Back to the Future: health and housing working together

Guest post by Patrick Vernon, Health Lead, National Housing Federation

The launch of the Due North report in September 2014 was a rallying cry for greater priority around tackling health inequalities with a manifesto in how all stakeholders and system players can recycle effectively the £136 billion in public spend for transforming services. Since May 2015 we have a new Government with a clear agenda on austerity, public sector reform and the revitalisation of the devolution agenda with the mantra of the "Northern Powerhouse". In the middle of this maelstrom has been the Government's approach to tackling the housing crisis with the immediate reduction of 1 per cent in rents over the next four years, the extension of the Right to Buy and the ongoing impact of welfare reforms. These changes have become a major turning point in the history of the social housing sector along with the changes in supported housing.

Although there is an emotional, political, moral and (increasing) evidence base for the links between poor housing and health, the gap between fact and reality still feels light years away. There is a clear role for the social housing sector to work with the NHS, social care and employers in transforming services and care pathways to meet demographic, lifestyle and morbidity changes in the population. A step in the right direction is the Memorandum of Understanding (MoU) to support joint action on improving health through the home which was signed by all stakeholders in the health and housing sector in Autumn 2014. The document highlights at a strategic and national level the key principles and actions around a collective approach around delivery. However, what is currently missing is a regional approach that is embedded in the devolution agenda. This is already happening in Greater Manchester as part of DevoManc (giving greater powers to the combined authority working in partnership with a directly-elected Mayor). In the North East we need to ensure that housing and health are part of the devolution plans.

Thus the Fuse Quarterly Research Meeting (QRM) ‘Creating Healthy Places in the North East: the Role of Housing’ on Tuesday (20 October) in Darlington is the start of another important chapter in the health and housing trilogy (or may be pre-sequel) on how health, social care and housing can work together in meeting the needs of local communities in a period of austerity. All the speakers at the event had - in essence - the same message: a need for strengthening partnerships and system leadership along with collating, translating and communicating the evidence for cost-effective interventions.

The event not only had international examples from the Netherlands and New Zealand but also local case studies from a number of housing associations such as Thirteen Group (Middlesbrough Recovering Together project), Gentoo Housing (Boilers on Prescription), Home Group (social prescribing), Tyne Housing (working with homeless people in the community) and South Tyne side Homes (sheltered accommodation for residents with dementia). The case studies illustrated how better commissioning and service integration can make a difference to the lives of people.

The challenge in a period of reduced budgets and further potential cuts in the forthcoming Comprehensive Spending Review is how we make the business case and get the right people in the room to transform services, building on the spirit and vision of the Due North report in tackling health inequalities and achieving greater health equity.

I think one of the key outcomes of the QRM is for Fuse to act as broker between service providers, commissioners and service users in creating a strong North East dialogue between the health, social care and the housing sector. This can be achieved by networking, sharing good practice, supporting development of the evidence and, finally, an advocacy role in influencing the devolution agenda.

Thus, if Marty McFly and Doc Brown pop out of their DeLorean DMC-12 again in the future, we can share with them the successful journey that we have undertaken in ensuring that the housing sector is a valued, respected and key partner in delivering better health and social care services and an integral agent in tackling the public health agenda.

For more information visit the National Housing Federation website or read the Fuse research brief accompanying this event: Creating healthy places in the North East - the role of housing.


Photograph 'Back to the Future DeLorean Time Machine' by AdamL212 via Flickr.com © 2007: https://www.flickr.com/photos/lautenbach/1393032429

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Obesity: How neoliberalism made us fat

Posted by Ted Schrecker, Fuse Associate Member and Clare Bambra, Fuse Associate Director

A 2010 editorial in the Journal of the American Medical Association warned: “If left unchecked, overweight and obesity have the potential to rival smoking as a public health problem, potentially reversing the net benefit that declining smoking rates have had on the US population over the last 50 years”. Obesity increases the risk of developing cardiovascular disease (CVD), certain types of cancer, Type 2 diabetes, and orthopaedic problems. At the end of the 1970s it was estimated that 15% of US adults were obese. By 2012, this had more than doubled, to 35%. Among adolescents the increase is even more striking – from 5% at the end of the 1970s to 20% in 2012. In the UK, it is estimated that obesity nearly tripled between 1980 and 2002, from 6% amongst men and 8% amongst women to 23 percent and 25 percent women respectively. Amongst children in England, obesity has increased from 11% among boys and 12% among girls in 1995 to around 20% today.

In our book Neoliberal Epidemics: How Politics Makes Us Sick we argue that obesity in high–income countries is partly the result of political and economic choices made since the 1980s. Since the early 1980s, neoliberalism or “market fundamentalism” has dominated politics and economics across much of the globe, perhaps nowhere more conspicuously than in the post-Thatcher UK. Obesity is a neoliberal epidemic – one of four, along with austerity, stress, and inequality. They are neoliberal because they are associated with or exacerbated by the rise of neoliberal politics. They are epidemics because they are on such an international scale and have been transmitted so quickly across time and space that if they were a biological contagion they would be seen as of epidemic proportions.

North American contrasts between rich and poor urban areas, less than a mile from one another
Photo: T. Schrecker

Other high-income countries have also experienced increases in obesity. Obesity has no single cause; the many influences include changes in the food environment (including advertising, marketing, accessibility and affordability); the growth of sedentary work occupations and leisure time activity, such as television viewing; changing settlement patterns, notably the rise of a privatised approach to planning organised around driving rather than walking or the provision of public transportation; and changes in the built environment that reduce the safety and attractiveness of physical activity, especially for those who do not live in leafy places. However, countries that have gone farthest down the neoliberal road, the UK and the US in particular, have experienced greater increases in obesity – suggesting that neoliberalism has magnified and accelerated trends that are present to some extent throughout the high-income world.

Obesity is a neoliberal epidemic for several reasons. These include: (1) economic and social policies that have meant fewer people can afford a healthy and balanced diet; (2) increasing time poverty, as when the demands of work (often on unpredictable schedules), transportation, and (especially for women) child care within ‘flexible’ labour markets are combined, there is not much time or energy left for eating a healthy diet and the attraction of a quick stop at the shopping park’s fast food outlet are strong; (3) the role of aggressive corporate marketing of unhealthy, energy-dense foods, notably as multi-national supermarkets, manufacturers of ultra-processed food and fast food chains expand into developing economies with the lowering of barriers to foreign investment. This helps to explain why overweight and obesity are now also rising rapidly in many middle- and some low-income countries, with prevalence in Mexican adults comparable to levels in the United States.

Corporate food systems and time poverty interact at the shopping park.
Photo: T. Schrecker

A fourth connection was addressed at a groundbreaking workshop at the University of Oxford in 2009: political structures such as welfare state regimes. More specifically, higher levels of economic insecurity – associated with neoliberal policies like the rollback of welfare state protections and opening up labour markets to the “creative destruction” that Joseph Schumpeter extolled as a defining virtue of capitalism – are causally linked with a higher prevalence of obesity through both biological (stress-related) and psychosocial (comfort eating) mechanisms, in addition to the more direct effects on time and food budgets.

Public health researchers, who agree on little else, recognize that reducing overweight and obesity is a formidable challenge. A first step is to avoid the lifestyle trap. A recent literature review on policy interventions to tackle what has been called the obesogenic environment produced by the Scottish Collaboration for Public Health Research and Policy provides some useful directions. Its authors do not shrink from arguing the need for large-scale interventions that may be expensive or challenging to vested interests, noting (for example) that the transport mode split in urban areas is 84% by car versus 9 percent walking in the United States, while it’s 36% by car versus 39% walking in Sweden. “Suffice it to say, it has been a concerted combination of infrastructure provision, integrated transport planning and disincentives for private cars which has helped to bring about the higher active travel rates.” We have no easy solutions, but emphasise that neoliberalism and the associated political choices have exacerbated the obesity crisis. Obesity is an example of how politics makes us sick.

Links: Schrecker, T. and Bambra, C. (2015) Neoliberal Epidemics: How Politics Makes Us Sick, Palgrave Macmillan, available at: http://www.palgrave.com/page/detail/how-politics-makes-us-sick-ted-schrecker/?K=9781137463098

Professors Schrecker and Bambra will be discussing their new book 'How Politics Makes Us Sick' at an event at Durham University on 15 October 2015. For more details click here.

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About the authors

In June 2013, Ted Schrecker moved from Canada to take up a position as Professor of Global Health Policy, Centre for Public Policy and Health, Durham University (UK). Since 2002, most of his research has focused on the implications of globalization for health; he also has long-standing interest in issues at the interface of science, ethics, law and public policy. A political scientist by background, Ted worked as a legislative researcher and consultant for many years before coming to the academic world, and co-edits the Journal of Public Health. Among his publications, he is editor of the Ashgate Research Companion to the Globalization of Health (2012) and co-editor of a four-volume collection of key sources in Global Health for the Sage Library of Health and Social Welfare (2011). Ted is also an Associate Member of Fuse. Ted can be followed on Twitter @ProfGlobHealth.

As well as being an Associate Director of Fuse, Clare Bambra PhD is Professor of Public Health Geography and Director of the Centre for Health and Inequalities Research, Durham University (UK). Her research focuses on the health effects of labour markets, health and welfare systems, as well as the role of public policies to reduce health inequalities. She has published extensively in the field of health inequalities including a book on Work, Worklessness and the Political Economy of Health (Oxford University Press, 2011). She contributed to the Marmot Reviews of Health Inequalities in England (2010) and Europe (2013); the US National Research Council Report on US Health in International Perspective (2013); a UK Parliamentary Labour Party Inquiry into international health systems (2013), as well as the Public Health England commissioned report on the health equity in the North of England: Due North (2014). She is a member of the British Labour Party and can be followed on Twitter @ProfBambra.

End of life care: looking through a different lens

Guest post by Joanne Atkinson, Director of Programmes, Northumbria University to coincide with World Palliative Care Day 2015.

When reflecting on my professional journey I often ask myself how did I get where I am today? The thing is your personal story has great resonance for you as a professional; this is an insight into my doctoral journey.

I have worked in palliative care for many years, firstly as a Macmillan Nurse in the acute sector, and then at Northumbria University teaching palliative care. Commencing a professional doctorate I had a stuttering start, but eventually arrived at where I am now with my research which is a study using Foucauldian discourse analysis. My research explores the influence and impact of emerging, competing and overlapping discourses on practice in end of life care, and provides insight into the discursive tendencies impacting on end of life care practice in the hospital setting.

Recent years have seen unprecedented media interest in end of life care, and the emergence of powerful discourses that influence health care professionals delivering care. My research focusses on the tensions, challenges and possibilities that emerge from this intersection.

You may recall some time ago the tragedy that occurred in Greater Manchester when Harold Shipman, a GP, killed his patients. The media coverage that occurred as a result of this has had a significant impact on the way in which doctors and nurses caring for people at the end of life. The public and other professionals questioned the prescribing of opiates for pain and symptom relief. This cultured the germ of a research idea. So my research journey started.

As I commenced my professional doctorate the media frenzy related to end of life care and the Liverpool Care Pathway developed, and I found myself at the cutting edge of end of life care. It is fair to say that I was taken aback by some the media outputs. 

I undertook an analysis of artefacts from journalistic press not tabloids (although this did include the Daily Mail!) and terrestrial television (factual outputs). Initially this was to be over a period of six months, but this was extended due to the profile of end of life care at the time. In addition tape-recorded narratives were taken from four consultants and six clinical nurse specialists working in palliative care, and a cancer centre. Participants recorded the narratives over a two-week period.

The media artefacts and narratives have reaffirmed the metaphorical language utilised when discussing end of life care, and highlighted the impact that the sensationalisation of end of life care has on practice, instilling a moral panic that both disables and fuels the need for change. Prominent discursive formations have emerged related to the power of representation and the impact on practice when caring for people at the end of life.

Back to my personal story which is inextricably linked with the research journey, having life happen throughout this research has no doubt enriched my understanding, but holding a very old man’s hand when he thinks he is going to be killed because he is so ill makes the impact discussed above so real especially when that very old man is your father.

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Photograph (5138623107_b05613223b_o) by More Good Foundation via Flickr.com © 2009: https://www.flickr.com/photos/moregoodfoundation/5138623107

Animation designers…'the day in the life of a researcher'

Guest post by Megan and Glen (TeamAlpha)

TeamAlpha (The alcohol team at Teesside University: Professor Dorothy Newbury-Birch, Dr Emma Giles, Dr Grant McGeechan, Dr Victoria McGowan, Gillian Waller, Lisa Anderson, Robert Sayer) were joined by two young people from local schools - Megan and Glen – who helped the team to develop the groundwork for an animation video. This video is part of the SIPS JR-HIGH trial, a multi-centre individual-randomised controlled trial of the effectiveness of brief alcohol intervention for 14-15 year olds in a school setting. This animation video is currently being developed to show to young people in the school setting, and will be used to provide advice on how to complete the questionnaire component of the trial. This animation replaces the need for individual researchers to enter all the schools in the trial to inform the young people about the study process.

In order to develop the animation Megan and Glen spent two days drawing storyboards, drafting scripts, searching for background music, and even thinking of examples of voices for the characters. This blog was drafted by Megan and Glen to highlight their thoughts on being a researcher and graphic designer for two days.

Day one

Brainstorming and initial storyboards were created as we worked hard all morning. We had a jolly start to the day and thought it was quite interesting and fast going, however more tiring than anticipated!

Individual tasks were completed as we both researched ideas for the animation, even though we had to overcome difficulties associated with having to think of our own ideas for the initial designs for the animation. We definitely thought it was more hands on than we thought it would be, given the number of tasks planned throughout the day. We developed character images and screen shots for the video and really liked the process of doing this.

Storyboards

We felt that we worked hard during the first day at the University but we really enjoyed ourselves. This is partly due to the fact that we’d both like graphic design careers, and so a ‘taster’ of the process was really helpful. We were busy most of the time throughout the day; this was tiring, but also stopped the boredom setting in. This project showcased our skills in graphic design and our use of technology that we have learnt from school. Our experience of drawing, researching pictures and mood board designs really impressed TeamAlpha. As the day went by we described our visit to TeamAlpha as interesting but “full on” given that we did a 9-4 job!

TeamAlpha was very welcoming and Dot (the Professor!) helped us with our ideas and team work. Emma also mentored us throughout the two days, helped guide our ideas, and helped us to showcase our skills as designers. Initially it was hard to build a rapport with each other, since we came from different schools, but by the end of the first day we worked as a duo much better.

Day two

The second day was more relaxing since we knew who we were working with in terms of TeamAlpha, and we were also getting used to each other. Additionally, the environment felt more relaxing since we had been there before; this helped us to interact better with each other and helped us to work on our tasks much more quickly. The day was very interesting, particularly when we found out what the animation script was – basically what each character says during each scene. We enjoyed editing this script to make it relevant for the target audience, which will be Year 10 students. It was good to see all of the different components coming together to become the animation.

Overall reflections

The two days were interesting for us both and I think our experience with TeamAlpha was brilliant. We thought the team were really cooperative and they communicated very well with each other – particularly during our ‘picnic’ lunches. We feel that the work that we created and produced on these two days will enhance our CVs and help inform the work that we will be doing in school and college next year. We were really surprised by the range of tasks that researchers undertake, and the amount of thought and research that has to go into making such a short (2 minute!) animation. We really feel that we have learnt the basics of research, working independently and as part of a team, and overall we really enjoyed being in such a creative environment. We’re really excited to see the finished animation later in the year, to see how our thoughts and work have helped shape the final video.

TeamAlpha

Green and blue commuting

Guest post by Dave Berry, Lecturer in Pharmaceutics, Durham University

How do you get to work? Like most people, I personally use a car. Sometimes I run, more often than not though, I use a bike. However, I was asked to blog about the times I do none of these things and still get to work.

As I’ve said I regularly cycle to work, I do this for a number of reasons: 

1) I have a bike and walking past it in the morning makes me guilty
2) It saves money
3) I’m lucky enough to live within 6 miles of work
4) It’s good for the environment
5) It keeps me happier

On the way to work

The last point may not seem like a particularly pertinent one, but exercise has a significant benefit on my mood and leads to positive outcomes across the rest of my life. Without exercise everything has a tendency to get a bit black for me. This was made worse by a move of job two years ago to the North East where the darkness in winter becomes quite oppressive for the uninitiated. Despite the cold and dark I enjoy cycling in winter, coming home cold and wet to then become warm and dry, gives me a feeling of taking winter head on and most of the time it feels like I’m winning. I do however sometimes get bored. It’s still just cycling repeatedly down a road when it boils down to it.

I love being outside and our move to the North East, from the Peak District, makes getting to wide open spaces feel hard at times. I do happen to live near a river, with a lovely path down to it very close to my house. I’m also very lucky to work even nearer a river, specifically three metres from the same river, so one bored day I made the logic leap and decided it would be quite nice to try and canoe to work.

This would have been very simple if:

a. I owned a kayak/canoe
b. I had any real experience (since scouts) of paddling. 

By this time though I’d become excited, so these small obstacles seemed less relevant, especially since I’m a strong swimmer. I bought a kayak on Ebay, a paddle (having heard tales of problems without one) and a spray deck.

Nearly at work

I did a bit of homework before setting off on my maiden voyage, as I/my wife were unsure of many practical points. These included:

• What happened if I fell in? Emergency clothes stashed at work.
• How would I get the Kayak from home down to the river? Kayak trolleys can be bought (£25-80) for the 800m trundle. Got some strange looks from the neighbours though.
• How long will it take to get the six miles? I picked a day where I had no specific time to get to get to work and discovered I moved at about five and a half miles an hour (which is pretty average).
• What happened if I fell in, how clean is the Tees? Quite clean actually, there are salmon living in it.
• Showers? Gym at work (I’m lucky enough to work for a University)
• Where would I store my kayak? I’m lucky enough to work at a University with a boat house - otherwise it would have been funny looks with it locked in the bike shed.
• What are the rules for navigating a river? Very basics are drive on the right, if it’s bigger than you- get out of the way to the right of it.

One practicality that I hadn’t really considered was the need for a license to travel on the water. This can be purchased from the canals and rivers trust on an annual or day rate basis.

There was a little bit of a splash on the first attempt and the emergency clothing was called for, but it did get me the seclusion, exercise and general feeling of adventure I was looking for. So I’d recommend it.

I appreciate that I’m incredibly lucky to be able to do this and have a fairly unique set of circumstances, but in the UK we all live near a river and many of them are managed by the Canal and Rivers Trust, so there probably is a river or canal near you that could be used. Go on, make a splash.

A map of the canals and managed water ways can be found here: https://canalrivertrust.org.uk/canals-and-rivers

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Shielding against the impact of the dementia time bomb

Guest post by Mark Parkinson, Postgraduate Researcher, Department of Public Health & Wellbeing, Northumbria University

Today (September 21) marks the anniversary of World Alzheimer’s Day which aims to raise public awareness about this most common form of dementia.

Dementia represents one of the main causes of disability in later life. Current estimates indicate that someone is diagnosed with the disease every 68 seconds. Alzheimer’s affects 44 million people globally with this figure predicted to triple over the next 35 years - a phenomenon aptly named 'The Dementia Time Bomb'. Advances in health mean many more people are surviving life-threatening diseases such as cancer, but susceptible to life limiting diseases such as dementia.

By 2030 more than 20 million people in the UK will be aged 60 or over. For people familiar with dementia it is one of the diseases most feared as they approach 60 years of age, a fear justified given the increased prevalence of the disease once we reach this milestone, a fear heightened by the fact that it is irreversible and terminal.

The impact of all this truly hit home during a recent conversation with my mother. Renowned for her ability to trounce all-comers at Scrabble, she struggled to recall the word ‘padlock’ prompting her to quip, with mock seriousness, that perhaps she was succumbing to the disease. My mother’s perception of Alzheimer’s still follows a traditional and mistaken one that Alzheimer’s disease is a typical and therefore ‘normal’ part of ageing. She is not alone: it is estimated that around 60% of people worldwide also incorrectly believe this, while 40% of people mistakenly think it is not fatal. I on the other hand stopped dead in my tracks. The sudden realisation that my mother’s uncharacteristic memory block might genuinely be a precursor to the more serious cerebral ‘padlocks’ associated with dementia. As a researcher involved in dementia I was only too well aware that Stage 2 of the disease is generally represented by very mild cognitive decline, including deficits to semantic memory that can include a sudden inability to recall everyday words. Much worse though was my knowledge that the later stage of Alzheimer’s can be marked by far more severe symptoms as part of a terminal degenerative process that can endure for 15 long years. A key question ran through my mind at this point: who would care for my mother if she did develop dementia?

In the vast majority of cases it is a family member who will elect to take on this role. One in eight of the UK adult population already provides such an unpaid but invaluable service. However, a central problem with our continued reliance on unpaid care is that, in general, family carers of people with dementia experience greater health inequalities due to the chronic stress commonly associated with long-term caregiving. This threatens carers' health whilst also undermining their ability to continue to provide care. A key question therefore is, ‘who will care for the carers?’ This question was the springboard for the research project I am presently engaged in which seeks to investigate, ‘What works to support family carers of people with dementia?’ While myriad resources exist that might potentially be made available, what is noticeably absent is any agreed ‘gold standard’ of support that might be put into place, tailored according to the different stages of Alzheimer’s. Unlocking this particular dementia challenge will not prevent the ‘time bomb,’ but it can offer families a much needed protective shield if and when that time does come. The need to raise awareness of dementia and the challenges associated with it has never been more urgent - the disease lies on all our doorsteps. 

Mark is currently engaged in a project concerned with several key questions related to Alzheimer’s disease: (i) which factors remain crucial to resilience-building for family carers of people with dementia (PWD) in order to maintain and sustain informal caregiving and which hinder it (ii) how can tailored support best be targeted to address the needs of specific carers? (iii) how can the inherent health inequalities faced by family carers of PWD be reduced? 

UK Dementia Awareness Week 2015 took place 17-23 May. If you wish to find out more about Alzheimer's please visit the Alzheimer's Society website.

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Savour the flavour! Expanding young people's experience of food & eating

Posted by Duika Burges Watson, Fuse staff member and Lecturer in Evaluation and Policy Interventions in Centre for Public Policy & Health, Durham University

Food and drink that is high in fat, sugar and salt (HFSS) is disproportionately marketed and promoted to children and young people in the UK. Public health practitioners have long cried that excessive consumption of HFSS foods is detrimental to health but, overall, the health statistics show that globally, people are consuming more HFSS foods and have less healthy diets[1]. So, is there another way?

Chef Sam Storey applies blue colouring to a teacher's tongue

We decided to test an idea with a group of 14 year 9 students from Whitley Bay (a seaside town on the North East coast) to see how they would respond to a workshop exploring the science and gastronomy of ‘taste’ and ‘flavour’. The idea came from work in the NIHR/RfPB funded project, ‘Resources for Living: Exploring the potential of progressive cuisine for survivors of head and neck cancer’. In the course of doing this research we’ve expanded our own understanding of what is ‘good’ to eat. The multi-disciplinary team includes a research chef, Sam Storey, and with him we’ve been playing with food and flavour to try to improve cancer survivor’s experience of food and eating. We used teaching resources available from the Institute of Food Research[2] alongside ‘food play’ ideas developed in our project.

Our workshop involved students from Whitley Bay High School who were participating in a local Enquiry Based Learning (EBL) event. All 300 year 9 students were involved in one of 24 projects – a three day activity in the local community. Our group of 14 spent their three days exploring the senses; this involved a food play workshop, building a raised sensory bed in the local community garden, and talking with the chef and users of New Prospects, a centre for people with learning difficulties, about their experience of food and the senses.

In our two-hour food play workshop we demonstrated how taste and flavour are not the same thing. Salt, sugar and, some scientists now say, fat as well, are largely experienced through taste – that is, via receptors on the tongue and around the mouth; but flavour refers to a much broader ‘multi-modal’ experience[3] of food that includes the very powerful element of aroma. We know that we have around 350 different types of odour receptor that stimulate thousands of flavour experiences. Chewing a flavoursome sweet whilst holding their noses, the students could experience sweetness, but it was not until they let the nose go mid chew that they could identify the flavour of strawberry, blueberry, lime etc. We explored more about aroma on a tour of the Whitley Bay Station Master’s Community Wildlife Garden – rubbing herbs and other edibles to release the volatile compounds and experience numerous delicious smells.

There were many elements to our playful explorations of multi-modal flavour perception. In one experiment we gave the students three coloured jellies and asked them to tell us what the flavours were – red, green, and yellow. Uniformly they responded with colour recognition flavours – red was raspberry, green: lime, and yellow: lemon. When we ‘revealed’ that in fact, all the jellies were identical other than the colour – all flavoured with lemon – they were astonished.

If you think about the experience of food in a contemporary UK supermarket, the only ‘smell’ that really stands out is that of baking bread. Students noted that supermarket shopping while on summer holidays abroad was different – French or Italian supermarkets had more diverse smells. Could critical food awareness challenge their taste for HFSS foodstuffs and make them notice the over-use of piped bread smells? In the school evaluation of the EBL project, our senses workshop rated the highest of all programmes. Students highly valued the experience, which suggests that more could be done. Could flavour appreciation workshops change how young people eat?

Coming up: Flavour masterclass: with Dr Rachel Edwards Stuart, part of the Wolfson Research Institute's Special Interest Group on Culinary Innovation, Senses and Health Seminar Series. St Cuthbert’s Society, Durham - Monday 5 October 12-1pm.

Energy drinks: Don't believe the hype

Guest post by Shelina Visram, Lecturer in the Centre for Public Policy and Health, Durham University

When asked where the idea for our study on energy drinks came from, I usually say it was through discussions with colleagues as part of another project I’m leading on in County Durham. But that's not strictly true. The original spark came from my experience a few years ago of lecturing at Northumbria University in the dreaded Tuesday 9am slot (student night in Newcastle is on a Monday), where I noticed some students regularly downing a couple of energy drinks throughout the lecture. This was my first encounter with these drinks being consumed during daylight hours and I was fascinated by the idea that some people might have them for breakfast. So this got me wondering - why would young, seemingly healthy students feel the need to use an artificial source of energy to get them through the day? Or was it just my lectures sending them back to sleep? (That is if they had even been to sleep).

Over the years I noticed more and more of these drinks appearing in shops, on TV shows, in adverts and as litter on the streets, and assumed that they were used primarily by adults to stay awake. Most cans and bottles state that these products are not recommended for children, given that they contain high levels of caffeine which children are advised to consume in ‘moderation’ [1]. But then I overheard a couple of external partners discussing energy drinks in the context of them being seen as a growing 'problem' in primary and secondary schools in County Durham. They were looking for support in scoping the evidence base and exploring what types of interventions or educational materials could be developed locally. Around the same time, a call was circulated via Fuse for research proposals to The Children’s Foundation [2]. Colleagues from Fuse and the Wolfson Research Institute for Health and Wellbeing at Durham University [3] were keen to collaborate on an application. We developed our proposal, were awarded funding, and the HYPER! (Hearing Young People’s views on Energy drinks: Research) study was born [4]. 

Since June 2014, the HYPER! study team has been busy: reviewing the published literature on children and young people’s use of energy drinks; conducting a series of focus groups and interviews with students, parents and staff from four local schools; and involving young people in a mapping exercise, drawing on their knowledge of the area around their school to identify local energy drink vendors. Here are some of the things we’ve learned:

• If you come across a paper that says ‘energy drinks are good for you’, check to see if the work has been funded by Red Bull or conducted by someone with shares in PepsiCo.
• Most papers that say ‘energy drinks are bad for you’ are based on expert opinion, rather than robust research.
• Young people in the UK drink more energy drinks than those in other European countries, yet there are no published studies from the UK.
• Sales restrictions might seem like a sensible option; they would help to send a clear message but our study participants had concerns that they would be difficult to enforce.
• The strong influence of the marketing activities of energy drink companies should not be underestimated.
• Any interventions should ideally involve children and young people, as well as parents, schools, retailers and the industry.
• There is a lot of confusion around whether energy drinks are safe for children, and parents, teachers and young people need help to make more informed choices.  At least one young person in all but one of our focus groups thought that energy drinks contained bull or horse sperm [5]. They don’t.

There are still lots of unanswered questions. For example, if the government requires energy drinks to carry warnings stating that they are not recommended for children, why are manufacturers allowed to market them so obviously towards young people? What are the long-term health and other effects? Is there a link to health inequalities? And why would anyone knowingly drink something that they thought contained bull sperm? We’re hoping to answer some of these questions by conducting further research so please get in touch if you’d like to collaborate with us or if you’re already involved in work on energy drinks. We would love to hear from you.

You can find out more about this study by reading the new Fuse Brief here.

Shelina spoke about the HYPER! study at the CPPH/Wolfson Seminar - Sweetness, social norms and schools: factors influencing children and young people’s food and drink practices (9 September)

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Translating local action to national policy

Guest post by Robin Ireland, Chief Executive, Health Equalities Group and Director, Food Active

North West England (NWE) has some of the worst health statistics in the country calling for transformative and challenging approaches by its local public health community. Merseyside-based social enterprise, the Health Equalities Group (HEG) including heart health charity Heart of Mersey has worked with and supported NWE’s Directors of Public Health since 2003.

Obesity and maintaining a healthy weight present huge problems both now and in the future. Balancing the need for a population-based prevention approach whilst government policy focuses on targeting individuals with expensive weight management programmes is particularly difficult. At the same time individual stigmatisation is both unhelpful and particularly damaging. Somehow we have to work towards changing cultures so that junk food is less easily available, that healthier food is the popular choice and walking and cycling are positively encouraged.

The NWE Directors of Public Health asked HEG to develop a collaborative approach to healthy weight in 2012 and the Food Active campaign was eventually launched in November 2013. It calls for policies to:

• Control the marketing of junk food to children and young people
• Place a duty on sugar sweetened beverages
• Enforce 20mph speed limits in urban areas (lower traffic speeds make cycling, walking and play safer)

In the same way Liverpool and the NWE played an important role in the development of smoke free policies, Food Active hopes to bring local pressure to bear on government in calling for a more upstream approach to addressing obesity.

We began by building the evidence base around attitudes towards sugary drinks and modeling the effects a tax on such drinks may have on consumption. This in turn can be compared with the prevalence and cost of type 2 diabetes, and bariatric surgery etc. As data show teenagers are the highest consumers of sugary and ‘energy’ drinks, we established a media-friendly campaign called ‘Give Up Loving Pop’ to raise the debate and heighten the pressure for action. In the same way that regional tobacco control organisations have worked closely with national charities such as Action on Smoking and Health (ASH), Food Active has developed relationships with the Children’s Food Campaign and Action on Sugar.

In 2014, learning from ASH and the excellent work of local government on the Local Authority Declaration on Tobacco Control, Food Active started to develop a similar declaration on healthy weight. A regional meeting followed by workshops with three North West authorities showed that such a declaration could:

• Raise with elected representatives and the public that local authorities have a role to play in addressing obesity
• Help to show a wide range of policies (such as transport, planning and leisure) all have a part to play in promoting healthy weight

A Local Authority Declaration on Healthy Weight is more complex than its tobacco control equivalent and it is being developed in two parts; the first with some generic commitments (such as agreeing that obesity and overweight are a priority), the second more locally focused and aligning with local policies and priorities (for example Local Transport Plans).

As previously, the North West’s health needs will help to make the call for more concerted and resourced national action.

Robin will be speaking about the Food Active campaign tomorrow (9 September) at the CPPH Seminar - Sweetness, social norms and schools: factors influencing children and young people’s food and drink practices 

Robin Ireland

robin.ireland@hegroup.org.uk
@robinHEG

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Getting our hands greasy: The joys of researching food and drink sold near secondary schools

Guest post by Wendy Wills, Sociologist of Food and Public Health, University of Hertfordshire

Next Wednesday (9 September) I will be at Durham University to present and discuss the findings from a study which colleagues and I conducted that focused on exploring the reasons that young teenagers at secondary school buy food and drink outside school.

It was a busy project, with just two weeks at each of our seven selected case study schools to run an online survey in classes of 13-15 year olds, as well as asking them to take part in a written exercise and focus groups. We also conducted interviews with the young people, as well as the head teachers, school kitchen supervisors and local retailers. Over 600 young people took part. I had two brilliant early career researchers working full time collecting data in Scotland (the work was funded by the Food Standards Agency north of the border) plus some part time help from colleagues.

I love conducting fieldwork – there is nothing quite like getting your hands dirty (or greasy in this case but more on that later) during data collection and no better way to fully get to the heart of your research questions than being ‘in the field’ with your team. I particularly enjoy research with young people as they are often very happy to tell you exactly what they think and indeed, they are often pleased to be asked about matters that they are often not consulted about – such as the food and drink they have access to.

So, being in Scotland and racing from classroom to chip shop to follow young people (with their consent of course!) as they decide where to go on a particular day to buy their lunch was something of an adventure.

The young people had us salivating over their lunchtime purchases, though not for any health-related reason! For the most part it was the complete opposite. Part of our plan was to purchase the same edibles as the young people we accompanied so that we could weigh and record each item (to later conduct a nutritional analysis of the unpackaged food and drink they bought). We often had bags full of (extremely cheap) deep fried ‘chicken balls’ with luminous orange sweet and sour sauce from takeaway shops; warm sausage rolls with the grease oozing through their paper bags from bakeries and bottles of bright green, blue or orange ‘energy drinks’ from corner shops that sometimes had questionable hygiene and/or felt a little intimidating.

'Chicken balls'

As all this action happened over lunchtime you can imagine the team were often hungry by the time we left each school and so we sometimes resorted to trying some of the rapidly cooling food and drink that filled the boot of our car. The worst thing I tried was the battered and deep fried pizza slice – words cannot really describe it – the hard and tasteless pizza base, the smear of tomato paste, the greasy battered coating.

The fieldwork did not only provide us with greasy hands but also an appetite for supporting effective policies and interventions that promote healthy eating to secondary school pupils.

Wendy will be presenting this research at the CPPH seminar 'Sweetness, social norms and schools: factors influencing children and young people's food and drink practices' on Wednesday 9 September at Durham University. 

Virtually on holiday

Posted by Emma Dorée, Communications Assistant, Fuse and Teesside University

The out-of-office replies are clogging the inbox and the rain is pouring… it must be that wonderful time of the year again – holiday time!

The blog has been working extremely hard this year, making sure that everyone is kept up to date with all the latest research activity taking place in and outside of Fuse. It has sat and listened to everyone
else’s holiday stories and seen everyone’s holiday snaps whilst beavering away, keeping all the virtual plates spinning.

But the time has now come for the Fuse blog to sit back and relax and enjoy a few weeks off.

After enjoying an active holiday in France last year, the blog has this year decided to go to Marbella to relax and be pampered so that it can get rid of all of its stresses. Following a strict plan of exercise and healthy food it will be showing off its beach bod while enjoying a month of sun (factor 30 at all times), sea and spas where its biggest decision will be deciding which of the cocktails (non- alcoholic of course) to try from the menu next. Plans such as jet skiing and testing out the Marbella nightlife (dancing is physical activity after all) are all on the agenda but of course we’re sure it will make time for a little culture and sightseeing too.

Hopefully it won’t get frustrated by the high fat and high sugar treats on offer at the airport or in the supermarkets and start posting pictures, but you never know!

So see you in September everyone! Happy holidays!

Would you accept money to be healthier?

Guest post by Emma Giles, Senior Research Lecturer in Public Health, Teesside University

As newspaper headlines have shown, the issue of encouraging individuals to adopt healthier lifestyle behaviours by paying them is controversial. Whilst many of us know that we should do a bit more physical activity, eat our five-a-day fruit and vegetables and even attend our vaccination and screening appointments, we don’t always do this. Many barriers prevent us from fully engaging with these healthy behaviours, and these barriers are often complex, individual, and are not always easily surmountable. These barriers range from living away from green spaces which would allow outdoor exercising, to deep-seated social norms that stop individuals from engaging in healthy behaviours because they are not well accepted by family, friends or the wider community.

In recent years there has been a growing body of research looking at paying people to be healthier. This essentially means providing individuals or groups with cash, shopping vouchers or gifts in return for the adoption of healthier behaviours. Such schemes include the Pound for Pound weight loss incentive scheme, the Give it Up for Baby scheme, and offering incentives for breastfeeding.

In order to hear recent research evidence, and to provide a forum for friendly debate, I organised the recent Fuse Quarterly Research Meeting, which focused on payment for health behaviours. Last Wednesday (22 July), policymakers, practitioners, and academics came together to hear presentations from four academics and practitioners working in the broad field of incentives. As Claire Sullivan, a Consultant in Public Health from Public Health England mentioned in her opening address as Chair of the meeting, often incentives can take various forms – including paper pants for Chlamydia screening!

In terms of specific incentives, Professor Pat Hoddinott, Chair in Primary Care, Nursing Midwifery and Allied Health Professions Research Unit at the University of Stirling, presented research which focused on incentives for breastfeeding and to quit smoking in pregnancy – the BIBS study. Key findings suggest that tailoring of incentives is important to meet local needs, but that they show promise to encourage these behaviours.

Professor David Tappin, Professor for Clinical Trials in Children within the School of Medicine at the University of Glasgow, followed Pat by showcasing data from the CPIT trial – a smoking cessation in pregnancy trial in its second phase. Results showed that there was a 14% increase in quit rate and further analysis showed that there was a 150g increase in birth weight of babies born to mothers who quit smoking. Findings suggest that financial incentives were found to be acceptable by the women involved, and may double the quit rate when used with existing smoking cessation services.

A practitioner perspective was provided by Mr Andrew Radley, Consultant in Public Health Pharmacy, NHS Tayside, who talked about operationalising the use of financial incentives in a stop smoking programme within a community pharmacy setting. In particular, 393 women in Tayside engaged with the smoking cessation services, and incentives were found to be effective. Of note was the finding that mothers preferred receiving their incentives on a weekly basis.

I spoke last and presented qualitative data exploring the acceptability of incentives. The findings suggest that incentives are more likely to be accepted if they are provided to certain population groups including pregnant women and those on a low income, but not for those who may have alcohol or drug problems. The ‘perfect’ incentive has yet to be identified, but it will need to be shown to be cost-effective for it to be accepted on a wider scale.

The presenters were then joined by Peter Kelly, Director of Public Health Stockton Borough Council, Jim Beall, Health and Wellbeing Board Chairman, and Dr Jean Adams NIHR Research Fellow at CEDAR for a panel discussion. The audience raised many questions and comments around the use of incentives, with particular concerns around incentives increasing health inequalities, aggressively placing the blame of poor health on individuals, and that incentives may result in moral implications when individuals are rewarded for their behaviour. The debate suggested that more research evidence is needed to discover what type of incentive works for whom, and in what setting, and to better explore group (rather than individual) incentives.

What is obvious is that paying people to be healthier is an emotive topic, a highly contested intervention approach, but at the same time, it also shows promise to encourage individuals to adopt healthier lifestyle behaviours. It certainly provides food for thought…how many of us would accept money to be healthier?

Follow this link to find out more about the Fuse Quarterly Research Meeting ‘Payment for health behaviours: the case of health promoting financial incentives’ on the Fuse website.

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Mind over matter in Fuse?

Posted by Peter van der Graaf, AskFuse Research Manager

Mental health is a rising star on national and local agendas. At national level, mental health was for the first time ever included in all of the main political party election manifestos and features significantly in the NHS Five Year Forward View. At local level, Public Health teams across the North East are reviewing their mental health services and upskilling themselves in the best ways to reduce self-harm and suicide. You may ask what all the fuss is about?

Various reports have pointed out that poor mental health is costing the UK economy £105bn per year, including £8bn annually in sickness absence, and a further £15bn in lost productivity absenteeism (where people are at work, but under-perform due to mental health issues). The Care Quality Commission (CQC) recently sounded the alarm over the state of mental health services in England. In its first ever review of mental health crisis care, the regulator found that 42% of patients did not get the help they needed.

The picture is particularly bleak in the North East, which has the highest suicide rates in the UK and rates have been going up steadily since the economic recession and public sector cuts (after a long period of stabilisation) and are likely to increase further with additional cutbacks planned in recent spending reviews. Not surprisingly, mental health issues are higher in deprived areas, among men, those who are unemployed, and related to alcohol problems, all of which the North East is leading on in national league tables. Mental health services, described by one of our practice partners as “the Cinderella of Public Health”, are bearing the brunt of these cuts, in times when you could argue that their service users need them most.

To make the most of existing intelligence and services, the Public Health Intelligence Northern England (PHINE) network recently organised a dedicated event on self-harm and suicide, offering participants access to various interactive data sets (e.g. Community Mental Health Profiles) to help local authorities make sense of national data for their own patch. Where are the suicide hotspots in different localities? Who are most at risk and what services can they access? The data profiles were well received by the audience but were also met with some criticism around lack of integration with local data, such as counselling data collected by GPs in the North East. Moreover, although this data helps to identify what is happening where, it does not allow for answers to the question why? Public health commissioners need help to interpret this data and understand why suicide and risks are going up in one area or user group but not in another.

What can Fuse do to support this? Are we making our research on mental health issues available to decision makers and professionals? For instance, where can Public Health practitioners find information about the lessons learned in the award winning Change UR Mind about Young People project (evaluated by our Translational Research programme); or about the literature review on self-harm produced by the Knowledge to Action Group within our Complex Systems programme? Moreover, is our research responding to local concerns and needs? Do we help them in interpreting national data and matching this with their own data? And do we support them in developing interventions to address hot spots? How can Fuse work more effectively with partners in the region that are working on suicide prevention strategies, post-event services and mental health research?

Partners are closer than you might think. For instance, The Westgate Unit at HMP Frankland is a therapeutic, personality disorder treatment service based in a high security prison setting.  The Unit helps prisoners diagnosed with Borderline Personality Disorder who are most at risk of self-harm and suicide. The unit has developed its own research on why different prisoners self-harm but is struggling with budget cuts and would welcome support from academics in developing and conducting further research. You might counter that this is not public health, but given the significant impact of mental health on the UK economy, the NHS and, last but not least, the impact on families and communities, I would argue that this is a unique opportunity for Fuse to get involved.

Our region already has a wealth of clinical expertise available on mental health: the Mental Health Research Group (MHRG) is a joint initiative of the Tees Esk Wear Valleys (TEWV) NHS Foundation Trust and Durham University, in which clinicians, academics and service users, including young people, collaborate to improve local health services. The group recently showcased their research during their annual conference. Unfortunately, Fuse is not a partner in this network. However, clinical staff in the Trust are keen to develop their research skills and contribute to a better understanding of mental health issues and interventions in the North East and would welcome collaborative research with Fuse.

This might be a good time to ask: should Fuse put mind over matter when it comes to mental health?

Who needs nudging, shoving, and shaming? Individuals or government?

Guest post by Victoria McGowan, Post-Doctoral Research Associate at Teesside Uni, Alcohol & Public Health Research Team

I recently attended International Society for Behavioural Nutrition and Physical Activity (ISBNPA) conference in Edinburgh (see #ISBNPA2015 on twitter). The conference was a great event and I’m very grateful to Teesside University for supporting my attendance.

Conferences have a tendency to be sedentary affairs and can often have limited opportunities for physical activity or even just standing during sessions. However, I was delighted to see that the conference organisers had marked out significant space for standing during sessions. Not only that, but there was the opportunity for yoga and health walks early every morning as well as lessons in ceilidh dancing at lunch time and a walk to Arthur’s Seat as part of the social programme. It was quite a physically active, physical activity conference.

Lunch time ceilidh dancing

However, there were some interesting discussions about whether us delegates were being socially shamed or nudged into partaking in physical activity during the conference. The conference opened with Professor Nanette Mutrie describing how she’d spotted one of her own researchers using the escalator as opposed to the stairs and encouraged delegates to give standing ovations to all speakers in an attempt to get us on our feet more. Although I found the level of physical activity on offer a refreshing change from being largely sedentary, I was slightly unnerved about the underlying social shaming.

I’m a strong advocate for informed choice, I love posters on stairs telling me how many calories I’ll burn by walking up them but I also love having the option of taking the escalator. There were stories of academics taking photos of people using the escalator to shame them for not using the stairs. It was interesting to watch the Mexican wave of delegates standing to applaud, a few individuals would stand and then row after row behind them followed suit… until it came to me and I would sit in defiance. Why did I stay seated? Because I have a choice and honestly, I don’t like being socially shamed into doing something. Yes, I agree obesity, nutrition, and physical activity researchers should not be hypocritical and practice what they preach. However, we also need to be mindful that we’re working with people who are more concerned about paying their rent, whether their children need new school shoes, zero hours contracts, whether they can get an appointment with their GP, the list goes on. Yes, taking the stairs may improve our health if we use them regularly but we have to understand that some individuals choose the unhealthier option due to a whole host of external pressures. Lecturing these individuals about taking the stairs may fall on deaf ears or, as in my case, may lead to defiance. I used the escalator on occasion because it was quicker for me to walk up/down the escalator to dash between sessions and avoid the crammed stairs.

There are other reasons why individuals choose the less healthy option and we need to understand these external pressures rather than shaming people into taking the stairs. As Professor Alan Batterham rightly pointed out in his debate with Professor Stuart Biddle we’re evolutionary predisposed to conserve energy whenever possible so sometimes we may choose the escalator. However, we may choose the stairs if we’re provided with information on why it’s good for our health, or if we alter the environment to make healthy choices easier. But please don’t shame us into choosing one option or the other as this could lead to unintentional detrimental consequences of purposeful rebellion. Yes, I’m aware of the obesity ‘epidemic’, but I’m also aware this is caused by factors which are outside of individual control. Professors Ted Schrecker and Clare Bambra’s book How Politics Makes Us Sick shows how the rise in neoliberal policies in the UK and US are associated with rises in obesity and health inequalities.

Inequalities are having the greatest impact on health

Kylie Ball highlighted this point at the end of her keynote speech, yes we need to help improve nutrition and physical activity BUT we also need to help reduce inequalities in nutrition and physical activity. Inequalities are having the greatest impact on the nation’s health, not occasionally taking the escalator.

It’s time to nudge, shove, and shame our government, not individuals, into reducing health inequalities and improving overall public health.

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Setting resolutions or finding solutions?

Posted by Dr Joanne-Marie Cairns, Fuse Post-Doctoral Research Associate at Durham University

So it’s National Childhood Obesity week and yet again we are surrounded by plenty of public health campaigns promoting us to lead healthier lives – be more physically active, join the gym, lose weight, eat and cook more healthily as well as problematic media rhetoric such as ‘beat the bulge’ and de-moralising and stigmatising imagery typically of overweight or obese children on scales or eating junk food. How is this helpful? This will only serve to further exacerbate the situation rather than help to bring about effective and sustainable solutions to not only help those who wish to become more active and lose weight but promote healthier population health more widely.

I am heartened to hear that Head of NHS England, Simon Stevens, has called for a national conversation to be held and a joined-up approach which has started to think about regulating food and drink companies. In my opinion this is long overdue. We may have a degree of individual ‘choice’ but how much choice do we really have when we are surrounded by (and in some places bombarded with) advertisements, local take away shops, overly-priced fresh nutritious food compared to the tempting ‘bogof’ (buy one get one free) offers which typically tempts us into getting double the amount of unhealthy snacks, often at a fraction of the price it would cost to get healthier options?

I came across this image as I was searching through websites related to National Childhood Obesity week on http://www.noaw.org.uk/about/ with reference to National Obesity week earlier on this year.

While I am sympathetic to this message which encourages us to make these positive changes I am also sceptical about the effectiveness of doing these alone. Repeatedly research studies have shown that educational and behavioural interventions have limited and short-term effectiveness, so why do we continue to focus on the individual rather than looking at the environment within which the individual is placed?

So I urge you, instead of making yet another individualised ‘resolution’ this coming New Year (which will come around before you know it!) to lose weight or exercise more, why don’t we collectively put our efforts together by standing up and protesting about the lack of resources or opportunities within our localities to be able to lead healthier lives and be more physically active? For example, if you have children in schools ask yourself (or better yet ask the school directly) the question: what is the school doing to not only promote healthier food and physical activity but to actually enable this to happen by creating school environments that support children to do this? Or what are supermarkets doing to help us to afford to buy fresh and nutritious food and drink that isn’t going to cost a fortune? Or write to your local MP to ask the government to recognise the wider issues that can prevent even those of us with the best of intentions from eating more healthily and increasing our exercise. Childhood obesity is not the responsibility of the child/family, since ‘responsibility’ infers that we have ‘control’ over something. It is rather a societal consequence, and therefore society should bear the responsibility for finding a solution.

Jo Cairns and Professor Clare Bambra have produced a Fuse brief entitled: What is the most effective way to reduce inequalities in childhood obesity?

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Collaborative research: agreeing to disagree?

Posted by Peter van der Graaf

Fuse sponsored a parallel session at the Faculty of Public Health conference last week in Gateshead, chaired by Professor John Ashton CBE, President, UK Faculty of Public Health. The session focused on the challenges and opportunities of collaborative research between academics, health practitioners and decision makers.

The four papers presented in the session outlined different challenges in collaborative research: Alyson Learmonth, reviewing Health and Wellbeing Strategies in the North East, highlighted the diversity in priorities between different areas, making it difficult to focus and combine resources across local authorities.

Silvia Scalabrini showed that, in spite of dedicated health economic support from academics to local public health teams in prioritising their investment and resources, the use of these formal tools was met with resistance by elected members who put a higher value on other sources of information, such as stories from residents.

I highlighted limits to collaborative working through a mismatch in timescales, funding and interests. For example, academics showing limited enthusiasm for applied research due to a lack of incentives within their institution, which put a higher value on high quality publications and research council funding.

Fuse Director Professor Ashley Adamson talked about the challenges in setting up data sharing agreements with different local authorities to access National Child Measurement Programme (NCMP) data, in spite of positive support and demand for the research from local government.

Listening to these presentations one might wonder whether collaborative working is really possible. At the same time, each presentation offered examples of where it was achieved and made a difference. For instance, Alyson Learmonth's appreciative enquiry demonstrated common interests between Health and Wellbeing Boards (HWBs) in giving each child the best start in life and in the social determinants of health, particularly interventions around education and housing.

Silvia Scalabrini highlighted the usefulness of the Portsmouth Scoring Card, developed by Austin, Edmundson-Jones, and Sidhu (2007)* for local authorities to prioritise their spending. I reflected on the value of responsive research services, such as AskFuse, to provide backstage negotiation spaces for what constitutes useful evidence. Professor Adamson discussed the benefits of matching data from the NCMP with local intelligence to increase the effectiveness of child obesity interventions and their evaluations.

I’m wondering where this leaves us? In spite of problems in setting priorities, even agreeing on the tool to do this, limits to willingness and capacity among academics and public health practitioners to collaborate on research projects, and barriers in data sharing once a project has been agreed, the different examples made it clear that not collaborating was simply not an option.

Public health practitioners have limited resources and lack the capacity to analyse and interpret data, while academics are increasingly required to demonstrate the impact of their research and lack an understanding of the context and processes in which evidence is used in practice. Working together is a must to ensure that public health can provide an answer to the questions it is currently being asked.

Moreover, the number of participants from academia and practice at the conference session, demonstrates that there is a clear appetite to work together on these issues as long as we are able to provide the conversation spaces for this.


*Reference. Austin, D., Edmundson-Jones, P. and Sidhu, K. (2007) Priority setting and the Portsmouth scorecard: prioritising public health services: threats and opportunities. Available at: http://www.publichealthconferences.org.uk/health_services_2007/presentations.php

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