Friday, 26 February 2021

Four practical steps to increase knowledge exchange between researchers and policymakers

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

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


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

Here I want to share practical guidance from our research on ‘how to do’ knowledge exchange by reflecting on a model that has been developed in Fuse over the last ten years. Our approach to achieving practice and policy change has been to engage with practitioners, policymakers and the public through communications and knowledge brokerage, to co-create relevant research, influence policy and practice debates and promote evidence uptake. Below I have broken this down into four practical steps:
  • Step 1. Awareness raising: Making evidence users, funders and support organisations aware of our existence, our research and engagement opportunities, including engaging our partners early in setting the agenda for future research.
  • Step 2. Sharing knowledge: Creating opportunities for research users and producers to come together to explore opportunities for mutual learning and knowledge exchange through collaborative events, our responsive research service (AskFuse), and patient and public involvement.
  • Step 3. Making evidence fit for purpose: Localising and tailoring evidence to context by offering a knowledge brokering service, embedded research, and increasing awareness of the different pressures faced by people in health policy, practice and academia.
  • Step 4. Supporting uptake and implementation of evidence: Developing long-term relationships with policy and practice partners to co-create evidence, build capacity for practice change, and change practice and policy.

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

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

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

Friday, 19 February 2021

"Whatever their answer, double it and you should be close..."

Posted by Hannah Mehmood, Medical Student, Newcastle University

Hannah undertook a 6-week NIHR School for Public Health Research (SPHR) internship with Fuse based at Newcastle University in summer 2020. She was supervised by Fuse / NIHR SPHR Doctoral Student, Cassey Muir.

A question asked in every GP consultation is how much alcohol a patient drinks. It provides a useful insight into a person’s physical, social, and psychological health. According to my GP tutor, most people underestimate the amount they drink, as well as the impact this has on them.

Substance misuse is a complex issue, and as a medical student I have learned to focus on the impact of problematic drug and alcohol use on individual patient wellbeing. Last summer, as an NIHR SPHR intern, I studied substance misuse from a different perspective. The basis of my internship was a research project focusing on young people whose parents misuse drugs and alcohol. I aimed to explore how young people viewed school and education to understand if this environment could be used to deliver supportive interventions.

I analysed ten UK based qualitative studies which examined the experiences of young people affected by parental substance misuse. Qualitative studies examine non-statistical data to develop themes and deep understanding of the research question. The young people from the studies I explored were under the age of 25 and from various social, economic and demographic groups.

Young people viewed school as a space away
 from issues they may face at home
I was particularly interested in the ways in which young people viewed school as a separate space away from issues they may face at home, to the extent that many young people did not even discuss their home life with close friends. But despite the mental separation of home and school, the reality of their home life often prevented a complete detachment of the two. One young person described how caring for her parent resulted in frequently missing school, while another recognised that his aggressive behaviour in school was a way to offload stress at home.

Many young people also expressed a lack of trust towards their place of education, as well as a desire to blend-in with their peers. This contributes to barriers in identifying young people who may benefit from intervention, as many are fearful of being singled out while in the detached school environment.

In conducting my research, I came to appreciate the difficulty in generating themes from such varied experiences. I often felt that my insights did not do justice to the nuances of each individual story. I discussed this in a virtual meeting with a programme coordinator at ADFAM, a national charity that works with families affected by drugs and alcohol. Her experience, delivering interventions at an operational level, allowed me to see how my research fit into the real world. I came to understand that while research is conducted with the aim of applying findings to whole populations, these findings are only actionable when combined with existing knowledge and expertise. This discussion was a lesson in the value of cross-collaboration, an important tool in bridging the gap between research and intervention.

Over six weeks I have broadened my understanding of public health, conducted my own research project, developed my professional skills, and furthered my personal career goals. Although this internship took place remotely, my mentors enabled me to virtually meet various public health professionals. Hearing about their research roles, motivation and future plans has shown me the variety of career paths available within public health and helped to develop my own ambitions. The NIHR SPHR internship with Fuse has been a valuable personal and professional experience and I would recommend it to other students interested in pursuing a career in public health.



Part of our Fuse blog Student Series
The Fuse blog Student Series showcases posts by students who have been challenged to write a blog as part of their studies at one of the universities in the Fuse collaboration, the NIHR School for Public Health Research, or perhaps further afield. The authors may be new to blogging and we hope to provide a 'safe space' for the students to explore their subject and find their voice in the world of public health research.


Images:

1. 'Doctor with prescription stop drinking alcohol' by Marco Verch Professional Photographer via Flickr.com, copyright © 2019 (Attribution 2.0 Generic (CC BY 2.0)): https://m.flickr.com/photos/30478819@N08/48719845996

3. Logo courtesy of ADFAM https://twitter.com/AdfamUK/photo

Friday, 12 February 2021

Placement, parcels and a pandemic: five weeks embedded in a public health team

Posted by Maisie Rowland, Research Assistant and Registered Nutritionist, Human Nutrition Research Centre (HNRC), Newcastle University

Newcastle Civic Centre
My research has taken me from primary schools in the West End of Newcastle to rural schools in the mountains of Moshi, Tanzania but I have always been curious about other job roles and what they involve. I have also been interested in how, as researchers, we can collaborate with those outside of academia to ensure that the research we do has the desired impact. So on seeing an advertisement for an embedded researcher placement in Newcastle City Council with the Public Health team, I put in an application. This felt like a great opportunity to expand my knowledge of other job sectors, while creating links outside the university and maintaining my work in the HNRC (working there one day a week). Before I knew it, I was walking to the city’s Civic Centre for the first day of my five-week placement.

I spent my first week learning about the wide variety of projects and roles the team were involved in, such as the redevelopment of Fenham library to include a drugs and alcohol recovery hub and the health education with schools and young people. I was able to sit-in on a number of interesting meetings and was able to contribute to the Wider Determinants of Health team meetings. I learned about how projects happen and was surprised at how much it differed from a university research setting, such as the different resources used for background research for projects and the differences in terms of ethical approvals. I was also given the opportunity to put forward my ideas and interests and, working alongside my colleagues Dr Annette Payne (Health Improvement Practitioner) and Lorna Smith (Speciality Registrar in Public Health), we developed an idea for a project working with food banks. As a nutritionist, I have a strong interest in this area. Through conducting online research, and visiting food banks and ‘pay as your feel’ supermarkets, we gained an insight into how these organisations and similar providers work. We also learned about the nutritional content of ‘standard’ emergency food parcels, the demographics of those who find themselves needing to use food banks, the situations these people might be in, and finally the shocking numbers of people finding themselves in need of using them. From this research, we developed a report which was presented at the Public Health Senior Management Team meeting for approval and feedback from other team members. Our project was well received, which was encouraging, and we were given the go-ahead to continue with our work.

Life Foodbank in Newcastle upon Tyne
From this background research, I learned that those who use food banks have usually been referred through care providers (such as through school or through social workers), and there is a limit on the number of times they are able to use the food bank. Help is given in the form of an emergency food parcel containing at least three days’ worth of food, and users are often offered help and advice which aims to resolve the issues that have led them there. Although there has been nutritional guidance on the food parcels, the reality is that a lot of the food comes from public donations. Therefore, as the donations vary, so will the food parcels. Within the team, we considered possible changes to the parcels that could be suggested, in order to benefit those who have to use food banks. It was quickly decided that any work we did would be with the food banks themselves, rather than those using the food bank. We devised a plan with three ‘phases’, including:
  • Phase one involved a consideration of how to suggest very small changes to the ‘food call outs’. For example, typical foods that are given in food parcels, and are regularly requested in the call outs, include breakfast cereals, soups, pasta and pasta sauces, rice, tins (beans, meat, vegetables, and fruit), tea or coffee, sugar, biscuits, snacks, jams, and fruit juice. Due to the variation in these particular food groups, and the variation in the foods that are donated to the banks, the nutrient content of the packages will also vary widely. Our suggested changes to the call outs will include requesting tinned fruit in juice rather than syrup, reduced sugar/salt baked beans and tinned pasta in sauce, tinned vegetables without added salt or sugar, and higher fibre/lower sugar breakfast cereals.
  • Phases two and three will involve creating some user-led resources for the food banks such as recipe cards, which will provide inspiration for different meals that could be made from the foods in the parcels. We also hope to include a ‘community access card’, which will provide information on nutrition, healthy weight ranges and local support available. The local support would involve signposting to free cooking classes, food banks and ‘pay as you feel’ supermarkets, community groups, and computer facilities at libraries.
Food parcel single person packing list from the Trussel Trust























As I approached the end of my placement (which felt like it was ending just as quickly as it started!), we made plans to keep in contact about the ongoing development of the resources. We planned meetings with a food poverty group and with those running the food banks, and felt that good progress was being made. However, during the last week of my placement Covid-19 put a halt to our work. The last meeting that I attended in the council was geared towards how it could help to mitigate the impacts of the inevitable poverty that the virus would induce, as schools and food banks began to close, and many people expected to lose their jobs. Current projects at the council are now on ‘pause’ and those working in Public Health are tasked with devising solutions to the increasing number of problems that are arising from the pandemic.

At a time in which increasing numbers of people may need to access food banks and services, projects in Public Health and nutrition seem particularly relevant. I hope to be able to continue the project that we started during my placement in the future, taking into account new factors that may develop through this pandemic.

Maisie has worked at Newcastle University for over five years, collaborating with colleagues and researchers in Public Health England, charities such as Coeliac UK, international nutrition research centres, and the media.


Images:

1. Bob Castle, CC BY-SA 3.0, via Wikimedia Common

Friday, 29 January 2021

Bringing the voice of lived experience and community learning into research

Posted by Angela Broadbridge, Peer Research Lead, The Young Foundation (former Research and Evaluation Lead, Fulfilling Lives Newcastle Gateshead)

“There’s something really interesting in our data here, we don’t quite have the full picture, let’s talk to some people to puzzle it over more.”
This is something I hear myself or the team at Fulfilling Lives Newcastle Gateshead (FLNG) say really regularly. We’re an 8 year National Lottery Community Fund learning programme working to improve the lives of people facing multiple disadvantage and build a trauma-informed approach within the services that supports them. We have a wealth of data from supporting over 250 people locally, and we work with a team of Experts by Experience, people with lived experience working to bring about change across the systems they have been through, using their voices to be heard across different platforms.
Fulfilling Lives Newcastle Gateshead Experts by Experience Network co-design session

As the programme has developed our relationship with Fuse has changed and connections have grown, we now do much of our ‘puzzling over’ with Fuse colleagues! I joined Fuse as an associate member back in 2017 when I took up my post as research and evaluation lead for FLNG. I attended Fuse Quarterly Research Meetings to build up my contact base and learn from others operating in this interesting space between frontline practice and research and learning. As I began to see frontline practitioners come into those sessions, I invited some of our own frontline staff to join me to share their experience of working with people who have experienced complicated and challenging circumstances and struggled navigating systems.

I want to highlight some of our learning from building collaborative relationships through and with Fuse researchers, as this has proved to offer new platforms for the voice of lived experience not just to be heard in research, but to set research agendas and co-produce work alongside academics.

In 2018, Dr Sheena Ramsey (co-lead of the Fuse Healthy Ageing Research Programme) invited me to attend a Research Hub Initiative event with Public Health England and I pitched a seed grant funding idea with support from Fuse researchers. Our recently published work on deaths in the multiple complex needs community, an issue our Experts by Experience network encouraged us to explore, was borne out of this funding. We have since joined up with Sheena again in a new study identifying effective and sustainable interventions to improve the oral health of adults with severe and multiple disadvantage. This collaboration works because Sheena and other researchers associated with the study took the time to really get to know our programme, and our Experts by Experience network. Sheena visited us at the men’s accommodation project where we were based a few years ago, met some of our frontline staff and also built trusting relationships with the network, introducing us to academic and practice colleagues to further situate our programme learning within Fuse.

Brainstorm - what makes a good collaboration?
While this was happening, Prof Susan Carr (Fuse Associate Director), set up a meeting with her team at Northumbria University and FLNG peer researchers to talk about projects we were both working on and to explore collaborations. She also arranged for our peer researchers to present early findings from their work to Prof Kevin Fenton, Public Health Regional Director for London, and it was at this point that we started to see how people with lived experience could be involved in local research and practice beyond being participants. There were opportunities for genuine collaboration and learning together.

Fast forward to early in the pandemic and we were involved in two applications to the NIHR Applied Research Collaboration (ARC) for the North East and North Cumbria. One of these applications was exploring food insecurity with Fuse Associate Dr Steph Scott, and Kevin Dobson and Keith Gibson from FLNG’s research team set about exploring our own programme data around foodbank use. Our Lottery funded programme is quite unique in that we have a personal budget fund to use to support people on the programme with anything from their basic needs, including food and accommodation, to more creative uses like buying art materials or enjoying an afternoon at the cinema. Once again we had a ‘there’s something interesting here’ moment.

I sent Steph an email saying:
“we’ve worked with 259 people in Newcastle Gateshead over 6 years and of these 127 individual client records contained a reference to food insecurity or food poverty. We had 14 unique cases, interestingly all female, whose notes had 10 or more references to food poverty and we can see from the notes frequent references to benefits being suspended, people not eating, or missing the foodbank opening times.”
Working with partners to surface system barriers and solutions
The conversation that followed led to us talking to the Experts by Experience about food insecurity, they were similarly enthused by the topic and together we made a successful joint application to the Catherine Cookson Foundation within Newcastle University for a project exploring mutual aid during Covid-19. Using our Lottery funded programme learning and building on our experience co-producing research in other projects with Fuse researchers we are working with a group of Experts by Experience who have developed research questions to start a listening exercise with their peers around their experiences of food insecurity, mutual aid and Covid-19.

This relationship with Fuse is evolving and changing, and it now feels like a relationship truly rooted in the principles of co-production. Our team report that they feel their frontline experience is listened to and helps shape research projects, and our peer researchers are involved in numerous projects and have the confidence to approach Fuse researchers to develop new pieces of work building on the issues that are important to them and their communities. As our programme comes to an end in March 2022, the Experts by Experience network is now thinking about its legacy, we very much hope to continue to build on this strong foundation for collaboration and learning.

Friday, 15 January 2021

Tackling malnutrition during the pandemic and beyond

Posted by Megan McGuire, MSc Dietetics student, Teesside University

Part of our Fuse blog Student Series
The Fuse blog Student Series showcases posts by students who have been challenged to write a blog as part of their studies at one of the universities in the Fuse collaboration, the NIHR School for Public Health Research, or perhaps further afield. The authors may be new to blogging and we hope to provide a 'safe space' for the students to explore their subject and find their voice in the world of public health research.

As a dietetic student looking into public health and nutrition, it can often feel that the majority of policy focuses on the issue of obesity and ‘over-nutrition’. However, undernutrition, or malnutrition as it is more commonly referred to, remains a significant issue which is often overlooked in terms of policy.

Malnutrition is a term generally used to describe when your body is not getting the nutrients it needs to function properly. Good nutrition is important for every organ in our body, and therefore the consequences of malnutrition can be vast. This can include, increasing our risk to infections due to a weakened immune system and compromising our ability to regulate temperature, leading to hypothermia and potential organ failure of the heart and lungs (BAPEN, 2018a). Malnutrition can also make worse some of the things that cause it, such as social isolation, through its impact on mental health, including depression, anxiety and self-neglect (Public Health England, 2017). 

Malnutrition is unfortunately a common problem, particularly in those aged over 65, and is thought to affect over three million people in the UK at a cost of nearly £20 billion (Elia, 2015). In light of this, it is crucial that it can be easily detected within vulnerable groups, so that the devastating downstream consequences can be prevented.

Unfortunately, Covid-19 has made this all the more challenging. I know, from my personal experiences of remote dietetic placement working in the NHS, that one of the hardest things to find out via an online or telephone consultation is accurate height or weight information from the person on the other end of the line. This is not only pivotal for the majority of dietetic care, but also to the Malnutrition Universal Screening Tool (MUST), which can be used by any healthcare professional to determine someone’s risk of malnutrition (BAPEN, 2018b).

Current policy focusing on older adults, the people most vulnerable to malnutrition, tends to focus on strategies to promote ‘healthy ageing’, enabling wellbeing into later life (Age UK, 2011; WHO, 2012). There is, however, a lack of policy addressing malnutrition, specifically for those living in the community. Guidelines from the National Institute for Clinical Excellence (NICE) recommend screening for those within care homes and inpatient settings (NICE, 2012).

I feel that if more effort was put into community screening and early intervention, there would be fewer people admitted to hospital as a result of malnutrition, and therefore this is where public health efforts should be focused.

Whilst it may feel that Covid-19 is all anyone can talk about right now; I think we need to consider the impact it may be having on levels of malnutrition. Before the pandemic hit, there were already vulnerable people within the community who may have struggled to get out and about to do their shopping and care for themselves. The threat of a potentially deadly infection, for many, has driven them further indoors and into isolation. Alongside the direct effects of reduced access to food, due to venturing out less frequently and people ‘stockpiling’, there are also the psychological effects of the pandemic to consider. I know at times I have found lockdown challenging, so I can’t imagine how difficult it must have been for those living alone and feeling extremely isolated and vulnerable. Alongside issues of digital poverty too. Another point to consider is that these individuals may be less inclined to visit their GP or be seen by other healthcare professionals at these times, meaning that malnutrition is less likely than ever to be picked up.

The Patients Association Nutrition Checklist
So, what is the solution? We need to find a way to access the most vulnerable within society, at a time when staying indoors and away from others feels most safe. Public health policy needs to look at GP surgeries and ways in which they can target those who fall within the ‘at risk’ category. This could involve the use of digital technology, which has been shown to be successful in identifying malnutrition but may not be the best fit for those who can already feel isolated by a technology-driven world (Peek, Sujan & Scott, 2020). Another suggestion could be the rollout of the Patients Association Nutrition Checklist (2018), a less clinical, simple and easy to use tool which has been validated against MUST as a reliable method to detect malnutrition.

Whatever the approach, this is something I feel is underrepresented in the media and requires more public health attention in light of the pandemic. While I make sure to keep an eye on those around me who may be vulnerable to malnutrition, not everyone has that support network to fall back on and as a society, we ought to do more.


References:

Images:

2. 'The Patients Association Nutrition Checklist' courtesy of The Patients Association: https://www.patients-association.org.uk/blog/patients-association-nutrition-checklist

Friday, 8 January 2021

Now that's what I call blogging 2020: the Covid edition

Posted by Mark Welford, Fuse Communications Officer, Teesside University

It was business as usual for the Fuse blog in January 2020.  PhD student Kelly Rose told us about having sleepless nights thinking about school food and teenage diets; Coral Hanson and her co-authors channelled their inner Mr Motivator to consider whether exercise referral was fit for a new decade; and Angela Wearn asked if reaching the ‘hard-to-reach’ meant leaving traditional academia at the door?

So far so good… and then the ‘C’ word arrived and the world changed and with it the Fuse blog in the form of John Mooney’s frighteningly prescient post on the 5 February - Coronavirus: expect the unexpected in an unfolding emergency.

Last year we published posts about workplace health, tackling obesity through planning policy, the impact of commercial actors on health, food shaming, mental health, the emotional road to impact, Universal Credit, facing a Parliamentary Select Committee, inequalities, family carers of people living with dementia, International Men’s Day (yes, there is one!), and kicking Coca-Cola out of Christmas.

Our authors asked: 

  • Can your education, income or even your job affect your chances of receiving newer cancer treatments? 
  • Why is it so difficult to change our health habits? 
  • Does antibiotic prescribing penalise communities in most need? 
  • Would easy-read documents for all mean a more inclusive healthcare system? and;
  • What is the recipe for a happy retirement?

But it will come as no surprise that the 2020 chart of the top five most-read Fuse blog posts is dominated by one topic: Coronavirus, Covid-19 or just plain COVID.

Here are our chart-toppers of 2020:


5. Experts by Experience challenge us to create opportunities for them to take the lead in research

First up is our only non-Covid related entry in which Angela Broadbridge and Ged Hazlehurst from the Fulfilling Lives Newcastle Gateshead project write about co-producing research with people with lived experience of multiple and complex needs.

Page views: 1727.  Posted: 15 May 2020


4. COVID-19 has brought the “digital divide” to the fore

Gemma Wilson from Northumbria University explores how a lack of access to technology and wider support networks during the pandemic is significantly heightening inequalities.

Page views: 1839.  Posted: 29 May 2020

 

3. Coronavirus: expect the unexpected in an unfolding emergency

Up next is the aforementioned post by John Mooney, Locum Consultant in Public Health at NHS Highland and one-time specialist in the epidemiology of respiratory infectious diseases. Published days after the first confirmed UK cases, John's blog was prophetic in highlighting the potential for symptomless transmission, virus instability and divergent strains.

Page views: 1909.  Posted: 5 Feb 2020

 

2. This crisis has shown how many people were only just about managing

Our runner-up is Mandy Cheetham from Northumbria University writing about her experience with a community hub delivering food parcels, prescriptions and supporting vulnerable people during the pandemic.

Page views: 2019.  Posted: 9 May 2020

 

1. Working from home isn’t for everyone - here’s how to cope if you’re struggling

"Being isolated at home can be hard; it is easy to feel cut off from friends and co-workers, to feel out of the loop when it comes to work decisions and to feel stressed with how best to work when at home."  

During the first national lockdowns imposed by the UK governments, Annabel van Griethuysen from Tees, Esk and Wear Valleys NHS Foundation Trust, shared her tips on working from home. These include keeping a routine, eating and drinking well, having a completely separate space to work (if possible) which is tidied or hidden away at the end of the day, staying connected and reaching out to talk to your social circles if you feel anxious and stressed.

At a time when many people are again being asked to work from home it is apt that Annabel's post should take the crown as most popular blog in 2020.

Page views: 2106.  Posted: 9 April 2020


So there you have it, the top five Fuse blog posts from 2020.  All five received more page views than last year's number one, which is thanks to our loyal readers and fantastic contributors - thank you!  

Can we do any better in 2021?  If you fancy giving it a go, please find out what we are looking for and how to take part here.  All contributors receive a much sought-after Fuse badge, and the writer of the most read post wins a rare and coveted Fuse paperweight.*

Happy New Year!


*when we are allowed back in the office!


Images:

  1. "Now That's What I Call Music! 1991" by Brett Jordan is licensed under CC BY 2.0
  2. Courtesy of Fulfilling Lives Newcastle Gateshead: http://www.fulfillinglives-ng.org.uk

All page views correct at the time of writing.

Thursday, 17 December 2020

Let’s kick Coca-Cola out of Christmas for good

Posted by Robin Ireland, Director of Research, Food Active, PhD Candidate, University of Glasgow @robinHEG

You may have thought Coca-Cola invented Christmas. In a sort of way, they did of course. Arguably, modern Santa was designed by an advertising campaign for Coca-Cola in 1933 (Forsyth 2016). And, Santa, whether in the twentieth or twenty-first century, is all about encouraging us to consume. In Coca-Cola’s case, a sweet brown liquid that should logically have absolutely nothing to do with a winter celebration in, originally at least, the Northern Hemisphere.


























Coca-Cola has been creative at making up traditions as part of their marketing campaigns since the soft drink was invented in Atlanta, USA, in the late nineteenth century. They have been muscling in on our favourite cultural practices pretty much ever since, in their growth to become a hugely successful and profitable transnational corporation. They have been involved with the Olympics since 1928 when vendors set up branded kiosks in Amsterdam (Keys 2004). A similar relationship with the FIFA World Cup from 1975 was seen as critical at expanding Coca-Cola’s influence into China and the Arab countries (Sugden and Tomlinson 1998).

Coca-Cola expert at manipulating our deepest wishes and our emotions whether they are talking Christmas or football. The pandemic may have prevented their Christmas Truck tour in the UK, but, never fear, their international marketing department is on the case. A two and a half minute commercial on YouTube featuring a little girl and her Dad’s attempts to deliver her letter to Santa at the North Pole had already received over 37 million views at the time of writing, whilst pulling at our heart strings.

Professor Dame Sally Davies, the previous Chief Medical Officer in England, wrote, “Commercial companies use a range of strategies and other approaches to promote products and choices that affect human and environmental health, defined as the commercial determinants of health” (Davies 2019 Annex D, p.4). And Coca-Cola are the masters. Luke Allen (Allen 2020) described the corporation as “virtually a cartoon villain in many public health circles” (p.29). Commercial determinants of health can be divided into four channels in which transnational corporations influence health (Kickbusch et al. 2016). Let’s consider how Coca-Cola use these channels.

The marketing is the most obvious. The red and white Coca-Cola brand is ubiquitous. This year the Christmas Truck Tour will not be visiting Liverpool or Glasgow and other major British cities. But the corporation’s partnership with the Premier League enabled it to tour those city centres in 2019.

This year the Christmas Truck Tour will not be visiting major British cities but the corporation’s 
partnership with the Premier League enabled it to tour those city centres in 2019

How about lobbying then? Marion Nestle (2015) has done a great job in describing how the ‘soda industry’ has learned from the tactics of the tobacco industry in funding dubious research. In funding campaigns and legal challenges to taxes on sugary drinks for example.

As many transnational corporations are criticised for the damage that consumption of their products can cause to human health, so, many try to position themselves as good corporate citizens. Coca-Cola adopt the same tactics and support a number of charities such as FareShare, Street Games, the World Wildlife Fund and Special Olympics GB. It’s sad that in a tough world, it’s often left to corporations to fund good causes rather than government. I thought that had been left in the Victorian age rather than reappearing in the twenty-first century. Coca-Cola also support the Department of Transport’s THINK road safety campaign. In this a volunteer is encouraged to be a Designated Driver to bring intoxicated friends home safely from their Christmas parties. The language of a “responsible drinking culture” is all part of the transnational corporations’ tactics of blaming all of us for believing their marketing and over-consuming their products. That’s right, the soaring levels of overweight and obesity and distressing images of tooth decay amongst youngsters in the UK, are all down to us, the irresponsible parents.

Finally, transnational corporations are experts at developing extensive supply chains to amplify their global ambitions. According to Nestle (2015), Coca-Cola claims to sell its products in two hundred countries with only Cuba and North Korea escaping its clutches. And that’s down to US trade embargoes not to Coca-Cola’s marketing executives.

It’s very hard to argue against Coca-Cola’s Christmas truck tour. Food Active and public health advocates have done so for many years being called the fun police along the way and advocates of the nanny state. We can only speculate the reasons why the tour has been scaled back in the North West in recent years (where Food Active largely operates), but we would take some comfort in the idea that our lobbying played a role in steering the truck off course.

Allen (2020), referenced Coca-Cola’s 2018 annual report, to show the corporation spends approximately US$4 billion per year on advertising. And they wouldn’t be spending that kind of money if the advertising didn’t work. The marketing has persuaded some that Christmas isn’t Christmas without the Coca-Cola Truck Tour. Well, you know the Holidays ARE Coming this year. Because this dreadful pandemic has at least kept some of Coca-Cola’s marketing out of our towns. Let’s just hope that the growing link between obesity and Covid-19 (Alberca et al. 2020) may encourage more to consider how we can limit the advertising of Coca-Cola and other transnational corporations that promote their high in fat, sugar and/or salt products to children. And let’s start to kick Coca-Cola out of Christmas.


References:

Alberca, R.W., Oliveira, L.d.M., Branco, A.C.C.C., Pereira, N.Z. and Sato, M.N. (2020) 'Obesity as a risk factor for COVID-19: an overview', Critical Reviews in Food Science and Nutrition, 1-15, available: http://dx.doi.org/10.1080/10408398.2020.1775546.

Allen, L.N. (2020) 'Commercial Determinants of Global Health' in Kickbusch, I., Ganten, D. and Moeti, M., eds., Handbook of Global Health, Geneva: Springer International.

Davies, S.C. (2019) Time to Solve Childhood Obesity, London, available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/837907/cmo-special-report-childhood-obesity-october-2019.pdf [accessed 27 November 2020].

Forsyth, M. (2016) 'Coca-Cola didn’t invent Santa ... the 10 biggest Christmas myths debunked', The Guardian, 21 December 2016, available: https://www.theguardian.com/lifeandstyle/2016/dec/21/coca-cola-didnt-invent-santa-the-10-biggest-christmas-myths-debunked [accessed 27 November 2020].

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Image 2: Coca-Cola Tour Bus. Liverpool, March 2019. Photo courtesy of E.Boyland.


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