Media representations of disabled people

Posted by Laura Navin, Health and Social Care student, Northumbria University

Picture by Laura Navin

Negative media representations of disabled people still exist in society and this needs to be addressed. I have dyspraxia which is a learning difficulty, and I sometimes struggle with my co-ordination, communication, processing and speed but it has not stopped me from achieving my goals!

In the media, disability tends to be portrayed through a medical or deficit model, with disabled people often treated as pathetic.^1,2,3 TV charity shows such as Children in Need encourage pity for disabled people² and people with disabilities are still seen as “the heavy burden of care”; “the helpless victim”.³ Yet even when well-meaning, encouraging pity is discriminatory as it creates stereotypical and negative assumptions about disabled people². These negative representations can decrease a disabled person’s self-esteem and make them feel like they are not part of society.^1,4

The issue is heightened by the absence of disabled people and their voices within mainstream media which might help to reclaim the narrative and counter negative stereotypes. As Caroline Casey, founder of The Valuable 500, a global movement putting disability on the business leadership agenda, has suggested “from daytime TV to adverts on social media, to the articles which publications run, representation and visibility of persons with disabilities simply does not reflect our society”. This was brought to light recently for example, when Sia’s decision to cast a neurotypical actress in the role of an autistic female protagonist in her upcoming film was widely criticised.

There are more positive portrayals of disability in the media however. Harry Potter star, Daniel Radcliffe has dyspraxia and acted as an inspiration to many when saying, “do not let it stop you. It has never held me back.”. In 2018, Lee Ridley from the North East won Britain’s Got Talent and in 2021, EastEnders star Rose Ayling-Ellis became the first deaf contestant on Strictly Come Dancing. Even these more positive representations are emblematic of the failure to represent disabled people as everyday, ordinary citizens however. As Lee Ridley claims, “Our government has a very weird relationship with disabled people. We are either seen as superhuman or as some sort of burden”.

Portrayals of disabled people as a burden on society have been shown throughout both austerity and the Coronavirus pandemic. Disabled people have been mocked as ‘scroungers’ in television shows and newspapers, with arguments that incapacity benefit had become a ‘lifestyle choice’ for the lazy, and that a disability benefit crisis was responsible for the UK economic crash resulting in the disproportionate targeting of disabled people within austerity measures.^5,6 Covid has been argued to be one of the biggest media outbreaks medicalising disabled people.^1,7 During the pandemic, disabled people were seen as ‘vulnerable’ and had to isolate from society.^5,8 ‘Vulnerable’ is a label that is often rejected by people with disabilities and its adoption does not portray the importance of disabled people’s rights and viewpoints.⁹ Labels such as ‘vulnerable’ or ‘immunocompromised’ when used to explain differential susceptibility to illness have also been argued to result in an unreasonable, unpleasant message about the value of disabled people’s lives. The sunflower lanyard which could be worn by disabled people to show they were exempt from wearing face masks helped in some ways to increase disability awareness and create more understanding, support and respect towards disabled people. However, this is another form of labelling, and not all disabled people want to identify their disability to the world. Greater understanding and training on disability ethics is urgently needed to avoid this sort of discrimination and support disabled rights more systemically.^9,10

 

It is also important that disabled voices are heard in society and that the media represents disabled people in a more positive light. Sometimes when I tell people about my dyspraxia they feel pity for me, but this is not what I want. I am telling my story to inspire others, not create sympathy, so please do not feel sad for me, feel happy for me! I have succeeded in my academic studies and graduated from university with second-class honours as a student with dyspraxia. I have been involved in podcasts and dissertation writing to raise my voice as a disabled person and in doing so I hope to give others the confidence to do the same. I am now studying for a postgraduate certificate in education (PGCE) to teach health and social care. I hope to continue to raise my voice and to inspire others.

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.

References

1) Cameron, C. (2014) Disability Studies: A student’s guide. London: SAGE Publications Ltd.

2) Barnes, C. (1992) Disabling imagery and the media: an exploration of the principles for media representations of disabled people. Halifax, England: The British Council of Organisations and Disabled People and Ryburn Publishing Limited.

3) Goethals, T. et al. (2020) ‘I am not your metaphor: frames and counter-frames in the representation of disability’, Disability & Society, 12 (1), pp.1-19. DOI: https://doi.org/10.1080/09687599.2020.1836478.

4) Casey, C. (2020) ‘Where all the disabled people on screen? We must increase representation or risk reinforcing damaging stereotypes’, Independent, 1 December. Available at: Where are all the disabled people on screen? We must increase representation or risk reinforcing damaging stereotypes | The Independent (Accessed: 22 March 2022).

5) Ryan, F. (2019) Crippled: austerity and the demonization of disabled people. London: Verso.

6) Briant, E. et al. (2013) ‘Reporting disability in the age of austerity: the changing face of media representation of disability and disabled people in the United Kingdom and the creation of new ‘folk devils’, Disability & Society, 28 (6), pp.874-889. DOI: 10.1080/09687599.2013.813837.

7) Shakespeare, T. et al. (2021) ‘Triple jeopardy: disabled people and the COVID-19 pandemic’, The Lancet, 397(10282), pp.1331-1333. DOI: https://doi.org/10.1016/S0140-6736(21)00625-5.

8) Courtenay, K. and Perera, B. (2020) ‘COVID-19 and people with intellectual disability: impacts of a pandemic’, Irish Journal of Psychological Medicine, 37, pp.231-236. DOI: 10.1017/ipm.2020.45.

9) Singh, S. (2020) ‘Disability ethics in the coronavirus crisis’, Journal of Family Medicine and Primary Care, 9 (5), pp.2167-2171. DOI: 10.4103/jfmpc.jfmpc_588_20.

10) McLean, S. and Williamson, L. (2007) Impairment and disability: Law and ethics at the beginning and end of life. Oxon: Routledge-Cavendish.

Should pregnancy 'be incentive enough' to quit smoking?

Guest post by Susan Jones, Research Associate, Teesside University

I have seen many people on twitter express the view that thinking about their baby should make pregnant women automatically quit smoking. Indeed many women when they decide to try for a baby or find out they are pregnant do quit smoking. However, it does seem illogical - and shocking - to many that this is not always the case.

 

Just searched #smoking #pregnancy #incentives - struck by many tweets that say 'pregnancy should be incentive enough' to quit smoking. Clearly the stats tell a different story for a significant minority - the question surely is why and what can be done? @ASH_LDN @FreshSmokeFree

— Dr Susan Jones (@Susan_E_Jones) December 10, 2020

For those who do continue to smoke, it is perhaps more of a hint of a complex web of reasons behind their smoking behaviour, rather than any greater willingness to harm their baby. Smoking throughout pregnancy is often associated with environmental and social deprivation, which gives us a clue. Hilary Graham’s seminal work into women’s smoking and its association with family health, published in 1987, opened the door to a new understanding of what some of the reasons might be for this apparently illogical and paradoxical behaviour on the part of pregnant women from deprived communities. Graham concluded that:

"The study suggests that, for a significant minority of mothers, poverty and caring combine with low levels of physical and emotional energy, with sleep problems and with feelings of social isolation. In this context, smoking appeared to provide a way of coping with caring-in-poverty: a way of coping alone with the demands of full-time caring and with the struggle of making ends meet."

This work revealed that there were other, stronger reasons to continue smoking, which counteracted any impulse to quit.

Guilt and shame

An earlier study of ours heard pregnant smokers confess to feeling guilty and ashamed of smoking in pregnancy and how they are very aware of the stigma associated with their behaviour:

“But then once I lit it up and had half of it I felt guilty. But it took that edge away, but I still felt guilty. So if I felt even more guilty I probably mebbees wouldn’t have touched it, but I feel weak because I have had to do it.”

“I think the kids always make it like, they have more effect on you than what anyone else does, because they're, well you feel guilty if you're letting them down and doing something they don't want you to do.”

We also found that sometimes it can be a distrust of public health messages combined with a real lack of knowledge about the mechanics of how smoking affects the developing baby. Nevertheless, it must be acknowledged that, for whatever reason, not everyone says they want to quit; but of those who do want to quit, some say they do not feel able to. For the sceptics out there, this may seem only subtly different to choosing to smoke, alternatively it may be a real barrier to quitting. Graham’s work would suggest the latter. More recent research has built on her findings and investigated what methods of support may work for these pregnant women, who do not quit, and for whom the health outcomes are comparatively worse for themselves and their babies.

What can be done?

Research over several decades has shown that there are ways to support pregnant women to quit smoking, focusing on:

• Referring to stop smoking support services
• Offering support to change behaviour
• Support through medication.

It is clear now that opt-out approaches to referral and carbon monoxide monitoring and much more personalised support are also helpful to women (see our short video below).

   

Work has been undertaken to implement these supports more fully; e.g. the Local Maternity Systems (LMS) in North East England designed the Maternity Pathway and have led the work across the organisational systems to integrate these mechanisms. Becca Scott, the North East Local Maternity Systems Public Health Prevention Lead says:

"The LMS have led North East organisations and service users to contribute to the target of 5% or less women smoking in pregnancy by 2025. That would mean 2723 fewer women smoking at time of delivery across the North East since 2018. It does this by offering all expectant mothers, and their partners, a multiagency-developed, smoke-free pregnancy pathway and minimum service standards (as detailed in each of the Maternity providers bespoke plans). The impact of the engagement with the work has seen prioritisation throughout all Local Authority Health and Wellbeing boards, as well as consistency in the way smoking in pregnancy is identified and supported, which is demonstrated in significant improvement in adherence to NICE Guidance."

What more can be done?

The results of this partnership work are encouraging. Is there anything else that can be done? The evidence for the effectiveness and cost-effectiveness of financial incentives to support pregnant women to quit has been building. Trials have been conducted which have found that there is "substantial evidence for the efficacy of incentives for smoking cessation in pregnancy" – however this idea has encountered significant public scepticism and opposition.

ash. Smoking in Pregnancy Challenge Group Webinar - Incentive schemes

Although there has been more balanced reporting too and more recently, the headline below suggests the idea has become more acceptable.

Capture from The Sun online (09/03/21)

Modelling financial incentives in smoking in pregnancy

A team of us (details below*) have been awarded funding from the NIHR Applied Research Collaboration (ARC) North East & North Cumbria Open Funding Competition to look into an alternative way to take into account the views and responses from all stakeholders, including staff, pregnant women, and the public. We will also be building a mathematical model based on Evolutionary Game Theory (EGT). EGT is a mathematical framework of contests, strategies and analytics into which Darwinian evolution can be modelled. It is designed to capture the strategic interactions between stakeholders, because ultimately these interactions will drive health behaviour. Incentivisation will be modelled to see how it affects some behaviours and in what contexts. We hope the model will be able to guide commissioning and provision, so that any intervention is as effective and cost-effective as possible, without having to conduct further lengthy and expensive trials beforehand. Watch this space!

*Associate Professor Emma Giles (Teesside University), Professor Falko Sniehotta (Newcastle University and University of Twente), Dr Jean Adams (University of Cambridge) and other partners working in NHS Trusts and local authorities. Colleagues in the School of Computing, Design and Digital Technologies, Associate Professor The Anh Han and Tedy Cimpeanu from Teesside University.

Only connect: social survival during lockdown

Posted by Mihirini Sirisena, Research Associate, Newcastle University 

During the time when stringent national lockdown measures were in place, I noticed a new habit I had picked up, whenever I was outdoors. Every time I crossed the road to make way for a fellow runner or a walker, I made an attempt to catch their eye to thank, say hello or at least smile. Smiling or saying hello had gained a new meaning for me. It meant that I established a sense of solidarity and therefore rebutted the slightest chance of offending the other through avoidance by crossing the road. I don’t think I was alone in feeling like this. I crossed paths with many who seemed keen to connect at some level, including one woman who pulled a mask out of her pocket as I approached, covered her mouth and said, “I hope we don’t have to do this for long.” Many would agree that one of most significant challenges brought on by the measures to control the spread of COVID-19 was lockdown, for not only did it curtail our movements, it compelled us to do something that we are incapable of doing as a species - staying away from each other.

Initially, as the news of the epidemic spread, so did the stories of our responses. These stories recorded an array of responses, ranging from stock-piling and racism to altruism, and expressions of fear, suspicion, insecurity in the face of uncertainty and looking for culprits to place blame. As the dust started settling, focus shifted ever so slightly to talking about the mental health costs of lockdown, specifically in relation to social isolation. Alongside this developed a repertoire of how we could stay connected.

One of the first things that appeared on social media when the UK government and mass media began speaking about social distancing was that it is not social but physical distancing that we needed to overcome the epidemic. The message did not become a tagline but in myriad ways, it was clear that we had started to pay heed and show that we are together though apart. We sort alternative ways to maintain connections through digital platforms, despite many of us - including myself - being previously cautious about social media. These are not new but during lockdown we turned to them with vigour, deploying the likes of Zoom, Skype, WhatsApp and Microsoft Teams as platforms to live both our professional and personal lives[1]. Even gaming was pointed out as an effective way of socialising during lockdown and an antidote to social isolation.

Along with the quick assertion of social media as the platform to maintain human connection followed the conviction that these platforms are capable of extending human connection. Movements such as ‘clap for carers’ which were initiated and marketed through social media, stood as evidence of this capacity. In celebrating the success of this capacity to reach and connect, which is largely facilitated through social media itself, we run the risk of creating a one-dimensional discourse or version of social connection during lockdown. For instance, placing emphasis on social media as a means of connecting allows less space to recognise the other creative and meaningful methods some of us turned to, such as letters in the post or checking in at the doorstep.

In addition, a less discussed aspect of social media is its use to brandish intolerance - arguably no different to times before COVID-19 - of those who were seen to have violated ‘lockdown rules’ by driving for exercise or those who were seen to have crossed ‘community boundaries’, however they were defined. Cyclists were a popular target of such diatribes[2]. Similar vindications were abundant when the UK government announced plans to open schools to certain pupils. A narrative that was underlying such vindications appeared to be one that called for the celebration of the nucleus social unit, which took different forms. At times, this unit was understood to be ‘family’ as in instances that called for parents to see the lockdown as an opportunity to connect and spend time with their children. At other times, it was the ‘community’ as in instances where residents wanted to protect their locality from visitors. 

Yet another layer worthy of consideration is the effects of recent developments, such as those that emerged during the second wave of COVID-19 related restrictions, where the public was encouraged to ‘snitch’ on neighbours, if they were thought to be flouting lockdown rules. At one level, these expose our convictions about who we connect with, under what conditions, at what level, in which ways and the modes and the media we resort to, to connect and disconnect. At another, they hint at far reaching implications for what we might come to see or mean by social connections. 

As researchers and practitioners, considering the different ways in which connections were made and maintained will be helpful in our efforts to support and improve collective as well as individual wellbeing. Most importantly, we need to consider the less discussed topic of complex realities of everyday life and how they impact upon the connections that we can and cannot make and, the ways in which they impinge upon our collective and personal wellbeing[3]. 

References:

1. Some suggest the rise in use of social media continues even as lockdown measures have begun to relax: https://thenextweb.com/growth-quarters/2020/07/21/everything-you-need-to-know-about-digital-use-around-the-world-in-july-2020/
2. See also: https://www.thesun.co.uk/news/11547977/cyclists-coronavirus-lockdown-social-distancing/ and https://www.bristolpost.co.uk/news/bristol-news/covidiot-cyclists-stay-home-spike-4083230
3. Particularly, in the period of time that followed the lockdown, popular discourses have begun to highlight ‘social connection’ as one of the positive developments that emerged during the lockdown. Such romantic notions of ‘connection’, which propose that it is 'not money nor fame that a good life needs but to be connected with the others,' tend to undermine the weight socio-economic realities of life have on individual as well as collective wellbeing. For instance, refer to Alain de Botton’s interview with Lauren Laverne on BBC Radio 6 (Aired on 27th August 2020) (https://www.bbc.co.uk/sounds/play/m000lyx0 from 2:08:45, last accessed on 07 September 2020).

Image 2: capture from the BBC news website, 26 April 2020, Coronavirus: Are cyclists being wrongly targeted during lockdown? By Alex Regan (https://www.bbc.co.uk/news/uk-england-derbyshire-52389245)

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.

References:

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 https://www.gateshead.gov.uk/media/10665/The-impact-of-the-roll-out-of-Universal-Credit-in-two-North-East-England-localities-a-qualitative-study-November-2018/pdf/Universal_Credit_Report_2018pdf.pdf
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: https://doi.org/10.3399/bjgp18X699977. 

Steering the Coca-Cola Christmas trucks off course in 2018

Guest post by Beth Bradshaw, Alex Holt and Robin Ireland, Food Active

You may remember our guest blog for Fuse from last year, which discussed the media frenzy that goes into overdrive when the Coca-Cola Christmas Truck Tour sets off on its journey across various locations in the UK. We also noted our own campaigns and the efforts of others such as SUGAR SMART to make the case against welcoming the truck into towns and cities already grappling with a childhood obesity and oral health crisis.

 

Every year, we are met with growing support from the public health community and the public including GPs, dentists, teachers and parents. Last year Public Health England issued guidance to local authorities about hosting the Coca-Cola truck. However, there was also some criticism of our position, especially where we were seen as ‘spoiling’ Christmas in some way.

However, this year, things seem to be different. We feel a change in the air this festive period with a scaling back of the Coca-Cola tour, both in terms of numbers of locations and less prominent venues.

There are a number of important changes that have happened both in the build-up and the start of the Coca-Cola Christmas Truck Tour for 2018. While these might appear small, together they demonstrate quite a significant shift by the soft drinks corporate giant.

This year, the Coke Truck allowed just three days between the announcement of the tour and its start, compared to 11 days last year. Within this time frame, SUGAR SMART coordinated an open letter to Coca-Cola bosses with over 40 signatories from local authorities, Clinical Commissioning Groups, and national campaign groups to oppose the truck visiting their areas [1]. This meant there was time to coordinate responses both nationally and locally, including a series of Tooth Fairy stunts, and for noise to be made to create negative publicity before the truck had even arrived.

The Coke Truck vs the Tooth Fairies

Another important shift is the size of the tour – downsizing by over a third (37% to be exact), from 38 stops last year to just 24 this year. The 2018 tour is also visiting some much smaller locations - the media has called it ‘snubbing’ cities such as Milton Keynes and Liverpool - and there are just four visits on council-owned land. We are pleased to see so few local authorities allowing the truck on council-owned land but would urge those that are welcoming the truck to seriously consider whether this is in the best interest of their local population.

There are also more stops hosted on supermarket car parks this year, with as many as ten of the stops to Asda and Tesco. The same Tesco that announced a five-year ‘strategic partnership’ with national health charities including the British Heart Foundation, Cancer Research UK and Diabetes UK to help ‘remove barriers to healthy habits’ earlier this year. A Coca-Cola truck pitching up in their car park is certainly a barrier to healthier habits, both literally and figuratively speaking. This move has also been met with criticism and Sustain and SUGAR SMART are calling on the public to write to Asda and Tesco to ask them to reconsider hosting the truck next year. On taking this action ourselves, we received a response from Asda customer relations which said:

“We have been in conversation with Coca-Cola prior to this tour and we are happy that they will be encouraging customers to sample their sugar-free brands. They will only provide Red Coke on request and they estimate that at least 90% of their drinks sampled will be sugar free.”

As of yet and unsurprisingly, we have had no response from Tesco.

Asda’s response is consistent with the quote provided by Coca-Cola’s press release, which also appears to have satisfied Public Health England’s concerns, as they have decided not to respond to the truck this year.

Finally, in the North West of England (where Food Active is based), the truck is visiting just one city in the region compared to six visits in 2016 and four in 2017. Over the past four years, Food Active has been lobbying against the arrival of the truck in the North West, including publishing an article in the British Medical Journal [2], writing an open letter to local and national press (with over 100 signatories) and supporting SUGAR SMART’s open letters to Coca-Cola bosses. We hope that this continued pressure, even in the face of significant criticism, has helped to steer the Coke truck away from the North West.

However, we know the battle is by no means over - 14 of the 19 stops in England have above average prevalence of excess weight amongst 10-11 years old, and in some locations including Manchester, over 30% of the children have experienced tooth decay.

Last year, our blog concluded that “our experience shows us that public health has to be persistent in ensuring our messages are heard in the current victim-blaming culture”. This statement is perhaps even more validated following this year’s experiences.

In the spirit of good will this Christmas, we thank Coca-Cola for helping more of our local authorities in the North West to help tackle issues of childhood obesity and dental decay in their areas - many of which are already disproportionately burdened with deprivation and health inequalities.

www.foodactive.org.uk

@food_active


References:

1. Ireland, R and Ashton, J.R. (2017) “Happy corporate holidays from Coca-Cola” i8633. Available at: https://www.bmj.com/content/356/bmj.i6833
2. SUGAR SMART (2017) Spending holidays in good health. Available at: http://www.foodactive.org.uk/wp-content/uploads/2017/11/Open-Letter-to-Coca-Cola.pdf

Images:

1. Courtesy of Beth Bradshaw
2. With thanks to Sustain and Sugar Smart UK: https://www.sustainweb.org/blogs/nov17_coke_truck 

When the Coca-Cola truck comes to your town

Guest post by Robin Ireland, Director of Research at Food Active and Beth Bradshaw, Project Officer at Food Active.

When Coca-Cola announced their 'Holidays Are Coming' truck tour (ironically coinciding with Sugar Awareness Week), our local media in the North West covered the story like it was the first sign of Christmas, the first cuckoo to be spotted in spring.

And in the run up to the big red shiny sugar-laden truck’s arrival to our towns and cities, from Bolton to Liverpool, Manchester to St Helens, the local newspapers will cover the story in page after page of advertorials, telling you where to get your picture taken posing with Coca-Cola's sugary products and even live blogs in some cases.

In previous years, at no time did the reporters consider that not everyone welcomed the truck in their neighbourhood. Many people are concerned that the truck was marketing Coke to children despite the company's protestations that they do not promote their products to the under twelves. Furthermore, in some locations in the North West the truck was allowed to promote their unhealthy drinks to children and families on Council owned landed. 

To demonstrate our concern, last year Food Active drafted a letter objecting to Coca-Cola's tour coming to the North West which was sent to the national and regional media. No less than 108 people signed in support including the current and past Presidents of the Faculty of Public Health, five Directors of Public Health, Professors, Doctors, educationalists and of course parents. If we are honest, we were shocked that the letter was almost entirely ignored. It would appear that Coca-Cola's commercial clout and public relations campaign counted more than the collective voice of those who are having to address the results of diets regularly fuelled by liquid sugar.

Just before Christmas 2016, Professor John Ashton and I (Robin) were in contact with the British Medical Journal concerning these issues and were invited to submit an editorial which was published in January [1]. In contrast to their previous experience the media attention was huge including coverage in over 60 regional and national newspapers and interviews on various channels including Sky News and Wales Today.

This year, the media attention and discussions around the Coca Cola Christmas Tour has continued. Before the tour was even announced, a news story hit the local press in the North West from Liverpool councillor Richard Kemp CBE (also Deputy Chair of the Community Wellbeing Board at the Local Government Association of England and Wales), who raised concerns about its arrival in Liverpool given the city is ‘in the grip of an obesity epidemic’ – although we know this is not an issue only in Liverpool – the whole country is in the grip on an obesity epidemic. Once the tour was announced, including six visits to the North West, we were pleased to see none were on council-owned land (in 2016 the truck visited Williamson Square in Liverpool which is owned by the Council)

Following this came a cascade of news stories from local and national newspapers and radio stations. This year, Food Active joined up with Sugar Smart to encourage Directors of Public Health, Council Leads and Clinical Commissioning Group Chairs across the country to sign an open letter to Coca-Cola opposing its arrival, given the health harms associated with the consumption of their products and calling for more responsible marketing during the festive period. The North West represented one quarter of the 29 areas, cities and towns who signed the letter. This advocacy may have helped to prompt a response from Public Health England and Public Health Wales – there is a sense that the argument against the Coca-Cola truck are now being taken seriously and media coverage of the 2017 Coca Cola Christmas Tour is not just about when and where you can get your photo taken - but also the health concerns. 

Coca-Cola says that it does not promote its products to the under twelves

Following excellent work by Public Health England, by national organisations including Action on Sugar, the Children's Food Campaign and many others, and of course by Food Active in the North West, we know that we must target sugary drinks as part of a strategy to address the tsunami of obesity, type 2 diabetes and dental disease we face in our poorest and most deprived communities. Moreover, as highlighted in a blog by Dr. Alison Tedstone, Director of Diet and Obesity at Public Health England, the truck will be visiting some of our poorest areas which are often disproportionately burdened with higher levels of obesity [2]. As such, a symbol of ill health should not be welcomed nor celebrated within our communities during a season of good will and cheer. 

However, this is not only about high sugar drinks. Protecting children from junk food marketing has been outlined as the number one priority in tackling obesity by the Obesity Health Alliance (a coalition of over 40 organisations committed to reducing obesity – of whom Food Active is a member). We must not mistake the Coca-Cola truck for anything but a very high profile marketing stunt. We do not allow products high in fat, sugar and salt to be advertised to children on children’s TV programmes, so why is the Coca-Cola truck welcomed into our communities year on year with such open arms? Speaking at the Socialist Health Alliance Public Health Conference, we called for junk food marketing controls to be extended to cover family attractions such as the Coca-Cola truck, as well as sports sponsorship and marketing communications in schools. By allowing the truck into our towns and cities, we are allowing Coca-Cola to exploit the festive period to market their products to the community – and to children in particular.

Our experience shows us that public health has to be persistent in ensuring our messages are heard in the current victim-blaming culture. There is little point in local authorities spending their ever restricted funds on promoting healthier eating and drinking if each Christmas we allow Coca-Cola and others to highjack our messages. There is certainly no excuse for local authorities at to allow this truck on their land and it is the responsibility of public health advocates to continue to make the case to Give Up Loving Pop in 2018. 

  

References:

1. Ireland, Robin, and John R. Ashton. "Happy corporate holidays from Coca-Cola." (2017): i6833. Available at: http://www.bmj.com/content/356/bmj.i6833
2. Tedstone, Alison. “An update on sugar reduction”. (2017). Available at: https://publichealthmatters.blog.gov.uk/2017/11/14/sugar-reduction-an-update/

Photo © Oast House Archive (cc-by-sa/2.0)


All views expressed in a post are exclusively those of the author or authors.

Brands, bottles and breastfeeding: sharing stories of early motherhood

Introduced by Nat Forster

Guest post by Justine Gallagher, Lecturer at Northumbria University

My own story of infant feeding is based in a community where breastfeeding was, and still is, not the norm. I was the first in my immediate family to breastfeed and I struggled with it in various ways. My breastfeeding journey ended much sooner than I had originally planned, when my son was just six weeks old. Two years later, my own sheer determination helped me to feed my second child, a daughter, for nine months.

Justine's first steps into motherhood

Later, in a professional capacity, I worked supporting families in my role as Community Development Worker in Sure Start Children's Centres. I worked with mothers who had similar feeding stories to my own, as well as many women who had never breastfed. They, like most of the people around me, never had any intention to breastfeed.

The guilt I felt for breastfeeding my first child for a short time stayed with me for a long time. I did not understand why it had such an impact. Why did I feel the need to breastfeed when others around me did not appear to give breastfeeding a second thought? When the opportunity came for me to undertake PhD research, my choice of topic was never in doubt.

My research, which is supervised by Dr Deborah James from Northumbria University, is focused on the infant feeding stories of nine women who live in an area where breastfeeding rates are low. All of the women’s stories are equally important however, for the purposes of this blog I would like to introduce you to Claire (names have been changed to preserve anonymity), who formula fed her baby Sophia from birth.

Claire, her parents and grandparents have lived in the same local area all of their lives. Claire was a single parent and lived with Sophia’s grandparents when her daughter was first born. Sophia’s grandmother took an active part in her care. She looked after Sophia for two nights a week when she was first born, reducing this to just one night per week as time passed. Following a biographical narrative approach, which allows participants to tell their stories without interruption, I asked Claire for her story with the use of a single question;

"So, please can you tell me the story of your experiences of feeding milk to your baby?"

"Well I started when I was pregnant, erm, I’ve always wanted to bottle feed her er, cause there was pink bottles that I wanted to get her erm and also knew the milk that I wanted to put on her erm, and just bottle feeding become very easy to us."

Claire’s story was dominated with discussion of branding and consumer goods. The pink bottles and the various brands of infant formula Claire gave to Sophia reveal the way media and advertising can influence infant feeding practice. Claire demonstrates that she was careful with her bottle-feeding choices. These choices were not arbitrary; she made clear decisions between brands and bottles. Claire wanted me to know that she had made the right choices for her and her daughter.

It was also quite clear that Claire’s identity, as the mother of a daughter, was an important part of her story. The ‘pink’ bottles represent this in a very visible way, she could perform her identity as a mother of a daughter with the right choice of bottle. Claire’s relationship with her own mother was important to her and she appeared keen to demonstrate that this mother-daughter bond would continue for another generation.

These stories help us to understand why some women breastfeed and others do not. Upon reflection, for me, I feel that breastfeeding was about being the best mother I could be, which explains the guilt I felt when I stopped. For Claire, feeding her baby was also about the same thing, only for Claire, being a good mother was about making the right consumption choices. In my thesis, I expand on how Claire’s choices were based on the social norms, the unwritten rules of how to be a mother, in the culture around her.

Bridging the gap between (mental) health services and needs: negotiating power and political values

Guest post by Dr Angus Forsyth, Senior Lecturer in Mental Health Nursing, Northumbria University

As Monday was World Mental Health day, there will be familiar messages in the media about the barriers faced by people with mental health problems when seeking appropriate care and treatment. These include (but are not limited to) the difficulties that children and young people face in accessing local services, not to mention specialist services, such as support for young people who may experience eating disorders. For adults the suicide rate has increased, and there are more and more pressures on crisis services and in-patient beds. As overall funding within the NHS is further reduced, mental health services face additional financial cuts as their funding is diverted to other clinical groups whose needs have been identified as more of a priority. 

Steve McDonald (Simon Gregson) battled depression in Coronation Street

As if lack of access to mental health services is not problematic enough, people with mental health problems are also more predisposed to physical health disorders due to the combined effects of certain medications, lifestyle factors, such as smoking and lack of exercise, contributing to obesity and other metabolic disorders. This contributes to early mortality for people with long standing mental health diagnosis such as schizophrenia, having a reduced lifespan of 20 years. Despite these inequalities the Department of Health’s guidance (2011) recommended parity of esteem for people with mental health problems to have the same level of access to services as those with physical illnesses. And even this recommendation has yet to be achieved. 

On the positive side, there has been a relative increase in coverage of mental health related issues within the media and society, either through celebrities disclosing personal issues, storylines in popular TV dramas; magazines, and social media. However, there still persists a stigma associated with the experience of mental ill-health, for example that people with Schizophrenia are unpredictable and predisposed to violence (Houses of Parliament 2015).

Whilst fear and lack of understanding are factors that maintain stigmatising beliefs and attitudes, power inequalities are also evident when exploring the above barriers to meaningful services. These power imbalances can lead to the development of oppressive social systems and organisational practices where the exercise of authority or power can lead to the marginalisation of specific groups. An example of this is the implementation of government policy, for example the reduction of resources and the subsequent allocation of funding by commissioning agencies (as servants of government), can result in further disadvantaging of citizens as in the case of young people attempting to access mental health care. In the majority of these cases, care can only meaningfully be accessed when there is a serious risk to self and others and is provided under the legislative procedures of the mental health act and in locations far from the individual’s home. This example illustrates how healthcare is provided in an oppressive system.

This brief summary of the challenges in accessing comprehensive care and resources that are available to people with mental health issues highlight that as the expression of mental health becomes more dominant, service provision and resource allocation has not kept pace with increasing need and demand for services. This is particularly in light of mental and physical ill-health co-existing and becoming common bedfellows in chronic disease management. Let’s hope that World Mental Health Day not only highlights issues related to the experience of mental health but acts as a catalyst to mobilise meaningful social actions such as:-

1. Reviewing the public and political structures to include the meaningful involvement of service users at all levels of the decision making process (Rethink 2016). This would further highlight inequalities and disadvantage experienced by individuals and meaningfully influence the development of comprehensive mental health service provision.
2. Reorganise health and social care structures around the holistic needs of service users rather than in the functional silos that currently operate.
3. Use World Mental Health Day to evaluate the impact of service delivery for vulnerable groups to identify meaningful changes and clarify further challenges.

References:

• Department of Health (2011) No Health Without Mental Health, DH.
• Houses of Parliament (2015) Parity of Esteem for Mental Health. Postnote No 485.
• Rethink mental Illness (2016) News & Views: Co-production & Commissioning - how the people who decide on mental health services can partner with the people who use them. Rethink Mental Illness.

Is the UK an intolerant society for children?

Posted by Peter van der Graaf, AskFuse Manager, Teesside University

UNICEF statistics about child wellbeing among the 29 wealthiest countries in the world made for uncomfortable reading in 2007 with the UK bottom of the league table. Children and young people in Britain were among the unhappiest, unhealthiest, poorest and least educated in the developed world in the early years of the new millennium. Since then many initiatives and policies have been implemented to increase child wellbeing in the UK and when the league table was repeated by UNICEF in 2013 the UK moved up 15 places to a mid-table position of 16th.

However, we are still behind many European countries and with the ongoing austerity measures and continued disinvestment in health and social care services for children we could find ourselves back at the bottom league in the not too distant future. This begs the questions whether ‘simply’ improving health and other services for children is enough?

According to Sir Al Aynsley-Green, Professor Emeritus of Child Health at University College London and former President of the British Medical Association, the problem runs much deeper. He argued at the Fuse Knowledge Exchange Seminar yesterday in Newcastle, titled 'Think Adult - Think Child', that the real problem in the UK is that we are becoming an intolerant society for children. He pointed to the dire straits of politics for children in the UK: not only is the voice of children lacking from national policy making (an argument that he is well positioned to make as the first Children’s Commissioner for England), the policy making itself has often been poor.

The BMA published a damning report in 2013 in which it concluded that “the national focus on children has been short term, inconsistent and untrustworthy”. Specific policies to support children, such as Every Child Matters, have been systematically eroded by consecutive governments; the recent much watered-down Childhood Obesity Strategy is another example of this and Theresa May’s new enthusiasm for grammar schools strikes further fear into the hearts of child rights advocates.

Politicians are not the only ones to blame according to Sir Al: the media regularly publish headlines about children and young people being a nuisance and causing crimes, while shops put up signs in their windows stating that dogs are welcome but that kids can only enter two at a time and, only then, without a backpack and when closely supervised. Most shockingly, public places such as railway stations are increasingly being fitted with high pitched devices that adults can’t hear but which are very unpleasant for young people and deliberately intend to drive them away.

One area where the neglect of children’s needs is particularly visible is bereavement: every 22 minutes a child in the UK loses a parent. While no routine data are collected in the UK on this group, estimates suggest that the majority of young people face the death of a close relative or friend by the time they are 16 years old. In spite of the many services available to families to help them stop smoking, exercise more and eat healthier, there is very little available for children who experience bereavement.


Sir Al presenting at the Fuse Knowledge Exchange Seminar

Specialist service providers attending the Knowledge Exchange (KE) seminar expressed their concern about not being able to cope with the current demand, as school teachers and parents lack basic skills in being able to talk to children about emotional problems, such as bereavement. In spite of this, we know from research that bereavement can have a lasting impact on the life of children long into adulthood. Bereavement in childhood has been linked to educational underachievement, joblessness, fractured adult relationships, adverse psychological and psychiatric consequences, together with poor physical health.

Sir Al’s presentation was therefore more a call to arms. What can we do in and outside Fuse to improve child health and wellbeing in the North East? Firstly, we can act as an advocate organisation to draw more attention to the needs of children and their position in society. Are their voices heard within Fuse? Do we engage with them in our projects?

Secondly, we can bring partners together across public health and related sectors in the North East to focus attention on this topic and bring together evidence and best practice to inform new collaborations. The KE seminar provided a platform for this that could be followed up. We also have a dedicated Early Life and Adolescence Programme (ELAP) within Fuse but does our research link to education and events later in the life course? For example, in Finland shops can rent a grandparent to help them engage with children when they visit their shop.

Thirdly, we need to turn this dialogue into a research agenda for child wellbeing in the North East. How can we mobilise evidence to change the prevailing attitude among politicians and the wider society so that they instead see children as valuable assets and a key policy priority for any government? This also involves challenging popular concepts, such as school readiness, which focus on individual responsibility. As Sir Al suggested at the end of the seminar, we should turn this concept around: are schools ready for children and what do they need to be able to be ready? Are they able to support children’s emotional development and can they help them to cope with bereavement experiences?

Making the UK a better place to live for children requires more than service redesign, it needs political will and consistent pressure from a coalition of organisations to achieve this, supported by actionable research to change hearts and minds.

Not just a can of pop: the social meanings of energy drinks

Posted by Mandy Cheetham, Fuse Research Associate at Teesside University

Children and young people can sometimes be conspicuous by their absence in public debates about sugary drinks, so I’ve enjoyed reading the series of blogs posted since September, which describe research and activities involving young people. As children and young people are the predominant consumers of sugary drinks, it is claimed they are one of the groups whose health will benefit most from efforts to control or reduce their consumption (FPH 2015), such as the introduction of a duty on sugary drinks advocated by PHE (2015) and popularised by Jamie Oliver.

Our study on energy drinks showed that cost was one of the major influences on young people’s choices. The mapping exercise we did with Year 6 and Year 9 students in their local area showed walls of cheap, appealing, attractive displays of multiple flavoured energy drinks to tempt young people, with ‘buy one, get one free’ offers to share with friends. As important as the economic considerations are, the social meanings of energy drinks also have a major role to play. These are often misunderstood or ignored by adults planning public health interventions to reduce the risks of obesity.

Young people described the social spaces in which they drink energy drinks, whether consumed at weekend sleepovers, whilst gaming, hanging out with mates in the park, or on the way to or from school. Shared, swapped, and exchanged, energy drinks, and the sponsorship, branding and marketing associated with them, are woven in to the social fabric of young people’s lives. Energy drinks are part of the construction and maintenance of particular gendered identities, associated with extreme sports, alien elimination, looking hard, sophisticated and / or attractive. They offer young people opportunities to conform to certain ideas about what girls and boys like and do, and become part of the currency of young people’s daily interactions. In short, social meanings matter.

In Wendy Wills’ presentation at the Sweetness, Social Norms and Schools seminar in September, (CPPH/Wolfson Seminar - Sweetness, social norms and schools: factors influencing children and young people’s food and drink practices), I was struck by the similarities in young people’s comments about the importance of social relationships, interactions with friends, and the value of friendly respectful exchanges with local retailers, informing their lunchtime decision making. Young people were keen to be involved in efforts to improve the school food environment. Young people in our study were similarly fired up to make positive changes, and questioned why and how energy drinks companies can target young people under 16. They had ideas about what would make a difference and were realistic about the challenges of restricting sales of energy drinks to young people.

In September, Fuse welcomed Professor Helen Roberts, a self confessed fan of evidence informed public health advocacy, to deliver a knowledge exchange seminar prompting debates about our role as academics and advocates. Constrained by restrictions placed on us by funders, some appear nervous about compromising assumed notions of independence. If we want our research to have impact, should we not frame public health debates in ways which make sense to those who participate in our research? Rather than simply highlighting the health risks of energy drinks, this means understanding the social meanings of young people’s food and drink choices and more critical engagement with the industry that promotes them. Our efforts would be further strengthened by encouraging young people and colleagues to connect with other campaigns such as RRED and GULP.

To download the Fuse Energy Drinks report click here, or the Fuse Brief can be viewed here.

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Would you accept money to be healthier?

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

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

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

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

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

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

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

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

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

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

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

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Go for the plums!

Posted by Mark Welford, Fuse Communications Officer

The title of this post was the provocative take home message from a session on ‘Writing for the media and Public Health Today’ at the Faculty of Public Health (FPH) conference held at the Sage in Gateshead earlier this week.

Public Health Today is the quarterly magazine for FPH members, featuring a range of articles from topical news items, to in-depth interviews with key public health figures. It is distributed to over 3,300 public health professionals in the UK and internationally.

Led by Richard Allen, Productions Editor of the magazine, the session aimed to give attendees an idea of what he and his team are looking for from contributors. The FPH want to hear about your research, but there are ways in which you can make it more likely that what you provide ends up in the magazine. Much of this also applies to the media and providing journalists with stories through press releases.

As the title says: ‘go for the plums’. Hit readers with the most important, unexpected or unusual fact, anecdote, or quote first. Your top line may not be the most important message but the ‘sweetie on the top’ designed to draw readers in and convince them to read on.

The first sentence should get across the key message and/or provide a brief summary of the research in 20 words. Many articles that the FPH receive start from the beginning. Instead, reverse history and put the background in later with the conclusion first.

Be concise. Richard and his team are looking for articles of 550 words – stick to the word count. Remove the long words and jargon, the public health and management speak. Use everyday language and write acronyms in full in the first instance. The news stories on the BBC website provide a good example of this.

Include short quotes that add opinion or emotion. This humanises the story and brings it to life. Write as though you’re describing your research to an educated friend.

Each issue of Public Health Today is themed. June's edition is on sex. The themes of future issues aren’t easy to find but I did eventually discover them in the latest FPH e-bulletin.

The special features for the other editions in 2015 are:

• September: Disasters & emergencies
• December: Healthcare public health

An editorial board decide on the themes for the year ahead at a meeting in December. Could you suggest a theme?

Here are Richard’s top tips in a handy list:

1. Go for the plums!
2. Is there anything ‘new’ in my article – what’s current?
3. Is there anything unusual or unexpected about it?
4. Would this be of interest and understandable to anyone outside of public health?
5. What, who, when, where and why?
6. Reverse history 
7. Be concise
8. Keep sentences short
9. Avoid jargon
10. Avoid management speak
11. Avoid acronyms
12. Use quotes to provide insight, not information
13. Stick to the word count
14. No references /footnotes
15. No multiple bylines
16. Provide contact details

Richard, like me, was once a journalist and it’s helpful to be reminded of good practice. So I’m going to follow no.13 and keep to the 550 word limit.

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Bull sperm and ‘poor parents’: the role of myths in public health practice

Posted by Stephen Crossley, Research Assistant on the Fuse HYPER! Energy Drinks research project and a PhD student at Durham University

One of the most interesting themes, in my opinion, emerging from the current research into young people’s consumption of energy drinks, is the way that different messages about energy drinks – who (supposedly) consumes them and how – circulate and often deliver contradictory images and information. Not only are young people targeted by a range of clever advertising strategies from the companies that produce and sell these drinks, but they also receive information from teachers, parents, public health practitioners, media outlets (including social media) and their peers. Adults also receive information from similar sources.

By way of example, many people are aware that lots of energy drinks contain Taurine. Some people, no doubt helped by internet search engines, social media and classroom rumours, also believe that the taurine that is in energy drinks is extracted from bull sperm. This info lies firmly in the realm of ‘urban myth’, although you can perhaps understand where it originated from, given that taurine was first isolated from ox bile and it is present in bull sperm. It can also be found in fish and meat, and in breast milk, although we’ve yet to come across any young people who believe there is industrial scale maternal ‘pumping’ going on in an effort to give the population wings. Somewhat predictably, the taurine in energy drinks in synthetically produced in labs.

Urban myths, although they contain a degree of plausibility, are relatively easy to disprove due to a lack of robust evidence. But there are other types of myths which are sometimes harder to disprove, despite similarly lacking credible evidence bases. Christopher G. Flood (2002) identified ‘political myths’ as coherent narratives which orient discourses in the one ideological direction rather than another. He argued that political myths:

can be said to exist when accounts of a more or less common sequence of events, involving more or less the same principal actors, subject to more or less the same overall interpretation and implied meaning, circulate within a social group.

Contemporary political myths include there being ‘no alternative’ to austerity, the need to crackdown on ‘skivers’ who are ‘welfare dependent’ and the dangers posed by migrants acting as ‘benefits tourists’ or ‘health tourists’. The idea of a group of ‘poor parents’ (in both senses of the phrase) representing a major public health risk to their children as a result of problematic parenting behaviours is, I would argue, another such political myth. These parents are often marked out as being different from ‘us’ by virtue of their residence in ‘deprived’ areas and by their ‘inferior’ parenting practices. In Flood’s words, therefore, the same principal actors are subject to more or less the same overall interpretation and implied meanings.

During the course of our research, we have encountered a small number of stories about parents blending a MacDonald’s ‘Happy Meal’ or a ‘Sunday dinner’ and putting it in baby’s bottles or parents filling milk bottles with energy drinks or other inappropriate drinks/liquids. Previous experience within the research team suggests that similar stories will probably be familiar to many people working in public health and/or nutrition.

Views about ‘poor parents’ have a long and undistinguished history, stretching back to at least Victorian times when there was concern about a ‘social residuum’ (see John Welshman’s fascinating book Underclass for a comprehensive history). Public health practitioners also have a long history of involvement with these ideas and the roles of Chief Medical Officers in propagating ideas about a ‘social problem group’ in the 1930s and ‘problem families’ in the 1950s are particularly sobering, given that they were influenced and supported by The Eugenics Society. Despite over a century of social scientific research, there is no credible evidence of a large number of families with different cultural values or behavioural norms from ‘the rest of us’.

As noted above, many of these ideas originate from politicians, who are keen to differentiate between ‘skivers’ and ‘strivers’ or ‘troubled’ and ‘hard-working’ families and who would have us believe that there is an ‘underclass’ whose parenting deficiencies are ruining the lives of their children. Unfortunately, some public health practitioners do little more than repeat and embellish these political myths, giving them more credibility and potency than they perhaps deserve.

I am not denying that there may well be a parent - or maybe even parents - who have blended a Happy Meal or given their child an Energy Drink. What I do doubt is whether the potential, but as yet unfounded, actions of an extremely small number of parents is worthy of repetition from some - though not all - public health practitioners on the scale that we sometimes see. Shouldn’t we be setting the bar a little higher than second or third-hand anecdotes in terms of ‘evidence-based’ practice and policy making? Not believing, or at least questioning, some of things we read on the internet or that we are told by politicians and, in some cases, colleagues, would be a good place to start. Failure to challenge such stereotypes leaves the way clear for the wider political myth that, in the words of Stanley Cohen (1985), ‘the deprived are not much different from the depraved’.

Cohen, S. (1985) Visions of Social Control, Cambridge: Polity

Flood, C.G. (2002) Political Myth, Abingdon: Routledge

Welshman, J. (2013) Underclass: A history of the excluded since 1880, London: Bloomsbury

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