Fuse open science blog

Friday, 29 June 2018

Why we must stop using the F-word in relation to Gypsies & Travellers

Posted by Natalie Forster, Senior Research Assistant at Northumbria University and Fuse, and Helen Jones, CEO, Leeds Gypsy and Traveller Exchange

Fascination. Not the word you expected? Then read on to find out why we find it so problematic when people say they are ‘fascinated by’ Gypsy and Traveller Communities.

We frequently hear ‘fascination’ cited as a motivation for
working with Traveller Communities by practitioners

There is certainly a captivation with Traveller Community ‘lifestyles’ in society. The numerous Gypsy and Traveller autobiographies and television programmes devoted to Traveller Communities (perhaps best exemplified by the Channel 4 ‘Big Fat Gypsy Weddings’ phenomenon) have led Gypsy and Traveller life to be described as a ‘bestseller’, with little sign that this interest is fading. Television programmes are often badged as an exposé on Traveller Community lives, starting with the premise that Traveller Communities are hidden, closed-off and exotic. The Channel 4 Big Fat Gypsy Weddings series for example, promises a ‘Revealing documentary series that offers a window into the secretive, extravagant and surprising world of Gypsies and Travellers in Britain today’ (emphasis added). This language is not value free, and seems to foster a sense of intrigue or fascination in order to appeal to viewers.

Traveller Community members have a lack of opportunities to shape their own image in popular culture. A complete absence of Gypsies or Travellers among the proposed cast for an upcoming BBC Film adaption of Mikey Walsh’s memoir ‘Gypsy Boy’ recently drew attention to the exclusion of Traveller Community voices in the film industry. The understandable reluctance of many Gypsy and Traveller Community members to disclose their ethnicity for fear of racism and discrimination also means there are a lack of images or stories to counter the negative stereotypes peddled within mainstream media. That said, younger Traveller Community activists in particular are increasingly making use of forums through which they can challenge these portrayals.

What though are the implications of this issue for health practitioners, researchers and the public? Of course, we recognise that many of our colleagues share our aversion to programmes such as Big Fat Gypsy Weddings and the hugely problematic representations of communities that these advance. Yet, the underpinning premise of these shows remain unchallenged by many, and we frequently hear ‘fascination’ cited as a motivation for working with Traveller Communities by practitioners.

Why do we feel uncomfortable when someone says they are ‘fascinated by’ Traveller Communities? The use of ‘fascination’ echoes the voyeuristic sentiment of many television programmes and reinforces notions of Traveller Community members as exotic and worthy of special attention or interest. When mentioning working with Traveller Communities, the very reference to these groups often appears to prompt greater interest, but why should this be the case?

It is problematic, we think, in its divisiveness; in the impression it gives of Traveller Communities as mysterious and ‘other’, and a community that ‘outsiders’ can only look into. This downplays the possibilities for seeing commonalities between Traveller Communities and other sections of society – Gypsies and Travellers are seen less as people ‘like us’, facing similar experiences or challenges in life, and more as groups we should find out ‘about’ or gather information ‘on’.

A sense of fascination also seems to shift the motivation away from the interests of Gypsy and Traveller Communities themselves, and towards fulfilling the agenda of those working with these groups. A desire to satisfy one’s own curiosity about Traveller Communities can result in questions that are insensitive, such as those about the cost of someone’s caravan, or aspects of culture that are unconnected with the purpose of a visit.

It is for these reasons that we call for the reconsideration of the use of ‘fascination’ in relation to Traveller Communities and other groups who are seldom heard, as well as for greater questioning of the assumptions that lie behind this term, and the interests it truly serves.

Friday, 22 June 2018

Public health isn’t good politics (part 2)

Knowledge exchange lessons from the spotlight event at the University of Sunderland

Posted by Peter van der Graaf, AskFuse Research Manager, Teesside University and John Mooney, Senior Lecturer, University of Sunderland

In our last blog, we reported on the 4th Fuse international conference on knowledge exchange in Vancouver, B.C. Provocative speakers explained that public health is, at best a hard sell to policy makers and at worst impossible to influence decision making. Luckily, they also presented short cuts for making it more likely that public health evidence would be heard by policy makers.

Sharon Hodgson, Shadow Minister for Public Health, speaking
at the Spotlight on Public Health event in Sunderland

These challenges and the potential short cuts were clearly present at the University of Sunderland spotlight event that we attended, which aimed to increase the visibility of public health research at the university.

Sharon Hodgson, the Shadow Minister for Public Health, opened the afternoon session with a passionate plea for introducing a minimum unit price for alcohol in England, following the example of Scotland. However, she made it clear that the Scottish choice for a 50p unit price would be a hard sell to both her voters and the Labour party. Labour colleagues simply dismissed the policy as a ‘tax on the poor’ and voters would feel the pinch on their already austerity squeezed household budget.

This ignited a lively debate with researchers in the room, who highlighted the research evidence that is available in favour of a 50p unit price. While statistical models consistently demonstrate that this would have the biggest impact on reducing alcohol related harm, such as liver disease, the Shadow Minister was concerned with how the price selected might impact on her voters. Specifically, she felt it was more important that increased costs to people living in more deprived communities were not dismissed, but instead presented as a health improvement incentive.

Having visited various supermarkets in her constituency to check the prices of different types of alcohol in order to work out the impact of different MUP limits, her conclusions sided with the views of the voters and Labour peers: 50p would hit all the different types of alcohol and not just the cheap ciders and therefore penalised not just the heavy drinkers but also the moderate drinkers in deprived communities. Instead, she argued for a 40p unit price, which would mostly affect the price of cheap ciders, and therefore target only the problem drinkers and not the other drinkers in her constituency. What counted as the most important evidence for the Shadow Minister was quite different from what the researchers in the room perceived as the best evidence to inform policy.

When an audience participant also tried to make the economic case by suggesting that the 50p tax would generate a better return for the Government that could be used to finance alcohol addiction services, the Shadow Minister remained unconvinced.

What did start to sway her was another suggestion to change the narrative from a ‘tax on the poor’ (which might be used as a stick by Conservative party members to beat their Labour colleagues), to a ‘tax for the wellbeing of all’. This narrative framed the 50p MUP as a policy that would affect all walks of life and could encourage a change in drinking cultures among all ages and classes, with the money raised being reinvested across a range of policy areas.

Shanon Hodgson agreed that this might make for an ‘easier sell’ and perhaps more importantly serve as the basis of a future health legacy that she could leave for her voters. By reframing the narrative from a small group problem (problem drinkers in deprived communities) to an emotive public issue of damaging drinking cultures, better policy and voter engagement might be secured.

Paul Cairney presenting at the 4th Fuse International
Conference on Knowledge Exchange in Public Health

The evidence that she really needed were stories to demonstrate meaningful (personal) health gains and cultural change across different sectors of society. This requires a new type of evidence. It does not mean dismissing academic research and all the rigorous evidence it generates, but it does require a careful consideration of the policy system and process in which it is used and a willingness to adapt the messages and narrative to that context and the other types of evidence that are prevalent in that context. This is neatly summarised in the top tips from political science offered by Paul Cairney in his presentation at the 4th international Fuse conference:

Find out where the action is (‘actors’)
Learn the rules (‘institutions’)
Learn the language/ currency (‘ideas’)
Build trust and form alliances (‘networks’)
Be entrepreneurs, exploit ‘windows of opportunity’

Public health researchers operating as political entrepreneurs might be a hard sell to academic institutions but they have a world to win when trying to get evidence into decision making where it matters and creates impact.

Friday, 15 June 2018

The Government’s new Clean Air Strategy – hope or hype?

Dr Susan Hodgson, lecturer in Environmental Epidemiology and Exposure Assessment at the MRC-PHE Centre for Environment and Health, Imperial College London

Air pollution was been high on the agenda at Imperial College London recently, with Environment Secretary Michael Gove choosing to launch the Government’s new Clear Air Strategy at Imperial’s Data Science Institute[1]. To coincide with this launch, Health Secretary Jeremy Hunt announced a new tool, developed by Imperial and the UK Health Forum, to help local authorities estimate the health-care costs due to air pollution - an estimated £157 million from exposure to fine particulates and nitrogen dioxide across England in 2017[2].

Academics and researchers worldwide have worked over many decades to produce an evidence base of high quality research which now clearly links air pollution and health. Globally, 4.2 million deaths are attributed to outdoor air pollution, with 91% of the world’s population living in areas where air quality exceeds health-based guidance limits[3]. Figures for the UK also make grim reading, with an estimated 40,000 deaths per year attributable to outdoor air pollution[4]. While research on this topic makes an unequivocal case for action, Government policy to improve air quality for public health has been found lacking, with the UK (along with France, Germany, Hungary, Italy and Romania) being taken to the European court of Justice for failing to meet EU limits for nitrogen dioxide.

The new Clear Air Strategy[5] outlines how the Government plans to protect the nation’s health. The stated intention of halving the number of people living where concentrations of fine particulate matter are above 10μg/m3 - the concentration of an air pollutant is given in micrograms (one-millionth of a gram) per cubic meter air or 'µg/m3' - by 2025, if achieved, would reap a significant health dividend. However, the focus on a ‘personal air quality messaging system to inform the public…about the air quality forecast [and] air pollution episodes’ places onus on individuals to avoid exposure, rather than creating clean and safe environments within which to live. While there is a place for such messaging, when more than 2000 education/childcare providers across England and Wales are within 150m of a road breaching the legal limit for Nitrogen dioxide pollution (25 of which are in the North East and more than 1500 in London)[6], is it clear that a population based approach is required to tackle this pressing public health issue.

The Strategy also restates the previously announced plan to phase out conventional petrol and diesel cars and vans by 2040, to be replaced by zero exhaust emissions vehicles. This is a positive step, but not sufficient to tackle traffic-related pollution. What comes out of the exhaust represents less than half of vehicle emissions; ‘clean’ vehicles will still generate pollution from tyre and brake wear, and re-suspension of road dust, as explained by Imperial PhD student Liza Selley in her 2016 Max Perutz Science Writing Award-winning essay[7].

The Strategy proposes steps to address not just road traffic pollution, but also shipping, aviation, agriculture and industry, and links health, the environment and economy, marking a welcome move away from silo thinking. There is also mention of ‘appraisal tools and accompanying guidance…to enable the health impacts of air pollution to be considered in every relevant policy decision that is made’ – it is not clear if this extends beyond policy decisions on air pollution, i.e. represents a move towards a coherent ‘health in all’ approach[8], but, if so, would represent a welcome prioritisation of health across Government departments.

Focussing on cleaner vehicles and technological solutions can only offer a partial solution to reducing the impact of air pollution on health, so it is good to see modal shift towards public transport and active transport is mentioned (briefly) in the Strategy. There are funds to support bus and rail infrastructure to improve public transport, and an ambition to double the levels of cycling by 2025 - though this would only raise levels from 2% to 4%, compared to 39% in the Netherlands[9].

If the Government is serious about adopting a more holistic approach to the environment, health and economy, then I feel far more could have been made of the great potential to tackle air quality, sustainability and health collectively. We need ambition and vision to create sustainable cities, and approaches to transport and living that reduce air pollution and additionally tackle inactivity and obesity, which are key drivers of population health. Barcelona’s Institute for Global Health recently launched its #CitiesWeWant initiative[10], which highlights some of the features we need to be prioritising in our cities to benefit future health and wellbeing. We have the research evidence to support these priorities, but Governments will require buy-in from experts and demand from the public to enact bold change. Those passionate about improving our environment for health have the opportunity to voice their views via the Government consultation on this newly launched Clear Air Strategy, which will inform a National Air Pollution Control Programme due March 2019.

The views represented here are those of the author, Dr Susan Hodgson.

Susan is a lecturer in environmental epidemiology and exposure assessment at the MRC- PHE Centre for Environment and Health at Imperial College London. Her research focusses on understanding how interactions with our environment (including air pollution), influences health.

More details at: www.imperial.ac.uk/people/susan.hodgson

References:

Friday, 8 June 2018

Young people in the UK drink more energy drinks than any other countries in Europe

Posted by Amelia Lake, Associate Director of Fuse and Reader in Public Health Nutrition at Teesside University and Shelina Visram, Senior lecturer in public health at Newcastle University

It would be a bit shocking to see children and teenagers drinking espressos, yet it’s socially acceptable for young people to reach for energy drinks to give them a quick “boost”.

Energy drink sales in the UK are now worth more than £2 billion a year

Unaffected by the economic crisis, energy drinks are the fastest growing sector of the soft drinks market. Between 2006 and 2012 consumption of energy drinks in the UK increased by 12.8% – from 235m to 475m litres.

These drinks are very popular with young people – despite coming with a warning (in small letters on the back) that they are “not recommended for children”. A survey conducted across 16 European countries found that young people between the ages of ten and 18 in the UK consume more energy drinks on average than young people in other countries – just over three litres a month, compared to around two litres in other places.

More than two-thirds of young people surveyed in the UK had consumed energy drinks in the past year. And 13% identified as high chronic consumers – drinking them four to five times a week or more. Research also suggests that these drinks are more popular with boys and young men.

What goes into energy drinks?

Energy drinks are usually non-alcoholic and contain ingredients known to have stimulant properties. They are marketed as a way to relieve fatigue and improve performance: “Red Bull gives you wings”.

They contain high levels of caffeine and sugar in combination with other ingredients, such as guarana, taurine, vitamins, minerals or herbal substances. A 500ml can of energy drink for example, can contain 20 teaspoons of sugar and the same amount of caffeine as two cups of coffee.

Caffeine stimulates the central and peripheral nervous system. Consumed in larger doses, it can cause anxiety, agitation, sleeplessness, gastrointestinal problems and heart arrhythmias.

In the UK, there are no clear recommendations for caffeine intake for adults or children, although both the Food Standards Agency and the British Soft Drinks Association recommend that children should only consume caffeine in “moderation” and that caffeine content over [150mg/l] should be declared on the packaging. The current scientific consensus is that [less than 2.5 mg a day] in children and adolescents is not associated with adverse effects.

Should we be worried?

The evidence indicates that these drinks do not give you wings – or any other positive benefits. In fact their intake in young people, is associated with adverse health outcomes. There is growing evidence of the harmful effects of these drinks. Teachers are concerned about the detrimental impact these drinks have on pupils in their classrooms. There is also a known association between soft drink intake, dental erosion and obesity.

Lesser known are the effects of the cocktail of stimulant ingredients – such as guarana and taurine – contained within these drinks.

Our recent review of the scientific literature set out to look for any evidence of associations between children and young people’s consumption of energy drinks and their health and well-being – as well as their social, behavioural or educational outcomes.

We found that for young people, drinking energy drinks is associated with a range of adverse outcomes and risky behaviours. They are strongly and positively associated with higher rates of smoking, alcohol and other substance use – and linked to physical health symptoms such as headaches, stomach aches, hyperactivity and insomnia.

Why do young people buy them?

We also spoke with young people about their intake of these drinks. Discussions with our participants aged between ten and 14 indicated just how accessible and available these drinks are. They are also cheap – in some cases significantly cheaper than other soft drinks, as one of the girls we spoke to explained:

"I think it’s because like a normal can of Coke is like 70p, and [own brand energy drinks] are like 35p."

Our research found that energy drinks are often marketed on gaming sites and linked to sports and an athletic lifestyle – and are particularly aimed at boys. Taste, price, promotion, ease of access and peer influences were all identified as key factors in young people’s consumption choices.

Speaking with parents and teachers about these drinks there was confusion. Parents themselves identified the need for more information about energy drinks – and many admitted to not being fully aware of the contents and potential harmful effects on children.

Should they be banned?

Image used in a recent campaign led by Jamie Oliver
to ban the sale of energy drinks to under-16's

Recently there has been a move to restrict the sales of these drinks to under 16’s – an approach which has also been taken by other countries. This saw the self-imposed sales restriction by many larger retailers – including most supermarkets – to not sell to children under 16. But many places still continue to sell to young people – including convenience stores, which offer a wide range of brands, flavours and package sizes.

The Commons Science and Technology Committee’s enquiry into energy drinks called for submissions in April 2018 and will be reviewing in June 2018 – when we will also give oral evidence.

Of course, legislation to prevent the sales of energy drinks to under 16’s would be helpful. But the marketing of these drinks to young people through computer games and their association with sports is also a much wider issue. Far reaching discussions are needed about the direct and indirect marketing of these drinks (and other food and drinks) through multiple platforms other than TV – particularly through computer games.

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

Friday, 1 June 2018

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

Friday, 25 May 2018

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

Wednesday, 9 May 2018

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!

Friday, 27 April 2018

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:

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.

Friday, 16 March 2018

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.

Friday, 9 March 2018

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

Friday, 9 February 2018

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

Friday, 26 January 2018

'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.’

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