Two cheap ways councils can fight health inequality

By Clare Bambra, Durham University and Danny Dorling, University of Oxford

In the UK today, there are sizeable inequalities in health – and sometimes that gap isn’t just about north versus south. In Stockton Tees in the north-east of England, for example, there’s a 15-year gap in life expectancy between the least and most deprived areas. In London, the gap between such areas is nearly 25 years; and there is a five-year gap between the 10 tube stops between Westminster and Canning Town on the Jubilee Line. Glasgow has an infamous 28-year gap in life expectancy across the city.

It’s clear that the problem isn’t just national but local. And the British Academy has just launched a collection of opinion pieces from leading social scientists with ideas on what councils could do to reduce these inequalities, based on the evidence. They come in the wake of Michael Marmot’s 2010 review into the scale of the problem in England, where people with a better education, a higher income, or a better occupation, experience better health and a longer life.

A US analysis of things that most influence health suggest our physical environment counts for about 10%, clincial care (for example hospital treatment) 20% and health behaviour such as smoking and diet accounted for 30%. But the biggest influence on our health was socioeconomic factors at 40% – these of course also influence health behaviour.

The government has suggested local authorities are best placed to influence these factors. But local authorities have limited powers and are also being subjected to large (up to 50%) budget cuts. So what can they still do?

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Claire Bambra: tackle health-related worklessness

Reducing worklessness has had a high profile, but previous policies have failed because they’ve largely ignored the root cause – ill health.

There is a strong relationship between ill health and unemployment and  one of the key drivers of health inequality is health-related worklessness. We know that being sick or disabled greatly reduces an individual’s employment prospects – the employment rates of people with a disability or chronic illness in the UK are around 40% compared to 70% for those with good health.

But being out of work also results in poorer health and health-related job loss is more likely to be experienced by those in lower social groups. There are also substantial geographical inequalities, with rates highest in the north and in the most deprived areas.

There are areas where improvements have come from looking at the issue in a different way. The County Durham Worklessness and Health programme, for example, which was commissioned by the NHS in partnership with the local authority, has been successful in addressing barriers to employment such as debt or housing among those in receipt of incapacity-related benefits by seeing health as the key issue. Over six months an evaluation showed the general and mental health of participants almost doubled and that the intervention was good value for money.

There’s clear potential for this health-first approach. And it could be an important way for clinical commissioning groups, work programme providers and local authorities to work in partnership.

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Danny Dorling: replace 30mph zones with 20mph

When asked what single policy I would suggest to improve public health, I always reply “20mph” or, if I’m being a little more verbose: “20’s plenty”.

This normally elicits some surprise. The person I’m speaking to usually expects me to suggest reducing poverty by reducing unnecessary privileges for the rich, narrowing economic inequalities, or improving health services or education; not simply slowing cars down. All these things are very laudable, but if you want to do just one thing, then the thing you can actually do, the thing that makes a difference that you can feel, see and measure straight away, is to stick a sign that says 20mph on a circular piece of plastic over the 30mph signs where you live.

Implementing 20mph speed limits (where 30mph ones have been) could be one of the cheapest and most effective methods for improving public health today. Easily enacted at the local level, this very literal slow-down would reduce the risk of pedestrian – and especially child – fatalities and bring about wider benefits such as less pollution and stronger communities.

The proportion of pedestrian road crash deaths is steadily increasing, and it tends to be in the poorer parts of cities that people are most at risk of being hurt or killed by cars.

Besides reducing death and injuries, a widespread slow-down of fast cars would reduce the indirect harm that comes from them, including that affecting ill health suffered by the family and friends of those who are victims of road crashes.

20mph speed limits have now been implemented in more than 100 local authorities already (including the City of London just last year). Success stories include Burnley in Lancashire where a pilot scheme to introduce 20mph from February 2011 to April 2012 resulted in the overall figures falling from 46 casualties a year, with six deaths and serious injuries, to 25 casualties a year with only two deaths and serious injuries.

At almost the same time in Newcastle upon Tyne it was recently reported: “The number of car-related accidents on Newcastle’s residential streets has dropped by more than half in some areas of the city following the council’s introduction of 20mph speed limits.”

Therefore, I would urge other councils to follow their example. Changing the speed limits in residential areas to help significantly improve public health.
Danny Dorling is a patron of the charity RoadPeace

Clare Bambra does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.
This article was originally published at The Conversation.
          Read the original article.
       

52 weeks of public health research, part 3

Posted by Bronia Arnott and Martin White

From Bronia Arnott: Waiting at Central Station Newcastle to go to a meeting I thought this represented one of the projects that I am working on, Reflect, which is all about transport behaviour (change).

From Bronia Arnott: Are YOU engaging users and stakeholders in your research? This week has been full of meetings with stakeholders and finding out more about public involvement in research. This photo was taken at Newcastle Civic Centre, the venue of one of the meetings this week. 

From Martin White: I am not a coffee-holic, but I do like a decent cup and will go out of my way to get one. Once a day, mid-morning. Brown powder that transforms into a vaguely coffee tasting hot drink just won’t do (although with a lot of sugar works quite well for a hangover - not that I am alco-holic either, mind). It has to have a real coffee taste and aroma. Some might find this vaguely snobbish, but I don’t care too much about where it comes from, as long as it tastes good. What has this to do with work? Well, there comes a point, usually about 2 hours after my breakfast tea (don’t get me started on tea...) when it becomes genuinely hard to concentrate. My mind starts to drift and I start to imagine the smell and taste of that well-earned cup of morning coffee. Bear this in mind if you have a meeting with me between 10 and 12.

From Martin White: The internet has quite simply revolutionised academia. And I am big fan of open access publishing. However, there is something reassuring about the thud of a weighty package on your desk, signifying the arrival of a real, ink on paper, printed copy of your latest research output. I have been fortunate in the last couple of years to have a couple of articles accepted by Milbank Quarterly, the North American health policy journal. The published output looks and feels like a paperback book. And you receive a nice hand-signed letter from the publishing editor with your copy. All very reassuringly old fashioned.

 

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Just to remind you:

Each Thursday of 2014 we’ll try and post around four pictures on the Fuse blog that capture our weeks in public health research, from the awe-inspiring to the everyday and mundane. Given that more of the latter than the former exists in my life, I foresee problems compiling 208 images worth posting on my own. So this is going to have to be a group project. Send me an image (or images) with a sentence or two describing what aspect of your week in public health research they sum up and I’ll post them as soon as I can. You don’t have to send four together – we can mix and match images from different people in the same week.

Normal rules apply: images you made yourself are best; if you use someone else’s image please check you’re allowed to first; if anyone’s identifiable in an image, make sure they’re happy for it to be posted; nothing rude; nothing that breaks research confidentiality etc.

Also, this doesn’t mean we wont also be posting words. You word-based posts are, as always, much appreciated.

Ladles of Marxism and feminism

Posted by Jenni Remnant

‘It was one of those events full of eminent (and emeritus) professors where I felt slightly out of my intellectual depth. I didn't trust myself to say much. But I tried to listen well.’ – Jean Adams in a Fuse blog post from February last year.

Deciding to write a blog on here is pretty much (for me) an echo of the above, except very out of my intellectual depth rather than slightly. That said, some posts here are about holidays and lots have pictures in, so there’s no harm in writing something. 

Sorry - feeling a tad embarrassed

So, introductions.

I just started an ESRC funded studentship at IHS, that isn’t remotely scientific or epidemiology-y, or even medical really, which kind of makes it feel like the bastard child of the bastard child twice removed of the medical faculty. Alas. The only way is up. And actually it’s a really cool project that has tonnes of really fascinating theory that maps onto current events and has an excellent match in methodology. I appreciate that this is part and parcel of academic projects, but it’s still very satisfying, and very new to me.

The focus of the project centres on work, worklessness and cancer. It fits in remarkably well with the mental health stuff I was involved with as a research assistant before heading to Newcastle to do a masters. This is perhaps due to the patterns of the illnesses involved; symptoms, diagnosis, treatment, recovery, relapse, treatment, recovery…etc – in addition to both being banner titles for a huge variety of illness experiences on a spectrum of severity.

Another similarity is the ESA50 form, and for many the following Work Capability Assessment, and then the exciting wait before finding out if you are Fit For Work (Hurrah), need to join the Work Related Activity Group, or whether you will stay in the Support Group where the ‘big bucks’ are. The really excellent news is people that may not feel that they are fit for work actually are, for example, those with terminal cancer or a severe and enduring mental health problem.

So currently the plan is to explore all this, hook it all together with ladles of Marxism and feminism and then, when something is particularly interesting, or the pathway to get there was particularly interesting (or when I have something I want to shamelessly promote) blog about it. I will attempt not to lament the hardships of a PhD (jokingly referred to in the office as a Permanent HeaDache – which we appreciate doesn’t quite work) to a load of people that already have one and somehow fit in amongst the decent blogs, despite being out of my depth.

52 weeks of public health research, part 2

Posted by Jean Adams

Thanks for all the positive feedback on 52 weeks of public health research, part 1. Here's part 2:

Ski touring in the French Alps with the most enthusiastic guide ever. When I was a teenager, outdoor adventures were considered totally legitimate transferable and leadership skills development. Should have remembered that when developing my NIHR leadership training programme ;) 

Happy non-Nestle surprise left by a nice person on my desk on the first day back at work after 3 weeks off.

Decided over the holidays (for no particular reason) not to drink quite so much coffee. Lost my resolve after 2 hours back in the office. Probably need more effective goal setting, action planning, coping planning etc.

A trip to Teesside for a Fuse Communications Group meeting.


--------------------

Just to remind you:

Each Thursday of 2014 we’ll try and post around four pictures on the Fuse blog that capture our weeks in public health research, from the awe-inspiring to the everyday and mundane. Given that more of the latter than the former exists in my life, I foresee problems compiling 208 images worth posting on my own. So this is going to have to be a group project. Send me an image (or images) with a sentence or two describing what aspect of your week in public health research they sum up and I’ll post them as soon as I can. You don’t have to send four together – we can mix and match images from different people in the same week.

Normal rules apply: images you made yourself are best; if you use someone else’s image please check you’re allowed to first; if anyone’s identifiable in an image, make sure they’re happy for it to be posted; nothing rude; nothing that breaks research confidentiality etc.

Also, this doesn’t mean we wont also be posting words. You word-based posts are, as always, much appreciated.

52 weeks of public health research, part 1

Posted by Jean Adams

Sometimes research seems all about words. Grant proposal, papers, presentations, emails, blog posts. This year I thought it might be interesting to try and communicate our lives in public health research using images more than words. So, inspired by similar projects on other themes, I hereby launch the ’52 weeks of public health research’ project.

Each Thursday of 2014 we’ll try and post around four pictures on the Fuse blog that capture our weeks in public health research, from the awe-inspiring to the everyday and mundane. Given that more of the latter than the former exists in my life, I foresee problems compiling 208 images worth posting on my own. So this is going to have to be a group project. Send me an image (or images) with a sentence or two describing what aspect of your week in public health research they sum up and I’ll post them as soon as I can. You don’t have to send four together – we can mix and match images from different people in the same week.

Normal rules apply: images you made yourself are best; if you use someone else’s image please check you’re allowed to first; if anyone’s identifiable in an image, make sure they’re happy for it to be posted; nothing rude; nothing that breaks research confidentiality etc.

Also, this doesn’t mean we wont also be posting words. You word-based posts are, as always, much appreciated.

Here goes. 52 weeks of public health research, part 1:

Trying to catch up on emails during the holidays but getting a bit distracted by knitting and sending parcels.

Packing for skiing and, for the first time in my life, getting the heebie-jeebies from someone else’s story of how dangerous ‘adventurous sports’ are. Stopping to consciously talk myself through the epidemiological principles of how one celebrity ski accident does not make skiing any more or less dangerous for me, or any more or less dangerous than last year. 

Enjoying an early passage in this Christmas present about the self-serving nature of universities providing protection for those who couldn’t thrive elsewhere:

“It’s for us that the University exists, for the dispossessed of the world, not for the students, not for the selfless pursuit of knowledge, not for any of the reasons that you hear. We give out the reasons and we let a few of the ordinary ones in, those that would do in the world; but that’s just protective colouration. Like the church in the Middle Ages, which didn’t give a damn about the laity or even about god, we have our pretences in order to survive.”

Sneaky three-in-one from Martin White: having to work a rainy day of the holidays in order to spend a sunny work day tidying up one of our trees that had fallen on a neighbour's fence. 

An academic post

Posted by Liane Azevedo

When I was asked to write a story about how I managed to move from contract research to an academic post, I realized that my life did not follow this route. Having a research academic post came as a reward from an old wish I’d had since I started my studies in exercise science.

Exercise and sports has always been part of my life, I started as a swimmer and then competed as a triathlete for many years (no one could tell this now when I just manage to sprint to get the train!). Although sport has always been part of my life I decided to do my undergraduate degree in biology.

Then one day I went to a seminar in exercise science from a professor who later became my masters supervisor. That presentation really changed my life and on that day I decided what I wanted to do. I was really intrigued by how my body was responding to exercise and really wanted to learn more. So, I decided to do my undergraduate dissertation in exercise physiology for my degree in Biology and started to explore ways that I could do performance tests with the athletes.

By that time, I had a serious injury and was struggling to compete in triathlon at the level that I was used to. So I had more time and lots of friends that I could count on to be my “guinea pigs” and try the performance tests. I did some courses, started a masters degree and open a little company called “Performance Lab” where we performed tests on athletes, did exercise evaluations at gyms and provided consultancy for a shoe company.

So, I was working long hours and getting lots of practice. However, there came a point where I started to feel that I was repeating the same information to my “clients” every day and wasn’t learning anything new. Until one day I went to a conference, not as an attendee but to work in the exhibitor hall for the shoe company that I was providing consultancy to. There I saw that one of the people presenting was Professor Tim Noakes from University of Cape Town. He is a well-known scientist in our field and an amazing speaker. By coincidence I had his famous book “Lore of Running” with me that day, which I used a lot to help me with prescriptions for running shoes. I was sooo excited when I saw him that my friend asked me if I had seen Brad Pitt! I said almost…

I filled myself with courage and went to talk to Prof. Noakes and ask for an autograph on my book. He was amazingly kind and the conversation went on and he asked if I was interested in doing a PhD in South Africa! You can understand that that night I didn’t sleep and the next day I started drafting my e-mail to his department. To make the story short I was accepted for the PhD in the area of biomechanics and I lived in South Africa for an amazing 3 years.

However, jobs in South Africa are not easy to get, especially for foreigners, so I started to look for jobs across the world. I saw a post for a lecturer in the UK that I thought it would really fit well with my expertise as the university had a biomechanics lab and were providing consultancy work. So, I applied and worked as a lecturer for 3 years. I enjoyed my time there but I was mainly teaching 9am to 5pm and I really missed the research atmosphere that I had had in South Africa. So, I kept my eyes open until I saw the Fuse post at Teesside.

Without going on too much about my own experience, I think some important advice that I could give people who are completing a PhD and want to move to a academic research post is that you might not get to where you want straight away. You might need to go for a teaching post for some years first. But if an academic post is really what you want you shouldn’t loose sight of it. Look for posts that are more research orientated and more importantly try to publish, attend conferences and if possible be involved in grants - which might be able to “buy out” some of your teaching and give you more opportunity to be involved in research.

I think being involved in practice has also helped me in my career. In public health this could mean trying to do applied work with practice partners that could maybe turn into a research project so you could slowly move yourself slowly towards a research academic post.

Christmas Geekery

Posted by Peter Tennant

'Do scientists get days off at Christmas?'

So asked school pupil Avril Kings during a recent run of the online engagement event I'm a Scientist Get me out of here. Like most things that have nothing to do with my PhD, it got me thinking.

Most scientists, thank goodness, wouldn't dream of working on Christmas day. That's just silly. Christmas is for over-eating, trashy TV, and drunken arguments about the 'true meaning of Christmas'. Besides, as much as we scientists may consider our work to be absolutely life-changingly vital; the outside world can usually afford to wait a few weeks - or decades. Even for those with no choice (i.e. those poor Biologists who have to feed their cells), coming into work on Christmas day isn't made very easy. Most UK Universities shut down between Christmas and New Year, so don't expect a nice greeting. Or heating, for that matter. 

Do geeks get days off at Christmas

But is 'not working' the same as having a 'day off'? Or are we all, to some extent, trapped in our ways of thinking? Do public health practitioners, for example, start Christmas with a bowl of fruit, before having salad for lunch, going for a brisk 30 minute stroll, and finishing with no more than two small glasses of wine in the evening? My own scientific training is tyrannically apparent (or so I'm told) when I cook the Christmas dinner, which I like to organise with laboratory-like precision. And I'm not just talking about my need to weigh-out every ingredient to the last gram. Nope. For me, every good Christmas dinner has a Gantt diagram. In theory, this is supposed to reduce the risk of project slippage (where the meal overruns and 'ruins Christmas'). In practice I'm always outwitted by the roast potatoes.

OK, so I may be confusing being a scientist with being a geek. With so few scientists in the public eye, it's probably not very helpful for me to just trot out the same tired stereotypes (which, by the way, have been excellently satired in this valentine's guide on, 'how to woo a scientist'). Since the abysmal Science: It's a girl thing video, the ScienceGrrl movement has made great strides showing that, contrary to popular belief, science is not exclusively populated by geeky men. More recently, scientists were also central to Twitter-sensation #OverlyHonestMethods, which not only helped to reveal the people under the lab coats, but was also one of the funniest things on the internet.

Which is all very nice, but - scientist or otherwise - I am a geek. And this Christmas, I have some fantastic geekery for you. In the form of another Twitter movement called #XmasSongsAsPapers. The idea was simple (if indeed, there was an idea) - try to make a Christmas song (either the title or content) sound like the title of an academic article. The result: a fantastic collection of mini brain-teasers that makes for an excellent Christmas quiz. Merry Christmas everyone! 

TWEET-TEASERS (answers below):

1) Awareness of Major Christian Festivals Among Populations of Sub-Saharan Africa, by B. Geldof and M. Ure (by @pingulette) – incidentally, this is the tweet that kicked it all off.

2) Ostracisation of an Infant with Congenital Scarlet-Nose: A case-study in a population of flying reindeer (by @Peter_Tennant)

3) Briggs,R. 'Hypothermia and nocturnal levitation hallucination in young boys. A phenomenological study' (by @HeatherTricky)

4) MacGowan & MacColl (1987) Alcohol in domestic disputes: an ethnography of Irish economic migrants in New York City bars (by @sadieboniface)

5) Michael & Ridgeley: Previous cardiac transplant rejection associated with increased donation specifications one year on (by @BroniaArnott)

6) Trapp et al. Rhythmic Repetition and Obsessive Compulsive Disorder: A Case Study of One Boy and his Drum (by @pwhybrow)

7) Favourably regarded, unelected feudal overlord observes cold & clear climatic conditions facilitate biofuel collection (by @DrJPritchard)

8) Gardner D. (1944) “Orthodontics as the facilitator to the individual perceptions of contentment” (by @FuturesSarah)

9) Rea, C. (2007) Use of sedentary modes for seasonal commuting: an ecological momentary assessment of subjective well being (by @BroniaArnott)

10) Impact on childhood perception of family structure following inadvertent witness of suspected maternal infidelity (by @gingerly_onward)

11) Carey, M. (1994) Comparative perceived satisfaction of singular romantic attachment during the festive period (by @dr_know)

12) Cole (1946). Dry heat instigates pericarp rupture and increasing endosperm palatability in the true nut Castanea sativa (by @Aristolochia)

13) Lords-a-leaping: Dismantling hereditary nobility and privilege to demonstrate duodecimal number systems (by @CSUFoE_Research)

14) Sedentary travel using a novel 'one-horse-open-sleigh' is associated with an increase in self-reported well-being (by @Peter_Tennant)

And finally, the picture round:

15) Fig. 1 (Gruber & Mohr, 1818) (by @mc_hankins)

ANSWERS
1) Do They Know it's Christmas?
2) Rudolph the Red Nosed Reindeer
3) I'm Walking in the Air
4) Fairytale of New York
5) Last Christmas (I Gave You My Heart)
6) The Little Drummer Boy
7) Good King Wenceslas
8) All I Want for Christmas is My Two Front Teeth
9) Driving Home for Christmas
10) I Saw Mummy Kissing Santa Claus
11) All I Want for Christmas is You
12) The Christmas Song (Chestnut's Roasting on an Open Fire)
13) The Twelve Days of Christmas
14) Jingle Bells
15) Silent Night

Forgive me father for I have sinned…

Posted by Louis Goffe

Although I am not a man of faith I have been shouldering some of my wife’s catholic guilt for a while and I have chosen the church of the Fuse blog to repent my sins. My shame for which I deeply wish to apologise for is that I was a fattist. I don’t mean this as a glib remark, I feel genuinely remorseful and embarrassed.

As with many –isms their spread is the result of mistruths and manipulation. On a search for the aetiology of my own previous held prejudicial views I realised that they were born out of a combined biblical belief in “the energy balance” and “a calorie is a calorie is a calorie”. The zeal to which many of us hold these two principals up as beyond reproach has blinded us to the wealth of research into the role of leptin, insulin and satiety in response to each of the macronutrients, the thermic effect of food and the overwhelming influence of our genetics in our predisposition to gaining weight. As a result the failure of this regulatory process is not blamed rightly on the foods we eat but the twin sins of greed and sloth.

I have always been thin, but instead of viewing this fortune as the luck of the genetic hand that I was dealt I smugly believed that it was down to my excellent constitution. But arrogance is the preserve of the misinformed and I was content in my protective shield of ignorance and happy to vilify those overweight as lacking in that intangible latent variable of ‘will power’.

This shift of focus from a physiological to a behavioural discipline has not only resulted in a generally accepted persecution, and in many cases resultant self-loathing in overweight individuals, but it also plays into the hands of the food companies that got us there in the first place. A blatant disregard for some quality science has led us down the path of poor food regulation and as a result we have become addicted to the most toxic dietary substance, that of sugar and we are left fighting an almost unwinnable battle.

The saccharine fortified tentacles of these confectionary and soft drinks companies have become entwined in all aspects of our lives to the point in which we cannot untangle. They are promoted by the world’s biggest stars, i.e. the most powerful role-models, to the young and easily influenced. We‘ve allowed them to sponsor school programmes and our national game although “there’s no nutritional need or benefit that comes from eating added sugar”. And how do they get away with this crime? Because we have all colluded behind the excuse that they can be enjoyed “as part of a calorie controlled/balanced diet”. This shows a total disregard to both their addictive properties and the resultant metabolic response.

These companies are smart. They haven’t just been one small step ahead of us but one giant leap. They were acutely aware of physiologist John Yudkin’s work linking sugar consumption to heart disease and started a campaign not only to discredit him but also crucially buy them time. The intervening years have bought these companies great wealth and substantial lobbying power. But finally, it seems that the sweet tide is starting to turn and there is greater acceptance that sugar is the silent assassin in our diets. Unfortunately our love of their products runs deep, this combined with their formidable defence force has meant that any meaningful change will be incredibly difficult, as demonstrated by the New York soda ban. Therefore to win this war over the health of our hearts we must present a strong, clear message to win over people’s minds.

As much as the prejudices are born out of an oversimplification the excuse for a fix are blamed on an over-complication. Many a toothless smile would have beamed across the boardroom of Sugary Drinks Ltd. on the release of the Foresight obesity systems map. As this incomprehensible, impenetrable and unvalidated model was held up as highlighting the innumerable potential pathways to obesity. So instead of being the Ace of Spades in the most wanted list they quietly disappear into the ether as one minion amongst millions. As a result there are now too many competing interests in the quest to tackle the obesity epidemic and we have to filter the wheat from the chaff, or more appropriately the raw sugar from the harvested cane. There should be an increased focus on the metabolic effects of the macronutrients so that we have the full backing of the scientific community when we next have these companies backed into a corner so that we are able to disarm them of their twin-barrelled attack of ‘calories’ and ‘complexity’.

A further symptom of our collective inability to target the sugar-daddies is the perpetuation of the futile debate of whether obesity should be classified as a disease. All this does is to further stigmatise those that are suffering. Now whatever your personal opinion the clear fact remains that those of us that are clinically defined as obese are significantly at greater risk to a huge number of illnesses many of which are fatal. But instead of showing compassion a quick glance to the magazine rack would imply that we are happier in the role of Mr Nasty on a real-world talent show judged exclusively on weight status.

The sensation of hunger is paramount to our survival, but there is a catastrophic failure of our current diet to satiate and provide the appropriate nutrition for a sustainable lifestyle. But instead of pointing the finger at the food, the individual and their supposed ‘weak will’ has become the object of our ire. The shocking fact is not that one third of all adults are obese but how some still remain thin in an environment so predisposed to making us fat.

Feelings of distain towards the obese might provide you with some fleeting sense of misplaced superiority but crucially they contribute nothing to the solution. Chastising the victim of any given disease is never the basis to formulate effective public health policy. Ridiculing those of us that are overweight will not reverse the trend but just serve to elevate the level of infighting while those pumping the noxious substances into our bodies continue laughing all the way to the bank.

I am not a Doctor: Part 2

Posted by Heather Yoeli

Shortly before this blog’s summer campervan trip, Jean wrote about her experience of not being a doctor. She is and she isn’t a doctor. Jean is a doctor in that she graduated from the MBBS course at medical school with a string of stellar accolades, and she is also a doctor in that she has an epidemiological PhD in something I don’t quite understand. However, Jean is not a doctor in the practicing medical sense of doctor that you’d go to see with a worrying cough or a sore toe – and that’s the sort of doctor members of the public tend to think of when they hear the term ‘doctor’, which is where things get complicated. I’m not a doctor either, though not in any sense of the term – my pre-public health degrees are in Religious Studies and Creative Writing, my PhD is still two years from completion, and the only people who call me Dr Yoeli are the endless PPI insurance call centre operatives who think they’re speaking to my husband. Nevertheless, it’s often the case when I try to members of the public what I do within Fuse that people assume that I am a medically-qualified and practicing doctor, and sometimes the case that I’m asked for advice on the basis of this assumption, too. I always feel that I’m disappointing people by telling them I can’t help. But really, most of us in Fuse would tell you that they couldn’t help, either. I thought I’d write this blogpost to explain why not.

1. We study public health, not illness. We try to make populations healthier, not sick people better. There are many fine lines and commonalities and contested territories between public health and medicine. However, we won’t necessarily know much, if anything, about the illness you’re describing. Although we may be able to explain why and how you should stop smoking to lessen your chances of getting lung cancer, we probably won’t know enough about cancer itself to be able to comment on whether your father-in-law is receiving the appropriate chemotherapy regime for his stage and grade of tumour. So given that we know there are others more qualified to answer the question than ourselves, we’ll probably advise you to contact one of the relevant charities or advocacy groups with helplines dedicated to supporting and informing carers.

2. We do academic work, not clinical practice. We deal with people as research participants rather than as patients – and many of us deal with statistics or qualitative data rather than with people at all. As Hippocrates wrote, being a doctor requires not only knowing about illnesses but about patients. Although we may know that the blood glucose reading of Nmmol/l you got from borrowing your neighbour’s monitor is abnormally high and almost inevitably indicative of diabetes, we probably won’t have enough awareness of your personal medical history or sufficient experience of others presenting with similar blood glucose levels to know how likely you are to suddenly fall into a coma. So given that we probably know that untreated diabetes can be extremely serious and sometimes fatal, we will almost inevitably simply advise you to seek immediate medical help from a practicing clinical doctor.

3. Doctors are insured for giving medical advice; we’re not. Medical doctors in clinical practice are indemnified by specialist medico-legal practitioners which underwrite the risk of them giving incorrect advice or doing harmful things to patients. So if you sue a doctor for giving your father-in-law the wrong chemotherapy drug or for erroneously reassuring you that you don’t have diabetes, the doctor’s insurers will pay. If you were to sue us for offering dodgy advice, our university’s insurers would not pay. And because our university’s insurers would not pay, our universities would immediately fire us for the very grossest of gross misconduct, probably at rather massive cost to our career standing. So given that we know that we won’t necessarily be able to offer you good advice, and given that we could face catastrophic consequences for offering you bad advice, we tend not to offer any advice at all.

Most people in Fuse wont offer medical advice, because they don't want to get sued...

This three-point explanation aside, however, there’s a lot of theory about when, why and how ‘lay referral networks’ function to determine the circumstances people might or might not seek medical advice for a particular illness or symptoms. My anecdotal impression is that some people do seem to gain some validation or comfort from having academics tell them that they’re really not able to provide the medical advice requested. Has anyone ever studied the phenomenon or role that academics might play within this process? I would be interested to know.

How to choose a PhD topic

Posted by Heather Yoeli

A few of us were discussing recently how and why we had chosen the PhD topic we did.

Firstly, you won’t necessarily have the opportunity to choose. Increasingly, PhD studentships from the major research councils and other funding bodies are being advertised with fairly tightly-defined research questions and with methodologies already pre-determined. These studentships tend to suit both students seeking a clear assignment and those already confident of the area and approach with which they want to work.

Secondly, you might not necessarily want to choose. Some prospective PhD students may not necessarily know precisely what they want to study but are keen to work with a specific supervisor and therefore ask or allow their prospective supervisor to determine their topic. Within most areas of academia, the person by whom you’ve been supervised can count as much as or even more than your PhD topic or institution itself. It may be helpful to your career aspirations to decide in whose reflected glory you’d hope to bask.

Thirdly, your discipline or subject area may have an obvious current ‘issue’ which will make your work more timely/popular/publishable/trendy. In public health, these ‘issues’ tend to be determined by government policy ‘directives’ and ‘agendas’, which are determined by wider political and social trends and can be hard to predict in advance. If you’re looking for a PhD topic which will be the significant ‘issue’ on your submission date in three or four years time, you might benefit from a daddy who in the highest echelons of the power in determining such things... or alternatively, a crystal ball.

Fourthly, you might have something in which you have a very personal and passionate interest and therefore wish to study. There’s a prevailing view within academia that we should all be ‘detached’ and ‘objective’ and therefore not too emotionally invested in our topic, so by deciding entirely to ‘do your own thing’ you may risk being seen as a bit odd, but equally, it’s hard to remain focused and motivated if you don’t have a certain level of geeky fascination for what you’re studying. Academics have a time-honoured reputation for being somewhat eccentric, and with enough charismatic charm you can work that to your advantage. However, in today’s difficult economic times, you may have to find your own funding.

Most often, I think, people come to their PhD topics by a mixture of all of the above strategies. I applied for and was awarded a Fuse studentship which was very clearly about public health in marginalised communities, but have worked with successive supervision teams to develop a research approach of interest both to them and to myself. For me, this has worked well, and five years later I’m still every bit as interested in the subject as I initially ever was.

Many of my colleagues, though, have had very different paths. Many have come to their PhD topics through very novel routes or for fascinating reasons; many have started with one topic or approach and changed their thinking quite radically.

So, how did others come to be doing the PhD they are doing, or planning, or did...?

Taking control

Posted by Jean Adams

Being an early career researcher (ECR) isn’t always easy. So much emphasis is put on finishing your PhD, you slog your guts out getting the thing done, then a bottle of champagne and a long sleep later and life doesn’t seem to have changed much. As an early post-doctoral researcher you aren’t paid a whole lot more than a PhD studentship. And whilst that studentship might have been three, or even four, years of fairly secure ‘employment’, now you are suddenly in at the sharp end of short term contracts. On more than one occasion, I got sent a redundancy notice before I’d received the relevant contract to sign. You are generally beholden to more senior colleagues to find money to pay your salary and the dark arts of patching together pots of money from here and there to make a job can seem incomprehensible, sinister and even vaguely illegal.* It is easy to feel like your career is suddenly way out of your control.

It ain't easy being an ECR

At the same time, the demands can be overwhelming. The PhD that you thought was going to be the crowning glory of your CV suddenly feels as irrelevant as your GCSEs were the day you got some A-levels. It now has to be added to with teaching experience, publications, grants of your own, and examples of impact, engagement and outreach. All at the same time as fulfilling the demands of the day job, or jobs, that the person, or people, who have found you a salary require.

High demands. Lack of control. Sound familiar? It’s not surprising that so many ECRs feel totally stressed out by the whole thing. It is the very definition of a stressful working environment.

Of course the story above is a gross over-simplification. There are all sorts of pathways by which people come to the role of ECR. Just as there are all sorts of pathways that ECRs take from the point of PhD onwards. I don’t know the magic formula for ‘making it’. But I would suggest that if you want to get a grip on the stress, there are two things you can do: reduce the demands, or take back some control. I am not too great at moderating the demands of academic life. There always feels way too much to do, I’m hopeless at saying ‘no’ (and make it worse for myself by using synonyms for ‘no’ and then getting pissed off when these are interpreted as ‘yes’), and I’m never sure who I could or should delegate to. So my main strategy is to try and maintain a modicum of control.

Here is my five-step plan:

1. Decide what you want to do. Having a PhD doesn’t mean you have to stay in research, or that you will have failed if you don’t. It might feel like that in a university, because that’s what the people who seem to have the most status do. But I know lots of people with PhDs and MDs who have fulfilling lives and careers outside of university research. On the life achievement side, all of them have more children than I do.

2. If you want to stay in research, decide what sort of role you want. Not everyone has to be a professor. In fact, it’s quite obvious when you look around any university department that it’s pretty unlikely that every ECR could become a professor. Without a massive expansion in the sector, there will just never be enough professorial positions to go around. But there are other jobs within research - either within the ‘lab’ as a career researcher, or outwith it in research support.

3. Work out a plan. Once you’ve decided what you want to achieve in the long term, work out what the main steps are for getting there - say over the next 5 to 10 years. Then work out a more detailed plan for achieving the first of the steps - say over the next couple of years.

4. Make sure you have formal and informal mentors and support groups. The ‘answers’ to steps 1 to 3 are going to be obvious to some people and totally opaque to others, with a range of experience in between. Throughout your career (just as throughout your life) you are going to need advice and support. Make use of all the advice and support you can to help you work out where you want to go, how to get there, to keep you on track, and to remind you that you are awesome. It’s way too easy to forget, in an environment full of high achievers and extraordinarily clever people, that you too are amazing.

5. Reappraise regularly. If you’re not getting what you want from your chosen plan then go back to step 1 and reconsider.


*I promise they aren’t. They just seem that way.

Have we taken our eye off the ball?

Guest post by Andy Graham - specialty registrar in Public Health, County Durham

A couple of years ago I found myself in need of a dissertation topic for an MSc in Public Health – ‘make sure it’s something you are interested in’ was the advice. Simple I thought, I just need to weave football and beer into a research project! All joking aside though, I have become interested in the relationship between the two over the years. As a public health professional and former A&E nurse, I am well aware of the potential harms of excessive alcohol consumption. Also, as a fan who both attends matches and watches on TV, I have become increasingly aware at how visible this relationship has become. Of course, football and beer have long been associated, ever since Victorian landlords would set up teams, use the land out back for a pitch and, in the amateur days, employ the team as barmen in lieu of pay.

The Strawberry Pub, Newcastle, Phil Thirkell

But at the risk of sounding like my dad, when I ‘was a lad’, you either went to the match, where as a young working class man it was normal to have a pint with the lads, or you waited for Saturday night’s Match of the Day for your football fix. The pubs were open sporadically, had no TVs, and the football was rarely broadcast anyway. Fast forward a few years and we have football on satellite TV almost every night of the week and all day at weekends, most top flight football clubs sponsored at some level by an alcohol brand, marketing of alcohol, beer in particular, is rife and the norm appears to be drink beer and watch football with the lads in the pub. Opportunities to do both are far more common than when ‘I was a lad’, and not just within pubs, but within living rooms, where the cheaper alcohol deals of the supermarkets are very popular. As a dad myself I was disturbed by these developments, but hadn’t been able to quantify them.

I decided my dissertation would try to measure the amount of alcohol marketing that football TV viewers were exposed to. With the help of Jean Adams at Newcastle University, I planned the research. I chose six live broadcasts representing over 18 hours of footage, developed coding frameworks and watched 40 hours plus of coding footage to consider all the verbal and visual references.

The results shocked me:

• Over 2,000 visual images, 111 per hour on average, or around 2 per minute.

• 32 verbal references.

• 17 traditional advertisements, accounting for 1% broadcast time.

• Over 1,100 visual images in one alcohol sponsored Cup competition alone

The issue of traditional advertising commercials is interesting because the ‘voluntary’ codes of practice in place to regulate how alcohol is portrayed (should not appeal to youth, should not suggest social success, etc.) are most relevant to this type of advertising. Given that we know that quantity of alcohol marketing is more important than content, then the apparently unchecked stream of visual references in this research may be even more important, and we could argue that the current controls are completely inadequate because they are focused on content, rather than quantity.

I can’t help but feel that we have taken our eye off the ball – the globalisation of sports such as premier league football as a product, the satellite age, the endless thirst for profit and market share within corporations, the ‘self’ regulation that fails to control the exposure reported above, the relaxed licensing laws in this country, and the increase in type, availability, and affordability of alcohol. All of these things create a perfect storm in which alcohol and sporting idols become normalised as one and the same, and the brand becomes a member of the team. It feels as though the relationship between sport and alcohol has evolved towards its perfect and logical form.

I am disturbed to be one of a generation of football fans that has been manipulated in this way and that my children are also targets. And meanwhile, the alcohol industry has a seat at the policy making table through the Public Health Responsibility Deal. So we must ask the question: are we sleepwalking into a situation where drinking alcohol is so closely associated with the sporting heroes that children see on TV, that they are being actively normalised to become drinkers? No one seems to question this, but it is time someone did, and through public health advocacy it may just be up to us.

Sci-comm-ing

Posted by Jean AdamsI went to my first science communication conference at the weekend. I’ve wanted to do this for ages. Going to my two favourite academic conferences – the annual meetings of the Society for Social Medicine and the UK Society for Behavioural Medicine – makes me feel so alive. They are environments where I feel entirely immersed in my people, buzzing with ideas, invigorated to go back to my desk and do new and better things. And also often both physically and mentally exhausted.

I thought a science communication conference might make me feel more part of that community. Oddly, it didn’t. Probably because I’m not part of the scicom community and one conference a community member does not one make. Probably this feeling of being a little out of it and like I’m not absolutely sure I’m following the conversation is exactly how I felt the first time I went to SSM in Oxford all those years back. 2001 if you must know.

At SpotOn London 2013, I was taking part in a session on scientist-2-scientist communication – primarily via the medium of blogging. If you happen to be interested (and have an hour to kill), you can see a video of the session here.

Beforehand I’d been worried that talking about blogging at a scicom conference was a little passé – preaching not just to the converted, but to the evangelical. A quick show of hands on the day confirmed that about 90% of the 40-50 people at the session were bloggers.

But it seemed to go okay. The session generated a lot of Twitter chatter (#solo13blogs). Predictably, although the panel discussion covered a lot of ground, the audience conversation seemed to get a little bogged down in the very last (and, I think, maybe least important) issue we discussed – if it matters whether or not people comment on your blog.

Are we in the Wild West of science blogging?

I’ve previously whinged a bit that hardly anyone comments on this blog. But I’ve got used to it. I know that posts can generate discussion in other forums and I’ve started to believe that people genuinely do read these posts – that we’re not just sending words into the void. It was still nice to hear that we’re not alone in our virtual comment-less-ness. One of the science correspondents at The Guardian confirmed that only about 0.5% of visitors to The Guardian website leave a comment and that about 80% of those are left by the same hard core of commenters. There are just a lot more comments on The Guardian website because they get a lot more traffic that the Fuse website (hard to believe, I know).

The other thing the guy from The Guardian pointed out was that building community takes time and effort. I know this. Who could not? But it’s nice to be reminded of it. I think that we could do more to build community within and beyond Fuse and I’d be interested in your thoughts on how we might do this. You could leave a comment if you’d like…

When I was originally asked to take part in SpotOn, I was pretty hesitant. I don’t think I’m some massive expert in blogging, or science blogging. I feel like we at Fuse came to the blogging party pretty late and that we are a fair way behind the curve, not in the vanguard of some great revolution. For me, this is okay. I mean, we’re a research organisation run by committees of academics, not a hack day run by precocious teenagers. But the current situation of science blogging was described by one participant as “the wild west” – a place with no rules yet, where only the strong enter and only the brave survive. I’m still not sure how much I agree with this. But it brought some fun images to mind.


With thanks to Roland Krause and Ingo Helbig of Channelopathist; and Lauren Tedaldi of What’s a PhD to do? for being part of a very well behaved and easy to manage panel.

The north loses out yet again under NHS funding proposals

By Clare Bambra, Durham University and Alison Copeland, Durham University

The north-south divide is a powerful trope within popular English culture and it’s also evident within the country’s health. A recent report by Public Health England showed that between 2009 and 2011, people in Manchester were more than twice as likely to die early (455 deaths per 100,000) compared to people living in Wokingham (200 deaths per 100,000).

This sort of finding isn’t new; for the past four decades, the north of England has persistently had higher death rates than the south, and the gap has widened over time. People in the north are also consistently found to be less healthy than those in the south across all social classes and among men and women. For example, average male life expectancy in 2008-10 in the north-west was 77 years, compared to 80 in the south-east.

A large amount of this geographical health divide can be explained by social and economic differences with the north being poorer than the south.  Certainly, over the past 20 years the north has consistently had lower employment rates (for example this is 70% in the north-east compared to 80% in the south-east).

This is of course associated with the lasting effects of de-industrialisation (with the closure of large scale industry such as mining, ship building and steel) and the lack of any replacement jobs or a strong regional economic policy.

While the NHS clearly cannot address all the issues that cause the north-south divide, there have been attempts to increase NHS funding in areas that have the worst health – and many of these are in the north. The current NHS funding formula considers factors such as deprivation and ill-health indicators by area, so places with worse health and higher deprivation have higher NHS budgets.

However, NHS England has a new funding formula out for consultation which fundamentally changes the way money is allocated to General Practitioners for the care of patients, and it appears that the north will lose out.

In our BMJ letter, we mapped the new NHS funding data and this showed clearly that the more affluent and healthier south-east will benefit at the expense of the poorer and less healthy north. For example, in areas like south-eastern Hampshire, where average life expectancy is 81 years for men and 84 years for women, and healthy life expectancy is 67 years for men and 68 years for women, NHS funding will increase by £164 per person (+14%).

This is at the expense of places such as Sunderland, where average life expectancy is 77 years for men and 81 years for women and healthy life expectancy is 57 years for men and 58 years for women, and where NHS funding will decrease by £146 per person (-11%). More deprived parts of London will also lose out with Camden receiving £273 less per head (-27%) under the proposed formula.

While the objective of the new formula is to provide “equal opportunity of access for equal need”, these geographical shifts are because it has defined “need” largely in terms of age and gender, with a reduced focus on deprivation.

It also uses individual-level, not area-level need, GP-registered populations rather than higher wider population estimates, and secondary care (use of hospitals and A&E) not primary or community care use. This means that areas with older populations have higher health care usage so they are getting money transferred to them from areas with fewer old people.

However, areas with more old people are also areas that have healthier populations who live longer – hence there are more old people. These healthy old people are largely in the south-east so, within a fixed NHS budget, the new NHS formula can only shift money to them by taking it from others.

The new formula appears to shift NHS funds from some unhealthy to healthy areas, from north to south, from urban to rural and from young to old.

Many of the areas that will lose NHS funding if the new formula is implemented are the same areas that have also lost out from above average cuts to local authority budgets. The scale of the potential NHS funding shifts will add further stress onto these local health and social care systems and potentially widen the north-south health divide by reducing access to NHS services where they are needed most.

The authors do not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article. They also have no relevant affiliations.


This article was originally published at The Conversation. Read the original article.
       

Alcohol marketing, football and self-regulation

Posted by Jean Adams 

This post is a 'story behind a paper'. All papers have a story. We would love to post more of them.

When we work at home, my partner and I share a workspace (or kitchen table as it is also known). This is generally friendly and allows for moments of mutually constructive musing and problem-solving. A recent exchange went like this:

Me: “Who is Everton’s shirt sponsor again?”

Him: “Emmm...is it Chang with the elephants?”

Me: “Yeah, right, thanks.”

Pause

Him: “Sorry, what are you doing? I thought you were working?”

Me: “I’m doing my talk on alcohol marketing in sport.”

Him: “What’s Everton’s shirt sponsor got to do with that?”

Me: “Well...duh...Everton’s a football team and Chang’s a beer.”

Him: “Chang’s a beer? That’s outrageous! What are they doing on Everton’s shirts?” [he’s a public health researcher too]

Everton player Louis Saha sports a Chang branded training top. Photo: nicksarebi

My partner is a not a football fanatic, but he knows a bit about football. Certainly enough to be able to easily remember Everton’s shirt sponsor; and Everton is not his team. Chang is definitely not his beer. So the only place he must know the brand from is Everton’s shirts.

When we set out to quantify the volume of alcohol marketing in televised English football, I knew there would be some, but I was caught off guard by quite how much there was. We found an average of almost two visual references to alcohol per minute of broadcast. But what was much more interesting was how embedded these references were. Less than 1% of the broadcasts were devoted to formal alcohol advertising during commercial breaks. Instead, almost all of the alcohol marketing we found was on or alongside the football pitch, or part of the graphics added by broadcasters. It was simple logos, frequently repeated.

We know that alcohol marketing affects children, in particular. When children are exposed to alcohol marketing, those who do not yet drink are more likely to start drinking, and those who already drink are more likely to drink more. Children are also very aware of alcohol marketing. More than three-quarters of Scottish 12-14 year olds are aware of some sort of alcohol marketing, and two-thirds of them are aware of alcohol marketing in sport.

In the UK, alcohol marketing is governed by an industry sponsored self-regulatory code of conduct. When commercial industry is charged with regulating its own marketing, the potential for conflict of interest is obvious. In the sphere of food marketing to children, there seems to be numerous examples of industry involvement in regulation leading to watering down of who and what is covered by the regulations. Indeed, in the USA, industry backlash led to the White House abandoning efforts to even introduce standardised self-regulation. There is now clear evidence that the UK alcohol industry is breaking its own code of conduct by making specific efforts to target products at under-age drinkers.

In addition to the inherent problems of self-regulation of marketing and the growing failure of such self-regulation, the frequency and nature of alcohol marketing we found in televised football highlights a mismatch between what the code of conduct is designed to restrict and what is actually shown. The alcohol marketing we found in English football was almost entirely frequently repeated exposure to simple branding and logos. In contrast, the code of conduct focuses on what alcohol should not be associated with.

According to the code, alcohol marketing should not “in any direct or indirect way…suggest any association with bravado, or with violent, aggressive, dangerous or anti-social behaviours…illicit drugs…sexual activity or sexual success…[or] that consumption of the drink can lead to social success or popularity”.

The impact of marketing is related to both exposure and power. Power refers to the creative content of marketing -- how memorable a single exposure is and how well it appeals to particular individuals. Power can be difficult to quantify, but is why Don Draper gets paid so well. Exposure is simply about how often you see the marketing. There is no simple formula linking impact, exposure and marketing. But clearly if you can’t have one, you would be well advised to go all out for the other.

The UK’s alcohol marketing code of conduct seems to focus entirely on marketing power. It restricts the creative content of the sort of narrative advertisements shown in the commercial breaks between programming. It has absolutely no impact on exposure.

It is difficult to say if restrictions on alcohol marketing power triggered increases in exposure, or if industry lobbied for restrictions on power rather than exposure because they know something about the relative influence of each on impact. Or perhaps there is no simple either:or. But what we are left with is a code of conduct that appears to have little bearing to the nature of the huge volume of alcohol marketing seen in televised football (and, I would wager, elsewhere).

Stronger restrictions on alcohol marketing in sport, and elsewhere, are never going to be a magic bullet that will solve the problem the UK currently seems to have with alcohol. But as part of a suite of approaches limiting advertising, affordability and accessibility it would make an important contribution.

This post was originally posted on the OUPBlog

Finagle’s law, Murphy’s law or Sod’s law?

Posted by Balsam Ahmad

I am finally writing a post for the Fuse blog. It is not the happy one I anticipated, but rather a reflection on one of the worst nightmares for a PhD student. That is a corrupted word file of a PhD thesis minutes before turning it into the final PDF that I was hoping to send to Print Services in the library.

I still remember the day vividly as if it was yesterday. The day that was supposed to be the beginning of the end of a PhD project that took me such a long time to complete. What happened proved to me the accuracy of three laws I knew about, Finagle's Law of Dynamic Negatives, Murphy’s Law and Sod’s Law. Finagle’s Law says “ Anything that can go wrong, will—at the worst possible moment”. This is similar to Murphy’s Law that most of us know “Whatever can go wrong, will go wrong” and what an ‘unlucky sod’ I was. According to Wikipedia ‘"Toast will always land butter side down" is often given as an example of Sod's Law in action’ and ‘being "mocked by fate"’ is another enactment of it.

Now I just want to tell the story for it has many learning points that are maybe of use to other PhD students. Even if there are none, the story in itself is interestingly spooky.

On the 30th of September, I had a plan to integrate the revisions that were approved by my PhD external examiners into my thesis and update it so that it was ready to print. I anticipated this work would take 5-6 hours, which I had planned out of my work for this purpose. Everything was going well and I was pleasantly surprised that even my Endnote file with more than 360 references, which caused me a lot of anguish at times, was behaving nicely. I even remember pinching myself in disbelief that I could finally see an end in sight. After 6 hours of meticulously working through the PhD file correcting typos, mistakes and tidying the formatting and referencing, the disaster struck. In my final attempt to save and update the document everything froze and my whole 400 page PhD thesis turned into one page of footnotes. The strange thing was that it had the same large size as the original PhD file.

I was in utter shock as my whole thesis dwarfed in a matter of seconds literally just before I turned it into the final pdf to send to print. I tried to stay calm though and searched for temporary saved files and for backups. Nothing appeared on my personal folder on the university network drive. I tried retrieving earlier versions but nothing worked. It was 8 pm then and I was anxious that if I stayed at work any longer, I would miss my children’s bedtime so I carried myself home feeling very tearful. I found sharing my status on twitter that evening quite helpful as the messages of sympathy and advice from colleagues poured in.

The Twitter support network kicks in

I spent the next two days emailing and meeting various people in IT and support services across the university. A whole team of 3-4 people worked relentlessly to find backups and recover my thesis file. At the end of the day on the 2nd of October I got the following message from someone in support services:

“Unfortunately we have not been able to recover the content in Word. It is there, but not visible and we don’t know why. You may just have to revert to a previous version of your thesis…let me know how you get on and if one of my colleagues comes up with a miracle we’ll send you a message. So sorry we can’t help you at this time.”

Having lost any hope for retrieving my document I realised that I had to redo the work. It took me a few evenings to complete but worse was having to complete the work whilst feeling so terrified that the same thing would happen again.

So reflecting back now, these are the lessons learnt that I want to share with you:

1. Never trust 100% that saving your work on a network drive is entirely safe. Try to save throughout on a flash drive or a different medium as well.

2. Email yourself with a copy even mid-way through your work. Do not wait until the end.

3. Take regular breaks and never work when tired.

But, like a fairy tale, the story has a happy ending. On the 1st of November I submitted two copies of my thesis to the Graduate School of the Faculty of Medical Sciences. Fingers crossed I will graduate from the PhD program in December this year!

Proof that there is a happy ending to this fairy tale

A thousand words

Posted by Linda Penn

I am invited to speak at a conference next week (6th November). This conference is “Organised and provided by Diabetes UK Northern and Yorkshire Region, the University of York and the University of Huddersfield in collaboration with healthcare professionals representing their diabetes services from around the region”.

I know this invitation is a huge privilege and I am aware of the responsibility to properly present work which involves many people. I might analyse the data, sometimes I conduct interview studies as well, and I might draft the research papers with input from statisticians and co-authors, but I never really feel that I do the real work.

The ‘real work’ is done by the intervention delivery staff. Thus I am anxious to do them credit and I was thinking about this when my son (who is a painter) sent me a text about prints. This prompted me to request intervention photos. Problem solved. The data is of course of paramount importance, but my guess is that people will mostly remember the pictures.