Prevention by any other name would smell as sweet

Guest post by Tom Embury, Public Affairs Officer, British Dietetic Association

Next week, June 4th - 8th is Dietitians Week 2018, where the British Dietetic Association and its members and allies celebrate the work of dietitians. This year’s theme is “Dietitians Do Prevention”, which intends to highlight the important role that dietitians have to play in prevention and public health. We know nutrition and hydration underpin so much of our health and getting it right can reduce the impact of illness, aid recovery, or prevent some diseases and conditions altogether.

NHS England’s Five Year Forward View, in the most recent frameworks from NHS Scotland and the Northern Irish Health and Social Care Service and is embodied in the principles of the Wellbeing of Future Generations (Wales) Act.

It has been made clear by everyone from Marmot to the NHS Confederation that we need to strengthen prevention and that it should be everybody’s business. Despite this, many dietitians (and indeed healthcare staff in general) still don’t think of themselves as doing prevention or public health, especially as so many work in hospital settings, delivering acute care. Our recent 2018 member survey has shown that 40% of our members don’t feel that they do prevention or public health activity. This may be because they don’t have the time or resources, despite wishing to do so, but in some cases, it is because they don’t see public health as part of their remit.

Of course, we believe all our members “do prevention” and public health, but not everyone will call it by that name. Indeed, the term public health often seems to have quite a narrow definition, associated with the work of local government public health teams. This is important work, but by no means is that everything public health entails.

This is why, in preparation for Dietitians Week this year, we asked all our specialist groups for their view on how they do prevention. Our specialist groups cover pretty much all of the areas of dietetics - from paediatrics to older people, public health to critical care. What we found is that there are dozens of words and terms used to describe activity that is essentially a form of prevention.

Some were variations, like primary, secondary or tertiary prevention depending on where you work and what types of illnesses your patients have. Others, such as Making Every Contact Count or Healthy Conversations, relate to specific campaigns or initiatives. In areas like Mental Health or Paediatrics, a whole different language can exist. Even rehabilitation or recovery after acute illness is a form of prevention - preventing future episodes, further hospital visits or complications. One great example comes from Fuse itself – the research carried out into the impact of energy drink intake amongst young people has had an impact on national level policy making.

This is why we are trying to celebrate prevention in all its forms and with all its various names. Dietitians are and should to a greater extent be a core part of the public health workforce.

Our incoming Chairman, Caroline Bovey, highlighted this issue with terminology and understanding at our recent Annual General Meeting. She asked the crowd of over 100 dietitians to raise their hands if they were involved in public health. Some hands went up but they were definitely in the minority. She then asked who had a twitter account where they talked about diet and nutrition – far more hands shot up. “You are all”, she said, “doing public health dietetics”.

So, whether you’re having a healthy conversation or making every contact count, supporting rehabilitation or reducing hospital admissions, celebrate the way that you do prevention. We can’t let the terminology get in the way of sharing best practice or spreading good ideas. We’d love you to tell us about it as part of Dietitians Week! Get in touch via dietitiansweek@bda.uk.com

Public health isn’t good politics

Knowledge exchange lessons from the 4th Fuse international conference (part 1)

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

When I attended the Fuse knowledge exchange conference in Vancouver, B.C. earlier this month, I did not know that some Canadian squirrels are black.

I also did not know how much knowledge exchange was embedded in Canadian research. In the UK we are struggling to get researchers involved in knowledge exchange while working in an academic system that does not reward these activities. For Canadian researchers this is a fundamental part of their job and firmly embedded in the CIHR (the Canadian equivalent of NIHR) mission statement: "… excel the creation of new knowledge and its translation into improved health for Canadians" (Canadian Institutes of Health Research Act).

As surprised as I was to see black squirrels skirting the trees in Stanley Park in Vancouver, I was also surprised by the number of Canadian presenters at the Fuse conference who pointed to the impossibility of translating research evidence into practice.

For instance, Steven Hoffman, made a convincing case about public health being not good politics and therefore difficult to translate into policy. He argued that everything that public health does makes it invisible to policy makers. For example, we focus on prevention instead of treatment, which is much more difficult to observe and showcase.

An image from Steven Hoffman's presentation

Moreover, the more successful we are (when we prevent population diseases from spreading), the greater our invisibility becomes (there is no longer a disease to worry about) and, consequently, the more difficult it is to ask for more resources to keep prevention efforts up.

We also focus on supporting long-term chronic conditions instead of delivering acute services that can provide an instant solution to health problems. Furthermore, our data, as a population science, is based on statistical lives instead of individuals with a face and story. This all makes public health a hard-sell to politicians.

But it is not only our modus operandi that causes this hard sell: the system in which policy makers operate makes the use of research evidence unlikely. Paul Cairney from the University of Stirling explained in his talk that policy makers must ignore almost all the evidence that they are presented with to make decisions. They do this, not by weighing up the evidence carefully as we as researchers would like them to do, but by taking shortcuts, which Paul described as ‘bounded rationality’.

Policy makers either select evidence that helps them to reduce uncertainty about how to achieve their goals or, (and this is the more popular option) they apply their gut-level, emotional, belief-driven knowledge to reduce ambiguity about policy options. Moreover, policy makers are often not in control of the policy process and therefore they cannot tell us what evidence is useful, when and how it will influence the decision-making process.

If public health policy is not good politics and research evidence is a hard sell to policy makers, what can we do to make a better investment case for public health? Luckily both speakers provided their own shortcuts for making it more likely that public health and our evidence would be heard and used by policy makers:

1.) Recraft the narrative. Smoking was banned in public places not because smoking was harmful to smokers but because the campaigns focused on the dangers of second-hand smoke to the wider public, particularly children. By reframing the story from an individual blame game to an emotive public issue, public interest could be galvanised and used to put pressure on national Government to take action, building on local interventions already in place with a proven evidence-base.

2.) Take account of how democracy works: politicians need votes. As public health researchers we need to give them glory in the eyes of their voters and provide them with opportunities to leave a visible legacy. We could this by advertising our successes more clearly and by making it personal. Eugene Milne, Director of Public Health at Newcastle City Council, summed this up in a simple statement: "...‘it could happen to me’, mobilises people".

3.) However, to do this effectively, we need to be aware of hierarchy in politics and different policy contexts and networks. Most importantly, we need to be able to navigate diffused decision-making processes. As Paul emphasised in his presentation, policy makers have different ideas about what counts as good evidence, and there are many ‘policymakers’ across many levels and types of government. In other words, there are many sources of policy relevant knowledge that public health research evidence has to compete with.

It will take time and long-term relationship building to understand and navigate the different policy contexts, networks and types of evidence used in both. Unfortunately, public health students are generally poorly equipped to navigate these networks. Steven Hoffman remarked that we are not equipping our PhD students with knowledge of political systems and, in not doing so, set ourselves up for continued failure to make public health and our evidence visible to policy makers.

This does not mean that each student should become a political expert and advocate fiercely for her/his research findings. But it does entail a student being able to recognise their role in the wider system that they are part of, including various political networks and contexts. How can we teach our students to act from their position in a political system in a way that will make public health more visible?

This brings me back to squirrels. The squirrels that I encountered in the park stood out because they were black; a different colour to the common British grey and (less common) red squirrels that I’m used to seeing. In a similar vein, we could make our PhD students stand out by teaching them how to take evidence shortcuts in the political system.

Sharon Hodgson, Shadow Minister for Public Health, speaking
at an event in Sunderland

When I returned to the UK, with more appreciation for squirrels, I attended a spotlight event at the University of Sunderland the next day, which aimed to increase the visibility of public health research at the university. Although heavily jet-lagged, what sparked my interest at the event was a debate that took place between Sharon Hodgson, the Shadow Minister for Public Health and various researchers in the room. They sparred about the evidence for introducing a minimum unit price for alcohol in England and whether 40p made more ‘sense’ (and to who) than 50p. The ensuing debate demonstrated many of the arguments made in this blog and therefore will be the focus of my next blog (part 2) with John Mooney, Senior Lecturer at the University of Sunderland.

We will use this example to demonstrate how Canadian experiences might inform local practice in the UK by recrafting the narrative, taking account of Labour as an opposition party, and making it personal for voters.


Image: "Black Squirrel" (11997818194_8f66516b30_z) by DaPuglet via Flickr.com, copyright © 2018: https://www.flickr.com/photos/dapuglet/11997818194

Getting physical activity research moving

Posted by Louise Hayes, Research Methodologist, Newcastle University and the Fuse Physical Activity Group

So, we all know we should be more physically active – the evidence is out there. People who are more active are less likely to suffer from many chronic diseases, have more energy, better mental health, sleep better…… But how do we get people to be more active?

We knew researchers across North East England were working on physical activity related research and we knew that practitioners were delivering physical activity interventions, with the aim of getting more people active. What we didn’t know was who was doing what and whether or not the evidence from the researchers was getting to the practitioners or if the practitioners were delivering evidence-based intervention or evaluating their interventions. So, a little over five years ago, Martin White, the then Director of Fuse, Laura Basterfield and I (two physical activity researchers at Newcastle University), set about getting physical activity researchers from across the region together. We wanted to provide a forum for researchers to share information on current and future research and to identify opportunities for collaborations across individuals and teams conducting PA research in the Fuse partner universities. The inaugural Fuse Physical Activity Workshop (#FusePAW) was held at Newcastle University in May 2013.

It quickly became apparent that there was an appetite for a Fuse Physical Activity Group to be formed to build upon the enthusiasm for collaborative working and developing a shared physical activity research agenda that was in evidence at this first PAW. Several people also made it clear (and yes, we do mean you, @Scottylloyd1979!) that there was a need to widen the base of the group to include our practitioner partners involved in delivering physical activity interventions on the front line and to build relationships across sector boundaries. And so the Fuse physical activity group was born!

Liane Azevedo and I took on the role of leading the group, along with a team including Scott Lloyd, Caroline Dodd-Reynolds, Alison Innerd and Natalie Connor representing the North East Universities and public health partners. Since then we have had twice yearly Fuse PAWs, hosted by each of the five Fuse Universities and covering a range of topics from inequalities in physical activity to measurement of physical activity and physical activity during pregnancy. We’re proud to say that we’ve achieved an equal balance of academics and practitioners attending the events.

From the outside it might look like it’s been plain sailing – we’ve attracted an amazing cast of physical activity researcher royalty to present at our events, (see the list below - to name but a few!). On the inside there has been blood, sweat and occasional tears! Will the speakers agree to come? Will anyone sign up to attend? Will there be enough parking spaces/coffee? Will we be able to afford fruit during the breaks or just (unhealthy, but delicious) biscuits? (The latter has often been uppermost in the minds of some of our delegates if the feedback we receive in our, now infamous, shiny blue feedback box* is anything to go by!)

We were nervous that attendance might suffer when austerity measures cut into our budget meaning we were no longer able to provide lunch – but happily attendance has steadily increased and we have begun to attract individuals from outside the North East and sometimes even from outside the UK!

It was great to celebrate our tenth PAW on 20th April 2018, following #Fuse10 on 19th April, and to think about our previous events. All the hard work definitely felt worthwhile as we reflected on the many interesting presentations, workshops and discussions that have come out of the FusePAWs as well as collaborations, including a joint evaluation of the Redcar school pedometer intervention by Northumbria and Leeds Beckett Universities.

As #FusePAW, we have a responsibility to ‘do

’ physical activity research better and try to capture how FusePAWs inform physical activity within the region and further afield. To this end we discussed how we can work together more effectively as academics and public health practitioners to challenge traditional methods for delivering and evaluating physical activity interventions to nudge the field forwards at this event.  If you have any suggestions on how we can do this please contact me at louise.hayes@ncl.ac.uk

Watch this space for findings!


The Fuse Physical Activity Group is Louise Hayes, Liane Azevedo, Scott Lloyd, Caroline Dodd- Reynolds, Alison Innerd and Natalie Connor


Just a few of our amazing cast of presenters

Professor Ashley Cooper (University of Bristol), Dr Esther Van Sluijs (University of Cambridge), Dr Paul Kelly (University of Edinburgh), Dr Nick Cavill (Public Health England), Bob Laventure (Loughborough University), Prof Charles Foster (University of Oxford) Dr Mark Tully (Queens University), Prof Tess Kay (Brunel University), Prof Adrian Taylor (University of Plymouth) and Prof John Saxton (Northumbria University).

* Look out for our next event to see it for yourself!

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.