Friday 29 June 2018

Why we must stop using the F-word in relation to Gypsies & Travellers

Posted by Natalie Forster, Senior Research Assistant at Northumbria University and Fuse, and Helen Jones, CEO, Leeds Gypsy and Traveller Exchange

Fascination. Not the word you expected? Then read on to find out why we find it so problematic when people say they are ‘fascinated by’ Gypsy and Traveller Communities.

We frequently hear ‘fascination’ cited as a motivation for
 working with Traveller Communities by practitioners
There is certainly a captivation with Traveller Community ‘lifestyles’ in society. The numerous Gypsy and Traveller autobiographies and television programmes devoted to Traveller Communities (perhaps best exemplified by the Channel 4 ‘Big Fat Gypsy Weddings’ phenomenon) have led Gypsy and Traveller life to be described as a ‘bestseller’, with little sign that this interest is fading. Television programmes are often badged as an exposé on Traveller Community lives, starting with the premise that Traveller Communities are hidden, closed-off and exotic. The Channel 4 Big Fat Gypsy Weddings series for example, promises a ‘Revealing documentary series that offers a window into the secretive, extravagant and surprising world of Gypsies and Travellers in Britain today’ (emphasis added). This language is not value free, and seems to foster a sense of intrigue or fascination in order to appeal to viewers.

Traveller Community members have a lack of opportunities to shape their own image in popular culture. A complete absence of Gypsies or Travellers among the proposed cast for an upcoming BBC Film adaption of Mikey Walsh’s memoir ‘Gypsy Boy’ recently drew attention to the exclusion of Traveller Community voices in the film industry. The understandable reluctance of many Gypsy and Traveller Community members to disclose their ethnicity for fear of racism and discrimination also means there are a lack of images or stories to counter the negative stereotypes peddled within mainstream media. That said, younger Traveller Community activists in particular are increasingly making use of forums through which they can challenge these portrayals.

What though are the implications of this issue for health practitioners, researchers and the public? Of course, we recognise that many of our colleagues share our aversion to programmes such as Big Fat Gypsy Weddings and the hugely problematic representations of communities that these advance. Yet, the underpinning premise of these shows remain unchallenged by many, and we frequently hear ‘fascination’ cited as a motivation for working with Traveller Communities by practitioners.

Why do we feel uncomfortable when someone says they are ‘fascinated by’ Traveller Communities? The use of ‘fascination’ echoes the voyeuristic sentiment of many television programmes and reinforces notions of Traveller Community members as exotic and worthy of special attention or interest. When mentioning working with Traveller Communities, the very reference to these groups often appears to prompt greater interest, but why should this be the case?

It is problematic, we think, in its divisiveness; in the impression it gives of Traveller Communities as mysterious and ‘other’, and a community that ‘outsiders’ can only look into. This downplays the possibilities for seeing commonalities between Traveller Communities and other sections of society – Gypsies and Travellers are seen less as people ‘like us’, facing similar experiences or challenges in life, and more as groups we should find out ‘about’ or gather information ‘on’.

A sense of fascination also seems to shift the motivation away from the interests of Gypsy and Traveller Communities themselves, and towards fulfilling the agenda of those working with these groups. A desire to satisfy one’s own curiosity about Traveller Communities can result in questions that are insensitive, such as those about the cost of someone’s caravan, or aspects of culture that are unconnected with the purpose of a visit.

It is for these reasons that we call for the reconsideration of the use of ‘fascination’ in relation to Traveller Communities and other groups who are seldom heard, as well as for greater questioning of the assumptions that lie behind this term, and the interests it truly serves.

Image: "Seeing My World Through a Keyhole" (4592429363_292aec80c9_z) by Kate Ter Haar via, copyright © 2010:

Friday 22 June 2018

Public health isn’t good politics (part 2)

Knowledge exchange lessons from the spotlight event at the University of Sunderland

Posted by Peter van der Graaf, AskFuse Research Manager, Teesside University and John Mooney, Senior Lecturer, University of Sunderland

In our last blog, we reported on the 4th Fuse international conference on knowledge exchange in Vancouver, B.C. Provocative speakers explained that public health is, at best a hard sell to policy makers and at worst impossible to influence decision making. Luckily, they also presented short cuts for making it more likely that public health evidence would be heard by policy makers.

Sharon Hodgson, Shadow Minister for Public Health, speaking
at the Spotlight on Public Health event in Sunderland
These challenges and the potential short cuts were clearly present at the University of Sunderland spotlight event that we attended, which aimed to increase the visibility of public health research at the university.

Sharon Hodgson, the Shadow Minister for Public Health, opened the afternoon session with a passionate plea for introducing a minimum unit price for alcohol in England, following the example of Scotland. However, she made it clear that the Scottish choice for a 50p unit price would be a hard sell to both her voters and the Labour party. Labour colleagues simply dismissed the policy as a ‘tax on the poor’ and voters would feel the pinch on their already austerity squeezed household budget.

This ignited a lively debate with researchers in the room, who highlighted the research evidence that is available in favour of a 50p unit price. While statistical models consistently demonstrate that this would have the biggest impact on reducing alcohol related harm, such as liver disease, the Shadow Minister was concerned with how the price selected might impact on her voters. Specifically, she felt it was more important that increased costs to people living in more deprived communities were not dismissed, but instead presented as a health improvement incentive.

Having visited various supermarkets in her constituency to check the prices of different types of alcohol in order to work out the impact of different MUP limits, her conclusions sided with the views of the voters and Labour peers: 50p would hit all the different types of alcohol and not just the cheap ciders and therefore penalised not just the heavy drinkers but also the moderate drinkers in deprived communities. Instead, she argued for a 40p unit price, which would mostly affect the price of cheap ciders, and therefore target only the problem drinkers and not the other drinkers in her constituency. What counted as the most important evidence for the Shadow Minister was quite different from what the researchers in the room perceived as the best evidence to inform policy.

When an audience participant also tried to make the economic case by suggesting that the 50p tax would generate a better return for the Government that could be used to finance alcohol addiction services, the Shadow Minister remained unconvinced.

What did start to sway her was another suggestion to change the narrative from a ‘tax on the poor’ (which might be used as a stick by Conservative party members to beat their Labour colleagues), to a ‘tax for the wellbeing of all’. This narrative framed the 50p MUP as a policy that would affect all walks of life and could encourage a change in drinking cultures among all ages and classes, with the money raised being reinvested across a range of policy areas.

Shanon Hodgson agreed that this might make for an ‘easier sell’ and perhaps more importantly serve as the basis of a future health legacy that she could leave for her voters. By reframing the narrative from a small group problem (problem drinkers in deprived communities) to an emotive public issue of damaging drinking cultures, better policy and voter engagement might be secured.

Paul Cairney presenting at the 4th Fuse International
Conference on Knowledge Exchange in Public Health  
The evidence that she really needed were stories to demonstrate meaningful (personal) health gains and cultural change across different sectors of society. This requires a new type of evidence. It does not mean dismissing academic research and all the rigorous evidence it generates, but it does require a careful consideration of the policy system and process in which it is used and a willingness to adapt the messages and narrative to that context and the other types of evidence that are prevalent in that context. This is neatly summarised in the top tips from political science offered by Paul Cairney in his presentation at the 4th international Fuse conference:
  1. Find out where the action is (‘actors’) 
  2. Learn the rules (‘institutions’) 
  3. Learn the language/ currency (‘ideas’) 
  4. Build trust and form alliances (‘networks’) 
  5. Be entrepreneurs, exploit ‘windows of opportunity’
Public health researchers operating as political entrepreneurs might be a hard sell to academic institutions but they have a world to win when trying to get evidence into decision making where it matters and creates impact.

Friday 15 June 2018

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

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

© 2018 Imperial College London
Air pollution was been high on the agenda at Imperial College London recently, with Environment Secretary Michael Gove choosing to launch the Government’s new Clear Air Strategy at Imperial’s Data Science Institute[1]. To coincide with this launch, Health Secretary Jeremy Hunt announced a new tool, developed by Imperial and the UK Health Forum, to help local authorities estimate the health-care costs due to air pollution - an estimated £157 million from exposure to fine particulates and nitrogen dioxide across England in 2017[2].

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

© 2018 Imperial College London
The new Clear Air Strategy[5] outlines how the Government plans to protect the nation’s health. The stated intention of halving the number of people living where concentrations of fine particulate matter are above 10μg/m3 - the concentration of an air pollutant is given in micrograms (one-millionth of a gram) per cubic meter air or 'µg/m3' - by 2025, if achieved, would reap a significant health dividend. However, the focus on a ‘personal air quality messaging system to inform the public…about the air quality forecast [and] air pollution episodes’ places onus on individuals to avoid exposure, rather than creating clean and safe environments within which to live. While there is a place for such messaging, when more than 2000 education/childcare providers across England and Wales are within 150m of a road breaching the legal limit for Nitrogen dioxide pollution (25 of which are in the North East and more than 1500 in London)[6], is it clear that a population based approach is required to tackle this pressing public health issue.

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

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

© 2018 Imperial College London
Focussing on cleaner vehicles and technological solutions can only offer a partial solution to reducing the impact of air pollution on health, so it is good to see modal shift towards public transport and active transport is mentioned (briefly) in the Strategy. There are funds to support bus and rail infrastructure to improve public transport, and an ambition to double the levels of cycling by 2025 - though this would only raise levels from 2% to 4%, compared to 39% in the Netherlands[9].

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

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

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

More details at:


Friday 8 June 2018

Young people in the UK drink more energy drinks than any other countries in Europe

Posted by Amelia Lake, Associate Director of Fuse and Reader in Public Health Nutrition at Teesside University and Shelina Visram, Senior lecturer in public health at Newcastle University

It would be a bit shocking to see children and teenagers drinking espressos, yet it’s socially acceptable for young people to reach for energy drinks to give them a quick “boost”.

Energy drink sales in the UK are now worth more than £2 billion a year

Unaffected by the economic crisis, energy drinks are the fastest growing sector of the soft drinks market. Between 2006 and 2012 consumption of energy drinks in the UK increased by 12.8% – from 235m to 475m litres.

These drinks are very popular with young people – despite coming with a warning (in small letters on the back) that they are “not recommended for children”. A survey conducted across 16 European countries found that young people between the ages of ten and 18 in the UK consume more energy drinks on average than young people in other countries – just over three litres a month, compared to around two litres in other places.

More than two-thirds of young people surveyed in the UK had consumed energy drinks in the past year. And 13% identified as high chronic consumers – drinking them four to five times a week or more. Research also suggests that these drinks are more popular with boys and young men.

What goes into energy drinks?

Energy drinks are usually non-alcoholic and contain ingredients known to have stimulant properties. They are marketed as a way to relieve fatigue and improve performance: “Red Bull gives you wings”.

They contain high levels of caffeine and sugar in combination with other ingredients, such as guarana, taurine, vitamins, minerals or herbal substances. A 500ml can of energy drink for example, can contain 20 teaspoons of sugar and the same amount of caffeine as two cups of coffee.

Caffeine stimulates the central and peripheral nervous system. Consumed in larger doses, it can cause anxiety, agitation, sleeplessness, gastrointestinal problems and heart arrhythmias.

In the UK, there are no clear recommendations for caffeine intake for adults or children, although both the Food Standards Agency and the British Soft Drinks Association recommend that children should only consume caffeine in “moderation” and that caffeine content over [150mg/l] should be declared on the packaging. The current scientific consensus is that [less than 2.5 mg a day] in children and adolescents is not associated with adverse effects.

Should we be worried?

The evidence indicates that these drinks do not give you wings – or any other positive benefits. In fact their intake in young people, is associated with adverse health outcomes. There is growing evidence of the harmful effects of these drinks. Teachers are concerned about the detrimental impact these drinks have on pupils in their classrooms. There is also a known association between soft drink intake, dental erosion and obesity.

Lesser known are the effects of the cocktail of stimulant ingredients – such as guarana and taurine – contained within these drinks.

Our recent review of the scientific literature set out to look for any evidence of associations between children and young people’s consumption of energy drinks and their health and well-being – as well as their social, behavioural or educational outcomes.

We found that for young people, drinking energy drinks is associated with a range of adverse outcomes and risky behaviours. They are strongly and positively associated with higher rates of smoking, alcohol and other substance use – and linked to physical health symptoms such as headaches, stomach aches, hyperactivity and insomnia.

Why do young people buy them?

We also spoke with young people about their intake of these drinks. Discussions with our participants aged between ten and 14 indicated just how accessible and available these drinks are. They are also cheap – in some cases significantly cheaper than other soft drinks, as one of the girls we spoke to explained:

"I think it’s because like a normal can of Coke is like 70p, and [own brand energy drinks] are like 35p."

Our research found that energy drinks are often marketed on gaming sites and linked to sports and an athletic lifestyle – and are particularly aimed at boys. Taste, price, promotion, ease of access and peer influences were all identified as key factors in young people’s consumption choices.

Speaking with parents and teachers about these drinks there was confusion. Parents themselves identified the need for more information about energy drinks – and many admitted to not being fully aware of the contents and potential harmful effects on children.

Should they be banned?

Image used in a recent campaign led by Jamie Oliver
to ban the sale of energy drinks to under-16's
Recently there has been a move to restrict the sales of these drinks to under 16’s – an approach which has also been taken by other countries. This saw the self-imposed sales restriction by many larger retailers – including most supermarkets – to not sell to children under 16. But many places still continue to sell to young people – including convenience stores, which offer a wide range of brands, flavours and package sizes.

The Commons Science and Technology Committee’s enquiry into energy drinks called for submissions in April 2018 and will be reviewing in June 2018 – when we will also give oral evidence.

Of course, legislation to prevent the sales of energy drinks to under 16’s would be helpful. But the marketing of these drinks to young people through computer games and their association with sports is also a much wider issue. Far reaching discussions are needed about the direct and indirect marketing of these drinks (and other food and drinks) through multiple platforms other than TV – particularly through computer games.

This article was originally published on The Conversation. Read the original article.

Friday 1 June 2018

Prevention by any other name would smell as sweet

Guest post by Tom Embury, Public Affairs Officer, British Dietetic Association

Next week, June 4th - 8th is Dietitians Week 2018, where the British Dietetic Association and its members and allies celebrate the work of dietitians. This year’s theme is “Dietitians Do Prevention”, which intends to highlight the important role that dietitians have to play in prevention and public health. We know nutrition and hydration underpin so much of our health and getting it right can reduce the impact of illness, aid recovery, or prevent some diseases and conditions altogether.

NHS England’s Five Year Forward View, in the most recent frameworks from NHS Scotland and the Northern Irish Health and Social Care Service and is embodied in the principles of the Wellbeing of Future Generations (Wales) Act.

It has been made clear by everyone from Marmot to the NHS Confederation that we need to strengthen prevention and that it should be everybody’s business. Despite this, many dietitians (and indeed healthcare staff in general) still don’t think of themselves as doing prevention or public health, especially as so many work in hospital settings, delivering acute care. Our recent 2018 member survey has shown that 40% of our members don’t feel that they do prevention or public health activity. This may be because they don’t have the time or resources, despite wishing to do so, but in some cases, it is because they don’t see public health as part of their remit.

Of course, we believe all our members “do prevention” and public health, but not everyone will call it by that name. Indeed, the term public health often seems to have quite a narrow definition, associated with the work of local government public health teams. This is important work, but by no means is that everything public health entails.

This is why, in preparation for Dietitians Week this year, we asked all our specialist groups for their view on how they do prevention. Our specialist groups cover pretty much all of the areas of dietetics - from paediatrics to older people, public health to critical care. What we found is that there are dozens of words and terms used to describe activity that is essentially a form of prevention.

Some were variations, like primary, secondary or tertiary prevention depending on where you work and what types of illnesses your patients have. Others, such as Making Every Contact Count or Healthy Conversations, relate to specific campaigns or initiatives. In areas like Mental Health or Paediatrics, a whole different language can exist. Even rehabilitation or recovery after acute illness is a form of prevention - preventing future episodes, further hospital visits or complications. One great example comes from Fuse itself – the research carried out into the impact of energy drink intake amongst young people has had an impact on national level policy making.

This is why we are trying to celebrate prevention in all its forms and with all its various names. Dietitians are and should to a greater extent be a core part of the public health workforce.

Our incoming Chairman, Caroline Bovey, highlighted this issue with terminology and understanding at our recent Annual General Meeting. She asked the crowd of over 100 dietitians to raise their hands if they were involved in public health. Some hands went up but they were definitely in the minority. She then asked who had a twitter account where they talked about diet and nutrition – far more hands shot up. “You are all”, she said, “doing public health dietetics”.

So, whether you’re having a healthy conversation or making every contact count, supporting rehabilitation or reducing hospital admissions, celebrate the way that you do prevention. We can’t let the terminology get in the way of sharing best practice or spreading good ideas. We’d love you to tell us about it as part of Dietitians Week! Get in touch via