Responsibility for addressing obesity in local authorities: a changing landscape?

Posted by Dr Amelia Lake, Fuse Associate Director, Reader in Public Health Nutrition at Teesside University and Tim Townshend, Professor of Urban Design for Health at Newcastle University 

Planning and obesity has been in the news again – it’s a topic that is hotly debated in local authorities across the country.

In April 2013 public health came ‘home’ to local government. This coming home meant a shift from the NHS to closer collaborations with other local authority colleagues. We wondered what it meant in reality, how did local authority staff from two disciplines - public health and planning - see their role around obesity prevention in this changed landscape? Our research [1], conducted between November 2013 and March 2014) explored the views of individuals working in public health and those working in planning within local governments on their responsibilities for addressing obesity using spatial planning.

We know that planning policy can impact on people’s wellbeing and health in terms of access to food and the environment encouraging physical activity. Using planning policy to tackle health problems such as obesity may not be novel but it could help tackle a global problem.

Our research was based in North East England. We interviewed three Directors of Public Health, one Deputy Director and four planners with a range of seniority.

There were some clear differences in their approaches to the issue of responsibility. Planners were asked about responsibility for obesity, physical activity and community nutrition. They saw a clearer link between planning and physical activity than with community nutrition, primarily citing sustainable transport, path provision and recreation, though one identified takeaways. One planner said, “At the end of the day, it’s down to the individual to address their obesity (Planner 4)”.

These differences in views on responsibility for health would suggest a difference of understanding amongst some within local government about the complex causes of obesity and how to address inequalities. However, one planner did point out that it is health professionals’ responsibility to “make the link” between planning and health, “because I don’t think people from planning would start from a health improvement stance”. This has implications for leadership and leadership roles.

Overall, our interviews identified a range of barriers to engaging with planners, including an insufficient understanding of the causes of obesity and the importance of addressing obesity via multi-agency approaches (involving cooperation between several organisations), fragmentation in the health system and conflicting priorities. Planners could be better engaged in the obesity agenda via formal incentives (e.g. written within planners’ job descriptions or regulations), and aligning priorities via ‘soft approaches’ (e.g. public health leadership roles).

There have been attempts to reunite health with planning. International evidence has highlighted the transdisciplinary (involving investigators from different disciplines) effort required to tackle obesity due to its multifactorial nature (it has, or stems from, a number of different causes or influences) and underpinning health inequalities. However, there appears to be little evidence that English planners have engaged with the new public health agenda. No detailed investigation has attempted to fully understand the barriers to engaging planners in health issues.

Gateshead City Council’s award winning
Supplementary Planning Document

Despite our region having national recognition for planning policies (see Gateshead City Council’s award winning Supplementary Planning Document), there are clearly some issues around increasing responsibility within the area of planning and health. However, this is a rapidly developing field. A recent survey of authorities in North East England, showed that all, bar one authority, now has, or is in the process of developing, guidance to prevent the proliferation of hot food takeaways (with some policy already being tested at appeal). Furthermore, a chance for planners and public health officers to meet to discuss the issue at a Fuse event on 21st May 2018 has been greeted with much enthusiasm. This suggests attitudes may be changing, particularly with planners engaged with policy development, who appreciate that health may line up with other planning aims such as protecting shopping area vitality. We will report on this soon.

The event on planning for health will be held on May 21st in Newcastle.  To register or find out more visit the event page on the Fuse website.

Reference:

1. Lake AA, Henderson EJ, Townshend TG (2017) Exploring planners and public health practitioners’ views on addressing obesity: lessons from local government in England. Cities & Health, 1-9.

Image: "Station Street, Birmingham - opening soon - Tarana" (33510099710_d44de7a552_z.jpg) by Elliott Brown via Flickr.com, copyright © 2017: https://www.flickr.com/photos/ell-r-brown/33510099710

Knowledge mobilisation: relationship guidance for ‘stubborn’ practitioners and ‘smug’ scientists

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

Last week, I presented at the UK Knowledge Mobilisation Forum in Bristol, which is an annual event for all those with a passion for ensuring that knowledge makes a positive difference to society. The Forum brings together practitioners, researchers, students, administrators and public representatives who are engaged in the art and science of sharing knowledge and ensuring that it can be used.


Getting creative sticking to ‘unconference’ principles

One of the key note speaker, Dez Holmes who is the Director of Research in Practice with 20 years of experience in championing evidence-informed practice in social care, vented her frustration about a question she was often asked by people interested in knowledge mobilisation (KMb): where can I access training in this? Her response: you can’t! Knowledge sharing is personal and therefore a social skill that you can only develop by practising it.

The skills needed to practice KMb are everyday skills, such as listening, emotional intelligence and persuasion. Reciprocity and mutual respect are crucial in relationships and therefore in knowledge mobilisation. Knowledge mobilisers use these skills to make knowledge relatable and therefore relevant to people’s lives. Dez used a Japanese word to sum up these skills: ‘ikigai’ (meaning “reason for being”): if we can’t relate knowledge to people’s sense of self they won’t be inclined to use it.

Acknowledging feelings in knowledge mobilisation is therefore important, not least because implementation barriers for knowledge are often personal. Dez quoted the common misperception between practitioners and academics that are at the heart of the so-called knowledge-to-action gap: “scientist blame the stubbornness of practitioners for insisting on doing it their way, believing they know their patients best, while practitioners lamented the smugness of scientists who believe that if they publish it practitioners will use it”. These misperceptions signify emotions at work in the knowledge gap that need to be addressed before we can start mobilising knowledge.

A great example of on the job knowledge mobilisation learning was captured in a story told by Vicky Ward, Associate Professor in Knowledge Mobilisation at Leeds University and one of the organisers of the Forum, who reflected on her research about knowledge sharing between professionals in social care. The story, titled ‘Dealing with the carousal of knowledge’, illustrates how practitioners continuously added new and different types of knowledge to their team meetings but never really made use of this knowledge until Vicky started asking some ‘constructively clue less’ questions. These questions helped them to recognise the emotions they attached to the client cases that they were discussing and enabled them to discover patterns in their carousel of knowledge. Identifying patterns allowed the professionals to select knowledge that was most useful for each case and made this knowledge transferable.

The conference format itself acknowledged the relational and context-specific work involved in knowledge mobilisation: participants were encouraged to hone their skills in randomised coffee trials, open space discussions, interactive poster sessions, market stalls, short presentations and practical, interactive workshops. The programme was deliberately based on ‘unconference’ principles, which means that it focused on offering opportunities for conversations, creativity and collaborative learning, with much of the direction being driven by the participants instead of the conference organisers. In this sense, the conference was a training ground for knowledge mobilisers to practice and learn new skills.

How industry-funded organisations mislead the public on alcohol & cancer

Guest post by Dr Nason Maani Hessari, Research Fellow, London School of Hygiene and Tropical Medicine

When it comes to the risk of cancer associated with alcohol consumption, there is a significant disconnect between scientific evidence and public opinion.

The evidence of the independent link between alcohol consumption and cancer is clear, as emphasised by recent comprehensive reviews by the UK Committee on Carcinogenicity* (Committee on Carcinogenicity of chemicals in food, 2015), and the International Agency for Research on Cancer (IARC, 2012). Drinking alcohol can cause a range of cancers, including oral cavity, pharynx (cavity behind the nose and mouth), larynx (voice box), oesophagus (gullet), colorectal (bowel and colon), breast and liver cancer. Furthermore, the risk of developing cancers of the mouth, throat and breast increases with any amount consumed on a regular basis (Department of Health, 2016). However, public awareness of this link remains low, with a 2016 survey reporting only 12.9% of respondents identifying cancer as a potential consequence of drinking too much alcohol (Buykx et al., 2016).

What does this have to do with the alcohol industry? Well, in the UK and many other countries, alcohol-industry funded organisations, called Social Aspects Public Relations Organisations (SAPROs), present themselves as sources of health information to the public, particularly around ‘responsible drinking’, underage drinking and drink driving (Maani Hessari and Petticrew, 2017). These organisations have been criticised for their inherent conflict of interest, as they are linked to large multinational alcohol producers, for whom a large proportion of profits come from harmful drinking (Casswell et al., 2016). The industry has a track record of focusing on education and individual responsibility, while lobbying against population-level measures to reduce alcohol-related harm (Babor and Robaina, 2013), even though these are evidence-based (Burton et al., 2017), and form the basis of the WHO Global Alcohol Strategy, in which alcohol producers participated (World Health Organisation, 2010).

Considering the role of the alcohol industry in providing information to consumers, we decided to examine the extent to which the industry fully and accurately communicated the scientific evidence on alcohol and cancer. To do this, we systematically examined the content of 27 industry-funded organisations or websites. In each case, we analysed how information regarding alcohol and cancer was presented, and whether the statements they made about cancer risk were in agreement with the scientific evidence, as presented in the Committee on Carcinogenicity (COC) and IARC reviews.

We found that most alcohol industry SAPROs appeared to misrepresent evidence by denying, distorting or distracting from links to cancer, particularly breast cancer (Petticrew et al., 2017, Petticrew et al., 2018). A full list of examples can be found in our paper and the supplementary information, but as an example of denial, consider this:

“Moderate wine intake may actually reduce the risk of oesophagus, thyroid, lung, kidney and colorectal cancers as well as Non-Hodgkin’s Lymphoma…Concerning breast cancer, there may also be a protective role for wine.” [Wine Information Council].

When some risk was acknowledged, it was often presented alongside a range of other confounders, thus undermining the evidence that there is an independent relationship. For example:

“Alcohol has been identified as a known human carcinogen by IARC, along with over 1,000 others, including solvents and chemical compounds, certain drugs, viral infection, solar radiation from exposure to sunlight, and processed meat.” [International Alliance for Responsible Drinking]

Or in another instance:

“Not all heavy drinkers get cancer, as multiple risk factors are involved in the development of cancers including genetics and family history of cancer, age, environmental factors, and behavioural variables, as well as social determinants of health.” [Australia: Drinkwise].

It is not clear how the consumer is meant to interpret this information. The use of such descriptions to describe risk of cancer from smoking would in essence be both equally correct, and equally misleading. In fact, this type of language is highly reminiscent of arguments used by the tobacco industry, which emphasise the complex causes of lung cancer and coronary heart disease, in order to help deny the scientific evidence and identify other independent risk factors for smoking-related diseases to deflect focus from their products (Petticrew and Lee, 2011).

Since the publication of our findings (Petticrew et al., 2017, Petticrew et al., 2018), additional examples of alcohol industry representatives openly disputing the link between alcohol and cancer continue to emerge. For example, a recent study in the Yukon, Canada, examining the effects of adding a cancer warning label to alcohol (as one of three potential labelling options) has been suspended due to industry pressure.

Perhaps even more striking: as part of the ongoing debate in Ireland regarding the Public Health Alcohol Bill (PHAB), when a physician noted on live TV that alcohol was a carcinogen, a leading alcohol industry spokesperson countered inaccurately that alcohol was in fact, not a carcinogen, and that there were “…as many studies, medical studies, as there are on the ‘pro’ side…” (clip below).

Dr Ciara Kelly and Patricia Callan clash on Claire Byrne Live pic.twitter.com/KyXqpgnJxj

— RTÉ ClaireByrneLive (@ClaireByrneLive) September 18, 2017

It has been argued that greater public awareness, particularly of the risk of breast cancer, poses a significant threat to the alcohol industry (Connor, 2017). In response to other threats to profits, there is evidence that the industry has attempted to engage in “denialism” (Katikireddi and Hilton, 2015), and it appears this may also be the case for cancer, particularly breast cancer.

Currently, the alcohol industry remains involved in developing alcohol policy in many countries, and in disseminating health information to the public, including school children. Our research findings, which build on existing evidence regarding the activities of SAPROs (Babor and Robaina, 2013, McCambridge et al., 2014, Moodie et al., 2013), should be cause for a re-evaluation of such arrangements. The World Health Organisation has previously stated that ‘In the view of the WHO, the alcohol industry has no role in the formulation of alcohol policies, which must be protected from distortion by commercial or vested interests.’(Chan, 2013). The clear and obvious similarities to tobacco industry tactics that we report, which reflect the inherent conflict of interest, serve as a reminder that policies are but one aspect at risk of industry distortion.


All views expressed are those of the author.


References

BABOR, T. F. & ROBAINA, K. 2013. Public health, academic medicine, and the alcohol industry's corporate social responsibility activities. Am J Public Health, 103, 206-14.

BURTON, R., HENN, C., LAVOIE, D., O'CONNOR, R., PERKINS, C., SWEENEY, K., GREAVES, F., FERGUSON, B., BEYNON, C., BELLONI, A., MUSTO, V., MARSDEN, J. & SHERON, N. 2017. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. Lancet, 389, 1558-1580.

BUYKX, P., LI, J., GAVENS, L., HOOPER, L., LOVATT, M., GOMES DE MATOS, E., MEIER, P. & HOLMES, J. 2016. Public awareness of the link between alcohol and cancer in England in 2015: a population-based survey. BMC Public Health, 16, 1194.

CASSWELL, S., CALLINAN, S., CHAIYASONG, S., CUONG, P. V., KAZANTSEVA, E., BAYANDORJ, T., HUCKLE, T., PARKER, K., RAILTON, R. & WALL, M. 2016. How the alcohol industry relies on harmful use of alcohol and works to protect its profits. Drug Alcohol Rev, 35, 661-664.

CHAN, M. 2013. WHO's response to article on doctors and the alcohol industry. Bmj, 346, f2647.

COMMITTEE ON CARCINOGENICITY OF CHEMICALS IN FOOD, C. P. A. T. E. C. 2015. Statement 2015/S2.

CONNOR, J. 2017. Alcohol consumption as a cause of cancer. Addiction, 112, 222-228.

DEPARTMENT OF HEALTH 2016. UK Chief Medical Officers' Alcohol Guidelines Review - Summary of the proposed new guidelines.

IARC 2012. Personal habits and indoor combustions. IARC monographs on the evaluation of carcinogenic risks to humans.

KATIKIREDDI, S. V. & HILTON, S. 2015. How did policy actors use mass media to influence the Scottish alcohol minimum unit pricing debate? Comparative analysis of newspapers, evidence submissions and interviews. Drugs (Abingdon Engl), 22, 125-134.

MAANI HESSARI, N. & PETTICREW, M. 2017. What does the alcohol industry mean by 'Responsible drinking'? A comparative analysis. J Public Health (Oxf), 1-8.

MCCAMBRIDGE, J., KYPRI, K., MILLER, P., HAWKINS, B. & HASTINGS, G. 2014. Be aware of Drinkaware. Addiction, 109, 519-24.

MOODIE, R., STUCKLER, D., MONTEIRO, C., SHERON, N., NEAL, B., THAMARANGSI, T., LINCOLN, P. & CASSWELL, S. 2013. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet, 381, 670-9.

PETTICREW, M., MAANI HESSARI, N., KNAI, C. & WEIDERPASS, E. 2017. How alcohol industry organisations mislead the public about alcohol and cancer. Drug Alcohol Rev.

PETTICREW, M., MAANI HESSARI, N., KNAI, C. & WEIDERPASS, E. 2018. The strategies of alcohol industry SAPROs: Inaccurate information, misleading language and the use of confounders to downplay and misrepresent the risk of cancer. Drug Alcohol Rev.

PETTICREW, M. P. & LEE, K. 2011. The "father of stress" meets "big tobacco": Hans Selye and the tobacco industry. Am J Public Health, 101, 411-8.

WORLD HEALTH ORGANISATION 2010. Global Strategy to Reduce the Harmful Use of Alcohol.

*Carcinogen is any substance or agent that promotes the formation of cancer

Image: ‘Spilling wine’ (3375802661_fc4ff615ba_z) by Gunnar Grimnes via Flickr.com, copyright © 2009: https://www.flickr.com/photos/gromgull/3375802661

How I chanced upon the 70 year War in Public Health: Aye vs Nay for Water Fluoridation

Guest post by Priyanka Vasantavada, PhD student, School of Health and Social Care, Teesside University

Exactly a year ago to this day, I embarked on my PhD at Teesside University. Little did I know then that a year later I would find myself working on one of the most widely debated and contentious issues in public health.

Water Fluoridation is the controlled addition or removal of fluoride to water supply. Fluoride level of water is maintained at a level that is optimum for preserving dental health by making teeth resistant to decay. The practice of water fluoridation remains controversial even though half a century has passed since its first introduction. This is attributed to various issues such as, the possible negative health effects of fluoridation, lack of dose regulation at the individual level, if fluoride is mass medication and the ethical issues of consent or lack thereof.

Most academics seem surprised when I mention that water fluoridation is controversial. This may be because of the amount of research that already exists supporting the notion of the intervention being both efficient and safe. Water fluoridation happens to be one of the most widely researched topics in public health. Countries that artificially fluoridate water undertake systematic reviews every 5-10 years to update the evidence base. Studies conducted in areas with naturally high fluoride levels (i.e., fluoride endemic regions in parts of Asia) have linked high fluoride levels to skeletal disorders, and cancers etc. However, these studies are not relevant to artificial water fluoridation schemes as the health effects are dose dependent.

I vividly remember my first meeting with my Director of Studies Professor Vida Zohoori who had then asked me to come up with an original research idea and remarked, “A PhD is to foster independent scientific thought and not merely to work on a previously designed project”. I was a little taken aback by that as I had indeed applied for, and was selected to work on, an advertised PhD project! I ended up asking her what was left for me to research on this subject as seemingly all bases had already been covered. (I was neither completely wrong nor completely correct as I would realise in the months that followed.)

So, that day when I went home, I did what any millennial would do and Googled ‘water fluoridation’. Now before any of my readers from academia roll their eyes at this, I would like to clarify that I had already done a fair amount of background reading on water fluoridation from scientific databases and I also happen to be a dentist!

Through the looking glass

The search results were in equal parts exciting and exasperating. With each search results page I visited, my heart sank a little more. Every single idea that floated in my head was destroyed by the discovery of a research paper on the same. Then half exhausted and half asleep, I followed the millennial motto of ‘If you can’t read, why not watch it’!

I clicked on YouTube and just like Alice, fell right into a world I had never known existed! The ‘water fluoridation’ videos on YouTube were more mindboggling and engaging than any literature I had ever read (including but not limited to Game of Thrones). The videos attributed properties to water fluoridation or fluorides, which I had neither heard, read nor even imagined in my wildest dreams.

My curiosity peaked, and I kept trying to look for the scientific basis for the content in the videos. This search led me right into the thick of the controversy: the seemingly contradictory evidence, the prejudices, the sides and the politics around it. I found that it was not merely a controversy but an ongoing war where no one trusts one another and where battle lines are clearly demarcated. Pardon my use of dramatic language but this is the only way the situation can be described.

There are two major parties: those in favour of fluoridation and those against it. These groups are very heterogenous in their composition and no generalisations can be made. Both lobby for their own point of view and battle it out at every place across the world where water fluoridation as a public health measure is considered. And in this cacophony, I felt that the real opinion of the public is lost.

I then discovered that scientific studies on public opinion had been conducted in the US, Canada, Australia, New Zealand, Europe, Japan, South Korea, South Africa, Norway, Denmark and Brazil. Small fluoridation opinion studies have been conducted amongst dentists and in certain localised parts of UK as well. However, a comprehensive study examining the aspects of public perception and engagement had not yet been undertaken in the UK. I had finally found a gap and thank God for it as in the months to follow, the advertised study I had applied for had to be shelved due to ethical concerns.

Since the fluoridation debates and discussions mostly take place on the web, I felt that this the ideal platform to engage people about the issue. To examine the public’s awareness and attitude towards water fluoridation in the UK, I have designed a 10-minute web survey (with optional follow-up e-mail interviews). There is even a prize draw for 10 e-shopping vouchers worth £10 each up for grabs! So, if you are interested to know more about the research or would like to participate, please follow the links below or email me at P.Vasantavada@tees.ac.uk.

You can complete the survey here



Image: By josconklin (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

'Not making decisions on our behalf': Empowering communities to tackle health inequalities

Guest post by Sue Lewis, Senior Research Associate, Institute of Health & Society, Newcastle University and Emma Halliday, Senior Research Fellow, Lancaster University

Community empowerment and the mobilisation of resident knowledge have long been seen as fundamental in tackling health inequalities. Recent strategic documents (e.g., Public Health England’s A guide to community-centred approaches for health and wellbeing and The National Institute for Health and Care Excellence community engagement guidance have, more recently, also drawn attention to the need to place communities at the centre of approaches to reduce damaging differentials in health and wellbeing.



Photo: Courtesy of Liz Kessler

Are we – practitioners and public – ready to make this happen? What do we know (from research, from local experience) and what do we still need to understand or address? Delegates at the recent Fuse Quarterly Research Meeting (QRM) spent a lively morning pondering these important questions.

Emma’s reflections on her experience of research in this field sets the scene:

“Since joining Lancaster University, much of my time has been spent interviewing residents and practitioners about community engagement in area based initiatives.

One of my first encounters was a retrospective look at New Deal for Communities (NDC) approaches to engagement. In some areas, people shared powerful examples of what had been achieved from collaboration placed on a more equal footing. As one resident explained: ‘it was physically, mentally everything, you were involved in it all and you feel proud because you’ve had, you’ve taken part in something good…there’s an awful lot of these projects have come to fruition and you can see, you know, you can actually see the difference that it’s made.’

Yet within the same programme, experiences varied significantly. Elsewhere, residents were left disillusioned about the falling away of an early commitment to engagement where the model became increasingly driven by ‘top down’ pressures. 

‘It moved away from gathering the views of the people and acting on the views of the people to involving the people in New Deal for Communities’, explained another resident.

More recently, the Big Local programme, funded by the Big Lottery and managed by Local Trust, has been the focus of research. The NIHR School for Public Health Research (SPHR) Communities in Control study, undertaken by a collaboration of academic partners including Fuse (Fuse lead, Professor Clare Bambra; researchers Dr Sue Lewis and Dr Vicki McGowan) and led by Professor Jennie Popay at LiLaC, is evaluating the health and social impacts of the resident led programme. While still early days, latest findings show positive impacts for wellbeing for residents actively involved in the programme but also that experiences of involvement can at times also be stressful and challenging.”

So the Fuse QRM (Empowering communities and mobilising resident knowledge to tackle health inequalities, January 11th, 2018) was an important opportunity for public health partners in the North East to reflect on ways of working that enable more equitable collaboration between citizens, the public and the third sector. An exercise to warm people to the topic indicated that many in the audience agreed that there were opportunities in the region (and beyond) for citizens to influence decisions that affect the places where they live. In contrast, far fewer felt that public sector agencies had a sufficiently good understanding of the barriers that impede participation. We clearly have a lot still to learn from one another.

James Hadman, Stockton Catalyst, stimulated thinking
 about grassroots projects having positive impacts but also
drew attention to the times when things don’t work so well

It’s important, then, to share what we already know. The morning included presentations that provided complementary perspectives on the issues at hand. Insights from James Hadman from Stockton Catalyst stimulated thinking about grassroots projects having positive impacts including the role of the Stockton Voice Forum (which gives Stockton’s voluntary, community and social enterprise sector a say in strategic developments in the Borough). Importantly, however, he also drew attention to the times when things don’t work so well, including barriers that were also identified in the New Deal for Communities (NDC) research: where engagement is top down, or driven by professionals’ agendas.

Alison Patey (Yorkshire and Humber Public Health England) gave the national picture, arguing that working with communities should be considered as valid as any other social determinant. A new programme of support is also offering online training for practitioners. And presentations from Emma and myself (Sue) offered the view from research, including findings from the Communities in Control study (in which three North East Big Local areas participated).

Looking ahead, the Communities in Control programme has received SPHR funding to produce resources for residents and practitioners. These will draw attention to the public health evidence already available for place based initiatives and take inspiration from stories of community action that illustrate the potential effects (positive and negative) for community participation and collaboration and, ultimately, empowerment, control and health inequalities.

There aren’t quick fixes to overcoming the imbalances of power between citizens and agencies. But it is, as a resident interviewed in the Communities in Control study put it, about creating a public health system where decisions don’t get ‘made on our behalf as to what they think we should have.’

Kale and running shoes

Posted by Amelia Lake, Associate Director of Fuse, Dietitian and Reader in Public Health Nutrition at Teesside University

"January is our busiest month" said Hayley in the bustling fruit and vegetable shop in the small North Yorkshire market town where I live. This was on the first Saturday of January. She said their sales of kale had rocketed as people started juicing, eating better and generally trying to improve their diet. All this following the excesses of Christmas.

On Sunday morning, when I was out running (or trying to run on the icy pavements!), I was surprised at the number of runners pounding the streets in our small town. Then I remembered, it's the first weekend in January. Maybe, like me they have a shiny new gadget that they are somewhat obsessed with (how many steps have I done today?). There must be an exponential increase in the number of runners and kale consumers.

What is it about 'New Year, New You' that never fails to deliver and how long will these new behaviours be sustained? Why is it that our print and broadcast media don't grow tired of feeding us (excuse the pun) the same January story of …”you've eaten and drunk to excess in December now it's time to abstain from alcohol (Dry January) and go on an excessive unsustainable dietary regime”... Or the most recent health “craze” of ‘raw water’.

Our social media feeds are filled with so called 'nutrition and fitness experts'. The Instagram squares show us before and after pictures of success stories, quick fixes, rapid weight loss etc. etc... Not so many squares saying - look at your diets, your lifestyle, make sustainable changes as these are more likely to succeed in the long term (well apart from one of my professional organisations The British Dietetic Association).

What about the evidence? Does it advocate New Year's resolutions? Are we programmed to wait for the longer term goals or do we need to have instant results? A study published in 2016 suggests that while individuals may exercise for the long term goal of improved health, it is actually the immediate reward that predicts their persistence in that behaviour.

Ultimately these resolutions are about an individual's behaviour change. Much of our public health policy focuses on individuals changing their behaviours. Anyone who has tried to do this knows how difficult it is. Yet, we (professionals, the media, society) continue to focus on the individual who is generally living in an environment where kale isn't an everyday option and running shoes only go on at the weekend – or sit looking pristine in the cupboard.

What we need is a change in the system or what is called a 'whole systems approach' to health and lifestyle problems. The most obvious lifestyle related problem is that of obesity. There is a chronic problem of energy imbalance affecting our whole population young, middle-aged and old. We are encouraged to eat less and exercise more but really, the environment doesn't support those changes (for the majority of the population). Will our policy makers have any New Year's resolutions to focus less on the individual and more on the system in which we make our behaviours? With changes such as a sugar levy coming into play, we are seeing food manufacturers reformulate or change product size. But we also hear reports of people stockpiling sugary drinks that are about to be reformulated. Is this the start of a shift away from the individual and to systems thinking? I very much hope so.

Kale and running shoes are not the answer to addressing a health and lifestyle crisis but long term supported and sustainable changes are.


Image: 'Marinated Kale Salad-2' (23204695074_92c53db643_z) by 'jules' via Flickr.com, copyright © 2015: https://www.flickr.com/photos/stone-soup/23204695074

Merry Christmas from Fuse

We would like to wish all of our readers and contributors a very happy festive season. We will return in the New Year - why not make a resolution to blog in 2018 and send us your posts?

Not addicted but still having an impact: children living with parents who misuse drugs and alcohol

Guest post by Dr Ruth McGovern, Institute of Health & Society, Newcastle University

There is growing political interest in the misuse of alcohol and drugs by parents and its impact upon children. The newly published Drug Strategy 2017 highlights drug and alcohol dependent parents as a priority group with an estimated 360,000 children living with parents who are dependent upon alcohol or heroin.

As a registered social worker, I have often identified ‘dependent parental substance misuse’ as a risk factor in many ‘child in need’ assessments conducted by Children’s Services. Around half of all child protection cases, recurring care proceedings (repeat children removed and placed into local authority care) and serious case reviews (enquiries following child death or serious injury where neglect or abuse is known or suspected) involve parents who misuse substances. However, the impact of parental substance misuse is not limited to addicts. The number of children living with parents who misuse but aren’t dependent upon alcohol and drugs is likely to be substantially more than the number of children living with those who are addicts. As such, greater harm in the population as a whole is likely to be experienced by these children.

I have been part of a group of academics and clinicians who have recently concluded a rapid evidence review funded by Public Health England (PHE). The review found evidence that parents who misuse, but aren’t dependent on substances, can have a significant impact on the physical, psychological and social health of their child. For instance, in early childhood we found that children of mothers misusing alcohol [1] were twice as likely to suffer a long bone fracture and five times as likely to be accidentally poisoned, than children whose mothers do not drink heavily. Children of mothers misusing alcohol or drugs are also more likely to require outpatient care or to be hospitalised due to injury or illness, and for longer. The impact of substance misuse by parents continues into adolescence, with our review showing an increased likelihood of antisocial, defiant and violent behaviour in late adolescence as well as substance misuse by the child. However, many of these children and families are not identified as being affected by the substance misuse of a parent and subsequently do not receive the help they need in the form of an intervention.

Therefore, our review also examined the evidence for effective interventions to help reduce the numbers of parents misusing alcohol and drugs. Family-level interventions, particularly those that offer intensive case management, or those which provide parents with a clear motivation (such as those linked to care proceedings) show promise in reducing the problem. Unfortunately, there was little research examining the effectiveness of interventions for parents misusing but not dependent on alcohol and drugs.

PAReNTS study logo

To respond to this evidence gap, we designed the PAReNTS study (Promoting Alcohol Reduction in Non Treatment Seeking parents). Within this study we are examining the feasibility and acceptability of alcohol screening (using the AUDIT-C questionnaire [2]) and brief interventions with parents involved in early help and statutory children’s social care services. The brief intervention is an adapted version of the ‘How much is too much?’ programme for parents [3] which combines advice and behaviour change activities and is delivered by both social care practitioners and the local alcohol service. Whilst alcohol brief interventions have been found to be effective in adults who misuse alcohol, little is known about the effectiveness of such interventions for parents with additional and complex needs. This presents unique challenges, for instance, parents may be concerned about the stigma of being labelled as having an alcohol problem, particularly if this could be used as a reason to remove their child from their care. There is clearly a need for a sensitive approach. In future blog posts, I hope to update you on the progress we make with the PAReNTS study and whether it is feasible to deliver early interventions with alcohol misusing parents to improve the wellbeing of children, who are often overlooked in public health.

References:

1. Below the age of 10 years, much of the evidence focuses on mothers with alcohol misuse problems as most caregiving is carried out by mothers during early years. 
2. The AUDIT-C is a 3-item alcohol screen that can help identify persons who are hazardous drinkers or have active alcohol use disorders (including alcohol abuse or dependence): https://www.integration.samhsa.gov/images/res/tool_auditc.pdf. 
3. This programme was highlighted by the National Institute for Health and Clinical Excellence alcohol prevention guidance (PH24): https://www.nice.org.uk/guidance/ph24.

Image credits:

• First image: Copyright: Alcohol Concern April 2008. Taken from the report 'Keeping it in the Family Growing up with parents who misuse alcohol'. ISBN number 1 869814 92 4: https://www.alcoholconcern.org.uk/Handlers/Download.ashx?IDMF=399c1dd7-1cb3-407d-a093-b3d486ac034d

Is it possible to have a research career without being a workaholic?

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

This was one of the burning questions that NIHR trainees put to an esteemed panel of career advisers at their annual meeting in Leeds. Every year the National Institute for Health Research brings together their trainees at a two-day event to network, share experiences, take part in workshops and generally learn more about the largest national clinical research funder in Europe. This year’s theme: Future Training for Future Health.

With all these bright minds in the room and a dedicated session on successful fellowships and grant applications, you would think ‘top tips on surviving an interview’ and ‘what mistakes to avoid in an application’ would be on the top of their list. However, after several inspiring presentations from previous and current award holders who had climbed the academic ladder - including Fuse Director Ashley Adamson a NIHR Research Professor - participants were equally, if not more, concerned about maintaining a healthy life-work balance.


Follow the yellow brick road to academic success

While Brexit questions made a brave entrance (Q: How will Brexit affect future research? A: In the long term, not all all!), they could not knock questions about mental health and wellbeing from the top spot. When Ashley included pictures of her son in a musical-inspired animation of her academic pathway (follow the yellow-brick road!) to explain that she preferred part-time work to spend more time with her family, participants immediately asked “but how do you fit family in with an academic career?”.

New gadget SLI.DO was introduced by the NIHR at the meeting this year: participants could submit questions through a mobile app, which others could vote to be answered by the panel (Bush Tucker Trial for academics). Not having to stand up in front of an audience to say who you are, might have given some participants the confidence to ask uncomfortable questions. The honest and open stories from the presenters about their own struggles and failures in academia (“my new post oscillated between agony and despair”) might also have contributed to this confidence.


Paul McGee emphasises the importance of
 looking after your mental health in academia

Experiences of stress and concerns over mental health in academic careers were acknowledged throughout the conference in various presentations and workshops. This was perhaps most evident in the closing session by Paul McGee (aka The Sumo Guy) who emphasises the importance of looking after your mental health in academia. His four key messages (be kind to yourself; get perspective; hippo time - to wallow - is ok; and keep pushing) resonated with many participants and provoked a strong response on social media.

As public health researchers, we are familiar with these messages. In our studies, we underline the link between physical and mental health, express our deep concern over the lack of mental health services and highlight the importance of resilience training from an early age in schools. However, it appears that we are not very good at applying this evidence to our own life and work.

This was recently confirmed by a systematic review of published work on researchers' well-being featured in the Times Higher Education. The review, commissioned by the Royal Society and the Wellcome Trust, found that academics face higher mental health risk than many other professions. Lack of job security, limited support from management and weight of work-related demands on time were listed as factors affecting the mental health of those who work in higher education.

Given this evidence, is it possible to have an academic career and stay healthy? Despite the questions raised at the annual event, the NIHR trainees were keen to acknowledge positive mental health messages: you can have a life and family outside academia (no need to be workaholic, although being a data geek is acceptable*); it’s ok to be different and carve your own path to develop your intellectual independence; and most of all: the key to success is self-care and not funding.

* An after-dinner presentation by @StatsJen taught us that there is a perfect correlation between eating cheese and death by entanglement in bedsheets. Will midnight cheese feasts be the next public health scare?

When the Coca-Cola truck comes to your town

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

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

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

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

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

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

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

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

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

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

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

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

  

References:

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

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


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

‘Afore ye go’… across the border for a cheap pint

John Mooney, University of Sunderland and Sunderland City Council, asks how Scotland’s minimum unit pricing policy would go down in North East England.

Like many former native Scots now living and working in North East England, the geographical, social and cultural parallels are just three areas of overlap that help keep homesickness for my country of origin at bay!

As a public health researcher some less fortunate similarities are often at the forefront of my mind, including a fondness for deep-fried food, an aversion to fresh vegetables and a damagingly long-ingrained culture of heavy drinking.  This is accompanied by an almost Scottish-scale public health burden to match. It will come as no surprise that as a whole, the North East has among the worst health statistics for alcohol related harm in England [1].

Of course it is also no coincidence that both North East England and much of Scotland’s central belt, particularly Greater Glasgow and Clyde Valley, have some of the most longstanding and concentrated areas of social deprivation and economic disadvantage in the UK. As recent research from Glasgow University has highlighted [2], deprivation and alcohol related health damage, present a particular kind of “double whammy”, even after adjusting for alcohol intake and other lifestyle factors such as smoking.

With these similarities in mind, there is an inescapable logic in looking to Scotland for a steer in terms of policy interventions that might reduce the unacceptably high public health burden due to alcohol in this part of the World. I refer of course to the introduction of a minimum unit price (MUP) of 50p for a unit of alcohol, which on the basis of rigorously evaluated international studies combined with sophisticated cost effectiveness modelling from the Alcohol Research Group at the University of Sheffield [3], is one of the best evidenced policies for reducing alcohol harm in the population.

Scotland is also at the forefront of (what may eventually lead to) a much more ‘fit-for-purpose’ legislative framework around alcohol licensing and availability: namely the inclusion of 'health' as a licensing objective (or ‘HALO’). In principle, this has the potential to transform the capacity of public health teams in English local authorities to make much more use of information on health harms as part of the licensing process. This would ensure that challenges to new licence applications - however potentially damaging the new licence may be - no longer need to be based exclusively on crime and public disorder evidence. To explore whether HALOs could also be used in England, our team at the University of Sunderland looked at the practicalities and logistics of using health information in English licensing decisions. The results have recently been published by Public Health England [4].

So what are the prospects for importing MUP and health objective policies to North East England?

Thankfully, on both policy and research fronts, there are also significant grounds for encouragement in the North East! Indeed, some of the most progressive public health policies around alcohol harm reduction, such as cumulative impact zones and late night levies, are now well established in a number of local authority areas. This has been possible thanks to strong political will and high profile regional level advocacy for alcohol harm reduction policies from Balance North East [5], which is funded collectively across most North East local authorities. Balance NE has already been calling for better controls on cheap alcohol availability in the wake of the Scottish Policy decision [6].

There is also no shortage of public health alcohol research effort in the North East, with a long tradition of internationally renowned research from the Universities of Newcastle, Teesside and most recently our own contributions to several national level evaluations (such as HALO mentioned above).

In brief, there are many regional policy drivers already in place for North East England to emulate Scotland’s very progressive approach to the reduction of alcohol harms. With regard to the often raised criticism that price based measures such as MUP are ‘regressive’ due to a disproportionate financial impact on the poorest, it is difficult to rival the response of Scottish novelist Val McDermid on Thursday's (16 Nov) BBC Question time: “it’s actually about preventing people in our poorest communities drinking themselves to death with cheap alcohol”. It is difficult to figure out what particular definition of the term ‘regressive’ that this conforms to…


References:

1. Local Alcohol Profiles for England [May 2017]: https://fingertips.phe.org.uk/profile/local-alcohol-profiles/data#page/0
2. Katikireddi SV, Whitley E, Lewsey J, et al. Socioeconomic status as an effect modifier of alcohol consumption and harm: analysis of linked cohort data. The Lancet Public Health 2017;2(6):e267-e76. doi: https://doi.org/10.1016/S2468-2667(17)30078-6
3. Sheffield Alcohol Policy Model:  https://www.sheffield.ac.uk/scharr/sections/ph/research/alpol/research/sapm
4. Findings from the pilot of the analytical support package for alcohol licensing: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/620478/Alcohol_support_package.pdf
5. Balance North East: http://www.balancenortheast.co.uk/about-us/
6. Balance North East news item: http://www.balancenortheast.co.uk/latest-news/balance-calls-on-government-to-follow-scotland-on-mup 

Images:

1. 'cheap booze, hackney' (3892082333_943f3cc70e_o) by ‘quite peculiar' via Flickr.com, copyright © 2009: https://www.flickr.com/photos/quitepeculiar/3892082333 (cropped)
2. Courtesy of Alcohol Focus Scotland: https://twitter.com/AlcoholFocus/status/922822671599054848

Public health, social justice, and the role of embedded research

Posted by Mandy Cheetham, Fuse Post doctoral Research Associate and embedded researcher with Gateshead Council Public Health Team

On this date (13 November) in 1967, Martin Luther King was awarded an Honorary Doctorate in Civil Law from the University of Newcastle upon Tyne. The speech he gave at the award ceremony is both powerful and moving. It was the last public speech he made outside the US before his assassination in April 1968. You can read it for yourself here or watch it here.

Newcastle was the only UK University to award an honorary degree to Dr King in his lifetime. In accepting the honour, he said “you give me renewed courage and vigour to carry on in the struggle to make peace and justice a reality for all men and women all over the world”. As I listened to the speech, it struck me that the three “urgent and indeed great problems” of racism, poverty and war, which Dr King described in his speech, are just as relevant today as they were then. It made me reflect on our role in universities now and on my role as an embedded researcher in Gateshead Council.

That's me on the left

On Sunday 29 October, I had the privilege of being part of the Freedom City 2017 celebrations held on the Tyne Bridge to mark this significant anniversary, inspire people, and stimulate academic debate about potential solutions. Performances across Newcastle and Gateshead came together to mark different civil rights struggles across the globe, including Selma, Alabama 1965, Amritsar, India 1919, Sharpeville, South Africa 1960, Peterloo, Manchester 1819, and the Jarrow March, Tyneside 1936.

The celebrations were timely, as I am just finishing an embedded research project in Gateshead, undertaken less than a mile from where we stood on the Tyne Bridge. It has been an inspiring year. I’ve learnt a lot, but I have also seen the devastating effects of austerity and poverty on North East families and communities. The research findings demonstrate all too clearly the continuing impact of the social injustices which Martin Luther King talked about fifty years ago.

I believe our role as writers and researchers in public health is not just to highlight the effects of these grave injustices, but to be part of the solutions, developed with the communities affected. If we accept that we are all caught up in what Dr King described as “an inescapable network of mutuality”, then universities have an important part to play in changing attitudes, working with others, facilitating connections, and inspiring efforts to “speed up the day when all over the world justice will roll down like waters and righteousness like a mighty stream”. (Dr Martin Luther King Jr. Speech on Receipt of the Honorary Degree, November 13, 1967).

I believe embedded research affords us valuable opportunities, to work alongside local communities with colleagues in public health and voluntary sector organisations, to challenge injustices and push for the kinds of social and political change advocated by Dr King.


Photo credits:

1. Martin Luther King Honorary Degree Ceremony: http://www.ncl.ac.uk/congregations/honorary/martinlutherking/. Courtesy of Newcastle University.
2. Photo by Bernadette Hobby of "the judge", representing the establishment, about to receive the Jarrow Marchers petition. The judge was made by Richard Broderick sculptor.
3. Freedom on the Tyne, The Pageant: http://freedomcity2017.com/freedom-city-2017/freedom-city-tyne/. Courtesy of Newcastle University.

Spice up your research life: match-making in public health

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

Three years ago, we had a crazy idea: what if Fuse had its own dating service for academic researchers and health professionals? Instead of innovative research findings gathering dust on lonely bookshelves, we wanted to provide a stage for academics and health professionals to meet and discuss how that evidence could be used in practice. We were keen to facilitate early conversations on how to collaborate on research that is useful, timely, independent, and easily understood.

Instead of health practitioners wandering around University campuses, trying to find the right academic to work with, we envisioned an open door leading to a welcoming friendly-faced guide. Someone who could do the matchmaking and help them to find or create evidence for spicing up their policies or interventions.

After checking our idea with various health practitioners in the region to make sure that it would make their hearts beat faster, we launched AskFuse in June 2013: Fuse’s very own rapid responsive and evaluation service with a dedicated match-maker (research manager) in post – that’s me!

Coming from an applied research background in social sciences, this post was certainly a challenge but also an incredibility exiting opportunity to develop something new with the support of an enthusiastic group of people across Fuse. The job has been a steep learning curve, but also a great way to meet a lot of people working in public health across the region, getting to understand their passions and … what keeps them up at night.

I quickly learned that there were many great public health projects and programmes being developed and delivered locally that deserved more attention and research (e.g. My Sporting Chance, Ways to Wellness, Boilers on Prescription).  I was encouraged by a real appetite among academics to support this work but felt the frustrations of health professionals caused by budget cuts and the need to decommission services rather than to develop them. I also noticed the limited research evidence informing some of these decision-making processes and the lack of knowledge among academics about how to influence these processes and mobilise their research evidence effectively.

AskFuse has supported more than 270 enquiries from a wide range of sectors, organisations and on topics ranging from Laughter Ball Yoga to Whole Systems Approaches to obesity. We have helped to develop new interventions and evaluated existing ones, made research evidence accessible and understandable, organised events to explore new topics, and pioneered new methodologies; all in collaboration with our policy and practice partners. We have also made mistakes, misunderstood procurement procedures, were not able to help in time, could not find relevant expertise or did not always follow-up on conversations.

Despite these challenges - or perhaps because of them - we have been able to build a dating service that (I think/hope) is perceived as useful by our policy and practice partners, that has helped us to build relationships (even in times of considerable system upheaval with public health moving to local authorities), and has informed new research agendas for Fuse going forward over the next five years as a member of the national School for Public Health Research.

As the service is expanding and my role is changing (I recently became a NIHR Knowledge Mobilisation Research Fellow, which I will talk about in another blog), we are looking for a new AskFuse Research Associate to work with me on strengthening the service and taking it in new directions. If you are interested in mobilising knowledge, fancy a challenge and want to work with a fantastic team, why not be part of it?

Why are veterans reluctant to access help for alcohol problems?

Guest post by Gill McGill, Senior Research Assistant, Northumbria University

 

With Alcohol Awareness Week fast approaching, the Northern Hub for Military Veterans and Families Research is busy planning a national conference to share findings from a project on improving veterans’ access to help for alcohol problems. The project was funded by the Royal British Legion and arose from two questions frequently posed by clinical practitioners working within the field of alcohol misuse services: 

1. Why is it so difficult to engage ex-service personnel in treatment programmes?  
2. Once they engage, why is it so difficult to maintain that engagement? 
    
   

In an attempt to test these perceptions, we carried out a systematic literature review of the existing evidence.  We then explored the relationship between being a UK military veteran (ex-serviceman/woman) and alcohol misuse services; and veterans’ experiences of engaging with these services. The research study involved interviews with commissioners and managers of services for alcohol misuse, interviews with veterans who are currently experiencing, or had experienced, problems with alcohol misuse, and focus groups with veterans who had no apparent experience of alcohol misuse.

 

The findings will be discussed in detail at the conference, so please join us there to hear more, but that quick plug aside, we thought we’d give you a sneak preview here!

 

Paradoxically, although alcohol misuse amongst UK veterans is estimated to be higher than levels found within the general population, we found a limited amount of research that specifically considered alcohol problems among UK veterans. Given that there are an estimated 2.56 million UK military veterans[1], this represents an important, but as yet, largely unaddressed public health issue.

 

Commissioners and managers of alcohol services expressed the view that veterans have difficulty navigating available support due to ‘institutionalisation’. Yet, when speaking to military veterans themselves, we found no support for this. Such a view point is also potentially problematic in stereotyping veterans as (at least in part) the architects of their own difficulties.

 

In all cases, it could be said that meaningful engagement with alcohol misuse services was being ‘delayed’ to a significant extent by the veterans involved in our study. They ‘normalised’ their relationship with excessive alcohol consumption both during and after military service and this hindered their ability to recognise alcohol misuse. Yet this was not mentioned by healthcare staff participating in the study. Participants also suggested that seeking help was contrary to ‘military culture’ and that this frame of mind tended to remain with UK military veterans after transition to civilian life. Delay in seeking help often meant that by the point at which help was sought, the problems were of such complexity and proportion that they were difficult to address.

Service commissioners/managers and military veterans highlighted a need for greater understanding of ‘veterans’ culture’ and the specific issues veterans face among ‘front line’ staff dealing with substance and alcohol misuse.

 

As a result of the research, one possible solution identified as worthy of further exploration is a ‘hub-and-spoke’ model of care. At the centre of the hub would be a military veteran peer support worker, with knowledge of local and national services, and experience in navigating existing pathways of care. This solution perhaps offers one way in which UK military veterans experiencing alcohol misuse problems might engage with the full range of existing services in a considered and individually bespoke way.

 

Reference:

1. Ministry of Defence (2015) Annual Population Survey: UK Armed Forces Veterans residing in Great Britain 2015. Bristol: Ministry of Defence Statistics (Health).

National Conference – Northumbria University and Royal British Legion
Veterans Substance Misuse: Breaking Down Barriers to Integration of Health and Social Care
Newcastle United Football Club (Heroes Suite)
Thursday 16 November
More information on the Fuse website.