Training tomorrow’s Public Health leaders: impact, innovation and prevention

Posted by Liz Morgan, Head of School for Public Health North East, NHS England

The North East Public Health Postgraduate Specialty Training Programme holds an event annually to showcase the work that has been done by trainees over the previous year. This annual showcase highlights how public health trainees in the North East are delivering practical, high‑impact work across the health and care system, demonstrating the value of prevention-led leadership at a time of increasing system pressure. It not only celebrates the tremendous work our trainees have been doing but also provides an opportunity to share that work with public health colleagues in multiple settings During this time, our trainees will have been immersed in communities, health and health-related systems and research environments, identifying challenges, designing solutions and implementing projects that demonstrate innovation and impact. The projects presented at our last meeting ranged from heath protection and health improvement to policy development and healthcare public health. Each one reflected the commitment, curiosity and compassion that defines our public health workforce.

Tackling air pollution through NHS leadership

Most NHS Trusts in the North East employ at least one public health consultant, valuing the broad benefits that this can bring, but also providing greater capacity for public health training. Dr Laura Keast had been undertaking a placement in Northumbria NHS Trust, implementing the Clean Air Hospital Framework and demonstrated the value of collaboration between public health and sustainability teams. Air pollution remains the single greatest environmental threat to public health in the UK, contributing to an estimated 30,000 deaths annually and worsening health inequalities. By making air pollution a tangible and locally relevant issue through accessible monitoring of nitrogen dioxide levels and clear health messaging, the initiative has generated engagement and momentum for action. Importantly, the project highlighted that public health leadership, data expertise, powerful health messaging and alignment with national policy levers are critical in overcoming uncertainty and organisational resistance to change.

Reducing missed outpatient appointments for children

Dr Mark Riley presented a service evaluation undertaken at South Tees NHS Trust exploring why children are not brought to outpatient appointments, an issue with significant implications for health outcomes and system efficiency. Using surveys and follow-up telephone calls, the evaluation identified five key themes:

• appointment timing
• forgotten appointments and reminders
• administrative barriers
• health literacy
• cost of attendance.

Forgotten appointments were the most common reason for non-attendance, with parents strongly favouring clearer and more frequent text reminders. Difficulties rearranging appointments, confusing letters and limited awareness of travel cost reimbursement schemes further contributed to missed care. The findings underscore how relatively small, system-level changes, such as health-literate communications in multiple languages and flexible appointment scheduling to include evenings, can reduce inequalities and improve service use. Finding a champion in the organisation to enable change was also critical.

How leaders make difficult priority-setting decisions

As pressures on the NHS intensify, difficult decisions about how to allocate limited resources are unavoidable. Dr Tom Seasman explored how senior health leaders justified priority-setting decisions. Qualitative in‑depth interviews with leaders across the English health system show broad support for prevention and reducing health inequalities. However, when faced with real-world trade-offs, decisions often favour short-term frontline clinical care over long-term preventative investment and leaders differ in their responses. Clinical leaders often prioritise immediate need and the “rule of rescue”, while those approaching the same problem from a public health perspective place greater emphasis on maximising population health gains through prevention. Political constraints, emotional proximity to patients and fragmented funding structures frequently limit leaders’ ability to shift resources from acute care to prevention, despite widespread recognition that long-term sustainability depends on doing so. These findings raise important questions about how the health system can better support leaders to make transparent and ethical trade-offs.

Policing and public health: prevention in action

Prevention also featured strongly in work exploring collaboration between policing and public health. This is important because of shared commitments to improve lives, reduce harm, reduce unnecessary demand on services, reduce vulnerability, improve equity and maintain public trust. Since the publication of a national consensus statement in 2018, prevention has become more explicitly embedded within policing policy and inspection frameworks. A 2025 review concluded that, while the original vision remained relevant, a refreshed consensus was needed to reflect current challenges and language. Kylie Murrell led on this national project, chairing the policing and public health collaborative, leading on the re-drafting of the document and sign off and associated ministerial briefing. The work highlights both the appetite within policing to engage more fully in prevention and the ongoing need for public health professionals to support cross-sector partners to identify upstream opportunities to reduce harm, vulnerability and demand. It's also an excellent example of how our trainees have led on national initiatives.

Supporting wellbeing within the public health workforce

Alongside the ongoing system-level challenges, attention to the wellbeing of the public health workforce itself is increasingly recognised as essential. Vineeta O’Key reflected on the work the trainees had been doing to support their own wellbeing and on how a Wellbeing Away Day could demonstrate how evidence-based wellbeing approaches could be embedded within training and professional development. Grounded in the “Five Ways to Wellbeing”, the day prioritised connection, learning, physical activity and engagement with nature through volunteering with Durham Wildlife Trust. Feedback highlighted the value of protected time for relationship-building, reflection and compassionate leadership, reinforcing the role of wellbeing as both a personal and professional competency in public health practice.

Julie Lowe presented her experience of travelling to Canada and the Netherlands on a Churchill Foundation fellowship. The Foundation funds approximately 100 Fellows each year to travel overseas to explore an issue of societal importance. This project focused on community interventions to improve the health and wellbeing of unpaid caregivers, who, as a population, experience poorer mental and physical health outcomes known informally as the ‘carer burden’. She shared reflections from her own experience as a young carer and motivation for choosing a career in public health. Findings from her experience included the importance of listening to diverse groups of carers to understand their needs and preferences, and the need for interventions that reduce carer burden rather than responding to health needs as they arise.

Taken together, these projects reflect a common theme: public health impact is maximised through leadership, collaboration and a commitment to prevention, even in constrained systems. Our trainees are already having an impact in their placements and communities by shaping national priorities, supporting workforce wellbeing and building partnerships beyond health. Creating spaces like this conference where recent projects and ideas can be shared, and challenges are explored are vital and demonstrates how public health continues to be pivotal in navigating complexity and working towards more equitable and sustainable futures. I would strongly encourage all of our public educators and senior public health colleagues to attend this event. As Public Health influencers, the task of considering, adapting and altering these ideas and interventions for the benefit of the populations we serve rests with us.

Brand to ban: What young people really think about energy drinks

Posted by Professor Amelia Lake, Fuse Deputy Director; Dr Helen Moore, Fuse Associate; and Grace Stewart - Teesside University. 

Walk into any corner shop, and you’ll see them lined up in the fridge: brightly coloured cans promising energy, improved focus and even hydration. They’re everywhere online too, all over social media feeds... What are we talking about? Energy drinks. They have become a familiar part of the landscape in the UK, but particularly for young people who are consuming them in ever increasing numbers; the question is, why are they so popular, and what is being done about it?

What are energy drinks?

High-caffeine energy drinks are soft drinks that contain at least 150 milligrams (mg) of caffeine per litre of drink, which is higher than other soft drinks. Back in 2018, Jamie Oliver led a campaign that resulted in many retailers voluntarily banning sales to under-16s. Fast forward to July 2024, and the new Labour Government announced in the King’s Speech that it would restrict the sale of energy drinks to under-18s. There is currently a live Government consultation around banning the sale of high-caffeine energy drinks to children which will close on 26 November 2025. If you want to contribute, please do so.

Our research

Our mixed-method qualitative study was published in the Journal of Human Nutrition and Dietetics this week. The work was carried out in North-East England and sheds light on the reasons behind young people still consuming these drinks in large numbers, and what they, the consumers, really think could be done about it.

Our research involved:

• Focus groups with 50 students aged 9–14 years old
• A survey completed by 22 Year 9 students (aged 13–14 years old)

The aim was to understand how children and young people perceive energy drinks and hydration drinks, and to explore their consumption habits post the UK’s 2018 voluntary sales ban to under-16s. This follows on from our earlier work published in 2017.

What did we find?

• 81.8% of surveyed students (13-14 year olds) consume energy drinks, with boys drinking more frequently than girls.
• Most young people drink EDs 2-4 times a week, and many started before age 12 years.
• Taste, branding, and peer influence were major motivators.
• Corner/local shops were the most common purchase point, often with little enforcement of age restrictions.
• Hydration drinks (e.g. PRIME) are seen as healthier alternatives, though their actual health impact is still unclear.

So, why are energy drinks so popular?

Through the focus groups, we learned that young people are really clued-up about energy drinks. They talked about branding, marketing, taste, peer influence, cost, and just how easy it is to get hold of them. From YouTube ads to celebrity endorsements (think F1 and YouTubers like Logan Paul and KSI), marketing was seen as a powerful force driving consumption. One young person said:

“If I made the exact same drink, in a bottle, no one would buy it.”

Bright colours, cool designs, and slogans were all cited as reasons that young people are drawn to these products. Many of the young people taking part in the research knew that they were being targeted by the manufacturers, but they didn’t mind. In fact, some saw energy drinks as part of their identity, linked to gaming, sports, or just being “cool.”

Policy gaps and opportunities

Despite the 2018 voluntary ban mainly in supermarkets, energy drinks remain easily accessible. Many children believed there was a legal age restriction but said that they could still buy energy drinks from shops or online without ID checks. This links back to the importance of the current live consultation around Energy Drinks and sales restrictions.

This raises an important point for policymakers to consider: if energy drinks are still seen as aspirational, accessible, and part of youth culture, young people will find ways to get them, or switch to similar products that exist outside of the ban. There needs to be a wider strategy to tackle this, which means tighter regulation of marketing (anywhere that young people spend their time - including online spaces), effective, up-to-date, accurate education about the health impacts of energy drinks and the tactics used by manufacturers, and importantly including young people in this conversation.

Our research shows that young people are not passive consumers of energy drinks. They’re thoughtful, aware, and influenced by a range of social and cultural factors that need to be understood if we want to reduce energy drink consumption.

Our study had several possible interventions suggested by young people:

• Actual legislative enforcement of age restrictions.
• Changing product placement in stores (e.g., away from essentials and in areas similar to cigarettes and alcohol).
• Duller packaging and clearer health warnings.
• Wider awareness around health risks.

Why this matters

Energy drinks are linked to a range of health issues; from insomnia and anxiety to obesity and poor academic performance. Yet, their appeal among young people remains strong, driven by clever, pervasive, marketing in addition to peer influence.

Our paper highlights the urgent need for strong policy action, increased awareness, and further research in this space.

Images:

1: Photo by (Joenomias) Menno de Jong from Pixabay

2: Photo by thom masat on Unsplash (with modifications)

Changing the narrative on gambling harms in the North East

Posted by Dr Andrew Richardson - Research Associate (Gambling Harms), Newcastle University; Alice Beadle, Public Health Specialist - Gambling Harms, Middlesbrough Council; and Laura Sheridan, Public Health Officer – Gambling Harms, Middlesbrough Council

Gambling is staking money, or something of value, on the outcome of something involving chance. Gambling activities can include arcades, esports and video games, betting shops, online betting, gaming machines, lotteries, bingo, casinos and other common types of gambling. Gambling harms affect thousands of people across England but the North East faces the greatest risk. National estimates suggest that 3.8% of people are at elevated risk from gambling. In the North East, that figure rises to nearly 5% of people aged 16 and over - the highest rate of at-risk gambling in the country. These people experience a range of negative consequences, from financial hardship to serious mental health challenges.

To explore the scale and impact of gambling harms in the region, read the Regional Health Needs Assessment for Gambling.

What are gambling harms?

Gambling harms are any negative consequence or side effect experienced because of gambling. They may be felt by the person who is gambling or may be experienced by those close to them, such as a family member, friend or colleague, known as ‘affected others’. For each person who experiences gambling harm, on average six others are affected - often partners and children.

Whilst anyone can be harmed by gambling, it does not affect everyone equally. The harms from gambling are varied and may also be interconnected. They include:

• Increased stress and poor mental health (such as anxiety, depression and suicide risk).
• Financial hardship, debt, asset loss and bankruptcy.
• Relationship breakdowns due to increased conflict, issues with trust and stress associated with harmful gambling. There are also links between gambling and domestic violence.
• Reduced performance and absenteeism in education and in the workplace.
• Stigma and shame associated with gambling behaviour.
• Threatening behaviour, damage to property, fraud and theft.

For many, gambling harms leave a legacy and may be experienced for many years after the event.

A public health approach

The Association of Directors of Public Health in the North East (ADPH NE) Gambling Harms Programme aims to tackle the harm caused by gambling in the North East with a coordinated regional approach. The Programme received funding that originally came from a gambling operators’ penalty but was redirected by the Gambling Commission - called a ‘regulatory settlement’.

Gambling harms are complex, and prevention approaches need to move away from ‘personal responsibility’ to population-wide social, economic and environmental interventions. Messaging from the gambling industry often sets the narrative by placing responsibility onto the individual to address harmful gambling, despite the many ways gambling products are designed to be addictive. This can lead to increased stigma and shame and create additional barriers to help-seeking behaviour.

The Regional Office, a team hosted by Middlesbrough Council, supports the 12 Local Authorities in the North East to pilot prevention approaches to help reduce gambling harms. The Programme has developed resources which include awareness raising materials and evidence summaries to support practitioners in local authority settings.

Eight key priority areas have been established under the Regional Office:

1. Support and Partnerships – Responding to requests from local authorities and wider stakeholders to support understanding of gambling harms and embed prevention activity.

2. Advocacy – Contributing to the shaping of policy at a local, regional and national level by promoting a public health approach to support those impacted by gambling harms and to build an environment that prevents future harm.

3. Media, Communications and Education – Raising awareness of gambling harms and aiming to reduce stigma.

4. Treatment – Promoting regional treatment services and referral routes for residents and professionals across the North East of England.

5. Data, Research and Evaluation – Develop and create evidence bespoke to the North East and contribute literature to the national evidence base regarding gambling harms.

6. Licensing – Supporting planning and licensing colleagues to create environments that prevent future gambling harms.

7. Protecting Young People – Recognising the risks of gambling to children and young people, and developing resources to support caregivers to reduce risks of gambling harms.

8. Lived Experience – Co-producing all outputs with the Lived Experience Forum, made up of members from across the Region. This ensures all outputs reflect real-world experiences and have maximum impact.

To learn more about gambling and gambling harms, please use the ADPH NE Gambling Harms slide deck or access free Making Every Contact Count (MECC) and Gambling Harms training here.

You may also be interested in these national resources:

• Local Government Association (LGA): Tackling gambling related harm: A whole council approach.
• National Institute for Health and Care Excellence (NICE): Gambling-related Harms: Identification, Assessment and Management.
• OHID Gambling treatment and support in England: main findings and methodology.
• Gambling Commission Young People and Gambling report.

Learning from others

The North East Programme was inspired by the Greater Manchester Combined Authority and ADPH Yorkshire and the Humber to share findings and best practice. The three regional programmes collaborated on a Language Guide to promote language choices that reduces the stigma associated with gambling.

Building the evidence

The Programme will be evaluated and this will contribute to the evidence base on actions to reduce gambling harms, which is currently dominated by gambling industry narratives. The team is working with local partners to explore the wide range of healthcare services and practitioners who may be in contact with gamblers or people affected by gambling and educational toolkits for schools and communities etc. To learn more, see this academic paper co-authored by Fuse researchers or view a free slide deck that summarises the latest research on gambling harms.

Lived experience

The Programme also facilitates a Lived Experience Forum to help shape work happening across the region. If you have experienced gambling harms, either directly or as an ‘affected other’ and are based in or from the North East, this is open to you. If you would like to influence the work being done to tackle gambling harms in the region, please email GHR@middlesbrough.gov.uk.

Stay in the loop

The ADPH NE Gambling Harms newsletter includes news about events, new research, resources like podcasts and documentaries, and ways to get involved. Join the newsletter mailing list by contacting GHR@middlesbrough.gov.uk or complete the sign-up form here. New resources can also be found on the ADPH NE Gambling Harms website.

Treatment and support

Visit the Gambling Harms MECC page to find treatment, support and blocking tools. For some people in recovery from gambling harms, treatment may be the best option, whereas peer support groups may be better for others. Professionals can refer directly into these services. This may make it easier for those needing treatment and support to take the first step on their recovery journey.

Photo by Michele Lana on Unsplash

This time the hare might win: dark kitchens and the regulatory race

Posted by Helen Moore, Associate Professor (Research) & Fuse Associate, Teesside University 

Do you remember the fable of the tortoise and the hare? The one where the overconfident hare sprints ahead, but takes a nap, and lets the slow but steady tortoise win the race? Well, in today’s digital economy, that story’s getting a reboot, but this time, the hare isn’t napping.

In the world of food delivery and online ordering, the hare (the digital entrepreneurs) is wide awake and developing food purchasing opportunities at an incredible speed. Online delivery outlets, often functioning as dark kitchens, are agile, tech-savvy, and unburdened by the red tape of traditional business models. They’re using popular, well-known apps to reach huge numbers of people, launching new brands overnight, flooding menus with similar, but subtly different options and delivering meals faster than regulators can say “planning permission.” Low overheads, high levels of flexibility and choice have meant that rates of online food ordering are increasing, with the covid-19 pandemic accelerating this phenomenon.

Meanwhile, the tortoise (well-meaning but less agile local and national government) is still trying to understand the race in which it has been entered. Regulators are struggling to keep pace with a food industry that’s evolving in real time while the professionals working in local authorities hit ‘speed bumps’ which include outdated planning laws and limited evidence. For example, there is no clear use classification for dark kitchens, and some councils treat them as “industrial”, others as “sui generis” (unique), and there is inconsistent enforcement between local authorities. While some local authorities have implemented restrictions on takeaways opening close to schools, online food ordering apps mean that food can be delivered from places outside of the restricted areas. In addition, due to limitations with the recording of food outlet data, policymakers also find it hard to track spread or assess impact of dark kitchens which contribute significantly to this industry.

While innovation races ahead, regulation is not keeping pace, raising questions about public health, urban planning, and fairness. This isn’t just a story of speed, it’s also a story of systems, and unless the tortoise finds ways to modernise the traditional policy cycles to become proactive rather than reactive, and to reduce potential loopholes, the hare might just win this one, particularly as consumers like convenience and variety, which online ordering offers in abundance.

So, what can be done?

National and local authorities need to rethink how they engage with fast-moving digital industries - not to stifle innovation, but to ensure it serves the public good. We need clear national guidance on planning classifications, and health-focused planning laws that include digital-only food outlets. It isn’t all bad news though, there are some signs of progress with local authorities beginning to enforce planning permission requirements and with funded research projects examining various aspects of dark kitchens.

Free online training

To support local authorities and communities in using the planning system to promote healthier diets and reduce obesity, we have launched a new, free e-learning course called Planning for a Healthier Food Environment. The course was developed through a collaborative effort between Fuse (the Centre for Translational Research in Public Health), academic experts from Teesside University and Newcastle University, and the Office for Health Improvement and Disparities (OHID).

This one-hour online Fuse Research Event, held on 23 September, introduced the wider policy and planning context for the course, provided insights into its cross-disciplinary development, and outlined how the resource can be applied in practice to support healthier, more equitable environments.

Photo by Roman on Unsplash

Not just what’s on the menu - the hidden forces behind food choice

Posted by Helen Moore, Associate Professor (Research) & Fuse Associate, Teesside University 

On Saturday, I had one of those incredibly energising moments that remind you why you do the work you do. I was invited to present at the Right To Food UK Conference at the University of Westminster. It was a powerful event led by Ian Byrne, Labour MP for Liverpool West Derby. The event represented a crucial moment for shaping policy and driving action to realise the right to food in the UK. The room was full of policymakers, researchers, and advocates, all engaged and working together talking about the issues.

So proud to open the UK’s first national Right To Food conference today. No one should be going hungry in the world’s 6th wealthiest nation - hunger is a political choice & it can be solved, so that’s what we want to do: End hunger. #RightToFood #HungerIsAPoliticalChoice pic.twitter.com/p7IdeoeyQT

— lan Byrne MP (@IanByrneMP) September 13, 2025

Fuse Associate Helen Moore pictured third from the left

The invitation to speak followed my attendance at the launch of the Hungry for Change report by the Child of the North All Party Parliamentary Group (APPG) earlier in July. It’s been a privilege to be part of this journey, co-authoring the Environments chapter with Andrea Burrows, Amelia Lake and Claire O'Malley from Teesside University and Fuse (the Centre for Translational Research in Public Health), and Mark Green and Emma Boyland from the University of Liverpool.

Our chapter of the report looks at how the places and systems around us shape what we eat, often without us even realising it. We looked at everything from fast food outlets to social supermarkets, to advertising, to digital delivery platforms and planning policy. The big takeaway message? Food environments matter. And crucially they’re not the same for everyone.

So, what’s a food environment?

It’s not just about what’s in your fridge. It’s about what’s available in your local shop, what’s advertised to you on billboards and on your phone or computer screen, what your school or work canteen serves, how far you live from a supermarket, and even what your friends and family eat. It’s shaped by everything from planning and transport networks to cultural norms, pricing strategies, and national policies. Have you ever wondered why your local shops have two pizza places but no greengrocer? That’s a food environment in action. It is shaped by planning decisions, business models, and economic pressures, not just personal choice.

And here’s the kicker: these environments aren’t the same for everyone... If you live in a more deprived area, you’re more likely to be surrounded by cheap, high-calorie options, adverts for these types of foods and are less likely to have access to fresh, affordable food. That’s not a personal failing; it’s structural inequality.

What did our chapter of the report say?

Advertising
We explored how advertising aimed at children overwhelmingly promotes unhealthy foods. Even short exposure to adverts for fast food or sugary drinks can increase kids’ energy intake and influence their choices. And children in more deprived households tend to watch more commercial screen media, making them more vulnerable to this kind of marketing.

Community Food Organisations
We also discussed community food organisations, which are an innovative and alternative food relief model to food banks. They exist to try and tackle both food insecurity and food waste simultaneously. They utilise surplus from mainstream food retailers and sell via the usual supermarket format (adding items to a basket and paying at a checkout) but at greatly reduced prices. With lower costs than a traditional supermarket, and less stigmatising than using free emergency food aid, this model shows promise. Some of these organisations operate beyond a supermarket model, and offer additional social support, such as employment training, guidance with benefit claims, or community-building activities, but this differs across organisations. While these differences demonstrate the adaptability of the model, it also makes it difficult to establish a universal definition of community food organisations.

Fast food, screens, and the rise of dark kitchens
One of the most striking findings of our chapter was the increase in fast food outlet accessibility in the North, with an 84% rise in people living within 1km of a fast-food outlet between 2016 and 2025. However, we now must consider that access to food, including fast food, has moved to the digital space. We’re seeing a shift from people going to their local fast-food outlet to order, to using technology on a variety of screens to order food. In a recent piece of work, we found that one business (a delivery only kitchen, also known as a dark kitchen) could appear as eight different restaurant options on a food delivery app. What looks like more options for consumers, means more visibility for businesses, but all the food will be coming from the same place. It’s clever marketing, but it also widens the gap between consumers and the food they’re eating.

So, is this a problem?

I think it is something that needs looking at, particularly as another aspect of this is that planning regulations as they currently stand, (like preventing takeaways from opening near schools) don’t really apply to these virtual kitchens. They can deliver further, run more cheaply, and bypass traditional oversight. It’s a whole new frontier (this digital food environment), and one we urgently need to understand better.

Why does this matter?

At the conference on Saturday, I had the chance to present some of our report findings and speak directly with people who were interested in making changes in this area and improving food access for all. Seeing their genuine interest, being able to answer questions and provide context, was incredibly rewarding. These are the moments that remind me why this work matters, not just in theory, but in practice.

We need to stop thinking of food environments as neutral. They’re shaped by policy, economics, advertising, culture, marketing and technology. Food environments have been shaped and moulded to encourage us to eat less healthy food. The good news is that they can be reshaped. That means investing in healthier options, regulating advertising and marketing, supporting community food initiatives, and making sure digital platforms don’t become the new food deserts and swamps.

Food is more than just fuel. It’s about dignity, culture, and care. And we all deserve a food environment that supports our health and potential no matter where we’re born. To borrow a line from the report’s foreword: “Food insecurity is not about poor choices – it is about a lack of choices.”

Everyone deserves access to good food. Whether you're a policymaker, a researcher, or someone who just wants better options in your community, there’s a role for you in reshaping the food environment.


🔗 Read the full report here - Hungry for Change: Tackling Obesity and Food Insecurity in the North of England

What did you eat yesterday? The messy science of measuring what we eat

Posted by Dr Kath Roberts, Senior Lecturer in Public Health Nutrition, University of York

Ask anyone what they ate yesterday and you’ll likely get a pause, a guess, and maybe a laugh. That’s the reality nutritional epidemiologists (scientists who study how diet affects people’s health) work with every day. Measuring what people eat sounds straightforward but is surprisingly complex. And yet, understanding dietary intake is central to advancing nutrition science, improving public health, and shaping government dietary guidelines.

Increasingly, attention is turning not just to what people eat, but how well they eat overall. The concept of diet quality, looking at the overall balance, variety, and healthfulness of the diet has become a cornerstone of nutrition research. It also offers a way to bring together fragmented messages about nutrients, food groups, ultra-processed foods and national guidelines into one meaningful measure. But defining and measuring diet quality is just as tricky as tracking individual foods.

This blog reflects on the practical and scientific challenges of defining, collecting, analysing and interpreting dietary data and reflects on how improvements in methods and technology are shaping the future of dietary data.

Why measuring diet is so difficult

Capturing dietary intake data involves a tangle of practical and methodological problems. First, there’s the human element. People often don’t remember exactly what they ate or may selectively forget. This recall bias is especially tricky with foods eaten on the go or in small amounts. Then there’s social desirability bias. People want to give the “right” answers, especially if being questioned by an actual human (as opposed to filling out a diary or survey). So while a few honest folk might confess to having a chocolate bar for breakfast and a midweek takeaway, many prefer to report kale and quinoa - or at least a committed adherence to the holy ‘five-a-day’ grail. The result? A gap between what people say they eat and reality.

Then there’s the issue of burden. Some methods, like weighed food diaries, ask a lot of participants. Accurately weighing and logging every bite is time-consuming and often tedious. It may even change behaviour just to make recording easier. My own experience some years ago with logging foods through a free and widely used app was that it made me lean towards buying and consuming processed foods that I could just scan the barcode of, rather than cooking from scratch or shoving whatever was in the fridge onto a plate as I usually would. Other methods like food frequency questionnaires (FFQs) and 24-hour recalls try to reduce this burden but come with their own compromises.

Tools of the trade: strengths, weaknesses, and trade-offs

FFQs remain popular in large epidemiological studies because they’re cost-effective and can capture habitual intake over time. However, they rely on memory and a fixed list of foods that might not reflect cultural or personal variation, only capturing, by design, data on what they ask about. 24-hour recalls offer more flexibility and less reliance on long-term memory, especially when conducted with structured prompts like the USDA's multiple-pass method. But they only capture a snapshot in time and one day rarely reflects the whole story. Diaries, whether weighed or estimated, provide rich detail but at a cost. They demand motivation, literacy, and a willingness to record every meal, snack, and nibble without altering usual habits.

Brief screeners, like the US Healthy Eating Index or dietary diversity scores, offer pragmatic options for surveys or interventions. They’re easier to administer and analyse, but they tend to gloss over the nuance of full dietary patterns. And they still face questions of sensitivity and specificity - are they really measuring what matters most for health?

So what is a healthy diet anyway?

Amidst the tangle of dietary data collection challenges, there is the important question of ‘what is a healthy diet’? This is where the idea of diet quality comes in. Rather than counting single nutrients or fixating on particular foods or food groups, diet quality looks at the whole picture: how balanced, varied, and aligned with health guidelines someone’s overall eating pattern is. It’s become a cornerstone of nutrition science and epidemiology, but it’s surprisingly hard to pin down and turn into a clear, usable measure for research.

This also matters for public health messaging. People are bombarded with a range of different messages. We have the NHS Eatwell Guide, the High Fat Salt Sugar (HFSS) advertising restrictions, front-of-pack nutrition labelling, SACN Dietary Reference Values, rising concerns about ‘ultra-processed foods’ - and these don’t always line up. Each of these frameworks is based on different criteria and assumptions; food-based, nutrient-based, processing-based - which can send mixed messages and make public health advice feel inconsistent or overwhelming. Without a consistent definition of what a ‘healthy diet’ looks like, it’s easy to get confused.

That’s why the idea of diet quality is so powerful: it can provide a coherent construct that integrates these strands and translates complex nutritional science into something more intuitive and holistic. But the reality of defining and measuring diet quality is messy. Efforts like the UK-DQQ show promise, offering a simple, food-based screener aligned with national guidance, derived from empirical dietary patterns and validated against both biomarkers (e.g. blood and urine) and nutrient intakes. But even this needs updating as dietary trends evolve and must be validated in diverse population groups.

The trouble with comparing apples to oranges (or diet scores to diet scores)

No universal agreement on how to define a ‘healthy diet’ contributes to variation between studies, making it hard to compare results or synthesise evidence. Some researchers focus on diet quality scores (like HEI), others on dietary diversity, others on adherence to national guidelines or cultural patterns like the Mediterranean diet. These varied definitions mean that two studies can report on ‘diet quality’ but be talking about quite different things.

The Mediterranean Diet Index and its adaptations, such as the relative Mediterranean Diet Score or alternate Mediterranean Diet Score, are widely used in Europe. These scores capture core elements of Mediterranean dietary patterns: a lot of vegetables, pulses, fruits, nuts, olive oil and fish; moderate alcohol drinking; and low amount of red meat and dairy. In countries like Spain, Italy and Greece, these tools have helped characterise regional diets and assess traditional dietary patterns in relation to cardiovascular disease, cancer, and overall death rate.

European examples such as the EPIC cohort (European Prospective Investigation into Cancer and Nutrition) show how differing dietary patterns and assessment methods between countries can complicate analyses. EPIC responded by conducting extra studies to adjust for differences in how diets were measured across countries.

The cost of precision

Gold-standard methods like weighed food diaries or duplicate meals offer unmatched detail, but they’re expensive, burdensome, and often impractical for large groups. Even with trained coders and food composition databases, analysis is slow and complex. Participants may forget to record, misestimate, or change how they eat.

And food diaries only capture a few days raising the question: are those days typical? People might eat differently on weekends, holidays, or when they’re sick. So we need multiple days, and sometimes biomarkers or repeat measures, to estimate what is usual. That’s time and resource intensive. And even then, we must account for people who report eating less than they actually do.

In the UK, the National Diet and Nutrition Survey switched from 7-day weighed diaries to 4-day estimated ones, to computerised 24 hour recall methods. These changes reflect the challenge of balancing accuracy, rigour, realism and resource constraints.

From challenge to opportunity: smarter tools, better insight

The good news? We’re getting better. Digital tools like Intake24, MyFood24 and ASA24 allow self-administered, online 24 hour recalls with built-in prompts, portion images, and food databases. These tools reduce burden and standardise data collection. AI is also being explored for recognising foods from images, helping reduce reliance on memory and self-reporting.

Dietary pattern analysis is also on the rise. Rather than fixating on individual nutrients, researchers are looking at how foods cluster together using tools like principal component analysis. These approaches acknowledge that we eat meals, not molecules and that whole-diet patterns may offer a more stable and interpretable link to people’s health.

What now?

Dietary data collection isn’t perfect and may never be. But it’s getting better. By balancing scientific rigour with practical constraints, and by using emerging technologies and analytic strategies, researchers can produce meaningful insights. Whether it’s via smarter recalls, better biomarkers, or dietary pattern-based analysis, the goal is the same: to understand how what we eat affects our health and how we live. That journey starts with listening carefully, thoughtfully, and with an appreciation for just how tricky it is to answer the simple question: “What did you eat yesterday?”

So the next time you try to recall what you ate yesterday, remember you're not alone - even science is still figuring it out!

This isn’t just about food. It’s about fairness, dignity, and giving communities the tools they need to support themselves

Why Community Food Organisations deserve a place in the Child of the North APPG report

Posted by Andrea Burrows, Dr Claire O’Malley, Dr Helen Moore and Professor Amelia Lake, Fuse researchers from Teesside University

Andrea Burrows, Helen Moore with other contributors at the launch of the report in parliament

Across the North of England, families are facing a dual crisis: rising food insecurity and growing food waste. In response, Community Food Organisations (CFOs) - like social supermarkets and pantries - are stepping up in powerful, community led ways. These aren’t just places to get food. They’re places of dignity, connection, and hope.

But despite their growing role, CFOs are still flying under the radar. They’re under-researched, inconsistently defined, and often left out of the bigger policy picture. That’s why they were included in the Child of the North APPG report.

What is the Child of the North APPG?

The Child of the North All-Party Parliamentary Group (APPG) is a cross-party group of MPs, peers, researchers, and practitioners working together to tackle the deep-rooted inequalities affecting children in the North of England. From poverty and poor health to educational disadvantage, the APPG is committed to finding evidence-based solutions that give every child a fair start in life.

Backed by research from the Northern Health Science Alliance (NHSA), Health Equity North and the N8 Research Partnership, the APPG has already produced influential reports on the cost of living, education, and health. Now, it’s time to shine a light on food, and the role CFOs can play in transforming communities and the lives of children.

A different kind of food support

Unlike traditional food banks, CFOs operate more like supermarkets, offering surplus food at low prices. Often delivered in a familiar, retail-style setting, this model not only reduces food waste but also gives people choice and dignity in how they access food. It’s a far cry from the stigma that can come with emergency food aid.

Research shows that this approach better meets the needs of people experiencing food insecurity. It empowers them, rather than making them feel like recipients of charity.

One model, many faces

CFOs are incredibly diverse. Some are membership-based and serve specific groups; others are open to all. Some offer wraparound support like job training or help with household income; others focus purely on food. This flexibility is a strength, it not only allows CFOs to adapt to local needs, but it also makes it hard to evaluate their impact or share what works best.

"Community Food Organisations... aren’t just places to get food. They're places of dignity, connection, and hope."

A recent review led by by colleague Claire O'Malley (currently under review) found that there’s no single definition of a social supermarket. And many operate informally, relying on local relationships and community goodwill to source food. This makes them agile, but also vulnerable.

Why now?

Since the pandemic, food insecurity has increased, especially in the North. But so too has the rise of CFOs. In the North East and North Cumbria, there are now 67 social supermarkets. In the North East town of Middlesbrough alone, the number of Eco Shops, the dominant social supermarket model, has jumped from nine in 2021 to 28 in 2025.

This growth shows just how much communities value these spaces. But it also raises urgent questions:

• How can we make these models sustainable?
• What support do they need to thrive?
• How do they fit into the bigger picture of public health and food policy?

Why the Child of the North report matters

Including CFOs in the report will:

• Raise national awareness of their role and potential.
• Create shared definitions and standards to help evaluate impact.
• Highlight best practices and support scaling of successful models.
• Ensure CFOs are recognised as part of the wider food and health system - not just a stopgap.

This isn’t just about food. It’s about fairness, dignity, and giving communities the tools they need to support themselves. CFOs are already making a difference. With the right recognition and support, they could transform community support with accessible, socially accessible methods of community aid.

About the authors:

Andrea Burrows is a Research Associate at Teesside University and a Fuse Associate member

Dr Claire O'Malley is a Research Associate at Teesside University and a Fuse Associate member

Helen Moore is an Associate Professor at Teesside University and a Fuse Associate member

Amelia Lake is Professor of Public Health Nutrition at Teesside University, Deputy Director of Fuse, the Centre for Translational Research in Public Health, a dietitian and public health nutritionist.

Understanding the ‘zoppie buzz’ in Teesside

Posted by Hannah Poulter, Teesside University, Visiting Research Associate, University of Bristol

Hannah's post coincides with International Harm Reduction Day, which is observed each year on 7 May and is dedicated to harm reduction approach to drug addiction.

At the conclusion of our research into Heroin Assisted Treatment (HAT) in the North East of England, so many questions remained for me, one of which was: What’s with the zoppie (zopiclone) ‘buzz’ in Teesside?

Teesside gets quite a bad reputation when it comes to drug and alcohol use, which perhaps isn’t surprising when you consider in Middlesbrough you’re more likely to die from a drug related death than a car crash. What we don’t often hear about is the ongoing innovative and groundbreaking work to create solutions to complex problems such as those spanning multiple public budgets - health, justice and social care.

Through our research on HAT we got an insight into the havoc caused by street tablets (such as zopiclone) in Middlesbrough, a story also found in other places within Teesside and further afield. Street tablets are defined as illicitly manufactured prescription-like tablets (that look similar to prescription medication in packaging) bought from illicit sources (street dealers) and used without medical advice.

The prevalence and availability of street tablets here, such as zopiclone, combined with their adverse health consequences and impact on treatment engagement makes a rather toxic combination of risk factors for people who are already vulnerable. I feel empathy for both the marginalised people struggling with their addiction to street tablets (amongst other substances), who felt that there was no feasible offer of treatment for them and the healthcare practitioners tasked to support them, with little advice to draw upon beyond ‘don’t take them’.

While we found there were pockets of great work being undertaken, we also saw that the work wasn’t particularly joined up and that there were lots of gaps in knowledge:

• What was the appeal of zopiclone in Teesside, a seemingly unique feature of the local drug market here?
• What do people who use street tablets think could be done to help improve treatment?
• How could we increase knowledge, collaboration and capacity between local practitioners, academics, people with lived experience and the police to address this public health issue together?

As an Early Career Researcher with a ‘non-standard’ research career (I had a career in business development, research and policy in the housing sector prior to re-entering higher education), I was both confident and daunted by the prospect of leading a project in this area.

Confident because I was sure I could achieve this as I had led on, and been part of many projects focused on collaboration, capacity development and research in the past. Daunted because this was one of the first projects I had led in my own research area as an academic, and I wanted to prove that I was able to do so alongside delivering academic outputs and impact.

I feel proud and relieved now this project is over and am incredibly delighted that we delivered extra value for the funders alongside some solid impactful work in this important area. Here’s a summary of our work:

Engaging people who are often less well represented in research and involving them in the process and co-production of solutions to addressing street tablet use.

One workstream of this project used Community Based Participatory Research with a lived experience researcher, Peter DaSilva from Recovery Connections. With Peter’s knowledge of the local drug market, operating context, and behavioural factors we were able to engage some of the most marginalised people at risk of a drug related death into the research process.

I am so passionate about lived experience recovery organisations and their crucial work using lived experience to engage and retain people in treatment. We have a publication on this currently under review with the Harm Reduction Journal.

Understanding the harms associated with zopiclone use and unique features of the zopiclone market in Teesside.

Several smaller spin off projects have been developed as a result of this grant. We delivered two student projects which involved speaking to healthcare practitioners (HCPs) in Teesside about their perceptions of street tablet usage. I’m currently working with Dr Jenny Scott at the University of Bristol to combine our data with a larger multi-site project on HCP insights, funded by the Economic and Social Research Council. To support the completion of my Stage 2 Doctorate in Health Psychology I’m conducting a rapid review of the existing evidence base on zopiclone. Another paper we have nearly completed is one analysing prescription rates to understand how changes to safe prescription of zopiclone may be associated with the illicit market. Through this portfolio of work we will have a much better understanding of the unique features of the zopiclone market in Teesside.

Developing ways to share information and access better technology within Teesside for real-time testing to help reduce harms and overdose risk for people who use drugs.

Key relationships and mechanisms of information sharing have been built, improved and solidified through this project. Dr Gillian Taylor (Teesside University) has been testing locally seized samples such as zopiclone and pregabalin to improve local knowledge sharing. Gillian and I have worked with Joanne Russell from Public Health South Tees supporting their establishment of the Local Drug Information System in Middlesbrough such as the standard operating procedure. Dr Taylor is now sharing testing information of locally seized samples to supplement local overdose alerts and has a formal relationship with Cleveland Police which she has developed as a result of engaging on this project.

Better knowledge exchange between academics, practitioners, and policy makers locally, regionally and nationally.

Local regional and national connections were key ingredients to this project and have led to knowledge exchange beyond the remits of this funding stream. The connection which has personally stood out for me, has been with the team at University of Bristol, led by Professor Graeme Henderson, Professor Matt Hickman and Dr Jo Kesten. Through engaging with them on this project, I was appointed as Senior Qualitative Researcher within the School of Clinical Epidemiology and Public Health at Bristol between September 2022 and March 2024 on their project: Opioid overdose deaths: Understanding the lethal interactions between benzodiazepines and opioids to develop new harm reduction strategies funded by the Medical Research Council. I have learned so much from working on this project, and from my colleagues, which I hope will lead to other projects in the future. We are currently writing up the outputs from our qualitative work, have presented our findings at the Society for the Study of Addiction conference in 2023 and our team presented our work at the European Conference on Addictive Behaviours and Dependencies in Lisbon in October 2024.

Where next?

Now this project is over, (and following me being on maternity leave for a year), we are working on writing up the key outputs from our work. Our ultimate goal is to improve the offer of care for people who use drugs in Teesside and beyond.

What I’ve learned from this project is that we can only do work of this nature, with the right funding, and right support from senior members of Teesside University and local decision makers. Having the funding to support me to completely dedicate one day a week to capacity building enabled by the Targeting Health Needs grant from NIHR Clinical Research Network, gave me brain space from my busy role within the Evaluation and Impact Team, was transformational. It takes time to create good quality dedicated multidisciplinary and translational research, and often the intangible but important factors in this process such as ‘connection building’ can take the most time.

The Heroin Assisted Treatment (HAT) study was funded by the National Institute of Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC)

Targeting Health Needs project funded by National Institute of Health and Care Research [NIHR] 2022/23 Clinical Research Network (ref: 17969707). 

How our ‘test & learn’ prototypes are strengthening Social Prescribing

Posted by Ang Broadbridge, Head of Implementation at Ways to Wellness, on #SocialPrescribingDay

Evaluation is often something that happens at the end of a project, but what if we built learning into the process from the very start?

At Newcastle-based charity Ways to Wellness, we believe that embedding a culture of learning from the outset helps social prescribing link workers share real-time insights, refine approaches, and ultimately improve support for the communities we serve.

One area where this model has been used is in maternal mental health

Co-designing for impact

A core part of our work is connecting with local communities to shape and refine prototypes that align with our mission:

• Improving health and wellbeing
• Tackling health inequalities
• Reducing demand on NHS services

To ensure our link workers could share learning, develop key messages, and highlight gaps in services, we adopted the Learning Communities model. As described in the Learning Communities Handbook, these are:

"A group of peers who come together in a safe space to reflect and share their judgements and uncertainties about their practice and to share ideas or experiences to collectively improve."

To embed this approach into recruitment and training, we:

• Included an expectation for link workers to actively engage in Learning Communities
• Encouraged participation in ‘test and learn’ approaches
• Provided ongoing support and facilitation to foster a sense of ownership and belonging.

This approach helped link workers collaborate across different host organisations, spanning locations across the North East and North Cumbria.

Extending learning into maternal mental health

One area where this model has been used is in maternal mental health. After eight months of Learning Community meetings, we expanded this approach through a series of external learning events. These events:

• Shared early insights from our maternal mental health prototypes
• Brought in new partners to co-develop next steps
• Strengthened cross-sector collaboration

A key learning was that while social prescribing is well known in GP practices, it was midwives and health visitors who played a crucial role in referring parents to our prototypes - roles that hadn’t previously collaborated with link workers.

By opening up new referral pathways, we helped develop best practices for integrating link workers into maternal healthcare settings.

Turning insights into action

Our Learning Communities aren’t just discussion spaces - they drive change. Link workers use them to:

• Identify barriers in accessing social prescribing
• Test new ways to connect people with support
• Share insights at external events and policy discussions

The impact has been tangible. For example, after testing different approaches, some link workers are now based in health appointment clinics - an innovation that has improved system-wide connectivity and access to services.

Why this approach matters

By embedding a culture of continuous learning, we are:

• Strengthening partnerships across health and care sectors
• Ensuring services are designed with communities, not just for them
• Maximising the impact of social prescribing

At Ways to Wellness, we believe that the voluntary sector, healthcare services, and community organisations must work together to tackle health inequalities.

That’s why we’re committed to testing, learning, and adapting - so that social prescribing continues to evolve, improve, and reach the people who need it most.

Find out more at: waystowellness.org.uk

Image credits: Ways to Wellness Limited company number: 08798423

Bringing dietetics into Public Health

Posted by Alex O'Connor-Sherlock, MSc Dietetic student, Teesside University.

Introduction by Steph Sloan, Senior Lecturer in Dietetics and Course Leader MSc Dietetics at Teesside University.

Practice-based learning (PBL) is a key part of dietetic training, with students required to complete 1,000 hours of hands-on experience in a practice setting. Traditionally, this has mostly taken place in NHS settings, with students working one-on-one with supervisors. However, as healthcare demands grow, diversifying placement opportunities is becoming increasingly important - not just to support student learning, but also to strengthen public health initiatives.

Suited and booted to present to a factory workforce

The Allied Health Professions (AHP) Strategy for England highlights the role of AHPs in disease prevention and health promotion, helping to reduce the burden on already stretched health and social care services. Diet-related diseases remain a major public health challenge, yet dietetic care is still largely focused on treatment rather than prevention. If the profession is to play a greater role in supporting population health, then equipping students with strong public health knowledge and skills is crucial.

To support this, Teesside University’s MSc Dietetics programme now includes public health placements alongside traditional NHS clinical placements. Here, Alex shares her experience of working in a Public Health practice-based learning setting. A must read in National Careers Week for anyone considering a future career as a dietitian!

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What I worked on

During my placement, I was involved in three projects focused on health improvement and disease prevention. My work involved meeting with stakeholders, conducting research, presenting findings, and engaging with the public. The projects covered a wide range of population groups, including expectant mothers, school-age children, local workforces, and food bank users.

1. Supporting parents with child nutrition

A key part of my placement involved reviewing the nutrition education available to parents of children aged six months to four years.

What I did:

• Conducted a literature and policy review
• Spoke to parents, NHS staff, and school representatives
• Attended a breastfeeding class to hear directly from parents
• Presented my findings to several teams, including the Director of Public Health

Why it matters:

The insights from this work will help shape future research and improve nutrition support for families in the local area.

2. Linking oral health and nutrition

There is a strong connection between what we eat and oral health, but not everyone has access to clear, easy-to-understand information about this link.

What I created:

• Infographics and presentations to educate local workforces
• Materials designed in an easy-read format, avoiding jargon

Why it matters: 

My presentation was really well received, and I was even asked to record it for wider distribution, so it could be shared with professionals working with children and people with additional needs.

 

Infographics to educate local workforces

3. Reducing food waste in a local food pantry

Many food pantry users rely on short-dated products, and without clear guidance, a lot of good food can go to waste.

What I did:

• Designed simple, visual signs with food storage and cooking tips (e.g. "Chop me then freeze me")
• Introduced a ‘Freeze me’ sign for bread and monitored its impact

What happened?

Twice as much bread was sold the day after the sign was put up compared to the previous two weeks combined!

Signs made to reduce food waste

What I learned

• Public health plays a key role in patient care - I saw first-hand how wider social factors impact people’s ability to manage their health and access services.
• Being proactive is crucial - I reached out to stakeholders independently, which helped me build confidence and leadership skills.
• Flexibility is a great learning experience - managing my own projects and working in a less structured environment improved my time management and adaptability.
• Self-care matters - the flexibility of this placement meant I could work in different settings, including from the park on sunny days!

Final thoughts

Introducing dietetic placements into public health settings is a win-win. It helps students gain a broader skillset, supports NHS capacity, and brings dietetic expertise into community settings.

Of course, doing things differently comes with challenges. Expanding placements into public health settings has required commitment from everyone involved - academics, placement providers, and students. But we’re constantly learning and improving, and we’re proud to be making a real impact on the health of our local communities.