Thursday, 30 July 2015

Virtually on holiday

Posted by Emma Dorée, Communications Assistant, Fuse and Teesside University

The out-of-office replies are clogging the inbox and the rain is pouring… it must be that wonderful time of the year again – holiday time!

The blog has been working extremely hard this year, making sure that everyone is kept up to date with all the latest research activity taking place in and outside of Fuse. It has sat and listened to everyone
else’s holiday stories and seen everyone’s holiday snaps whilst beavering away, keeping all the virtual plates spinning.

But the time has now come for the Fuse blog to sit back and relax and enjoy a few weeks off.

After enjoying an active holiday in France last year, the blog has this year decided to go to Marbella to relax and be pampered so that it can get rid of all of its stresses. Following a strict plan of exercise and healthy food it will be showing off its beach bod while enjoying a month of sun (factor 30 at all times), sea and spas where its biggest decision will be deciding which of the cocktails (non- alcoholic of course) to try from the menu next. Plans such as jet skiing and testing out the Marbella nightlife (dancing is physical activity after all) are all on the agenda but of course we’re sure it will make time for a little culture and sightseeing too.

Hopefully it won’t get frustrated by the high fat and high sugar treats on offer at the airport or in the supermarkets and start posting pictures, but you never know!

So see you in September everyone! Happy holidays!

Tuesday, 28 July 2015

Would you accept money to be healthier?

Guest post by Emma Giles, Senior Research Lecturer in Public Health, Teesside University

As newspaper headlines have shown, the issue of encouraging individuals to adopt healthier lifestyle behaviours by paying them is controversial. Whilst many of us know that we should do a bit more physical activity, eat our five-a-day fruit and vegetables and even attend our vaccination and screening appointments, we don’t always do this. Many barriers prevent us from fully engaging with these healthy behaviours, and these barriers are often complex, individual, and are not always easily surmountable. These barriers range from living away from green spaces which would allow outdoor exercising, to deep-seated social norms that stop individuals from engaging in healthy behaviours because they are not well accepted by family, friends or the wider community.

In recent years there has been a growing body of research looking at paying people to be healthier. This essentially means providing individuals or groups with cash, shopping vouchers or gifts in return for the adoption of healthier behaviours. Such schemes include the Pound for Pound weight loss incentive scheme, the Give it Up for Baby scheme, and offering incentives for breastfeeding.

In order to hear recent research evidence, and to provide a forum for friendly debate, I organised the recent Fuse Quarterly Research Meeting, which focused on payment for health behaviours. Last Wednesday (22 July), policymakers, practitioners, and academics came together to hear presentations from four academics and practitioners working in the broad field of incentives. As Claire Sullivan, a Consultant in Public Health from Public Health England mentioned in her opening address as Chair of the meeting, often incentives can take various forms – including paper pants for Chlamydia screening!

In terms of specific incentives, Professor Pat Hoddinott, Chair in Primary Care, Nursing Midwifery and Allied Health Professions Research Unit at the University of Stirling, presented research which focused on incentives for breastfeeding and to quit smoking in pregnancy – the BIBS study. Key findings suggest that tailoring of incentives is important to meet local needs, but that they show promise to encourage these behaviours.

Professor David Tappin, Professor for Clinical Trials in Children within the School of Medicine at the University of Glasgow, followed Pat by showcasing data from the CPIT trial – a smoking cessation in pregnancy trial in its second phase. Results showed that there was a 14% increase in quit rate and further analysis showed that there was a 150g increase in birth weight of babies born to mothers who quit smoking. Findings suggest that financial incentives were found to be acceptable by the women involved, and may double the quit rate when used with existing smoking cessation services.

A practitioner perspective was provided by Mr Andrew Radley, Consultant in Public Health Pharmacy, NHS Tayside, who talked about operationalising the use of financial incentives in a stop smoking programme within a community pharmacy setting. In particular, 393 women in Tayside engaged with the smoking cessation services, and incentives were found to be effective. Of note was the finding that mothers preferred receiving their incentives on a weekly basis.

I spoke last and presented qualitative data exploring the acceptability of incentives. The findings suggest that incentives are more likely to be accepted if they are provided to certain population groups including pregnant women and those on a low income, but not for those who may have alcohol or drug problems. The ‘perfect’ incentive has yet to be identified, but it will need to be shown to be cost-effective for it to be accepted on a wider scale.

The presenters were then joined by Peter Kelly, Director of Public Health Stockton Borough Council, Jim Beall, Health and Wellbeing Board Chairman, and Dr Jean Adams NIHR Research Fellow at CEDAR for a panel discussion. The audience raised many questions and comments around the use of incentives, with particular concerns around incentives increasing health inequalities, aggressively placing the blame of poor health on individuals, and that incentives may result in moral implications when individuals are rewarded for their behaviour. The debate suggested that more research evidence is needed to discover what type of incentive works for whom, and in what setting, and to better explore group (rather than individual) incentives.

What is obvious is that paying people to be healthier is an emotive topic, a highly contested intervention approach, but at the same time, it also shows promise to encourage individuals to adopt healthier lifestyle behaviours. It certainly provides food for thought…how many of us would accept money to be healthier?

Follow this link to find out more about the Fuse Quarterly Research Meeting ‘Payment for health behaviours: the case of health promoting financial incentives’ on the Fuse website.

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Thursday, 23 July 2015

Mind over matter in Fuse?

Posted by Peter van der GraafAskFuse Research Manager

Mental health is a rising star on national and local agendas. At national level, mental health was for the first time ever included in all of the main political party election manifestos and features significantly in the NHS Five Year Forward View. At local level, Public Health teams across the North East are reviewing their mental health services and upskilling themselves in the best ways to reduce self-harm and suicide. You may ask what all the fuss is about?

Various reports have pointed out that poor mental health is costing the UK economy £105bn per year, including £8bn annually in sickness absence, and a further £15bn in lost productivity absenteeism (where people are at work, but under-perform due to mental health issues). The Care Quality Commission (CQC) recently sounded the alarm over the state of mental health services in England. In its first ever review of mental health crisis care, the regulator found that 42% of patients did not get the help they needed.

The picture is particularly bleak in the North East, which has the highest suicide rates in the UK and rates have been going up steadily since the economic recession and public sector cuts (after a long period of stabilisation) and are likely to increase further with additional cutbacks planned in recent spending reviews. Not surprisingly, mental health issues are higher in deprived areas, among men, those who are unemployed, and related to alcohol problems, all of which the North East is leading on in national league tables. Mental health services, described by one of our practice partners as “the Cinderella of Public Health”, are bearing the brunt of these cuts, in times when you could argue that their service users need them most.

To make the most of existing intelligence and services, the Public Health Intelligence Northern England (PHINE) network recently organised a dedicated event on self-harm and suicide, offering participants access to various interactive data sets (e.g. Community Mental Health Profiles) to help local authorities make sense of national data for their own patch. Where are the suicide hotspots in different localities? Who are most at risk and what services can they access? The data profiles were well received by the audience but were also met with some criticism around lack of integration with local data, such as counselling data collected by GPs in the North East. Moreover, although this data helps to identify what is happening where, it does not allow for answers to the question why? Public health commissioners need help to interpret this data and understand why suicide and risks are going up in one area or user group but not in another.

What can Fuse do to support this? Are we making our research on mental health issues available to decision makers and professionals? For instance, where can Public Health practitioners find information about the lessons learned in the award winning Change UR Mind about Young People project (evaluated by our Translational Research programme); or about the literature review on self-harm produced by the Knowledge to Action Group within our Complex Systems programme? Moreover, is our research responding to local concerns and needs? Do we help them in interpreting national data and matching this with their own data? And do we support them in developing interventions to address hot spots? How can Fuse work more effectively with partners in the region that are working on suicide prevention strategies, post-event services and mental health research?

Partners are closer than you might think. For instance, The Westgate Unit at HMP Frankland is a therapeutic, personality disorder treatment service based in a high security prison setting.  The Unit helps prisoners diagnosed with Borderline Personality Disorder who are most at risk of self-harm and suicide. The unit has developed its own research on why different prisoners self-harm but is struggling with budget cuts and would welcome support from academics in developing and conducting further research. You might counter that this is not public health, but given the significant impact of mental health on the UK economy, the NHS and, last but not least, the impact on families and communities, I would argue that this is a unique opportunity for Fuse to get involved.

Our region already has a wealth of clinical expertise available on mental health: the Mental Health Research Group (MHRG) is a joint initiative of the Tees Esk Wear Valleys (TEWV) NHS Foundation Trust and Durham University, in which clinicians, academics and service users, including young people, collaborate to improve local health services. The group recently showcased their research during their annual conference. Unfortunately, Fuse is not a partner in this network. However, clinical staff in the Trust are keen to develop their research skills and contribute to a better understanding of mental health issues and interventions in the North East and would welcome collaborative research with Fuse.

This might be a good time to ask: should Fuse put mind over matter when it comes to mental health?

Thursday, 16 July 2015

Who needs nudging, shoving, and shaming? Individuals or government?

Guest post by Victoria McGowan, Post-Doctoral Research Associate at Teesside Uni, Alcohol & Public Health Research Team

I recently attended International Society for Behavioural Nutrition and Physical Activity (ISBNPA) conference in Edinburgh (see #ISBNPA2015 on twitter). The conference was a great event and I’m very grateful to Teesside University for supporting my attendance.

Conferences have a tendency to be sedentary affairs and can often have limited opportunities for physical activity or even just standing during sessions. However, I was delighted to see that the conference organisers had marked out significant space for standing during sessions. Not only that, but there was the opportunity for yoga and health walks early every morning as well as lessons in ceilidh dancing at lunch time and a walk to Arthur’s Seat as part of the social programme. It was quite a physically active, physical activity conference.

Lunch time ceilidh dancing
However, there were some interesting discussions about whether us delegates were being socially shamed or nudged into partaking in physical activity during the conference. The conference opened with Professor Nanette Mutrie describing how she’d spotted one of her own researchers using the escalator as opposed to the stairs and encouraged delegates to give standing ovations to all speakers in an attempt to get us on our feet more. Although I found the level of physical activity on offer a refreshing change from being largely sedentary, I was slightly unnerved about the underlying social shaming.

I’m a strong advocate for informed choice, I love posters on stairs telling me how many calories I’ll burn by walking up them but I also love having the option of taking the escalator. There were stories of academics taking photos of people using the escalator to shame them for not using the stairs. It was interesting to watch the Mexican wave of delegates standing to applaud, a few individuals would stand and then row after row behind them followed suit… until it came to me and I would sit in defiance. Why did I stay seated? Because I have a choice and honestly, I don’t like being socially shamed into doing something. Yes, I agree obesity, nutrition, and physical activity researchers should not be hypocritical and practice what they preach. However, we also need to be mindful that we’re working with people who are more concerned about paying their rent, whether their children need new school shoes, zero hours contracts, whether they can get an appointment with their GP, the list goes on. Yes, taking the stairs may improve our health if we use them regularly but we have to understand that some individuals choose the unhealthier option due to a whole host of external pressures. Lecturing these individuals about taking the stairs may fall on deaf ears or, as in my case, may lead to defiance. I used the escalator on occasion because it was quicker for me to walk up/down the escalator to dash between sessions and avoid the crammed stairs.

There are other reasons why individuals choose the less healthy option and we need to understand these external pressures rather than shaming people into taking the stairs. As Professor Alan Batterham rightly pointed out in his debate with Professor Stuart Biddle we’re evolutionary predisposed to conserve energy whenever possible so sometimes we may choose the escalator. However, we may choose the stairs if we’re provided with information on why it’s good for our health, or if we alter the environment to make healthy choices easier. But please don’t shame us into choosing one option or the other as this could lead to unintentional detrimental consequences of purposeful rebellion. Yes, I’m aware of the obesity ‘epidemic’, but I’m also aware this is caused by factors which are outside of individual control. Professors Ted Schrecker and Clare Bambra’s book How Politics Makes Us Sick shows how the rise in neoliberal policies in the UK and US are associated with rises in obesity and health inequalities.

Inequalities are having the greatest impact on health
Kylie Ball highlighted this point at the end of her keynote speech, yes we need to help improve nutrition and physical activity BUT we also need to help reduce inequalities in nutrition and physical activity. Inequalities are having the greatest impact on the nation’s health, not occasionally taking the escalator.

It’s time to nudge, shove, and shame our government, not individuals, into reducing health inequalities and improving overall public health.

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Thursday, 9 July 2015

Setting resolutions or finding solutions?

Posted by Dr Joanne-Marie Cairns, Fuse Post-Doctoral Research Associate at Durham University

So it’s National Childhood Obesity week and yet again we are surrounded by plenty of public health campaigns promoting us to lead healthier lives – be more physically active, join the gym, lose weight, eat and cook more healthily as well as problematic media rhetoric such as ‘beat the bulge’ and de-moralising and stigmatising imagery typically of overweight or obese children on scales or eating junk food. How is this helpful? This will only serve to further exacerbate the situation rather than help to bring about effective and sustainable solutions to not only help those who wish to become more active and lose weight but promote healthier population health more widely.

I am heartened to hear that Head of NHS England, Simon Stevens, has called for a national conversation to be held and a joined-up approach which has started to think about regulating food and drink companies. In my opinion this is long overdue. We may have a degree of individual ‘choice’ but how much choice do we really have when we are surrounded by (and in some places bombarded with) advertisements, local take away shops, overly-priced fresh nutritious food compared to the tempting ‘bogof’ (buy one get one free) offers which typically tempts us into getting double the amount of unhealthy snacks, often at a fraction of the price it would cost to get healthier options?

I came across this image as I was searching through websites related to National Childhood Obesity week on with reference to National Obesity week earlier on this year.

While I am sympathetic to this message which encourages us to make these positive changes I am also sceptical about the effectiveness of doing these alone. Repeatedly research studies have shown that educational and behavioural interventions have limited and short-term effectiveness, so why do we continue to focus on the individual rather than looking at the environment within which the individual is placed?

So I urge you, instead of making yet another individualised ‘resolution’ this coming New Year (which will come around before you know it!) to lose weight or exercise more, why don’t we collectively put our efforts together by standing up and protesting about the lack of resources or opportunities within our localities to be able to lead healthier lives and be more physically active? For example, if you have children in schools ask yourself (or better yet ask the school directly) the question: what is the school doing to not only promote healthier food and physical activity but to actually enable this to happen by creating school environments that support children to do this? Or what are supermarkets doing to help us to afford to buy fresh and nutritious food and drink that isn’t going to cost a fortune? Or write to your local MP to ask the government to recognise the wider issues that can prevent even those of us with the best of intentions from eating more healthily and increasing our exercise. Childhood obesity is not the responsibility of the child/family, since ‘responsibility’ infers that we have ‘control’ over something. It is rather a societal consequence, and therefore society should bear the responsibility for finding a solution.

Jo Cairns and Professor Clare Bambra have produced a Fuse brief entitled: What is the most effective way to reduce inequalities in childhood obesity?

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Thursday, 2 July 2015

Collaborative research: agreeing to disagree?

Posted by Peter van der Graaf

Fuse sponsored a parallel session at the Faculty of Public Health conference last week in Gateshead, chaired by Professor John Ashton CBE, President, UK Faculty of Public Health. The session focused on the challenges and opportunities of collaborative research between academics, health practitioners and decision makers.

The four papers presented in the session outlined different challenges in collaborative research: Alyson Learmonth, reviewing Health and Wellbeing Strategies in the North East, highlighted the diversity in priorities between different areas, making it difficult to focus and combine resources across local authorities.

Silvia Scalabrini showed that, in spite of dedicated health economic support from academics to local public health teams in prioritising their investment and resources, the use of these formal tools was met with resistance by elected members who put a higher value on other sources of information, such as stories from residents.

I highlighted limits to collaborative working through a mismatch in timescales, funding and interests. For example, academics showing limited enthusiasm for applied research due to a lack of incentives within their institution, which put a higher value on high quality publications and research council funding.

Fuse Director Professor Ashley Adamson talked about the challenges in setting up data sharing agreements with different local authorities to access National Child Measurement Programme (NCMP) data, in spite of positive support and demand for the research from local government.

Listening to these presentations one might wonder whether collaborative working is really possible. At the same time, each presentation offered examples of where it was achieved and made a difference. For instance, Alyson Learmonth's appreciative enquiry demonstrated common interests between Health and Wellbeing Boards (HWBs) in giving each child the best start in life and in the social determinants of health, particularly interventions around education and housing.

Silvia Scalabrini highlighted the usefulness of the Portsmouth Scoring Card, developed by Austin, Edmundson-Jones, and Sidhu (2007)* for local authorities to prioritise their spending. I reflected on the value of responsive research services, such as AskFuse, to provide backstage negotiation spaces for what constitutes useful evidence. Professor Adamson discussed the benefits of matching data from the NCMP with local intelligence to increase the effectiveness of child obesity interventions and their evaluations.

I’m wondering where this leaves us? In spite of problems in setting priorities, even agreeing on the tool to do this, limits to willingness and capacity among academics and public health practitioners to collaborate on research projects, and barriers in data sharing once a project has been agreed, the different examples made it clear that not collaborating was simply not an option.

Public health practitioners have limited resources and lack the capacity to analyse and interpret data, while academics are increasingly required to demonstrate the impact of their research and lack an understanding of the context and processes in which evidence is used in practice. Working together is a must to ensure that public health can provide an answer to the questions it is currently being asked.

Moreover, the number of participants from academia and practice at the conference session, demonstrates that there is a clear appetite to work together on these issues as long as we are able to provide the conversation spaces for this.

*Reference. Austin, D., Edmundson-Jones, P. and Sidhu, K. (2007) Priority setting and the Portsmouth scorecard: prioritising public health services: threats and opportunities. Available at:

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