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.

Sparking curiosity with Twinkle, Twinkle Arti

Posted by Nicola Aldridge, Research Associate, and Cassey Muir, Research Associate / Co-lead of the Fuse Early Life and Adolescence Research Cluster, both from Newcastle University

We were recently given the exciting opportunity to showcase the Twinkle, Twinkle Arti project at Discover Festival, a free, one-day festival organised by Newcastle University that brings together families, communities, and researchers through interactive activities and inspiring ideas.

Nicola and Cassey

Discover Festival is designed to spark curiosity, build connections, and encourage people of all ages to explore new ideas. Each year, the university creates a packed programme of family-friendly events, and this year, we were delighted to be part of it as members of the Twinkle, Twinkle Arti research team.

Bringing Arti's story to life

Throughout the day, we invited families to step into Arti’s world through the Twinkle, Twinkle Arti storybook. Developed by Fuse researchers at Newcastle University, with funding from the NIHR School for Public Health Research, the book was created and co-produced with families to support the wellbeing of children experiencing challenging family circumstances, such as drug and alcohol use. While these experiences inspired the story, its themes of feelings, belonging, resilience, and hope resonate with all children.

Visitors to our stall in the Great North Museum had the chance to watch a CBeebies Bedtime Stories style video of it being read aloud by the author. They could also explore puppets and original illustrations from the book, and view artwork created by primary school-aged children who had participated in a pilot study of classroom lessons based on the story.

Families were also able to take home a free copy of the storybook, along with a link to the online read-aloud video and a set of simple conversation prompts designed to encourage creativity, emotional expression, and meaningful family time at home. We handed out nearly 80 copies on the day!

Conversations that matter

Beyond engaging with families, it was equally exciting to see the conversations that the project sparked among professionals attending the festival. We spoke with people from a range of sectors, including teaching, school governance, clinical psychology, and general practice with social prescribing links. Their curiosity about the project and enthusiasm for its potential applications highlighted the broad relevance of Twinkle, Twinkle Arti and the importance of creating accessible resources that support children's emotional and social wellbeing.

One particularly rewarding conversation was with a family who shared their personal experience of the impact of alcohol on family life and how they might be able to use the book. Hearing their reflections was both moving and affirming. It served as a powerful reminder of why the project began in the first place and reinforced the continued need for resources that help children navigate difficult experiences. Moments like these bring the research to life, reminding us that behind every study, storybook, and activity are real families whose experiences matter and whose voices continue to shape our work.

Creating a community star mural

Another highlight of the day was our evolving community star mural. We invited children to create their own star by drawing, colouring, or writing ideas about what they or Arti could do when they felt sad or worried, with 114 stars being created on the day. It was wonderful to see children enthusiastically embracing the activity, and even more special to watch parents, carers and grandparents join in too, talking to their children about the messages in the book. The excitement on their faces as they added their stars to the mural was a lovely reminder of the power of creativity to bring people together.

A colourful celebration of hope and resilience

By the end of the day, the mural had grown into a colourful display of hope, kindness, and imagination. It was a privilege to share the Twinkle, Twinkle Arti project with so many families and to see first-hand how children connected with Arti’s story and messages of hope, resilience and belonging. Events like Discover Festival provide a fantastic opportunity to bring research into the community, and we were grateful to be part of such an inspiring day.

Find out more about Twinkle, Twinkle Arti

• Read this Fuse blog about the development of Twinkle, Twinkle Arti
• Read about Twinkle, Twinkle Arti as a NIHR School for Public Health Research (SPHR) case study
• Read about piloting Twinkle, Twinkle Arti in primary schools
• Listen to this Fuse podcast to hear Cassey discussing her research on social and emotional resilience in children and young people affected by parental substance use.
• Download the book for free.
• Watch a video of the book being read aloud.

Going beyond bricks and mortar to 'Up' awareness of healthy homes

Posted by Natalie Forster, Philip Hodgson, and Alex Kirton from Northumbria University

“It’s just a house”. Words famously uttered by Mr Fredricksen in the much-loved film, ‘Up’. But does this really do justice to the complicated relationships we have with our homes?

There’s a steady stream of evidence now showing that housing characteristics (including issues like overcrowding, poor insulation, damp and mould) can impact on physical and mental health. And far from being just a house, we know that where you live can make a big difference to how socially connected you are, the services you can access and how safe you feel.

This increasing awareness of home as a social determinant of health has led to many local authorities introducing initiatives to address housing-related issues. Yet, evaluations often look at the effects of specific housing enhancements in isolation, and more understanding is needed of how healthy homes services can tackle housing issues in their widest sense.

The Healthy Homes service in South Tyneside is an advice and signposting-based service that aims to address people’s home-related health needs. As Fuse researchers we set out to explore its benefits for residents. We worked with the service to create a data collection tool to help capture the financial benefits of advice given, alongside interviews to explore the experiences of those who used the service.

So, what did we find?

Our analysis showed that the service was reaching people with multiple and complex housing needs, including those related to health conditions, low income and age. We found the personalised approach taken by the service to be especially successful in engaging proactively with older homeowners (like Mr Fredricksen!) who often presumed they wouldn’t qualify for housing improvements, didn’t want to be seen to be asking for help or didn’t want to lose their independence. And without this support they would have otherwise put off seeking help until a crisis hit.

Some participants were keen to swap their bricks and mortar entirely and relocate to a more suitable home or area. For others, longstanding and deep psychological connections to homes and areas meant a move would be too painful. In these circumstances, changes to home environments made through the service (like getting extra bannisters or a stairlift, and support to address cold, damp and mould) helped reduce worries about housing problems and avoided the need for unsuitable coping strategies like coming down the stairs backwards. Participants described how small housing modifications – even getting a different lightbulb when you’re worried about your electricity bills – made a difference both practically and emotionally, helping them resume ordinary and taken-for-granted aspects of life like going to bed upstairs with your partner. Yet, for many, the service also worked on a different level, with the face-to-face interaction and warm and friendly manner of staff helping people feel heard and cared for.

Ultimately, the project illuminates the complex and varied issues and feelings people have around their homes. It underscores the importance of services which see beyond the bricks and mortar of houses and consider the importance of people’s “homes”, such as those offered by South Tyneside Council, but also the crucial role that other (non-home focused) services can play in addressing the interactions between homes, health and wellbeing. Many people we spoke to were unsure of what support they are entitled to and so there’s a need to raise awareness and take up of healthy home enhancements before problems escalate. Finally, both the stories of our participants and Mr Fredricksen demonstrate how our relationships toward our homes can shift and change over time, highlighting a need for long-term and sustainable models of housing care and support.

Natalie Forster, Assistant Professor, Social Work, Education and Community Wellbeing, Northumbria University and co-lead of the Fuse Health Inequalities Research Cluster

Philip Hodgson, Assistant Professor, Nursing, Midwifery and Health, Northumbria University

Alex Kirton, Research Fellow, Northumbria University

Image by Pascal Laurent from Pixabay

Part-time work can be a game changer for families and a smart strategy for organisations

Posted by Belinda Morgan, flexible work expert & author; Amelia Lake and Helen Moore, researchers from Fuse at Teesside University

Part-time work has the potential to change lives. Done well, it can drive hugely positive outcomes for individuals, families and society. But its potential isn’t widely understood, so part-time work still sits largely on the sidelines of organisational strategy – under-rated and under-utilised.

And even organisations who are leading the way with the accessibility and implementation of part-time work, are rarely doing it well at all levels. It’s still very uncommon to see senior leaders working part-time.

Amelia Lake, Fuse Associate Director, and Helen Moore, Fuse Associate, at Teesside University are bucking this trend. Both work in senior level roles in public health research, leading teams and both work part-time.

Amelia and Helen were two of the senior leaders I interviewed when writing my book Solving the Part-Time Puzzle: How to decrease your hours, increase your impact, and thrive in your part-time role. They shared their stories about how they make their part-time arrangements work, and the benefits they experience from working in this way.

Helen Moore (left) and Amelia Lake (right) both work part-time in public health research

Amelia said, “When I first started working at Teesside University, I would frequently get asked what was my ‘side hustle’ when I wasn’t at work and people were surprised to hear that I was doing family activities with my (then) young children. While I appreciate working part-time is a privilege, it allows me a better work-life balance and time with my children.

“During the pandemic, and post-pandemic, childcare has been difficult to access, and being part-time means some days of the week can be less stressful in terms of childcare. Working part-time means I work even more collaboratively with colleagues as their support when I am not at work is important. It can be hard to switch off emails and alerts on non-working days, and I don’t always do it, but I know it is important.”

Helen said, “It was, and is, important for me, as the primary carer of young children (I have two sets of twins) with a husband who works away in the Merchant Navy, to be able to have some flexibility around when and how I work. This supports me in being able to take them to, and pick them up from, school several days of the week, and to not have to rely all of the time on either family help (which can feel like an imposition) or paid childcare (which is both expensive and difficult to find when you have four children).”

So why is it so rare to see senior leaders working part-time? Largely because there’s an embedded belief that senior leadership roles are the most challenging to do part-time. Many people will tell you it’s impossible – and that it’s not even worth attempting.

Stories of leaders like Amelia and Helen are hugely important, because we badly need more senior leaders leading the way and working part-time. When senior leaders do so it demonstrates to others that part-time work is acceptable and encouraged, and that it’s possible to keep growing a career while working part-time.

The individual and family wellbeing benefits are quite clear, and should be reason enough for organisations to start creating more part-time work opportunities. But the reality is that more encouragement may be required.

The good news is that there are some other big reasons for organisations to get on board with this.

A clear and highly relevant advantage for employers is talent attraction and retention. In the context of the ‘great resignation’ of 2022 this is a critical consideration for organisations looking to find creative ways to solve the talent shortage.

Firstly, it allows employers to retain their talented people who reach a point where they want or need to work part-time.

In Amelia’s words, “We need to see more people in leadership roles working part-time. I was promoted to Professor in my part-time working pattern which illustrates that it is possible to do high quality impactful work building capacity and also doing research, while working part-time. Teesside University has both promoted me and supported me in my part-time role.”

It also enables employers to tap into a hidden talent pool of highly qualified people who either can’t or choose not to work full-time. They include people with caring responsibilities, people with health issues, and people at retirement age who would stay in the workforce longer if given the opportunity to work part-time.

Helen said, “I strongly believe that working part-time doesn’t equate to a reduction in performance, and that it is demonstrated by my promotion to Associate Professor and being one of two Teesside University Star Award Research Excellence finalists in 2021.

“Being supported by Teesside University to work part-time in a senior role enables me to both lead the work of the University’s successful Evaluation and Impact Team, and to be able to be present and care for my four children.

“Having managers who were willing to try something new, even take a risk, and recruit a person to work part-time hours to establish and lead a new team has paid off and worked well – it has enabled me to grow significantly as both a researcher and a research leader.

“Roles similar to mine which I have previously considered, have been strictly full-time hours only, and did not feel open to someone with other commitments like me. There are a lot of talented people who for various reasons would like to work less than full-time hours, and I’m hopeful that my experience shows it is possible.”

This is also, of course, about inclusion. The consulting firm Timewise warns that if a company’s diversity, equity and inclusion (DEI) programmes aren’t underpinned by a commitment to flexible working that includes part-time, they will struggle to be fully inclusive. 'This will not only have a negative impact on their gender pay gap, but is also likely to impact their employer brand'

As well as the talent related benefits, there are also productivity benefits to be reaped by organisations who are willing to introduce more part-time roles. Organisation for Economic Co-operation and Development (OECD) data confirms that productivity (defined as output per working hour) improves with shorter hours. Across the world’s richest countries, higher productivity correlates with lower working hours.

The power and potential of part-time work really is huge. It can be a game changer for families and a smart people strategy for organisations.

Belinda Morgan is a flexible work expert and author of the new book Solving the Part-Time Puzzle: How to decrease your hours, increase your impact, and thrive in your part-time role

Planning for a healthier future?

Posted by Tim Townshend, Professor of Urban Design for Health, Newcastle University

Can we plan for a healthier future by intervening in the built environment? You may be surprised to find out this is not a new idea! Indeed, the very concept of Town Planning emerged in the last quarter of the 19^th Century out of a concern for public health and to help prevent the spread of infectious diseases such as cholera.

Ebeneezer Howard - ‘slumless, smokeless’ garden cities

The resulting Victorian terraces, with fresh water supplies and internal toilets may seem unimaginative, but they were a huge improvement on what went before - and did indeed prove a boon to public health. What’s more many still provide decent homes today.

Early planning thinking was also dominated by a vision that the physical health attributes of the countryside – access to open space, clean air and fresh food could be combined with social and economic (mental health) benefits of the city – including opportunities for education, access to culture and wider social contacts. Such thinking is typified by the Garden City Movement associated with Ebenezer Howard and realised - at least in part - in towns such as Letchworth in, Hertfordshire.

Health was at the core of planning for much of the 20^th century, however, in the post-war period it became eclipsed by other issues - particularly the need for economic regeneration. Consequently, the health and well-being impacts of the way our towns and cities were developing was not considered carefully enough.

“...primarily designing around the needs of the private car - rather than humans - has been a disaster.”

In retrospect, primarily designing around the needs of the private car - rather than humans - has been a disaster.  Busy roads now cut noisy polluted swathes through communities; poorer neighbourhoods find themselves served by ‘toxic high streets’ – a deadly mix of nutritionally poor food, subprime financial services, betting shops and other potentially harmful outlets; and vast tracts of poor-quality new build housing - devoid of adequate open space, or local services - have been constructed in the suburbs.  At the same time rates of obesity (and associated health/well-being consequences), respiratory and so-called ‘lifestyle’ diseases have all soared. Moreover, these impacts are not felt equally across all neighbourhoods, and health inequalities unjustly burden the poorest in society.   

 Interlinked themes explored in Healthy Cities? Design for Well-being

It does not have to be this way, however. We can plan for a healthier future and create places that support individuals and communities to take healthier lifestyle choices. In ‘Healthy Cities? Design for Well-being’ I explore five inter-related topics and the ways in which the goal of a healthier future can be achieved.

There is for example a large and robust evidence base around our need for urban greenspace (as was highlighted so graphically during the COVID-19 lockdown period). Green (and blue) spaces in our cities not only facilitate physical activity and socialisation (positive for physical health and mental well-being) but can mitigate against issues such as, air and noise pollution, ‘heat islands’ (the significant heat increases in urban areas as compared to their surroundings) and alleviate flood risk. Crucially, however, greenspaces have also been shown to reduce stress levels and help restore cognitive capabilities - for example concentration levels - just by being there.  

Planning policies can also be used in conjunction with public health goals to tackle specific health issues. A great example of this, is the development of planning guidance and regulation to tackle the further spread of hot food takeaways – a key component of my ‘toxic high street’ concept, which I explore in more detail in the book.  While planning cannot tackle existing businesses it can limit further spread, especially in sensitive areas – for example near schools, as research has proven the link between hot food availability and overweight/obesity in older children. Issues we will explore at the Fuse Research Programme Meeting “Planning for a healthier future: Priorities and Practicalities” on May 18, 2022, at Teesside University (and available online).

Therefore by encouraging those aspects of the built environment that support healthy lifestyle choices, while constraining those aspects we know are linked with less healthy lives, healthier places are within our grasp – but this can only be achieved if we collaborate across disciplines and garner the political support required to make it happen!

Healthy Cities? Design for Well-being is available to order now

Image:

1. Howard, Ebenezer. "Diagram of a group of slumless smokeless cities.". 1898. From Ebenezer Howard, "To-morrow: A Peaceful Path to Real Reform" [London, 1898]. https://www.aaeportal.com?id=40518. Web. 12 May. 2022.

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

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

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

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

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

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

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

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

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

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

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

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

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

Can Forest School inspire the next generation to be happy & healthy?

Posted by Katie Beresford, undergraduate student, Durham University

Katie completed a 6-week NIHR School for Public Health Research (SPHR) internship with Fuse based at Durham University in summer 2021. She was supervised by Fuse / NIHR SPHR PhD student, Sophie Phillips.

Richard Louv, in his book Last Child in the Woods, theorises that lack of connection to nature is causing a plethora of health problems in children. Can reconnecting children to the natural world provide a holistic solution to health and developmental issues?

Growing up in the Lake District, I spent my childhood climbing trees, swimming in rivers, and making mud pies. Embracing nature and enjoying letting my imagination reshape the world around me was part of my everyday life. In contrast, I found school restrictive and struggled academically in my early years – often being described as a ‘late developer’.

While completing my NIHR SPHR summer internship within Fuse, I reviewed literature discussing the effectiveness of Forest School as a public health intervention. One article titled: The hare and the tortoise go to Forest School: Taking the scenic route to academic attainment via emotional wellbeing outdoors struck me as similar to my own story, describing how children considered ‘behind’ their peers could catch up, like the tortoise in Aesop's fable. Now nearly two decades later and about to go into my final undergraduate year at University, I truly believe in the power of the outdoors to inspire children to be curious and healthy individuals.

Forest School is a child-led educational practice, whereby children spend time in a Forest or woodland under the guidance of a trained Forest School practitioner. The ethos and philosophy of Forest School is based on a rich heritage of outdoor learning. This ranges from whole movements such as the romantic movement, which exalted the sublimeness of nature as a push-back against the industrial revolution, to the work of individuals such as the great educationalists like Steiner and Montessori. However, the concept of ‘Forest School’ emerged originally from Scandinavia, where in many cases children spend their entire early years education playing outdoors.

The practice developed in the UK in the early 1990s and is ubiquitous across the country today. Although much of the practice in the UK places emphasis on freedom and play, often activities are incorporated into the sessions designed to connect the children to the natural world. Forest School aims to be beneficial for the holistic development of children, offering a wide range of social, emotional, cognitive, and physical benefits.

My summer internship consisted of writing up a literature review which drew on both the current research on Forest School and the thoughts of practitioners and stakeholders in the field. I considered both the effectiveness of Forest School on the health and development of children and the accessibility of the programme.

Due to its rapid growth, there is still much work to be done on improving the evidence base for Forest School, but in general there is huge enthusiasm from researchers and practitioners alike on the effectiveness of the practice. Forest school appears to equip children with social skills such as teamwork and collaboration; emotional skills such as resilience and self-esteem and cognitive skills like problem solving. There is evidence that it also increases children’s levels of physical activity and improves their appreciation of nature.

But, perhaps the most striking finding was that Forest School not only had an impact during the session itself, but long after the children stopped attending the Forest School. Through the pure enjoyment of being outside and not bound up by the norms of classroom behaviour, the children were inspired to be curious about the world around them. They started asking questions and thinking creatively and collaboratively.

Taking the scenic route to academic attainment

Some studies found that through attending Forest School, children who were academically behind their classmates caught up to a similar level of academic attainment since their interest in learning had increased. Forest School impacted children’s overall wellbeing, as it encouraged them that physical activity and spending time in the outdoors could be fun and rewarding. The children were therefore more likely to want to exercise and complete similar activities to Forest School in their own time – asking parents to take them to local natural spaces after school and at the weekend. Conversations with practitioners showed that this was pivotal to challenging the cultural lifestyle of families, especially in more deprived areas, improving perceptions of what it means to be healthy.

In a changing world, where children spend far less time outside as a result of factors like the increase of technology and availability of entertainment, Forest School offers an innovative and holistic approach to reconnecting children with nature. Through this, we can hope to inspire the next generation to be the curious, positive, and healthy individuals of tomorrow.

This project was funded and supported by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR), Grant Reference Number PD-SPH-2015. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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.

Images:

1. Photo by Markus Spiske on Unsplash
2. The Tortoise and the Hare. From Childhood's Favorites and Fairy Stories, by Various. Project Gutenberg etext 19993 http://www.gutenberg.org/etext/19993. From Wikimedia Commons: https://commons.wikimedia.org/wiki/File:The_Tortoise_and_the_Hare_-_Project_Gutenberg_etext_19993.jpg

“Next slide, please!” Newcastle children’s reflections on the pandemic

 Posted by Laura Basterfield, Research Associate, Newcastle University

Often in research, once we’ve collected the data, analysed and published it, we don’t have the opportunity to go back to the participants to discuss what we found. When children are involved, we may give a feedback presentation at a school assembly, but let’s be honest it can be difficult to make Powerpoint fun!

I’ve worked closely with Walkergate Community School over the last few years on my research into children’s physical fitness and mental wellbeing and I wanted to deliver my feedback in an assembly that the children would enjoy. I thought the best way to do that might be to let them do it themselves, as who knows what children like better than other children? And I am so pleased I did; it was a fascinating process. 

The ‘Young Science Communicators’ project was due to have taken place in June/July 2020, but had been delayed due to the COVID-19 school closures. Whilst I was initially disappointed last year, the realities of the past 12 months brought an added dimension, intensity and poignancy that would not have been there otherwise.  

There weren’t many rules, but the assembly should include some of the results of the study, including both the physical and mental benefits of physical fitness and activity. Other than that I was happy for the children to take the assembly wherever they saw fit. To start, thirteen Year 6 pupils (aged 10-11 years) discussed with me the project specifically, fitness in general, and about the impact the COVID-19 lockdowns and school closures had on them and their families. Then I taught the children some of the key skills they would need to do my research. I wanted them to really understand why I do what I do, and what better way than to then practice on your friends?! There were some wonderful comments from the children about how they liked the experience: “I enjoyed it because I want to do your job when I’m older” and “I liked being in control!” (which must be quite unfamiliar at 11 years old), and they quickly learned both the techniques and how to talk politely to their class-mates! 

The following week it was over to the children and their ideas. The goal was for them to create an assembly, film their performance, and share it with the rest of the school – all within three days. Scott and Claire are practitioners with local theatre company Mortal Fools and they led the children on a games-based journey to increase their confidence, public speaking and team-working skills. The children were all totally engaged and willing to share their thoughts, feelings and experiences to create a collegiate and supportive atmosphere. For me as an observer at this point, I was struck by the children’s recreations of the school closure periods and how they articulated their feelings: “I had no motivation to do anything”, “I was lonely”, “frustrated”, “isolated”. This was especially the case for those without their own mobile phone – some were unable to speak to friends for weeks. They also showed a mature insight into how the adults in their life had been affected, acting out money worries, family health issues, the stress of getting children to do schoolwork and go to bed on time, when there was nothing to get up for the next day…

As the group moved on to the awkwardness of meeting up with people after such a long time “Errr… so have you been up to much?!”, to their joy and excitement of seeing family, friends and teachers again, the whole process felt reflective and cathartic. Claire and Scott’s skill was evident as the children’s confidence grew before my eyes. Along the way the children had us in stitches with impressions of Boris Johnson, ‘next slide please’, and Joe Wicks.

Finally, they got to film their creation with the help of a proper film-maker. Most scenes only took a couple of takes, and the children showed incredible focus and concentration throughout. The final co-produced 9-minute film is informative, funny and affecting, and the children should be incredibly proud of their efforts. We still weren’t able to completely escape COVID, as three children missed the filming day due to a positive case in their class, but their input on the previous days made it a true team effort. 

The process showed me how important it is that we involve children not just in our research but in everything that affects them – simply asking children how they are, what they are feeling, and what they would like to be involved in gives us a hugely important insight into their world. 

I hope you enjoy their film.

Thanks go to all the children and staff at Walkergate Community School; Scott Wilson, Clare Rimington and Helen Ferguson at Mortal Fools, and Matt Jamie the film-maker. Permission to share this film has been granted by the parents and school of the children involved. 

Funding from EngageFMS at Newcastle University supported this project. 

Originally written for VOICE.

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

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

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

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

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

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

Sir Isaiah Berlin 

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

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

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

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

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

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

Images:

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

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

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

Can putting distinct services under one roof prevent mental illness? We (cold) called in the experts to find out

In today's Fuse blog post, Fiona Duncan, Postdoctoral Research Associate from Durham University, writes about co-locating services to improve mental health and the perils of pulling together an expert panel during a pandemic. 

'Cold Calling' by Darren Tennant

This past year has been tough for many of us.  Financial worries, feeling socially isolated and lonely, facing unemployment, and missing opportunities for physical activity are just some of the things that have impacted on mental health and wellbeing during the pandemic.  This means that finding ways to improve mental health and prevent mental illness in our communities is more important than ever.

Over the past few months, I have been working on a NIHR School for Public Health Research (SPHR) project which aims to investigate how “co-located” services based in the community can be used to promote wellbeing.  A co-located service is where two or more distinct services are in the same physical space and the staff of each service interact with each other, either formally or informally.  Co-located services are often found within traditional health services like GP practices when welfare, legal and/or mental health services are delivered in the same building.  The project will investigate the benefits and disadvantages of co-locating in community spaces, rather than within traditional health services.  For example, a debt service within a faith institution, a welfare service in a library, a mental health support service in a sports centre, or a money advice service within a foodbank.  We are interested in finding out exactly how co-location helps to improve mental health and whether they work for all people in all circumstances, or just some people in certain circumstances. For instance, does co-location increase access, reduce stigma, or encourage a higher quality of service by allowing professionals to work together better?

To start this research, I was given the task of setting up and facilitating an expert panel workshop. The idea being that if we want to gain a deep understanding of how co-located services may or may not work then we should ask the people who actually design, fund or deliver these services in the real world.  We hoped that this workshop would consist of service practitioners, policy-makers, and commissioners at local authorities and people who work for organisations that provide funding for community projects. 

My first challenge in setting up the workshop was getting people to take part.  Where was I going to find these experts and would they be able to give up two hours of their time in the middle of a pandemic?  I was planning on the workshop being small (5-8 people) but, in the circumstances, I realised that I was probably going to have to ask a lot of experts to even hit this target!

I used a variety of approaches to find my experts.  I asked members of the wider research team to email any suitable contacts, we approached the other NIHR Schools and we advertised the study on twitter.  I also personally contacted some people that had participated in a previous research project and my colleague, Dr Emily Oliver from Durham University, mentioned the workshop during a webinar at which she was presenting. Through these methods, three experts signed up.  To get a few more people, I then started to ‘cold call’ potentially suitable people and organisations, including almost 40 local authority Directors of Public Health in England.  Despite the pressures that this group of people are currently under due to COVID, this ‘cold calling’ led to three more people agreeing to attend.

Having six people confirmed still felt like a very precarious position to be in, and it turned out that I was right to be nervous, as one person unfortunately had to pull out on the morning of the workshop. However, luck was on my side as at the last minute another expert who had found out about the workshop from a colleague at one of the organisations I had contacted, asked if they could come along.  Panic over!

Selfridges

The nerves kicked in again at the start of the event, as I had never facilitated a Zoom workshop before and it was clear that some of our experts were feeling nervous too.  This could have been a problem as we wanted them to freely and openly talk about the benefits and disadvantages of co-located services.  Luckily, Gillian Samuel, a member of our research team from the McPin Foundation, was able to facilitate a brilliant icebreaker exercise.  She asked everyone to talk about something that we all had in common, specifically, what we are looking forward to most when lockdown ends?  Everyone had some great answers to this question (the re-opening of Selfridges was my personal favourite answer) and this made for a more relaxed atmosphere.

This almost certainly helped the workshop discussions flow as our experts provided rich and detailed information about co-located services.  However, in some ways the workshop did not go as I had expected.  I thought the experts would talk about the benefits of their co-located services and the mechanisms involved in how these services work. I had prepared a long list of questions to prompt such a conversation, but it soon became clear that the panel had a lot to say about how co-located services quite often don’t work.  They were all clearly very passionate about what they do but expressed frustrations surrounding service delivery.  One theme to emerge was that co-located services are dependent on different types of professional working together, but the reality is that they often don’t communicate well with each other at all.

Although I wasn’t expecting the panel to say these things, I’m glad they did.  It helps us to understand how co-located services are working, or not, and is very important if we want to improve services and therefore improve mental health and prevent mental illness in our communities. This information will also be very helpful in the next part of our study where we will be interviewing people who work at and use selected co-located services.

Fiona works on the NIHR School for Public Health Research (SPHR) Public mental health programme through Fuse's membership of the School.

Images:

1. 'Cold Calling' by Darren Tennant via Flickr.com, copyright © 2014 (Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0)): https://www.flickr.com/photos/10678076@N03/16001016758

"Whatever their answer, double it and you should be close..."

Posted by Hannah Mehmood, Medical Student, Newcastle University

Hannah undertook a 6-week NIHR School for Public Health Research (SPHR) internship with Fuse based at Newcastle University in summer 2020. She was supervised by Fuse / NIHR SPHR Doctoral Student, Cassey Muir.

A question asked in every GP consultation is how much alcohol a patient drinks. It provides a useful insight into a person’s physical, social, and psychological health. According to my GP tutor, most people underestimate the amount they drink, as well as the impact this has on them.

Substance misuse is a complex issue, and as a medical student I have learned to focus on the impact of problematic drug and alcohol use on individual patient wellbeing. Last summer, as an NIHR SPHR intern, I studied substance misuse from a different perspective. The basis of my internship was a research project focusing on young people whose parents misuse drugs and alcohol. I aimed to explore how young people viewed school and education to understand if this environment could be used to deliver supportive interventions.

I analysed ten UK based qualitative studies which examined the experiences of young people affected by parental substance misuse. Qualitative studies examine non-statistical data to develop themes and deep understanding of the research question. The young people from the studies I explored were under the age of 25 and from various social, economic and demographic groups.

Young people viewed school as a space away
 from issues they may face at home

I was particularly interested in the ways in which young people viewed school as a separate space away from issues they may face at home, to the extent that many young people did not even discuss their home life with close friends. But despite the mental separation of home and school, the reality of their home life often prevented a complete detachment of the two. One young person described how caring for her parent resulted in frequently missing school, while another recognised that his aggressive behaviour in school was a way to offload stress at home.

Many young people also expressed a lack of trust towards their place of education, as well as a desire to blend-in with their peers. This contributes to barriers in identifying young people who may benefit from intervention, as many are fearful of being singled out while in the detached school environment.

In conducting my research, I came to appreciate the difficulty in generating themes from such varied experiences. I often felt that my insights did not do justice to the nuances of each individual story. I discussed this in a virtual meeting with a programme coordinator at ADFAM, a national charity that works with families affected by drugs and alcohol. Her experience, delivering interventions at an operational level, allowed me to see how my research fit into the real world. I came to understand that while research is conducted with the aim of applying findings to whole populations, these findings are only actionable when combined with existing knowledge and expertise. This discussion was a lesson in the value of cross-collaboration, an important tool in bridging the gap between research and intervention.

Over six weeks I have broadened my understanding of public health, conducted my own research project, developed my professional skills, and furthered my personal career goals. Although this internship took place remotely, my mentors enabled me to virtually meet various public health professionals. Hearing about their research roles, motivation and future plans has shown me the variety of career paths available within public health and helped to develop my own ambitions. The NIHR SPHR internship with Fuse has been a valuable personal and professional experience and I would recommend it to other students interested in pursuing a career in public health.

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.

Images:

1. 'Doctor with prescription stop drinking alcohol' by Marco Verch Professional Photographer via Flickr.com, copyright © 2019 (Attribution 2.0 Generic (CC BY 2.0)): https://m.flickr.com/photos/30478819@N08/48719845996

3. Logo courtesy of ADFAM https://twitter.com/AdfamUK/photo