Levelling Up: welcome news or overly ambitious and unrealistic?

Posted by Chloe Beck, Health and Social Care student, Northumbria University

Before his resignation, Boris Johnson unveiled his flagship ‘Levelling Up’ plan. Hailed as the ‘defining mission’ of his Government, this new plan strives to transform the United Kingdom by increasing opportunities and prospects for the whole population. It aims to shift Government focus onto the so-called ‘forgotten communities’ of Great Britain, through a decade long project consisting of twelve missions that have been given status within UK law. Although changes are now afoot in the Government, both candidates to replace Johnson - Liz Truss and Rishi Sunak - have stated their continued commitment to the policy. It seems therefore, that levelling up is here to stay (for a bit longer at least). But what might this mean for inequality in the UK and are its goals likely to be reached?

Rishi Sunak visiting Yarm in North East England, December 2021

As might be expected with such a bold promise, the Levelling Up plan has been both welcomed, and branded as overly ambitious (Wood and Swift, 2022). Some see the policy as a serious attempt at understanding and reacting to the regional inequalities that exist within the United Kingdom (HM Government, 2022; Wood and Swift, 2022). Supporters view the policy as a sensible plan, with missions that are collective and recognise the links between health, skills, education and the economy (Wood and Swift, 2022). It’s certainly clear that Levelling Up promises some huge and much needed changes to healthcare services and for the population within the UK (including upgrades to hospitals, increased GP appointments, new fruit and vegetable prescriptions to help tackle food insecurity, changes to the school curriculum to support healthy eating, and community hubs to tackle diagnostic backlogs). Whether these changes are do-able in the context of continued staff shortages and already under-funded health services remains to be seen.

The Labour party has described Levelling Up as a rehash of recycled policies (Harari et al., 2022), with others stating that it is too aspirational and impractical (Pope, 2022). It is argued that the policies breadth and scope may make it hard for the Government to maintain focus and could create a scattered approach (Newman et al., 2022; Pope, 2022; Wood and Swift, 2022).

One of the major problems appears to be a lack of long-term funding into the whole Levelling Up plan, with funds only extending to 2030 (Swinney, 2022). Levelling up may not be fully achieved if funds dwindle once 2030 comes around. Calls for Government to extend Levelling Up plans beyond 2030 (Swinney, 2022), to ensure its longevity and successfulness are unlikely to be met, especially in a political environment where short-termism is the norm and where the maximum term of a Parliament is five years (Marsh, 2013). Likewise, critics suggest that an agreement needs to be made between political parties to ensure Levelling Up is not scrapped once a new Government comes into power (Davenport and Zaranko, 2020; Swinney, 2022).

Even despite levelling up actions, differences in productivity between areas within the United Kingdom will likely remain (Atherton and Webb, 2022). This is because different places have different roles within the economy, with London being top of the chart for professional services, and Wales for the manufacturing sector for example (Sykes and Lisle, 2021). Setting area specific goals and targets (Atherton and Webb 2022), and implementing types of spending (Mason 2022) which take into account the specific demographics and economy of an area may help to combat this issue. Though, of course, this local variation may pose alternative challenges due to mixed ideologies and inconsistency with ideas laid out in the original white paper.

Setting aside concerns about feasibility, it has also been found that many disadvantaged areas are not prioritised within the plan (Atherton and Webb, 2022). This demonstrates a lack of attention and care towards the very thing that the plan is aiming to fix: inequalities! Data journalists at The Guardian found that some of the most deprived localities are receiving far less financial support than some of the most affluent areas, with Bromsgrove in Worcestershire receiving £148 per person and Knowsley in Merseyside receiving no money per person for example. This chimes with Rishi Sunak’s comments about redirecting funding away from disadvantaged areas and towards wealthier towns.

Overall, the new Levelling Up plan has both its positives and negatives. It is a clear start at aiming to try and reduce longstanding inequalities within the United Kingdom. However, the extent to which these policies will be followed as they have been set out is unclear, and only time will tell whether it manages to achieve its missions and ‘level up’ the country.

The cynic in me thinks that this push for equity may also have something to do with attracting votes...

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.

The views and opinions expressed by the author are those of the author and do not necessarily reflect those of Northumbria University or Fuse, the Centre for Translational Research in Public Health.

Image: HM Treasury, OGL 3, via Wikimedia Commons

Tackling stereotypes, stigma and self-help: What 'BoroManCan' is doing for the health and wellbeing of Boro Men

Posted by Shelina Visram, Senior Lecturer in Public Health, and Mabel Lie, Research Associate, from Newcastle University

It’s that time of year again… No, we’re not talking about Christmas. Today is International Men’s Day! If you’ve got no idea what this is, you may want to read the Fuse blog we wrote on the same day last year. The theme for 2021 is ‘Better relations between men and women’, recognising the need to promote gender equality for women as well as men. Which sounds good to us, as two female researchers who’ve been working on a men’s health project for the past year.

In last year’s blog we mentioned being awarded funding from the NIHR ARC NE&NC to conduct research into the BoroManCan campaign, which aims to inspire positive change around men’s health and wellbeing in Middlesbrough and Redcar & Cleveland. Colleagues from Public Health South Tees were keen to know which elements of BoroManCan were working and where improvements could be made. In collaboration with academics from Durham and Teesside Universities, we interviewed staff, representatives of partner organisations and other key stakeholders to capture their views on BoroManCan. We also trained and supported three peer researchers to gather insights from local men (and one woman). They chose to conduct interviews to explore men’s health and wellbeing needs, to help us understand whether BoroManCan could be doing more to improve their access to health services and other sources of support.

The interviews provided valuable insights into barriers to men’s help-seeking behaviour. To start with, Teesside’s industrial heritage has led to an expectation that the stereotypical ‘Boro man’ should be tough, resilient, and able to fulfil the roles of household provider and protector. Industrial decline, increasing unemployment and job insecurity were felt to have impacted negatively on men’s mental health. There was a general perception that men are not as likely as women to talk about their feelings or their health, and that there is a particular stigma to discussing mental health problems. Rather than accessing formal services, many Boro men prefer to avoid embarrassment by attempting self-help or using coping strategies such as excessive alcohol consumption and substance misuse. Apart from wanting to maintain their masculine image, there were also practical hurdles around demands from employment and the benefits system.

Two of the three peer researchers, Matthew (left) and Neil (right)

But it’s not all doom and gloom. We also identified a number of factors that were felt to impact positively on men’s health and wellbeing and their likelihood of seeking help. These included: having support from a partner or family members; activities such as Men’s Sheds that value life skills; creating male-friendly spaces; and providing opportunities to spend time outdoors. Some interviewees emphasised the importance of sport and particularly football as a way to connect with other men. What was clear was that apart from addressing men’s health within existing services, male-specific interventions such as BoroManCan were needed. The campaign was viewed positively as a way of sharing inspirational stories from others who have dealt with their own challenges, as well as signposting to relevant activities. Online elements such as the website and podcast were key to the campaign, particularly during the pandemic. However, staff and stakeholders were keen to return to offline elements such as the men’s health champion training and showcase events. Local men believed that the campaign needed to be promoted more widely to ensure it was reaching all those who might benefit.

Here's what our stakeholders had to say about the campaign:

"So I think one of the really good things about it [BoroManCan] is it's very specific to Middlesbrough. And obviously when you look at the stats, you know, you look at suicide rates and mental health in Middlesbrough, they're really high and I think men do struggle to engage. But when local men that are very similar to them are engaging, I think it helps other people." (Stakeholder 1)

"When people feel anxious, they're feeling alone. And BoroManCan, it was a way forward for them not to feel alone and to be able to share their story and find a way forward. 'Cos BoroManCan, it leads onto other things. If you share your story, you’re finding you're not alone. You find out how other people have pain, depression and anxiety and you can follow suit. It leads you to find help." (Stakeholder 7)

Today we’re hosting a webinar to share and discuss our research findings in more detail. For anyone who can’t make it, the webinar will be recorded and shared via the BoroManCan YouTube channel. Please get in touch if you’d like to know more about the campaign or the research; we’d be happy to share our final report once this is ready for publication. And watch this space for future blogs on this subject from our practice partners and peer researchers.

Below are links to support organisations relating to the issues raised in the post: 

• www.samaritans.org
• Samaritians phone number: 116 123 (for free, 24 hours a day, 365 days a year)
• www.mind.org.uk
• www.mhm.org.uk
• www.thecalmzone.net
• womensmentalhealthnetwork.com
• www.mentalhealth.org.uk/tags/bame
• mindout.org.uk
• www.rethink.org

(Re)taking liberties: Reclaiming positive freedom as a public health argument

Posted by Jack Nicholls, Lecturer in Social Work at Northumbria University

At the time of writing, the government intends to lift most remaining Covid restrictions still in place in England on July 19, widely touted as 'Freedom Day'. 

I recently passed my PhD viva defending a thesis that was concerned with the diverse ways a contested value concept is understood by human welfare professionals (in my case, 'social justice' and newly-qualified social workers). As a result of that undertaking, I am now habitually critical of the ways in which ethical and moral language is used and claimed for particular agendas. In the looming shadow of so-called 'Freedom Day', I have been thinking about how caring professions and health and wellbeing researchers might reclaim the word 'freedom' for ourselves.

Possibly in contrast to many of my wonderful colleagues in the caring professions and their associated research wings, I am in broad terms a libertarian rather than a collectivist*. Individual rights and freedoms - the ability to live as one chooses unfettered without just cause, to be different, to not fit or conform - are close to sacred to me. While I can be persuaded by arguments advanced by those of a more communitarian mindset, it is always despite, rather than because, they are communitarian. When, as I will here, express concern about the speed and totality of the easing of Covid restrictions, I do so from a liberty-minded philosophical position.

The 'Freedom Day' discourse draws almost entirely on the concept of negative liberty and is emblematic of a long-established idiolect that frames freedom (with personal responsibility) in a zero-sum game against statutory entitlement to and provision of help. Negative liberty refers to the absence of constraint and control. As an idea, it is of profound importance for those of us who believe rights and freedoms are inherent to personhood, and that it is for the state to uphold them, not hand them down as bounties and favours.

Sir Isaiah Berlin 

Alongside negative liberty however sits the concept of positive liberty (both liberty concepts were set out by Sir Isaiah Berlin (pictured right) in his 1958 lecture and subsequent written works). Positive liberty refers to the idea of freedom being enabled by active action and the provision of resources, facilities and support. The two work in tandem and, for the kind of libertarian I am, they are equally important and necessary for one another. Covid restrictions have impacted both our negative and positive liberties - the former by restricting our movement, travel and association, the latter, at least for many people, by restricting our incomes, our ability to access welfare, social security, safe transport, childcare and informal support networks.

The rationale for these actions, a rationale that was broadly accepted by the majority, can be understood as a trade-off with other positive freedoms, most notably seeking to keep as many people as possible, and particularly those at most risk of developing serious or fatal Covid symptoms, free from infection. It is a trade-off I would make again in a heartbeat under similar circumstances. That is part of why the present language about 'Freedom Day' is so galling, because for many, particularly those with high-risk health conditions, their families, and those who have not yet been able to be vaccinated, July 19 will not signal any kind of freedom. I can't tell you how much I'm looking forward to my first liberated Guinness, enjoyed in the hostelry and company I choose, with all the health risks confined to the pint glass. I can't do that on July 19, because the decision has been made to prioritise the negative liberty of those of us who can enjoy it over the positive liberty of those still at particularly serious risk. We aren’t choosing freedom; we are choosing some people’s freedom over that of others.

This situation behoves health and social service practitioners and researchers to consider whether we can reclaim the concept of freedom, particularly positive freedom, as a full and proper part of our value base and lexicon. I argue that we both can and should, for what are we if not participants in endeavours for more positive freedom through greater knowledge and better health and wellbeing. Freedom 'from' is fairly hollow and useless without meaningful freedom 'to', and though many who share my philosophical persuasion see an overbearing state as a legitimate risk to freedom of all kinds, no less important is freedom from preventable illness, pain, anxiety, suffering, burden, loss of control, and the wider contributors to health inequities, not least poverty and postcode.

Our professional fields, with the best of intentions, often couch our arguments in terms of the community or public good. Without besmirching the place and value of those arguments, it is my view that were we to speak also in terms of freedom, including individual freedom, we would do so with complete intellectual coherence and legitimacy. Rather than being unjustly tagged as over-cautious and dictatorial, we could put our criticism of the end of restrictions in pro-positive freedom language. Beyond that, we could reframe and bridge the unfounded but perceived gap between individual choice and public wellbeing, all while avoiding the former being reduced to callous responsibilisation, and the latter being unfairly painted as nannying control. We might even unlock a new set of tools for persuading individuals and institutions who are rarely engaged by welfarist, collectivist or even duty of care arguments about public health concerns. We've done it before; we rarely talk about the smoking ban nowadays, rather we refer to pubs and train stations being smoke-free. Likewise fat-free, alcohol-free - it's a nice word, and an effective one.

At this moment, whatever their diverse feelings about the end of restrictions (I should caveat, the end for some) freedom is high in the public consciousness. Let us who are concerned for public wellbeing liberate our arguments and reclaim the concept of freedom, particularly positive freedom, for ourselves.

*Collectivism: a social pattern in which individuals construe themselves as parts of collectives and are primarily motivated by duties to those collectives. More here: https://plato.stanford.edu/entries/culture-cogsci

Images:

1. Courtesy of Pixabay: https://pixabay.com/illustrations/bird-cage-aviary-freedom-flying-730478

2. Sir Isaiah Berlin by Rob C. Croes (ANEFO), CC0, via Wikimedia Commons

The views expressed in posts are those of the authors and do not necessarily reflect those of Fuse (the Centre for Translational Research in Public Health) or the author's employer or organisation.

What is the recipe for a happy retirement?

Independence, identity, planning and staying socially connected says Anastasiia Fedeeva, Postgraduate Researcher, from Northumbria University

For the last two and a half years, I have been working on a PhD that aims to promote wellbeing and physical activity in retirement. Over this time some people have asked me whether I ever felt too young to understand what retired people might need to live their lives better. I must admit that is a fair question but not just because of the potential age difference with my target population.

 

First, before designing and implementing any initiatives to promote wellbeing or physical activity, it is recommended that you have a good knowledge of the people that you want to help; their needs, preferences, and feelings (Laverack, 2017). Furthermore, retirement itself is a unique and complex phenomena. Retirement experiences vary considerably between individuals and are influenced by a variety of contextual factors, for example the characteristics of a job, personal health, social networks, or whether a spouse is working (Wang, 2007). Therefore, it is important to understand the gaps in what can predict positive retirement (Amabile, 2019; Van Der Zwaan et al., 2019). One way to explore retirement more comprehensively is by conducting qualitative research to find out about the experiences of retirees, as this allows us to identify the key ways in which people adapt to a successful retirement in connection with individual and contextual factors. That’s why I spent several months last year conducting focus groups and individual interviews in order to better understand psychological predictors of retirement adjustment such as people’s attitudes, feelings, and behaviours.

 

To understand what is so good and bad about retirement, it is important to recognise what people leave behind after quitting their jobs. Work brings a lot of positives to our lives and this is not only limited to our finances. Among the most common benefit is the feeling of belongingness and connectedness with our colleagues. Retired people can be very concerned about losing valuable connections from their previous employment. For some, work may be the main source of social interaction, and those people might feel particularly vulnerable in retirement. 

 

Another positive aspect of work is in giving us an identity. If you ask people: “Who are they?”, very often the first answer would be related to the person’s work role. As people leave employment, they can no longer define themselves by their professions, and it brings the question: “Who are they now?” Although work identity can be substituted with other roles, such as those that are family or hobby-related, this process might take some time and individual effort. For those with a particularly strong attachment to work, such identity transition can be very challenging. 

 

However, one benefit associated with retirement that many look forward to, is increased freedom and independence. Most are excited to have the opportunity to finally live in accordance with their own preferences and choices, free from work-associated obligations and routines. This desire for independence seems to develop beyond just freedom from work commitments. Retired people value independence in other areas of life as well, and sometimes this even takes precedence over the importance of social connections. One reason can be that people of retirement age have already had all variety of commitments, including work and family responsibilities, and retirement is viewed as a relief from that. Another possible reason is that retirement is seen by many as the beginning of ‘old age’. As individuals acknowledge age-related health decline, they start appreciating physical and mental independence more than ever.

 

Additionally, some recently retired people see creating a new routine as another restriction to their freedom but planning day-to-day activities can be beneficial for wellbeing in the long-run. Planning seems to enable a better use of this increased freedom by helping retirees to participate in different activities of their choice. Thus, establishing new routines can be remarkably empowering as they foster feelings of control, sense of purpose and self-value, that “I’ve got my life back!”. 

 

As such, regardless of the differences in experiences and expectations, social connectedness, independence, successful identity transition, and planning activities in retirement appeared to be important for the vast majority of my participants. These findings supported and added to our ideas on how to promote healthy retirement. 

 

Personally, I feel privileged to have shared in the stories of retired adults. This has made me feel much closer to them – they aren’t ‘just participants’ anymore but real people who have gone through life’s joys and struggles. I have realised even more that despite the generational, cultural, and life experience gaps, we might just be looking for the same things that contribute to our happiness and wellbeing after all.

 

  

References:

1. Laverack, G. (2017). The challenge of behaviour change and health promotion. Challenges, 8(2), 25. Retrieved from: https://www.mdpi.com/2078-1547/8/2/25
2. Wang, M. (2007). Profiling retirees in the retirement transition and adjustment process: Examining the longitudinal change patterns of retirees’ psychological well-being. Journal of Applied Psychology, 92, 455-474. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/17371091 
3. Amabile, T. M. (2019). Understanding Retirement Requires Getting Inside People’s Stories: A Call for More Qualitative Research. Work, Aging and Retirement. Retrieved from: https://academic.oup.com/workar/article/5/3/207/5521007
4. Van der Zwaan, G. L., Hengel, K. M. O., Sewdas, R., de Wind, A., Steenbeek, R., van der Beek, A. J., & Boot, C. R. (2019). The role of personal characteristics, work environment and context in working beyond retirement: a mixed-methods study. International archives of occupational and environmental health, 92(4), 535-549. Retrieved from: https://link.springer.com/article/10.1007/s00420-018-1387-3
   

Image:

1. "Your father's opted out of a dignified retirement." by Grizelda Grizlingham via University of Kent, British Cartoon Archive (Reference number: GGD1456, Published by: Spectator, 02 Mar 2018, with thanks to Copyright holder: Grizelda Grizlingham): https://archive.cartoons.ac.uk/Record.aspx?src=CalmView.Catalog&id=GGD1456&pos=23

Take it away: a masterclass in healthy takeaways

Post by Scott Lloyd, Advanced Public Health Practitioner at Public Health South Tees and Karen Pearson, Catering Monitoring & Advisory Officer at Redcar & Cleveland Council

Whether it is the Golden Cod or the Taste of India, independent hot food takeaways get a bad rap in Public Health circles. They serve food and drink that is predominantly higher in fat, salt and sugar and may contribute to noise pollution and other environmental ills. Furthermore, they may not be the best option for our beleaguered high streets as they tend to be shuttered up during the daytime.

Up to March 2018, for a variety of reasons (including health), 164 out of 325 Local Authorities (50.5%) have introduced powers through Local Plans or Supplementary Planning Documents (SPD) that aim to restrict the proliferation of hot food takeaways (Keeble et al. 2019)[1].

Watch this video to find out more about how we worked with takeaway owners
(click here if the video doesn't appear above)

But let’s be honest – that horse has already bolted. Analysis by Public Health England has shown that there is an average of 96.1 hot food takeaways per 100,000 population in England (Public Health England, 2018)[2].

Where we work in Redcar and Cleveland, the Local Authority introduced a SPD in 2008 that restricted the percentage of hot food takeaways (A5 class use in planning terminology) in any commercial centre to no more than 5% - but even then, each commercial centre already had more than 5% hot food takeaways.

So we have to accept that hot food takeaways are here to stay – at least for the foreseeable future. Many Local Authorities have implemented interventions such as award schemes that engage these businesses to support them to improve the healthiness of their food offerings, but with limited evaluation (Hillier-Brown et al. 2017)[3]. Indeed, we have a Food4Health award in Redcar and Cleveland, which is open to all out-of-home caterers. We were doing OK in engaging hot food takeaways but we wanted to try something different.

In 2015, the Foodscape team organised a Fuse Quarterly Research Meeting on developing interventions with out-of-home caterers. One of the presentations was by Louise Muhammad from Kirklees Council on the healthy takeaway masterclass that they had developed and delivered to over 20% of the eligible businesses on their patch. The masterclass was described as a three-hour session in which hot food takeaway owners and managers learn about the small, sustainable changes they can make so their food is a little healthier without costing a huge amount or that will actually save them money/generate new custom.

A few months later, we travelled down to Huddersfield to watch a masterclass being delivered. It was clear from the start that this was something that engaged businesses and had potential. The decision to repeat it in Redcar and Cleveland was easy.

Takeaway owners and managers learning about small changes to make their food healthier

We worked with the teams from Kirklees and Foodscape to deliver our first masterclass in May 2016. In line with what Kirklees do, we invited hot food takeaways with a food hygiene rating of three or above – the feeling was that any outlets with less than this really needed to concentrate on food hygiene first. In total, 181 invitations were sent out and 18 attended, representing 10% of those eligible – a figure that we practitioners were happy with (if not all the academics!).

The Foodscape team conducted a mixed methods evaluation to explore the acceptability and feasibility of the masterclass intervention (Hillier-Brown et al. 2019)[4]. The takeaways businesses that attended made a variety of pledges – the ones that required less effort and cost (e.g. reducing salt and sugar in pizza dough) were implemented more so than other more potentially costly or difficult changes (e.g. stocking reduced sugar tomato ketchup).

Pledging to use healthier alternatives

Has this work made the hot food takeaways in Redcar and Cleveland healthy? No it hasn’t. Like the rest of us, businesses owners have a living to make and will cater to what their customers want. But as an example, Carol - the owner of a sandwich shop in Guisborough who stars in the film above - pledged to take 10% of the sugar out of her baking. Did her customers notice? No. Did, this make her flapjacks ‘healthy’? Of course not but they are now a little healthier. Hence, has the masterclass via all the pledges made their food offerings a little healthier? Probably.

We have since delivered a further six masterclasses, with the offer extended to other out-of-home caterers such as restaurants. About 30% of all eligible takeaways in Redcar and Cleveland have now attended a masterclass, with follow up support provided by the Food4Health award.

Engaging with hot food takeaways can be difficult. We are now struggling to attract new businesses onto the masterclass and may hit a saturation point at 35% or 40% of those who are eligible. Some owners have other priorities and some may not accept the healthy eating messages. Also, some hot food takeaway owners are not even resident to the UK so engaging them is nigh on impossible. But we have to continue to try.

Another key learning point is that we need to work more closely with suppliers. The majority of masterclass attendees pledged to start using healthier alternatives, such as reduced sugar tomato ketchup or reduced salt soy sauce but they were unable to source these items from suppliers at a reasonable cost or not at all. Hence, wider work is needed with suppliers which, as one of the other Foodscape projects showed, is possible (Goffe et al. 2019)[5].

But the masterclass is an acceptable and feasible intervention to engage a good proportion of hot food takeaways. We will continue to deliver it once or twice a year as long as there is sufficient demand. We’re hoping to run the next class in September, so lookout for that.

What the masterclass doesn’t do is engage the big operators such as McDonald’s and Just Eat, accepting that the latter works mainly through local independent takeaways (but what requirements can the national corporation specify on their local deliverers?). It’s likely that national work is needed with those corporations, continuing the good work of Public Health England and others.

We also need to be mindful of the potential impact of “dark kitchens” – potentially the “satanic mills of our era”. But I’ll save that for another time…


Read our handy Fuse research brief to find out more about the Foodscape study.


References:

1. Keeble, M., Burgoine, T., White, M., Summerbell., C., Cummins. S., Adams, J. (2019). How does local government use the planning system to regulate hot food takeaway outlets? A census of current practice in England using document review. Health & Place, 57, 171 – 178. https://doi.org/10.1016/j.healthplace.2019.03.010
2. Public Health England (2018). Fast Food Outlets: Density by Local Authority in England. Available at: https://www.gov.uk/government/publications/fast-food-outlets-density-by-local-authority-in-england [accessed 27 May 2019] 
3. Hillier-Brown, F.C., Summerbell C.D., Moore, H.J., Wrieden, W.L., Adams, J., Abraham, C., Adamson, A., Araújo-Soares, V., White, M., Lake, A.A. (2017). A description of interventions promoting healthier ready-to-eat meals (to eat in, to take away, or to be delivered) sold by specific food outlets in England: a systematic mapping and evidence synthesis. BMC Public Health, 17 (1), 93. https://doi.org/10.1186/s12889-016-3980-2
4. Hillier-Brown, F. C., Lloyd, S., Muhammad, L., Goffe, L., Summerbell, C., Hildred, N. J., ... Araújo-Soares, V. (2019). Feasibility and acceptability of a Takeaway Masterclass aimed at encouraging healthier cooking practices and menu options in takeaway food outlets. Public Health Nutrition. https://doi.org/10.1017/S1368980019000648
5. Goffe, L. Hillier-Brown, F., Hildred, N., Worsnop, M., Adams, J., Araújo-Soares, V., Penn, L., Wrieden, W., Summerbell, C.D., Lake, A.A., White, M., Adamson, A.J. (2019). Feasibility of working with a wholesale supplier to co-design and test acceptability of an intervention to promote smaller portions: an uncontrolled before-and-after study in British Fish & Chip shops. BMJ Open, 9 (2), e023441. https://doi.org/10.1136/bmjopen-2018-023441

The toxic mix of Universal Credit, austerity and widening inequalities

Concerns about the mental health impact of government reforms under austerity are growing and emerged in Universal Credit research commissioned by Gateshead Council which is soon to be published in BMJ Open[1].

 

Mandy Cheetham, Research Associate at Teesside University, posts on Mental Health Awareness Week.

The invitation to present the findings at Newcastle University’s recent conference on human rights, health and welfare made me reflect on the multiple ways in which Universal Credit drives inequalities and undermines claimants’ rights.

Panel members (Mandy, pictured furthest right)

Want, Disease, Ignorance, Squalor & Idleness: Beveridge’s 5 giants

As part of a panel discussion, I was struck by the powerful comments of my fellow panel members who framed the rising need for food banks as a failure of social security. They described the “uncomfortable truth” of food poverty, the “violence of austerity” and the need to start from a position of love and care, offering people dignified, not demeaning responses to crises.

The sense of exclusion, shame, embarrassment and stigma surrounding food insecurity and the use of foodbanks was clearly articulated by the Universal Credit claimants in the study we did in Gateshead and Newcastle. One participant with a long term health condition commented:

"I think the most degrading thing about Universal Credit was that I had to go to foodbanks. I couldn’t afford to eat" (Claimant interview)

Universal Credit claimants and staff supporting them recognised the political choices which undermine people’s basic rights to food and social security, which are fundamental to health and wellbeing.

"It seems to be government policy at the moment to punish people for being poor" (Staff interview)

It is hard to see these choices as accidental when Amber Rudd, the Secretary of State for Work and Pensions, acknowledges that the rise in food banks is at least in part due to the roll out of Universal Credit. It is brutal and unrelenting in its effects.

Last week, I attended a thought provoking seminar by Guy Standing (co-founder of the Basic Income Earth Network), who reflected on the benefits of securing a basic income for all and described his view of the modern giants blocking transformative progress, including precarity: creating ‘supplicants’ with no rights, asking for favours from friends, family and bureaucrats, reliant on charity with no sense of agency or freedom. 

Digital exclusion, delays, deductions, intensified work related requirements, arbitrary risk of sanctions and maladministration by the Department for Work and Pensions associated with Universal Credit, all combine to maintain the precarious existence of claimants, undermining their rights to financial and material security, and social inclusion required for health and wellbeing.

This is not new. In a paper entitled ‘First do no harm’, Barr et al (2016)[2], found the programme of reassessing people on disability benefits using the Work Capability Assessment was independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing. The authors suggest that the policy may have had serious adverse consequences for mental health in England, which could outweigh any benefits that arise from moving people off disability benefits.

The four year welfare benefits freeze, austerity and implementation of Universal Credit is a toxic combination that has truly terrible consequences for those reliant on the state leaving people without enough money to fund the basics essential to participate in society. 

Piecemeal changes announced by government to phase out “unnecessarily long” three year sanctions under Universal Credit, for example, are welcome but do little to address the wider concerns raised about the continuing hardship which people experience on Universal Credit (Dwyer P. 2019)[3]. 

There are increasing calls for public health to respond in the face of mounting evidence of the harm to people’s physical and mental health which Universal Credit is causing. If government Ministers and policy makers were guided by the principles of “First Do No Harm”, it would be hard to see how the continued roll out of Universal Credit could be justified in the name of ‘welfare reform’. Public health needs to be at the forefront of efforts to address concerns about rising inequalities in different dimensions – income, work, mental and physical health, families and relationships, which were highlighted this week by the Institute for Fiscal Studies (Joyce and Xu 2019).

References:

1. Cheetham M, Wiseman A, Moffatt S, Addison M. (2019) The impact of Universal Credit in North East England: a qualitative study of claimants and support staff BMJ Open (in press).
2. Barr B, Taylor-Robinson D, Stuckler D, Loopstra R, Reeves A, Whitehead M. ‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study Journal of Epidemiology and Community Health, 70:339–345 http://dx.doi.org/10.1136/jech-2015-206209.
3. Dwyer P. [editor] (2019) Dealing with welfare conditionality, Bristol, The Policy Press. 
4. Joyce R. and Xu X. (2019) Inequalities in the twenty-first century: Introducing the Deaton Review, Institute for Fiscal Studies and Nuffield Foundation, London, UK https://www.ifs.org.uk/inequality/wp-content/uploads/2019/05/The-IFS-Deaton-Review-launch.pdf

Images:

1. Courtesy of Newcastle University Law School: https://twitter.com/NCLLawSchool/status/1121333821121671169
2. Courtesy of Ruth Norris (@ruthpnorris): https://twitter.com/ruthpnorris/status/1121512102437453830 
3. Courtesy of the Institute For Fiscal Studies: https://www.ifs.org.uk/inequality/chapter/briefing-note/

What old crisp packets dig up

Posted by Duika Burges Watson, Lecturer at Newcastle University based in the Institute of Health and Society

It appears that I’m an academic litter picker. I like to have hands on experience of topics I write and teach about. Inspired by the new module I’m leading on Global Health in the Anthropocene, and in particular a lecture on plastic pollution and health, I went litter picking. The Anthropocene is a new (ish) term to public health - considered to mark a turning point where “changes to the structure and function of the Earth's natural systems represent a growing threat to human health”[1].

I certainly found a good site for it. In less than 10 minutes from a 2 metre square area, I collected 69 crisp packets amongst the plastic bags and other items. I was intrigued, so I took them home and washed, sorted and ‘analysed’ them. Some use by dates were no longer visible, but of those I could read, 49 of 69 were Walkers crisp packets (parent company Pepsico) with use by dates from between 1996 to 2014. I went back the following weekend to the same site, dug a little deeper, and collected a further 89 crisp packets of which 51 were Walkers. The oldest packet was a Geordie company, Tudor (more on them later), with the use by date 10th January 1992.

Walkers bought out Newcastle
based company Tudor in 1987

There is a lot to be explored on crisp packets including use by dates, ingredients, health labelling and advertising.  Many even listed the time of production, often very late at night. For example, a Walkers smokey bacon use by 23rd June 2012 was made at 10.48pm. The irony of time was not lost on me in terms of the Anthopocene: we can know the exact minute the crisps were made (but not the date), they take about 2 minutes to eat and result in decades of rubbish.

Walkers began using foil bags in 1993 with plastic coatings. Yet people have been finding perfectly preserved plastic Walkers bags from the 80s in litter picking efforts. In September 2018, no doubt inspired by David Attenborough’s shocking profile of marine plastics in the series ‘Blue Planet’, the public started sending their bags back to Walkers. Royal Mail protested that people had to put them in envelopes first.

Walkers took up the challenge created by public protests. They have promised to find alternative solutions to the pesky bags by 2025, and until then have set up a recycling deal with company terracycle across the UK. There are collection points all over the UK.

But it wasn’t just the plastic pollution that concerned me. Crisp consumption is one of those things that people in public health worry about because these are classic examples of the high fat, salt, sugar foods where over-consumption can play havoc with our health. But we’ve been eating crisps for a long time, long before epidemics of obesity, and they have a cultural history to boot. A Brief History of Crisps (2012), suggests they were a British invention that turned up in the English edition of The Housekeeper’s Manual in 1829. The ‘modern’ industrial crisp really found its crunch after the first World War when the Smith’s company enrolled grocers and butchers across the UK to offer crudely made crisps (made in house with lots of fatty smells apparently). In the 1950s it all changed, technologies were imported from the USA and production scaled up. The first company to employ this technology was the previously mentioned Tudor. In 1967 they introduced the first ‘salt and vinegar’ chips to the UK market from their base in Sandyford, Newcastle. Tudor’s 1970s-80s commercials have a distinctly Geordie feel (note the ‘Dunstan Rocket’ in the first ad below – an iconic piece of architecture!). As a more recent immigrant to Newcastle, I had always wondered why every time I got served a sandwich it was with crisps – now I know – they have a proud Northern heritage. Walkers bought out the Tudor company in 1987.

In my ‘analysis’ of crisps, I have been wondering about their continued value as ‘food’. Is there a way we can still enjoy them as cultural icon without creating so much waste and without damaging our health? The one thing I’ve learned about food is that preferences change, tastes change – is the solution to learn to like something else? Last year the Walker’s crisp factory in Peterlee was bought by Heather Mills for her vegan food empire VBites. She is now looking to take over an abandoned factory in Northumberland. If successful, this would be the largest vegan food producing factory in the UK.

One of the sessions I’ll be leading in the Anthropocene module is on food – from source to senses. There is growing international concern about what kind of diet we ‘can’ eat if we want to protect and preserve the planet in the face of the Anthropocene and global climate change. The Eat Lancet Commission produced some rather controversial findings in January that offers their vision of what a ‘sustainable’ diet might involve[2]. Not unexpectedly, it involves cutting back on meat and eating more veg. Most agree that urgent change is required to farming systems and diet, but getting exactly the right mix of dietary components has created tensions. The Sustainable Food Trust, for example, points out that some land is not suitable for vegetable production and that grazing is the best option in some places. So, no simple solutions, and more debate to be had.

Another area of interest that will be covered in the course is new understanding of what it is that makes food ‘delicious’, how we ‘sense’ food, and what promotes ‘satiety’ or feelings of fullness. The ‘flavour’ of food involves a fusion of sensory inputs: smell, taste, colour, sound, trigeminal nerve stimulation[3], and our enjoyment of it is mediated by our culture, our history, our environment. Crisps are not difficult to figure out from a sensory perspective, like many other ‘fast’ foods, they are particularly heavy on salt, fat and sugar: what I would call ‘tongue’ foods. More complex ‘flavours’, particularly those involving smell, have been found to better trigger satiety – that’s why you can keep eating crisps without feeling full. But why do we like these ‘tongue foods’ so much? It’s complex; you’d have to join the course to explore this question.

So what about crisps then? Can we as public health researchers do more with ‘flavour’ to inspire different kinds of food choices? Could we encourage archaeological litter picking to engage the younger folk given so many foods are in single use plastics? People seem willing to give up plastic bags - could we encourage people to stop eating crisps until 2025 when they are in recyclable bags?  I don’t know the answer to these questions, but it will require more than litter picking to know. Food choice is academically interesting from a flavour point of view.  The crisp example throws up other challenges for public health - the Anthropocene creates interesting ethical questions about how we eat ‘beyond’ questions of the food itself. In March we will be running flavour masterclasses for the public where we get hands on to unpack the mystery of the humble crisp, why we like them, and what we should do about it! These questions are also being addressed by the Altered Eating Research Network (AERN) at Newcastle University, a new interdisciplinary collaboration that considers how our relationships with food are diverse, sometimes problematic, and how they intersect with the changing environments we live in and co-create. Keep an eye on the AERN website for details of flavour masterclasses and other upcoming events.

References:

1. Whitmee, S., Haines, A., Beyrer, C., Boltz, F., Capon, A.G., de Souza Dias, B.F., Ezeh, A., Frumkin, H., Gong, P., Head, P. and Horton, R., 2015. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet, 386(10007), pp.1973-2028.
2. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems (Walter Willett et al.). https://www.thelancet.com/commissions/EAT
3. The trigeminal nerve is responsible for sensations in the face and for motor control of biting and chewing. It is how we experience the ‘spiciness’ of food, the ‘coolness’ of mint or the ‘fizziness’ of carbonated drinks. Spence, C., Smith, B. and Auvray, M., 2015. Confusing tastes and flavours. Perception and its modalities, pp.247-274.

If at first you don’t succeed, try, try, try and try again…

Posted by Suzanne Moffatt, Reader in Social Gerontology, Institute of Health & Society, Newcastle University

Ways to Wellness Link Workers provide support to people with
 long-term health conditions who are referred by their GP

Publishing a study protocol is always gratifying (even though it counts for nothing in the Research Excellence Framework!). Publication of this particular protocol evaluating the impact of social prescribing on health and wellbeing caused me to reflect on the 58 months that had elapsed between that initial invitation to develop an evaluation and getting the study protocol into print. Why on earth had it taken so long and what had we done in those months? Well, we weren’t twiddling our research thumbs, but we did get quite a few knock backs in our efforts to secure “the big grant”, and I thought it worth sharing with the research community as multiple failures before success is often untold.

We started with an outline bid to the National Institute of Health Research (NIHR) Public Health Research Programme in 2015 which was shortlisted, but not successful at the full proposal stage. Fortunately an application to the Cabinet Office was successful that same year, which enabled us to complete a qualitative study exploring the impact of social prescribing for service users and perspectives of ‘link workers’ delivering the intervention (work currently accepted for publication). In 2015 (busy year!) applications to the School for Public Health Research (SPHR) Public Health Practice Evaluation Scheme (PHPES) and School for Primary Care were both unsuccessful. But in 2016 we achieved success with a ‘cut down’ version of our SPHR PHPES application (capitalising on end of year finances, I believe) that allowed us to pilot questionnaire data collection (paper rejected and currently being prepared for re-submission). 2017 also saw us obtain a relatively small grant from Newcastle University’s Institutes for Ageing and Social Renewal, allowing us to follow up 24 out of our original qualitative sample of 30 service users, findings of which have recently been published.

Ukulele group, Throckley Community Centre, Newcastle upon Tyne

Despite our lack of success so far in obtaining the “big” grant, we had contributed a valuable body of work on the impact of social prescribing and into the bargain employed some excellent researchers – Mel Steer, Kirsty Laing and Jo Wildman. Yet, in spite of the apparently unstoppable popularity of social prescribing as a way of addressing long term health problems and tackling inequalities, a systematic review demonstrated that a robust evidence base about impact and cost effectiveness is lacking. When the 2017 NIHR Public Health Programme call for research on Community Groups and Health Promotion[1] (16/122) hit my inbox, it dawned on me that another application (our seventh in case you had lost count) fitted the bill. I felt a mixture of dread and exhilaration. Definitely the last chance saloon.

So, why was this bid successful? In essence, because it was more clearly focused on a specific condition (type 2 diabetes), our substantial body of underpinning research, the mixing of quasi-experimental and ethnographic methods and a really excellent team of researchers. So now all we have to do is deliver. But remember, if at first you don’t succeed, sometimes persistence pays off.

For more information about our evaluation of Ways to Wellness Social Prescribing, visit the project website.

Applications to the SPHR Public Health Practice Evaluation Scheme (PHPES) are now being accepted with funded projects expected to start from January 2020.


After 10 years’ success, as of 18 July 2025, this initial project by Ways to Wellness is closed following a withdrawal in funding. However, the learning from it provided the foundation upon which Ways to Wellness was able to build its varied current prototypes. Find out more about the work it continues to do at www.waystowellness.org.uk/projects



Reference:

1. This work is funded by the National Institute of Health Research, Public Health Research Programme, Community Groups and Health Promotion (grant no. 16/122/33). The research was informed by a NIHR School for Public Health Research (SPHR) funded project (project reference: SPHR-FUS-PES-WTW).

The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

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: www.bda.uk.com/onebluedot

Image: 'Carl-Sagan-Pale-Blue-Dot' by Owen Iverson via Flickr.com, copyright © 2006: https://www.flickr.com/photos/oweniverson/4671868416

Why dramatic enquiry as a form of public engagement gave me my most enjoyable week as an academic

Guest post by Santosh Vijaykumar, Vice Chancellor’s Senior Research Fellow, Northumbria University

“It’s important to eat healthy but we also need sugars, although in moderation.” These are not the words of an expert on BBC’s Food Programme, but a Year 5 student at Chillingham Road Primary School in Newcastle, fidgety and impatient for the next activity to resume. And the caution came about not through a series of in-depth interviews by public health researchers such as myself, but through ‘dramatic enquiry’. Brad McCormick and Katy Vanden from Cap-a-Pie, the theatre company that developed this approach, describe it as one that “places participants in a fictional scenario where they are in-role from start to finish. They are placed in a situation where there is no clear ‘right’ or ‘wrong’ answer and where they have to express their own beliefs and values.”

Brad directing the drama

Over the course of a week, we conducted four such dramatic enquiry workshops with three schools in Newcastle, each session comprising approximately 30 Year 5 pupils (10-11 year olds). Although these workshops were part of the public engagement strategy of my ongoing ESRC funded project* that seeks to understand psychological drivers of confidence in probiotics products, we decided to explore broader themes beyond just probiotics. The aim – suggested by Brad and Katy and gladly welcomed by us – was to avoid a top-down health education approach, and instead utilise this engagement format to get children to think and talk about fundamental issues: why do they eat what they eat? Can food be healthy and unhealthy at the same time? Should the government control what foods we consume? What is the relationship between responsibility and choice in the context of food? We used these themes as a funnel to eventually involve the children in a discussion on probiotics.

Each workshop starts with the children seated in a semi-circle. As soon as they are settled, Brad catches them off guard. He starts shaking hands with one of them and says “I ate at your restaurant last week, superb!”, and then goes to another: “I read your article on raw food diets, so interesting!”, and so on and so forth, setting off a series of giggles or muffled peals of laughter among the children as they make sense of the goings on. Soon after they are informed that they are all members of the Food and Drink Committee of Arcadia (a fictional country) and are asked to take a pledge of allegiance to Arcadia. A series of dramatic games such as DilemmaRama, Shake Hands/High Fives and Stop/Go has now completely warmed them up to Brad and to each other. This lays the foundation for their enthusiastic participation in the ensuing small group activities, each of which is followed by a philosophical discussion or reflection.

The small-group activities include identifying and enacting their favourite dish in a freeze frame, contemplating what it means to be healthy, and explaining the rationale for why they agree or disagree with a certain food policy from different viewpoints (as a journalist, scientist, manufacturer, etc.). In the second half of the session, they are introduced to a fictional probiotics product, to develop a commercial for it, and then asked to make a decision about whether it should be sold after exposing them to news articles reporting conflicting evidence related to the health effects of probiotics products.

As a researcher, observing these sessions live can be tough – it’s so much fun, you want to participate with the kids and leave taking notes for later. And taking notes is not easy either, even after you have committed to it. For, you realise quickly that every activity and philosophical discussion reveals a new strand of thought among children, a sharp, counter-intuitive insight, or a larger ethical perspective. As someone who is newly baptised to this form of public engagement, I realise how uninhibited and enthusiastic kids are in terms of participating in what would seem tricky terrain for adults, and how even seemingly quieter kids volunteer to voice their opinions. I am beginning to understand how this approach lends itself to unearthing perspectives of greater complexity and nuance than a traditional research method, such as a survey or experiment would. Essentially, if one were to invest in dramatic enquiry as a means of formative research for investigating a public health problem, they would reap a rich, and dare I say endless harvest of research questions worth investigating in a format that’s fun, engaging, and revelatory.

If you are waiting to know what we learned from these workshops, I will share links to a podcast series (on this blog) sometime over the next few weeks. These podcasts will give you a more detailed idea about dramatic enquiry, how the participating children benefited from it, and some perspectives that emerged about how kids perceive scientists, media, and the industry that really surprised us.

When I first arrived into the UK academic environment in February 2017, public engagement seemed a policy or media interfacing, translational exercise for researchers. Being involved in dramatic enquiry has now broadened my personal understanding of public engagement and triggered a cascade of ideas about creative ways to get a conversation going with communities whose lives we seek to positively influence through public health research. And, without a doubt, it has given me my most enjoyable week in eight years as an academic. Brad and Katy deserve some chocolate cake, but in moderation.

*Acknowledgment: This project was funded by the Consumer Data Research Centre, an ESRC Data Investment, under project ID CDRC 085, ES/L011840/1; ES/L011891/1.

Safe negotiation of neighbourhoods should be non-negotiable

Posted by Lesley Haley, AskFuse Research Associate, Teesside University

It’s World Sight Day today. This annual event highlights a range of issues surrounding visual impairment, and the day is linked to the World Health Organisation’s Global Action Plan on sight health. Today is also ‘bin collection day’ where I live, when wheelie bins and recycling boxes migrate from their backyards and gardens to clutter our pavements. It’s a weekly event that occurs in every village, town and city. It’s also a weekly hazard to be negotiated and endured by thousands of our neighbours. Especially those with visual impairment.

It’s not an obvious connection - World Sight Day and ‘bin day’. And frankly it was a connection that didn’t occur to me either, until I went to the ‘Negotiating Neighbourhoods’ event earlier this year, run by Fuse, the Royal National Institute for the Blind (RNIB), and the Sight Service. The event examined getting around our neighbourhoods, and gave feedback on Newcastle City Council/RNIB’s Newcastle Street Charter. The Charter describes the barriers faced by people with sight loss or mobility issues, and the actions and commitments needed and agreed to reduce these barriers (Newcastle City Council 2017). At the event, policy makers, researchers and people who are experts by experience shared their opinions and insights into safely getting around the built environment of our streets, local neighbourhoods and public spaces. This included feedback on the proliferation of street furniture such as advertising boards, lamp posts, bollards, street signs, bushes, cars parked on pavements, and wheelie bins (Newcastle City Council 2017).

Sight loss affected more than two million people in the UK in 2015, with one in five people aged over 75 living with some form of sight loss, including macular degeneration (RNIB 2018c). So for a significant number of our neighbours with mobility or sight issues, street ‘clutter’ is an increasingly frustrating and problematic issue.

It’s a public health issue too. Street furniture is impacting the health and wellbeing of people with mobility or sight loss issues. The built environment, and the street furniture cluttering it, “is restricting physical activity participation for people with sight loss” (Phoenix et al, 2015, p.127). Sight loss is associated with reduced physical activity, and the adverse social, economic and psychological effects of sight loss are being more widely recognised, including loneliness and isolation (Sim and Mackie 2015). Even the Design Council (2017) reported that ‘hostile’ public spaces could increase people’s risk of disease as it contributed to sedentary lifestyles and social isolation.

Can the humble wheelie bin really be classed as ‘hostile’? The experts by experience at the ‘Negotiating Neighbourhoods’ event have bitter experiences to prove it. Research in public health would also back them up. In 2015, 95 per cent of blind and partially sighted people reported that, in the previous three months, they had collided with a street obstacle, and a third said they had injured themselves while walking around their local area (RNIB 2015a). Many participants in the research carried out by Phoenix et al (2015) talked about injuries and also damage to their self-esteem when outdoors, because of a poorly designed built environment. Street ‘clutter’ is literally having a big impact on our neighbours as they try to navigate our streets.

At the ‘Negotiating Neighbourhoods’ event, the audience was asked “What changes could make the situation better?” Well, from a personal perspective, I have tried to stop parking my car on the pavement, have changed where I place my wheelie bin on ‘bin day’, and have tried to write (this) my first ever blog to raise awareness of the issue.

So what are your thoughts? Could you make one small change in your neighbourhood to make everybody’s everyday journeys just a little bit safer?

Surely, on World Sight day in 2018, being able to safely negotiate our neighbourhoods, should not be negotiable?

#WorldSightDay


References:

Design Council (2017) Creating Health Places Available at: https://www.designcouncil.org.uk/what-we-do/built-environment/creating-healthy-places (Accessed: 23.08.2018).

Newcastle City Council (2017) Newcastle Street Charter. Newcastle: Newcastle City Council. Available at: https://www.newcastle.gov.uk/sites/default/files/wwwfileroot/your-council-and-democracy/equality-diversity-and-citizenship/newcastle_street_charter_final.pdf (Accessed on: 23.08.2018)

Phoenix, C. Griffin, M. Smith, B. (2015) ‘Physical activity among older people with sight loss: a qualitative research study to inform policy and practice environment,’ Public Health 129 (2) pp. 124-130

Royal National Institute of Blind People (RNIB) (2015a): Daily assault course of street obstacles and dangerous crossings injuring blind people. Available at: http://www.rnib.org.uk/daily-assault-course-street-obstacles-and-dangerous-crossings-injuring-blind-people. (Accessed 26.04.2018)

Royal National Institute of Blind People (2018c) Key information and statistics on sight loss in the UK. Available at: https://www.rnib.org.uk/professionals/knowledge-and-research-hub/key-information-and-statistics (Accessed: 01.06.2018).

Sim F, and Mackie, P (2015) ‘Sight – the most critical sense for public health?’ Public Health. 129 (2) pp. 89–90. Available at: http://dx.doi.org/10.1016/j.puhe.2015.01.009. (Accessed: 22/08/2018)

World Health Organisation (2009) Global Action Plan for the Prevention of Avoidable Blindness and Visual Impairment 2009-2013. Available at: https://www.iapb.org/resources/who-action-plan-for-the-prevention-of-avoidable-blindness-and-visual-impairment-2009-2013/ (Accessed: 23.8.2018)