Housing and health: aligning stars or weathering a perfect storm?

Posted by Peter van der Graaf, AskFuse Research Manager

Last Wednesday I attended the annual conference of the Housing Learning and Improvement Network (LIN), which explored how the housing and health sectors can work more closely and effectively together.

The case for this partnership was well made by the keynote speakers: not only are there already strong historic roots but the present day challenges faced by both sectors make them obvious partners. With the recent move of Public Health to Local Authorities, the central message from the Marmot review - improving social determinants is central to improving population health and wellbeing - has taken on a new significance for public health commissioners faced with the needs of other local government departments.

Housing is one of the key social determinants and has received much attention in recent Government policies that seek to redefine the remit of health. For instance, the Care Act outlines an overarching vision for adult social care and emphasises various housing solutions that can help to support the integration of health and social care.

The NHS has also recognised the role of housing and has proposed a new care model around housing in its Five Year Forward View, such as the Healthy New Towns initiative. As Neil Revely from Sunderland City Council and Chair of the Association of Directors of Adult Social Services (ADASS), proclaimed: “the stars seem to align once more to bring housing and health together”. For this reason, ADASS has worked closely with NHS England to develop a Memorandum of Understanding on Housing and Health.

However, the same politics that bring both sectors together could be stumbling blocks for the partnership to take off. As members of the audience pointed out, prevention services have been hardest hit by austerity measures and many local authorities have decommissioned the services that are now most needed. With a growing and ageing population, demand is likely to increase while resources are more likely to decrease with continued budget cuts. Moreover, the ageing population means an increase in complex needs that cannot be addressed by a prevention agenda alone and in which (supported) housing is just one part of the solution.

In short, the current political and financial climate might provide a perfect storm, making it difficult for housing and health to work effectively together. The balance might be decided by the ability of the partnership to access new resources and powers, for instance, by claiming a stake in the North East devolution plans, mirrored on the success of the Greater Manchester Devolution Agreement that includes an MOU on Health and Social Care worth £6bn each year (see also the Fuse blog post by Patrick Vernon on this topic).

To make the business case for these claims, the partnership will need to build the evidence base around the impact of a joint housing and health programme in the North East. An abundance of data is available to highlight the problem areas and populations, supporting the call to arms, but limited evidence was presented at the conference on what housing providers, public health teams and care providers can effectively do to address these problems and populations. Much of the current evidence is anecdotal and in the format of case studies.

The need for more evidence of the impact of the home/housing on health and wellbeing was also reiterated by Gill Leng from Public Health England (PHE) and this is an area where Fuse could provide helpful support. What research evidence do we have available within our Centre to support the North East partnership between housing and heath? What support can we provide in developing the monitoring and evaluation framework for their programme? The recent Fuse Quarterly Research Meeting (QRM) and corresponding research brief on health and housing is a first step in this direction and the upcoming QRM in April 2016 on planning and health another, but more practical evidence is required to align the stars of local policy, practice and research and help the North East health and housing partnership to weather the current political and financial storm.

Photograph 'Incoming Storms No. 2' by Mike Lewinski via Flickr.com © 2013: https://www.flickr.com/photos/ikewinski/9448689046

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Alcohol Awareness Week: just who are those risky drinkers?

Posted by Dorothy Newbury -Birch, Professor of Alcohol and Public Health Research at Teesside University.

It's national alcohol awareness week and I've been asked to write a blog about it and as I sit and wonder what I would like people to be ‘aware’ of, one thing comes to mind. It’s the thing that I say in every lecture I give and hope that it’s the one thing that people take away with them: “Its not a them and us issue when it comes to alcohol-related harm”. What do I mean by this? Well we know that around 30% of people (any people) who go to the GP will screen positive for risky drinking (an alcohol use disorder). That’s 30% of folk you see walking down the street and in shops – that’s us – not those people over there. If we realise this then we become more aware of how risky drinking is affecting all of us. If I were to screen everybody who is reading this blog then around 30% of you would screen positive for risky drinking and about half of you would have no idea that you had an alcohol use disorder. You don’t believe me do you? Well here is an alcohol screening questionnaire – have a go...

If you score 5 or more than you would be classified as a risky drinker. So, I hear you ask, what is a unit? Well this is a massive problem as a lot of us don’t know what a unit (or standard drink) is. Did you realise that a bottle of wine has around 9 units? Did you realise that a man drinking more than 4 units and a women more than 3 units in one go is classified as a ‘binge drinker’? Did you know that the recommended drinking units are 3-4 per day for men and 2-3 per day for women, with two days free per week? All sounds rather complicated doesn't it?

So what can we do about it if we are drinking too much? Well you've done something already by realising it – remember I said a lot of us don’t realise. Small things make a massive difference. We can keep an eye on what we are drinking; we can think about having a soft drink in between a glass of something; don’t drink in rounds (it’s much easier to drink more when in a round) and remember you can leave some wine in that bottle for another night. 

Alcohol-related harm costs the UK around £21 billion a year. Alcohol is a causal factor in more than 60 medical conditions including cancers, high blood pressure, cirrhosis of the liver and depression. Alcohol-related hospital admissions have increased by 35% in the nine years to 2011/12 when there were 1.2 million admissions related to alcohol. Alcohol is implicated in, or responsible for around 30% of visits to primary health care and around 70% of A&E attendances from midnight to 5am at weekends. These are well known statistics but who do they relate to? The Alcohol and Public Health Team at Teesside University is carrying out research to reduce the harm caused by risky drinking. This includes research with young people in the school setting (SIPS JR-HIGH) and the Accident and Emergency Setting (SIPS JR) and work in the criminal justice system.

If you want more information then have a look at the following websites: 

• www.nhs.uk/change4life/Pages/cutting-down-alcohol.aspx
• www.dryjanuary.org.uk
• www.balancenortheast.co.uk

If you want to find out more about the research, myself and the team that are involved, you can follow TeamAlpha’s research on www.facebook.com/TeamAlpha and @TeamAlphaTees

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Sublime and ridiculous: the glamorous life of a public health researcher

Guest post by Rebekah McNaughton, Research Associate in Public Health and Lecturer in Research Methods at Teesside University 

They say that variety is the spice of life and that is certainly true in my line of work. When I started my career as a public health researcher I understood that a great deal of my time would be spent reading other people’s research, doing fieldwork and writing numerous reports. That has certainly been true of the last 10 years of my career. What I didn't expect was the huge variety that I would come to love.

Doing fieldwork is by far my favourite aspect of the job. I'm naturally quite inquisitive and I'm really lucky to get paid to do something I enjoy- being nosey! So far, I have worked on projects with children and young people, parents, teachers, public health professionals and patients. You name it: I've probably worked with them. And, to be honest, it has ranged from the sublime to the ridiculous…

Crowd control: Some research participants refused to be quiet for the focus group

Yes, I've done focus groups in schools and community venues. I've sat on people’s sofas having a cup of tea and a biscuit. I've been challenged by young people determined to embarrass me whilst talking about sex and relationships education. All of this I expected as part of the ‘routine’.

What I didn't expect, however, was trying my hardest to concentrate on asking ‘the right questions’ whilst the washing machine was screaming in the background on the extended spin cycle. Or being mauled by a rather ‘licky’ dog and trying to make sense of the tape afterwards. I didn't expect to need crowd control skills when trying to carry out work with 24 new mums and their 28 babies and toddlers, all wriggling on the floor and not one of them being courteously quiet for the tape. However, today took the biscuit. I went to talk to two health visitors, at their place of work. Nothing out of the ordinary, or so I thought. In need of some privacy, I was led into a tiny windowless room (a cupboard), a cupboard lined with patient notes and not enough room to swing a cat. The three of us huddled around a mop and bucket, like women dancing around their handbags in a club circa 1989, whilst I held out the voice recorder. At the same time I was trying desperately not to drop it in the murky water swimming at the bottom of the bucket. Oh, the glamorous life I lead…

Would I change it? Absolutely not! No two projects are the same. Meeting participants is by far the best aspect of my job; it brings obstacles and challenges but most of all it makes my job a lot of fun!

Photo attribution: www.flickr.com, Anthony J, 'Six pack', The results of the 'final project' in our childbirth class, (Left to right: Sienna, Maguire, Sophia, Ethan, Claire and Noah)

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Too stressed for words? Involving those experiencing stress in research

Post by Fuse members Natalie Forster, Senior Research Assistant, Northumbria University and Sonia Dalkin, Lecturer in Public Health at Northumbria University

On this National stress awareness day, we wanted to take the opportunity to reflect on the ethics of involving those experiencing stress in research.

Fuse researchers are currently undertaking a realist evaluation to understand how, when and for whom, Citizens Advice Bureau (CAB) interventions improve people's health. CAB provide independent, impartial, confidential, and free advice to everyone on their rights and responsibilities. This includes advice on debt, benefits, employment, housing and discrimination.

Changes to physical health take a long time to show, and are therefore difficult to capture in the evaluation timescale. The impact of CAB on stress therefore forms a core focus of the study. As we know already that stress is linked to many mental and physical health outcomes, determining if and how CAB services reduce stress should enable us to project the potential health impact of CAB.

At the point when people approach CAB, they are often under considerable strain. Two in three people accessing CAB services report feeling stressed, depressed or anxious as a result of the problem or problems that they are experiencing, more than one in five people have had to move home or are worried about losing their home, and almost one in five are experiencing difficulties in relationships with other people.

We have had much discussion as a research team, together with CAB staff, around how to design the research in a way that generates sufficient data to assess the impact of the service, but which remains sensitive to what clients are experiencing. Imagine a scenario for example, whereby you approach a service for help already under significant stress, you are anxious to resolve a financial problem, yet before you can start to address the issue you're asked to fill in a lengthy questionnaire about your health. Furthermore, CAB have projects specifically designed to support those diagnosed with cancer. In the case of CAB clients who are currently undergoing treatment for, or supporting a family member with cancer, stress is likely to remain in spite of addressing financial concerns, and to ask if their health has improved would be inappropriate.

These are just some of the issues we've been grappling with and which have informed our decisions about which client groups we invite to participate, when we contact potential participants, and what they can reasonably be asked to take part in. A decision was made for instance, not to include a project for patients and families with cancer among those being evaluated. Baseline questionnaires will not be delivered before, but rather during or just after clients’ initial appointments. The number of questionnaires clients will be asked to complete has been carefully considered and where possible, shorter versions of questionnaires have been used in order to avoid over-burdening participants.

That said, we're also conscious of the risk of excluding people from taking part by making too many presumptions about participant preferences. We have often reflected during involvement with previous research on how generously people have shared their time and experiences even when undergoing difficult circumstances. We therefore continue to consider the balance between participant protection and autonomy when recruiting potentially stressed participants. In research with people experiencing difficult circumstances, involving potential participants and organisations working with them in designing data collection strategies is key to ensuring their appropriateness.

Photo attribution: Photograph ‘Anxious 1’ (File ID #1431663) by Joana Croft via freeimages.com, copyright © 2007: http://www.freeimages.com/photo/anxious-1-1431663

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