Friday 25 January 2019

Universally discredited?

Posted by Mandy Cheetham, Research Associate, Teesside University and colleagues.

I listened to the budget in October 2018 in anticipation of an announcement about Universal Credit. We had just completed a study commissioned by Gateshead Council about the impact of the roll out of Universal Credit. I had been profoundly moved by the accounts of Universal Credit claimants with health conditions and disabilities who participated in the research. In a budget for “strivers, grafters and carers”, Philip Hammond announced that the “period of austerity was coming to an end”. He promised an additional £1 billion over five years to ‘smooth the transition’ to Universal Credit. Despite acknowledging “genuine concerns” about implementation of the programme, “Universal Credit is here to stay” Hammond asserted.

Two weeks after the budget announcement, I had the pleasure of meeting Philip Alston, the UN Special Rapporteur for Extreme Poverty and Human Rights, who was visiting the North East as part of his UK tour. We presented the findings of the Universal Credit research and he asked probing questions about the implications. We were not alone in drawing attention to concerns about the adverse effects of Universal Credit on people with disabilities. A statement of Alston’s conclusions can be found here.

Our research report was published on 15 November and the findings covered by the Guardian and Independent newspapers, local radio and television news.  Doctors’ concerns about Universal Credit were also highlighted in a British Medical Journal feature which cites our research.

The research team and Gateshead's Director of Public Health have received emails from people sharing their experiences and thanking us for raising this important subject. It has been highlighted by the Association of Directors of Public Health. I have met with local MPs, elected members, and senior managers in the Council and voluntary sector in Gateshead where I work as an embedded researcher. The findings have been shared with Department for Work and Pensions staff and we have been invited to the House of Lords. This kind of (inter)national interest is rare and a bit overwhelming! The research was made possible, because Gateshead Council commissioned it. Independent academic research of this kind is essential if we are to understand the impact of government policy on North East communities.

The findings raise questions (again) about public health advocacy and research. What is our role if not to work with communities whose voices are often unheard or ignored in policy to enable their views and experiences to contribute to debates (Smith and Stewart 2017[1]). This research demonstrates the power those voices can have when assembled using robust qualitative research methods and in the absence of any other data. The policy changes taking place under the guise of welfare ‘reform’ present huge challenges to public health and wider efforts to address health inequalities. If Universal Credit continues to be rolled out, vulnerable claimants will continue to endure hardship and destitution. Suicide rates will rise and the human and financial costs to the health and social care system will increase. As public health researchers, we have a duty to raise awareness of the effects of a policy which is undermining the health and wellbeing, employment prospects, food, financial and housing security of the most vulnerable people in society. It remains to be seen whether the government is listening to a growing body of evidence (Arie 2018[2], Cheetham et al 2018[3], Walton 2018[4]) about the impact of Universal Credit or whether, as Philip Alston (2018: 1) observed, ministers will continue to dismiss concerns and doggedly resist change in response to the many problems highlighted.

Mandy will present her research at the Fuse Quarterly Research Meeting: The impact of Universal Credit on health & wellbeing in Gateshead.  Find out more on the Fuse website.

About the authors:
Dr Mandy Cheetham Research Associate, Teesside University
Dr Suzanne Moffatt Reader in Social Gerontology, Newcastle University 
Dr Michelle Addison Research Associate, Newcastle University 
Alice Wiseman, FFPH, Director of Public Health Gateshead Council

The views expressed here are those of the authors and do not necessarily reflect those of the author's employer or organisation.

  1. Smith and Stewart (2017) Academic advocacy in public health: Disciplinary 'duty' or political 'propaganda'? Social Science and Medicine Sep;189:35-43. doi: 10.1016/j.socscimed.2017.07.014. Epub 2017 Jul 21.
  2. Arie, S. (2018) Doctors concerns over universal credit are mounting BMJ 363: doi: 10.1136/bmj.k5131 5th December 
  3. Cheetham, M. Moffatt, S. Addison M. (2018) “It’s hitting the people that can least afford it the hardest” The impact of the roll out of Universal Credit in two North East localities: a qualitative study. Gateshead Council, Teesside university and Newcastle university and Fuse, the Centre for Translational research in Public Health
  4. Walton, E. (2018) Life and Times A truth universally acknowledged: moving to Universal Credit leads to large debt and poor mental health British Journal of General Practice 68 (677): 577. doi:

Friday 18 January 2019

Sustainable diets must be a public health priority

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

The publication this week of the EAT-Lancet Commission report on healthy diets from sustainable food systems makes it clear that our health and the planets are inextricably linked. As such, improving the sustainability of our diets must be a public health priority. This is something that the British Dietetic Association (BDA) has recognised for some time, and we have recently launched our One Blue Dot toolkit to help dietitians, as key public health actors, deliver on that priority.
Pale Blue Dot - photograph of Earth taken by the Voyager 1 space probe

One Blue dot – the only home we have

The BDA chose to name our Environmentally Sustainable Diets Toolkit 'One Blue Dot' for the famous image taken by Voyager 1. It is of the Earth from a distance over 3.5 billion miles, and in it our planet appears as a pale blue speck, less than one pixel wide, in the vast darkness of space. The astronomer Carl Sagan said of the image:
"To my mind, there is perhaps no better demonstration of the folly of human conceits than this distant image of our tiny world. To me, it underscores our responsibility to deal more kindly and compassionately with one another and to preserve and cherish that pale blue dot, the only home we've ever known"
Our eating habits are having an adverse impact on the environment and we are endangering the future of the planet – up to 30% of greenhouse gas emissions (GHGe) come from the production of food – and it’s the only one we’ve got. We also know that our current food system is not providing for human health either. Over 800 million people worldwide still do not have enough to eat, while nearly two billion are now overweight or obese.

We believe that eating more sustainably can be a win-win – good for us and good for the planet. It’s also the responsible thing to do. As Ursula Arens, one of the dietetic experts who helped us write the toolkit put it: "Eat healthily for you, eat sustainably for your grandchildren".

Practical help

The BDA’s 2017 policy statement on sustainable diets emphasised the central role we believe dietitians need to play, translating the complex science of environmental sustainability as it relates to food into practical dietary advice for patients and the public at large. The statement was well received by our members but they also made it clear that we needed to do more to support them to make this policy a reality. This is a big topic and can be daunting, not just for the public but for healthcare professionals as well. That is why the idea for a toolkit was born, designed to provide a summary of the key evidence, some practical tools and links for more advice.

So far, we’ve developed a comprehensive reference guide which looks in detail at the key elements of a sustainable diet, outlines the evidence on the impact of certain foods on areas like GHGe, land use and water use. We’ve included practical meal swaps, which highlight the relatively easy ways in which common meals can be made both more nutritious and have less impact on the environment. We then include detailed information on specific nutritional considerations, in particular those nutrients that may be lacking if red meat is reduced and dairy intake moderated, such as calcium, iron and iodine.

Key recommendations

The main two recommendations within the toolkit are to reduce red and processed meat (RPM), and to moderate dairy intake. These two actions will lead to the biggest reduction in GHGe in particular, and we know that there are positive health benefits from reducing RPM and shifting away from certain dairy sources such as cheese which have high environmental impact and are also typically high in saturated fat and salt.

Other considerations, like sourcing sustainable fish, eating more fruit and veg, consuming locally produced food and reducing food waste will also make an important contribution to public health. No one action will be enough on its own. It becomes clear once you delve into the science and evidence on sustainable diets just how complex this issue is, and that even seemingly innocuous differences in the way (or indeed where) food is produced makes a big difference to its environmental impact.

What next

This toolkit is not finished; it remains a live document which we hope to add to and update over the coming months and years. While the first part is focused on dietitians themselves, we know that the next phase will be to make this a public health message. We’ve already got some more materials planned, and been delighted with all the questions and suggestions from dietitians and others about what we could look to include in future iterations. If you have any further suggestions, including on how this message can be translated for public health audiences, they’re very welcome!

We know that changing our diets alone will not save the planet - we also need to make big changes in transport, energy, waste and many more besides. However, as the experts in diet and health, it’s the area in which we have the expertise to make the biggest difference.

You can find out more about the One Blue Dot toolkit on the BDA website:

Image: 'Carl-Sagan-Pale-Blue-Dot' by Owen Iverson via, copyright © 2006:

Friday 11 January 2019

New Year, New You or is it?

Happy New Year - or is it too late to say that? Eleven days in and how are the resolutions going? In this, the first blog of 2019, two Fuse experts take a wry look at the healthy change rhetoric around at this time of year.

New year, new backlash?

Amelia Lake, Associate Director of Fuse and Reader in Public Health Nutrition at Teesside University

Annually we have a period of feast (December) followed by a period of resolution and attempted behaviour change. Is it just me, or is there a trend away from the new year new you pressure? While there is the January diet season and 'detox' season (which requires a blog post in itself), there is also the increase in gym membership (in this article in the Independent, one gym claims a 40% increase in web traffic between December and January). Also the Veganuary campaign, encouraging people to try a vegan diet for the month, which passed 225,000 sign-ups in its first week.

I may be stating the obvious here but we go from excess to aspired deprivation. Add into the mix the oh so helpful food environment. Did anyone else notice Easter eggs appearing in supermarkets on Boxing Day? Just as pestered parents (me) breathed a sigh of relief that the queue at our local convenience store (Co-op I’m looking at you) wouldn’t be filled with chocolate after Christmas – no…. we've already moved onto April’s feasting!

Back to the new year new you backlash, there seems to be a movement away from drastic change and a desire to be self accepting, more realistic and thoughtful about food. I have noticed a number of intuitive eating books thrust into the limelight and a trend towards body acceptance.

I appreciate that social media in general can be an echo chamber. In the world of nutrition on twitter and instagram, I try to follow people with qualifications in nutrition, as opposed to the general #nutribollocks which is so abundant at this time of year.

However #nutribollocks or not, intuitive eating or not, detoxing or not… we are surrounded (physical, advertising, online) with unhealthy options, also known as the Obesogenic Environment. Finding the healthy option still remains challenging. With the increase in popularity of vegetarianism and veganism[1], food outlets have a broader range available, for example the now infamous VeganSausageRoll - still not a healthy option, but what an incredible social media team!

So despite the rhetoric at this time of year about healthy changes, until we have systemic changes in our environment that make the healthy option the easy option, that make it easy and safe for us to build exercise into our daily life, that make alcohol less accessible, we are not going to have a healthy population.

Amelia is a dietitian and public health nutritionist.

The benefits of dry January and remembering Scotch & Wry

John Mooney, Fuse Associate and University of Sunderland Senior Public Health Lecturer

The late Scottish Comedian Rikki Fulton’s sketch entitled New Year’s day sums up perfectly the rationale and motivation that many might share for giving up the demon drink, at least for a while, as the New Year dawns. Learning of the events of the previous night’s ‘Hogmanay party’, during which he had gambled away his car in a poker game and set fire to and destroyed his own uninsured house, the revelation that he had won a 5 litre bottle of whisky in the raffle was precious little compensation!

For most people choosing to abstain from alcohol in January however, their reasons are usually less extreme! Indeed one of the criticisms of the concept of “dry January” is that those most likely to successfully abstain are probably already light drinkers in any case and the resulting likely health gains are correspondingly small. At the other extreme of course, for those who are dependent on alcohol (by clinical definition), impersonating the Christmas leftovers by going ‘cold-turkey’ with respect to alcohol, can have serious adverse health consequences such as convulsions etc. and should be avoided. An evaluation by de Vocht and colleagues published in 2016 showed that while ‘dry January’ led to an increase in attempts to cut down, any detectable impact on consumption remained elusive[2]. In an era in which excess alcohol consumption has become normalised and the price of alcohol in real terms has never been cheaper (in the absence as yet of minimum unit pricing for most of the UK), the overwhelming consensus is that most of the population would benefit from reducing their alcohol consumption, particularly if the resolution held all year round!

John is a public health specialist and a part-time public health stand-up comedian.

  1. "In May 2016, the Vegan Society commissioned Ipsos Mori to poll 10,000 people on their dietary habits and found that Britain’s vegan population had increased from 150,000 to 542,000 in the space of a decade (alongside a vegetarian population of 1.14 million".  Hancox, D. (2018).  The unstoppable rise of veganism: how a fringe movement went mainstream. The Guardian, [online]. Available at: [Accessed 10 Jan. 2019].
  2. de Vocht F, Brown J, Beard E, Angus C, Brennan A, Michie S, Campbell R, Hickman M: Temporal patterns of alcohol consumption and attempts to reduce alcohol intake in England. BMC public health 2016, 16(1):917.