ‘justified’ by nine fallacies of dementia emanating from a general lack of knowledge and understanding about dementia.


The Great Wave off Kanagawa

• Fallacy No.1: Dementia was commonly perceived to be part of ‘normal ageing’. Dementia is now widely acknowledged as a clinical condition characterised by neurobiological abnormalities that distinguish it from so-called ‘normal’ ageing. The public perception of dementia as a disease that is separate from ‘normal’ ageing is increasing in the UK but campaigns such as Dementia Awareness Week are still necessary.
• Fallacy No.2: Dementia is unavoidable. Protective factors that help guard against vascular dementia in particular include our lifestyle choices, including smoking cessation, regular exercise, adherence to a healthy diet and avoiding becoming obese. The identification of potential triggers for dementia paves the way for future interventions that might mitigate the onset of dementia entirely, including monitoring for catalysts for dementia such as cardio-vascular disease, obesity, diabetes and depression. Intervention programs targeting at-risk groups have demonstrated success in preventing dementia, e.g. FINGER (a two-year programme that focuses on diet, exercise, cognitive retraining and monitoring and treating vascular risk). Latest research also highlights further candidate triggers for dementia such as interleukin 33 (IL-33) protein deficiency which may be remedied via injections to prevent dementia.
• Fallacy No.3: Dementia is irreversible. Although this remains the case for now, the development of treatments such as Galantamine have been shown to at least moderate the effects of dementia.
• Fallacy No.4: Dementia is untreatable. The search for a cure for dementia remains ongoing and we have moved into an era where the potential discovery of better treatments and an eventual cure has never been so high. For now though prevention via identification of key triggers remains the main option in the absence of a cure.
• Fallacy No.5: Dementia is a diagnosis to mortality within seven years. Dementia related diseases such as Alzheimer’s now have a typical duration of 10 or more years and evidence suggests that, in general, people with dementia are living longer. The challenge continues to be ensuring they live as well as possible.
• Fallacy No.6: Dementia is too varied and unpredictable to treat. Greater understanding of the different sub-types of dementia, their different causes and symptoms, combined with improved ability to detect them makes treatment for dementia a more viable possibility.
• Fallacy No.7: Dementia is only detected when it is already too late to act. This remains a key issue; however, improved diagnostic tests and screening have improved early detection of the disease.
• Fallacy No.8: Dementia is too expensive to treat. Recent interventions such as Cognitive Stimulation Therapy (CST) can be delivered to people living with dementia via just 14 hourly sessions. CST has demonstrated equivalent but more sustained effects compared to relatively expensive drug treatments.
• Fallacy No.9: The number of those with dementia will increase exponentially in the future. Recent comparisons between CFAS1 (Cognitive Function and Ageing Studies) (1991) and CFAS2 (2015) conducted by Cambridge University reveal that dementia prevalence in the UK has actually declined by 22 per cent over this 24 year period. Those born in the latter part of the 20th century exhibit a lower risk factor for dementia than those born earlier. The tsunami warnings of the 1980s have been proven wrong.

Importantly, all this does not signal a time to relax. The need to raise awareness of dementia and the challenges associated with it remains as urgent as ever. In the 1980s a sense of urgency towards tackling dementia provided a much needed catalyst for change. Today a key difference is that this urgency is no longer fuelled by impotent fear but by renewed hope and optimism that galvanises fresh impetus to all our endeavours to beat the disease.

With acknowledgement to the inspired presentation on 25 April, 2016 at the first Gateshead Dementia Conference by Dr.Daniel Collerton (Clinical Psychologist associated with dementia care at The Queen Elizabeth Hospital, Gateshead).

The 'Wow' moments

Posted by Rosemary Rushmer, Professor of Knowledge Exchange in Public Health, and Dr Peter van der Graaf, AskFuse Research Manager, Fuse and Teesside University

From the 26-28 April, Fuse hosted the Third International Conference on Knowledge Exchange in Public Health in Newcastle-Gateshead. The conference explored “Evidence to Impact in Public Health" in partnership with Tranzo (Dutch Scientific Center for Care and Welfare) and the World Health Organization (WHO), Regional Office for Europe. More than 160 participants from five continents descended upon the Quayside to discuss the latest research and evidence on knowledge exchange practices through papers, posters, interactive workshops and soapbox sessions – and continued these deliberations during the conference reception and dinner, organised walks and yoga sessions.

How do you sum up a conference like this? We are used to filling in ‘happy sheets’ when we attend conferences, giving our scores on the speakers, the accommodation, and if the food was hot…but what about the ‘Wow!’ moments that participants share with each other in the informal spaces?

Below are a few of those hidden moments:

(Day 1: Keynote speaker Professor Bev Holmes, Vice-President, Research
& Impact at the Michael Smith Foundation for Health Research, Vancouver)

‘Wow, she has a lovely way of asking really difficult questions in such a nice, unthreatening way…’

(Day 2: Keynote speaker Professor Hans Van Oers,
Professor in Public Health, Tranzo, Tilburg University)

‘Wow, how did they manage to carry out that research against all that opposition and yet laugh about it now… you can have a good time, be funny, and serious as well…’

(Day 1: Keynote speaker Professor Kieran Walshe, Professor of
 Health Policy & Management, Manchester Business School)

‘Hmm, we can learn about innovation in public health from the car industry and Amazon…’

‘(Sigh) Is that how much we spend on pharmaceutical research and how little we spend on working together to get evidence used. That needs to change…’

(Day 2: Keynote speaker Claudia Stein, Director of the Division of Information,
 Evidence, Research & Innovation, World Health Organisation (WHO))

‘Wow’ it’s that last presentation of the conference and the room is still full.’

(Day 2: Professor Peter Kelly, Director of Public Health
& Adult Social Services, Stockton Borough Council)

‘Goodness! Your Directors of Public Health (DsPH) have taken time out to chair sessions and present…’ (When I fed this back to one DsPH, to show the planning committee’s appreciation of their participation, he was surprised at the delegates surprise… ‘What on earth happens elsewhere…?’ he said.






Maybe we, in Fuse, do have a ‘special relationship’ with our policy and practice partner that makes Knowledge Exchange in public health easier in the North East of England. We, the organising committee, were wowed by the enthusiasm and engagement of all participants during the conference. Discussions were lively with active and positive contributions from not only researchers but in particular public health practitioners and policy makers. Their engagement in the conference is the real evidence of how far we have come with knowledge exchange in the North East and the impact we are having together on public health and local wellbeing, and this is being noticed internationally.

Here's to the next conference!

Visit the Fuse website to find out more about the conference: www.fuse.ac.uk

You are now reading the award winning Fuse blog

Posted by Mark Welford and Emma Dorée, Fuse Communications team, Teesside University

You may recall that in January we used this platform to make a shameless plea inviting readers to vote for the Fuse blog in the UK Blog Awards and a month later you may have heard the news that we had been shortlisted in the categories of Education, and Health and Social Care.

Well… (drum roll) …. We only went and won!  That’s right, you are now reading an award winning blog – fancy contributing?!

Last Friday (29 April), we took the Fuse blog monster on a road trip to the big smoke, that there London, where the streets are paved with, well… paving stones to attend the awards ceremony, in eager anticipation.

The awards ceremony was held at the swanky Park Plaza Hotel in Westminster, London and it is safe to say that it more than exceeded our expectations.  The invitation advised that we ‘dress to impress’ but some of the attire on show would have made Lady Gaga and James Bond feel underdressed.

We were welcomed to the event, themed on Roald Dahl’s The BFG with free drinks and canapes (not to mention all the frogsquinkers, buzzwangles, and bugwhiffles we could handle), while we networked with other bloggers and even the Big Friendly Giant himself. The most exciting part however was still to come: the awards ceremony itself.

Tech Reporter Kate Russell (you might know her from BBC show Click) hosted the evening and provided a great commentary, making every blogger there feel very welcome.  Her quirky comments worked to relax the atmosphere and ease frayed nerves.

Each category had two blogs that were highly commended by the judges, followed by an overall winner.  As the Education category came up on screen, we watched in anticipation - the Fuse Blog wasn't announced as Highly Commended - oh well there was still the other category - but then to our surprise as the overall winner of the category!

Having let out a little scream of excitement (and possibly the odd expletive), we went up onto the stage to collect our trophy – a rather lethal looking glass affair - and have our photograph taken with Kate and the judges. It was a surreal moment and very much unexpected with a dash of relief as there were no speeches.

Obligatory award selfie

Once the presentations were over, we were invited to have our photograph taken with the other winners. After which it was time to celebrate properly with more free prosecco (consumed in moderation), posh food and of course a little bit of disco dancing.

This was a great event to be a part of and the venue made it feel even more special and exciting. As the night drew to a close and we collected our certificate and goody bags (with complementary BFG themed dream jars), the fact that we had actually come away as winners had not yet sunk in - it still hasn't now to be honest!

Dream jars - also good for storing ginger biscuits

  
 This is a fantastic achievement for Fuse, as more than two thousands blogs were submitted. There were more than seventy eight thousand votes in total and it is great to think that the Fuse Blog has such a loyal following and a lot of support.

A special thank you must go to Jean Adams who founded the blog in 2011 and to everyone who has contributed over the years.  The posts have sparked great discussion and helped our readers learn what it is really like to work in public health.  Our many writers make the Fuse blog what it is.

We really hope that you will continue to enjoy reading our posts and don’t forget, if you would like to contribute to the Fuse Blog then please do not hesitate to get in touch.

If you would like to discuss a potential blog post or have something already written then please get in touch with Emma Dorée (E.Doree@tees.ac.uk).

An overseas institutional visit to Australia: expectations and initial experiences (part 1 of 3)

Guest post by Stephanie Morris, PhD Candidate at Durham University

Yesterday I sat in Perth’s Botanical Gardens in the Kings Park looking out over the city scape. As I sat and enjoyed the shade of a Eucalyptus tree I noticed a trio of children playing with a Frisbee barefoot on the grass in the sunshine. They stepped to throw and leapt to catch the Frisbee all within view of their parents who sat further up the incline. At one point one of the girls threw the Frisbee high in the air; it landed in the branches of another Eucalyptus tree (thankfully). The tallest boy then reached up to rescue it from where it was lodged so they could continue playing their game. At that point I began thinking about how different these children’s lives seemed to be in comparison to some of the boys I worked with in the North East of England during my ethnographic PhD fieldwork on daily physical activity. I remember images of some of the boys kicking a football down a back alley between terraced houses avoiding wheelie bins, broken glass and rubbish at the sides. Sometimes a ball would get kicked into a yard so one of them would climb over the wall or gate to fetch it. There were no bare feet on grass. There were no eucalyptus trees. But there were young people engaging in unstructured physical activity. I start to wonder about differences and similarities in contexts within and between Australia and the UK, and what exciting insights I will gain from others whilst I am here on the other side of the world.

This is my second full-day in Perth at the start of my seven-week Overseas Institutional Visit (OIV) to Australia. As part of this scheme I am writing a three-part Fuse blog to share my experiences, insights learnt and reflections on my visit ‘down under’. The OIV scheme is funded by the North East Doctoral Training Centre (NEDTC) and Economic and Social Research Council (ESRC), giving me the opportunity to visit the University of Western Australia, the University of Wollongong and the University of Queensland. These institutions are home to researchers who are at the forefront of applied and critical research on young people’s physical activity; I am going to be meeting some of the key academics I am citing (often time and time again) in my PhD thesis. Pretty big deal.

So what am I going to be doing during this visit? Firstly, I will be giving presentations about my PhD research to different groups of researchers at the three Universities all with an interest in health and physical activity. From these presentations I hope to gain feedback and discuss key ideas that are forming the discussion chapters of my thesis. Secondly, I am having meetings with various researchers and experts in my field; I hope to learn more about new and innovative current research projects, get new ideas for my own future research and uncover many pearls of wisdom about publishing and how to succeed in academia post-PhD. Thirdly, I’m going to shadow my hosts at certain points, attend events and get involved in any ongoing research projects they are involved with. I want to find out what it is like to work in these institutions, their research groups, and their small and large scale research projects.

I clearly have high hopes about the several weeks to come as well as, I must admit, a few fears. This is my first time in Australia, my first time giving presentations to people who are the experts in my field, and my first experience in any University other than Durham(!). So far my host Hayley at the School of Population Health here in Perth has given me an incredibly warm welcome; my first week has an exciting line up, including attending a launch event where the Department for Sport and Recreation are announcing the future strategic directions in Western Australian Sport and Recreation Industry. Until next time, all the best from ‘Down Under’.

Successfully reuniting planning and health

Posted by Tim Townshend, Fuse Associate and Acting Head of School, Director of Planning and Urban Design at Newcastle University

On Thursday 7 April I chaired an event that was jointly a Fuse Quarterly Research Meeting (QRM) and the fourth in the ESRC funded seminar series entitled ‘Reuniting Planning and Health’. It was the culmination of quite a few months of preparation and though it’s not the first such event I’ve organised it’s always a bit nerve-racking on the day – will all the speakers arrive? Will the participants enjoy themselves? Will lunch be any good?! As it was I needn’t have worried about a thing.

The day kicked off with a great overarching review of the need for planners and health professionals to work more closely together from Laurence Carmichael, Head of WHO Collaborating Centre for Health Environments – showing that while there is a lot of momentum behind the initiative there is much work still to be done. We then went north of the border with a presentation from Etive Currie, Glasgow City Council, who has been working on healthy planning initiatives for many a year – Etive’s presentation was full of amusing anecdotes about how local communities are not always initially receptive to such ideas! However there were also lots of really good news stories about individual lives that had been turned around. This was followed by Lee Parry-Williams, Public Health Wales, who gave a very informative overview of progress with Health Impact Assessment (HIA) in Wales – and also some insights into how political rivalries can stand in the way of real progress!

After a short coffee break, we had three further keynotes, Prof Ashley Cooper, University of Bristol – gave an excellent presentation setting out the complexity of linking children’s activity patterns to the built environment – it clearly demonstrated that for planning to deliver environments that are more supportive to healthy lifestyles, the research behind interventions needs to be extremely robust. Lesley Palmer – Chief Architect, Stirling University’s Dementia Services Development Centre, gave a really thought provoking presentation on how to design with dementia in mind – highlighting sufferers’ altered sense of reality – while showing elegant design solutions that could be incorporated into any environment that seeks to be age-friendly. The final presentation came from Gary Young, Director at Farrells, exploring the NHS Healthy Towns Initiative – including some of the initial housing at Bicester – a great talk to end with as it brought together so many key strands.

In the afternoon there were four interactive workshops – ‘The Casino’ a theatre based workshop run by local group Cap-a-Pie, explored how a proposed regeneration project for a run down seaside resort might impact a local community by actually asking participants to step into the shoes of the community themselves – an experimental methodology – it seemed extremely well received by those who took part. Jane Riley, Joanna Saunders and Carol Weir a team based at Leeds Beckett University gave a great workshop on the ‘total systems approach’ to obesity prevention – with participants asked to think about how they could make a real difference in their own work – quite a challenge! Douglas White of the Carnegie Trust did an excellent presentation on the Trust’s ‘Place Standard’ tool – which I’m sure participants will be using in future projects. Finally Pete Wright’s team undertook a kind of speed dating event so that participants could become familiar with various aspects of the MyPlace project based at Newcastle University’s OpenLab.

I observed all for at least a short time and was really impressed as to how participants became quickly absorbed – all the workshops were clearly thoughtfully prepared – the feedback overwhelmingly positive – so my huge thanks to all the organisers.

All round it was a fantastic day and all ran very smoothly – thanks very much to Terry, Ann and Peter the Fuse support team for all their help! And to The Core – it’s an excellent venue.

'Inappropriate' A&E attendance: One out of four ain't bad

Guest post by Dr Simon Howard, Associate Lecturer in Public Health, Northumbria University

Last week on the blog, Emma Dorée wrote about a statement from South Tees NHS Foundation Trust urging people not to attend Accident and Emergency departments for stomach aches caused by excessive consumption of Easter Eggs. Emma explained that one in four A&E attendances is considered inappropriate, and highlighted the NHS Choose Well campaign which helps people to select the right place to take their symptoms.

Photo attribution: www.thepoke.co.uk

This made me wonder… is one in four A&E attendances being ‘inappropriate’ really so bad?

Clearly, the NHS is stretched at the moment, and nowhere more so than A&E, where only 83% of patients are seen and sent on their way within four hours, as compared with a target of 95%. It is natural for us to want to see performance improve, and waiting times are doubtless inflated by ‘inappropriate’ attendees.

Of course, we should wonder what is meant by ‘inappropriate’ in this context. There are many possible classifications. Of course, attending A&E seeking treatment for a sick dog is undoubtedly inappropriate. But is it inappropriate to attend for ‘hangover help’? What if the symptoms of your hangover are difficult to distinguish from the symptoms of meningitis? The final diagnosis and healthcare provider’s perspective is not necessarily the best viewpoint from which to determine ‘appropriateness’.

Even if we assume that one in four attendances truly is inappropriate, it’s reasonable to question whether that is so bad. Considering the problem in terms of sensitivity and specificity, it is vastly preferable that the self-triaging process is sensitive (i.e. all people who really need A&E attend A&E), even if that’s at the expense of a degree of specificity (i.e. some of the people who don’t need A&E still attend A&E). As a doctor, I want everyone who has a life-threatening emergency to attend A&E, not for one or two to go to their local pharmacy, and I’m willing to accept that making that happen might mean that some less urgent cases also slip through the net.

People presenting to services inappropriately is anything but a new problem. Writing in The Lancet in 1849, Joseph Hodgson - the founder of what is now known as the Birmingham Midland Eye Centre - complained of the “growing evil” of “the indiscriminate admission of out-patients to charitable institutions”. His problem was, perhaps, a little different: people referring themselves to charitable hospitals even though “one half of the patients can afford to pay the surgeon his fee”. In order to avoid detection, many of his patients chose to “dress shabbily, and even borrow their servants’ bonnets and shawls”.

To my mind, the root of the modern problem is that we expect people, most of whom rarely use the health service, to self-triage between six (or more) levels of care. This is not sensible. Campaigns admonishing people for making obviously incorrect choices don't help this core problem, and may even counteract campaigns like Be Clear on Cancer, which encourage people to consult health services with symptoms which they may not recognise as ‘red flags’.

One solution to this problem is to introduce professional triage. Back in 1849, Hodgson suggested that “each applicant be compelled to bring a note of recommendations from the clergyman”; perhaps not quite such a useful recommendation for the 21st century. NHS Direct, and its successor NHS 111, were perhaps intended to provide the modern equivalent of the clergyman’s note, but do not enjoy a high degree of public or professional confidence. This is probably because triage over the phone is very difficult, even if it has been shown in research to reduce A&E demand. Perhaps options such as embedding GPs within A&E, as proposed by South Tees CCG, will provide an answer.

For now, here’s the bottom line: even as someone working in the system, I couldn't tell you where I'm supposed to take myself if I develop an unclear symptom. Telling me how inappropriate other people’s attendances are don’t help signpost me to the right place if I have, for example, sudden hearing loss or eye pain. Like very many other people, in situations of uncertainty, I am likely to err on the side of accessing a higher level of care, as I would not want to delay urgent treatment. Though I probably wouldn’t turn up wearing my servant’s bonnet.

Photo attribution: http://www.thepoke.co.uk/wp-content/uploads/2015/01/nhs_departments.jpg

It's April: happy stress awareness month everyone!

Guest post by Dr Emily Henderson, Lecturer in Knowledge Exchange in Public Health and Research Fellow in Complex Systems at Durham University

April is stress awareness month. Why, you may ask? Maybe because it’s tax season. Or because parents have to look after their children during the Easter holidays. Or perhaps it’s to help recover from all the April Fools’ Day jokes, like the poor guy in Canada this year who reportedly collapsed from heart palpitations after his work colleagues convinced him he had to cut his holiday short to meet a deadline that had been moved forward.

 

Whatever the reason, it is happening this month. The Health Resource Network has deemed it so. And we at Fuse think it is a good opportunity to raise awareness about stress.

But I am already aware that I’m stressed, I can virtually hear you reply. Fair enough. Nearly half of UK adults report feeling stressed every day or every few days, according to the Mental Health Foundation. With budget cuts, job insecurity and global crises, just to begin with, we all are stressed.

  

So what am I to do about it? We all have our coping strategies, which are biologically understood responses that humans and animals alike have evolved. Chimpanzees are known to groom each other to cope with threats and re-establish bonds. Stress and suffering are human universals. We can measure stress via stress hormones like cortisol, and there are physiological and some behavioural responses we can predict, like the ‘fight or flight’ response. But some behaviours are not predictable, and do not always make (immediate) sense. For example, Hilary Graham’s ethnographies of low-income single mothers showed us that, paradoxically, smoking was used to cope with suffering and thus improve wellbeing.

You, dear reader, have asked so many good questions up to this point, I have one for you: Considering the ‘causes of the causes’ of ill health, is the actual problem that these women smoked or is it the disadvantage they experienced? We have no choice but to cope in our own ways with stress. After trial and error, I know better now what I need to get perspective and find stillness inside. I am addicted to the oxygen highs I get through practicing yoga, and require connection with nature and people. But as a native to San Francisco, I am under cultural obligations to indulge in wine. Nobody is perfect. And nor should we ever aspire to this elusive ideal. Indeed, evidence for the health benefits of practicing compassion - either compassion for ourselves or for others - is growing. Beyond changing our behaviours, we must change the structures and systems that generate stress.

Spring is actually not about chocolate bunnies, but about renewal. So this April, in addition to trying new ways to cope with stress (see the Huffington Posts compilation of articles for Stress Awareness month, or NHS Choices mindfulness article), maybe get involved in a cause that seeks to alleviate suffering.

Please check out the Stress, Health and Wellbeing special interest group that I run through the Wolfson Research Institute for Health and Wellbeing at Durham University.

Photo credits

1. http://slstpaso.com/wp-content/uploads/2015/03/April-for-email.png

2. http://missinghumanmanual.com/wp-content/uploads/2011/05/grooming-chimps.jpg

3. https://thimesblog.files.wordpress.com/2014/02/keep-calm-make-your-voice-heard.png?w=600

An egg-cellent reason to go to A & E?

Posted by Emma Dorée, Fuse Communications Assistant, Teesside University

Easter is a time that many people look forward to, not only because we get a couple of extra days off work but because it is an excuse to over indulge in copious amounts of chocolate.

This year however, it seems that Easter has become a problem for many people, especially the NHS. South Tees Foundation Trust NHS have this weekend released an urgent statement on their social media sites, urging people who have given themselves stomach ache from eating too many Easter eggs not to attend Accident and Emergency.

Data for NHS England in January showed that 88.7% of patients attending Accident and Emergency were dealt with in four hours – the worst monthly performance since the target of 95% began in 2004. These figures show that Doctors are under a lot of time pressure but what they don’t show is why.

I did a piece of investigative journalism to unearth the most comical reasons why people attend A&E departments in the UK and need your help in deciding which reason is the most outrageous one.

Below are 10 reasons, most of which featured in the The Choose Well campaign developed by NHS North West in 2011 to urge people to go to the right place for NHS treatment after new figures revealed that one in four A&E patients could care for themselves or get treatment elsewhere. The campaign includes a number of short films depicting "inappropriate" A&E scenarios being played out by actors, which are very entertaining and might help you to make an informed choice.

We added stomach ache from eating too many Easter eggs as the ninth reason to keep the list up to date. Which one will get your vote?

Make sure to keep an eye on our Twitter page to find out the results!

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Supporting vulnerable communities in Australia and the UK: linking data through knowledge exchange

Posted by Theodora Machaira, PhD student at Teesside University

On the 8th of March we were pleased to welcome Jen Lorains, researcher from Australia, in Fuse. Jen was successful in winning a Winston Churchill fellowship and decided to visit Fuse as her main research interest is knowledge exchange and translational research.

As part of her visit, Jen delivered a Knowledge Exchange Seminar on ‘Early Childhood Data with Communities in Australia’. Her presentation focused on the Australian Early Development Census (AEDC) which is a national census which measures physical health, social skills, communication and general knowledge, language skills and emotions of 5 years old children. The AECD data is publically available and although it is not primarily used for knowledge exchange, it certainly facilitates it by enabling key stakeholders in early years to work with the data in order to improve child development outcomes.

Theodora (left) with Jen Lorains

Jen’s presentation was interesting on a number of levels but from a PhD researcher’s point of view, two things were most striking. First of all, thinking about child development assessments in diverse populations, I felt that Australia and the UK are not as different as I thought. In Australia, diversity exists mainly between indigenous and non-indigenous populations. Indigenous Australians have their own language, rituals and beliefs, which in early years and education settings can be challenging to deal with. Although, diversity in the UK is different and not as clear cut with many different cultures calling the country their home, diversity is also an issue over here and is now perhaps more prominent than ever. With that in mind, I was wondering, how fair (or accurate for that matter), is it to collect data on child development from all 5 years old children in English? Isn’t it possible that an indigenous child has good communication skills but in a different language? Of course, this cannot necessarily be taken into consideration in a national census. But surely that begs the question, are we classing children as having delayed development when perhaps we shouldn’t?

The second thing that got my attention was the issues with knowledge exchange in Australia that Jen discussed. She talked about how different professionals use the data and how challenging it is to have everyone on board when trying to develop common approaches to help children in areas where vulnerable children are identified as different professionals identify different solutions for highlighted problems. As my PhD focuses on systems change and developing a common approach between early years’ professionals, I again, thought about the similarities between Australia and the UK. Perhaps foolishly (I am only a year into my PhD!) I thought that these issues are a UK phenomenon, however, I quickly realised during Jen’s presentation that they are not.

Intrigued by these observations, I started talking to Jen after the seminar (and because Jen had an hour and a half to kill before her train) we decided to go for a drink after her seminar. Although some people might disagree, I thought that the pub was a great setting for knowledge exchange! We discussed my and her thoughts having travelled to the UK, USA, Canada and Peru, and realised that using research data with different communities in these counties requires researchers to be skilled in knowledge exchange. This will enable researchers to include these communities in interpreting the data and developing useful interventions with these communities. This might sometimes feel like fighting a lost battle but is essential to support vulnerable children identified through collected census data.

Obesity: many perspectives, no magic solution

Lorraine McSweeney, Research Associate, Newcastle University

To coincide with Nutrition and Hydration week Lorraine reports back from the Westminster Food and Nutrition Forum.

On the 9 March I attended a Westminster Food and Nutrition Forum titled: ‘Next Steps on Policy for Obesity - Prevention, Sugar Consumption and Priorities for Children’s Health’. The original purpose of the forum was to discuss the Government’s childhood obesity strategy. However, as publicised in the Guardian on the 26 February, this has been delayed; with the Department of Health calling it a ‘complicated issue’ that they want to ensure is a ‘game changing moment’. Despite the strategy delay the forum went ahead to allow ‘experts’ in the field to share ideas and possible approaches for the strategy.

Speakers and panel members were a diverse group ranging from Public Health England (PHE); School Food Plan; Southampton Health and Wellbeing Board; Children’s Food Trust; ukactive kids; Family Lives; primary care; Advertising Standard’s Authority; British Retail Consortium; Kantar World Panel; Food and Drink Federation; and London Food Board… the list goes on...

The McLympics - advertising and sponsorship

PHE stated that the average diet in the UK is poor with too much saturated fat and sugar and too little fibre, fruit and vegetables. This is having a knock-on effect on our children, with one in five primary school kids overweight or obese, by the time children leave primary school, this figure rises to one in three. Contrary to popular belief, this is not just an issue of poverty; obesity is happening in both the most and least affluent areas. We are bombarded with opportunities to eat 24 hours a day and there are many drivers to buy and eat. Advertising and sponsorship, which some people don’t associate with advertising, can have a negative impact on child health.

The Chief Executive Officer from the Children’s Food Trust argued that good food should be a part of a child’s life from day one, right through their life. Food should not be tailored to be ‘child-friendly’. Children should be encouraged to eat smaller portions of adult food and should not be targeted by the food industries. Parents need to be listened to and families should be helped to cook more.

The need to get children moving more was discussed and included comments about modern life not encouraging children to be active; and schools too scared to work with parents and tell them how to keep their children active. It was stated that only a third of children enjoy sports and other solutions need to be encouraged. The primary care representative felt that too many patients are being treated with the consequences of obesity. She believes that primary care professionals are missing opportunities to discuss weight with parents; however, GPs reported not wanting to cause offence and felt they did not have the time to deal with the issues.

An overarching theme from the ‘health’ representatives was that prevention is key and that the food industry was part of the problem and should be involved in solving the problem. We were informed that in an average supermarket consumers have 30,000 products to choose from and consumer change is very hard to drive.

The impact of volume of sales of products such as sugar and bread, which have no immediate substitute, are shown not to be affected by price rise. The introduction of a sugar tax was highly debated; some felt it would not change consumer behaviour, whilst others argued it would offer one solution. However, following the success of the reformulation of products to reduce salt and saturated fat, it was agreed that the reformulation of products containing sugar could be a way forward. However, representatives from the food and drink industries stated that sugars would be more difficult as it has a structural function in food.

In addition, if a product was made ‘healthier’ consumers may be inclined to eat more of the product but it was agreed that alongside reformulation, portion size control could be beneficial. There was much discussion of whether legislation should be enforced on food and drink companies – the representatives believed that due to diversity of companies, a voluntary approach was better. However, it was argued that ‘if consumers continued to make incorrect choices – legislation was all that was left’.

As you can see from this very brief summary, obesity continues to be a very complex issue; it was thought-provoking to hear the different perspectives from health, policy, practice and industry. However, the discussions emphasised the point that there is no magic solution; the publication of the Government’s childhood obesity strategy is eagerly awaited.

Photo attribution: flickr.com, Santo Chino, "McLympics": https://www.flickr.com/photos/santochino/2797034750