Do councils have what they need to help tackle obesity?

Guest post by Michael Chang, Project and Policy Manager, Town & Country Planning Association

The new revised National Planning Policy Framework (NPPF) is published by the Ministry for Housing, Communities and Local Government this week (24 July). It now provides the policy basis for planning healthy communities (Section 8 Paragraphs 91 and 92). In this context, here I want to explore whether there are enough planning powers to successfully tackle fast food outlets. At a Fuse event earlier this year on ‘Planning for Healthier diets: restricting hot food takeaway proliferation’, I also highlighted interesting results of recent planning policy developments and planning appeal decisions.
 

Back to the future… again?

Firstly it should be stated that concerns about the physical built environment and food environment in relation to people’s health and wellbeing are not a new trend. There has long been an understanding (with increasing supporting academic evidence) of the negative implications of food deserts and extant planning policies to tackle the negative environmental impacts from food outlets such as smells, noise, opening hours, litter and traffic generation.

The Foresight Tackling Obesities report was published in 2007 which, in the context of addressing the issue through a whole system approach, suggested two actions in which urban planners can effect change in the living environment, one of which refers to food and drink access and availability[1]. But a year earlier, the Royal Commission on Environmental Pollution, an independent standing body established in 1970 to advise the Queen, the Government, Parliament and the public on environmental issues, had already highlighted availability and cost of healthy food as an environmental determinant to cardiovascular risk in its seminal 26th report on The Urban Environment[2].

Is there an enabling policy environment to tackle obesity?

Given the weight of evidence, research and high-level recommendations in the last decade, in 2018, do planning practitioners working in local authorities have the right policy tools to do something about it? The main indicator is whether local plans, which each local authority across England have created, have the right policies? Local plans are powerful because in addition to setting out the council’s long-term vision and pathway for creating sustainable local communities, they are the basis with which decisions on planning applications are made from extensions to your house, to opening new shops on the high street to the creation of a complete new neighbourhood.

CEDAR (Centre for Diet and Activity Research) will publish more extensive results on local plans and fast food outlet policies so I will focus on the wider issue of tackling obesity. As part of the Planning Healthy Weight Environment work in 2014[3], the Town & Country Planning Association (TCPA) undertook an extensive policy review of local plans in England. Forty-one percent (41%) did reference obesity but generally only in the introductory paragraphs where they identified that obesity was a problem in the area. Only 17% followed through to the policy sections, but always in the supporting text rather than in the policy text. In statutory Joint Health and Wellbeing Strategies, only 31% make specific links to the built environment as one of the wider determinants of obesity. 

There is no reason, if supported by evidence and needs assessment, for councils not to have relevant policies such as on active travel, open space and food environment with a specific objective to help reduce local obesity rates. Recent planning inspector reports on draft local plans, before they are approved by councils, indicate a growing positive picture of a more welcoming stance on restricting fast food outlet policies including greater acceptance of the exclusion zone approach.

Have planning appeal decisions been favourable?

How are councils actually faring when they apply these policies in defending their decisions to refuse planning permission for new fast food outlets? The picture is more mixed with some councils successfully defending their decisions while many others have their decisions overturned by planning inspectors. The justifications by planning inspectors are not as you might expect.

"...this is politics, it's not medicine..." - 24 TV series

To illustrate the way planning appeals have been decided for and against planning applications for new fast food takeaways, take for example a scene from the hit American drama ‘24’. President Palmer’s advisor Wayne Palmer said to the President’s doctor Anne Packard: “It’s he said, she said, you see this is politics, it’s not medicine, so do me a favour and stay out of it”. 

Most, if not all the recent judgements I have seen (but there would need to be a more systematic review), do reference national guidance and support the obesity crisis as a valid planning reason. The health and medical arguments appear to have been won, but other wider considerations including local ‘political’ issues come into play and only evidence presented on the day are valid. This scene underlies the tension in planning decisions, which is why in its three reports into the government’s Childhood Obesity Plan in the last three years, the Health and Social Care Select Committee[4] has consistently called for health to be a material planning consideration in an arena of competing considerations from economic to employment.

What does this all means?

There needs to be more research done in the area to better understand the implications of proliferation of fast food outlets on population health from the health inequalities lens. There also needs to be more applied research to understand why practitioners could not effectively implement policies and what the real barriers are. Evidence and aspiration can only go so far. It is time we all take a breather from pursuing perfect evidence to properly supporting practitioners at the coal-face.


Michael Chang is a Chartered Town Planner at the Town and Country Planning Association (TCPA), leads on TCPA’s Reuniting Health with Planning Initiative and currently undertaking a part time Master by Research at Leeds Beckett University on using planning powers to promote healthy weight environments.


References:

1. Foresight, 2007, Tackling Obesities: Future Choices: https://www.gov.uk/government/publications/reducing-obesity-future-choices  
2. Royal Commission on Environmental Pollution (RCEP), 2006, The Urban Environment: http://webarchive.nationalarchives.gov.uk/20110322144101/http://www.rcep.org.uk/reports/26-urban/documents/urban-environment.pdf
3. Town & Country Planning Association (TCPA), 2014, Planning Healthy-weight environments: https://www.tcpa.org.uk/Handlers/Download.ashx?IDMF=7166d749-288a-4306-bb74-10b6c4ffd460
4. Health and Social Care Select Committee, Childhood obesity inquiries reports 2015, 2017 and 2018: 

• https://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/inquiries/parliament-2015/inquiry/publications/, 
• https://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/inquiries/parliament-2015/childhood-obesity-16-17/publications/, 
• https://www.parliament.uk/business/committees/committees-a-z/commons-select/health-and-social-care-committee/inquiries/parliament-2017/childhood-obesity-inquiry-17-19/

Images:

1. "318-365 Year3 On Our Way Home" by John Garghan via Flickr.com, copyright © 2011: https://www.flickr.com/photos/johngarghan/6351566649
2. By The original uploader was Tuxo at German Wikipedia. [Public domain], via Wikimedia Commons: https://commons.wikimedia.org/wiki/File:24-Logo.svg

How can governments reduce health inequalities in high-income countries?

Guest post by Dr Katie Thomson, Institute of Health and Society, Newcastle University

In recent months, there have been high profile stories of how governments can influence public health. The Scottish minimum unit price for alcohol introduced on the 1 May 2018, and more recently the publication of Chapter 2 of the Government’s Childhood Obesity Plan. This update proposed measures to address children’s exposure to junk food advertising on television and online, and called for a ban of price promotions on products that are high in fat, salt or sugar.

20mph zones were shown to increase inequalities in cycle accidents and

 rates of death between more and less deprived neighbourhoods

Such policies have great potential to improve public health, by shifting the distribution of health risk and addressing the underlying social, economic and environmental conditions (Hawe and Potvin, 2009)1. However, it is imperative to understand the impact of these policies on health across the entire social gradient. Thereby ensuring the most marginalised, are not adversely effected by policies which aim to improve health overall.

I have been part of a group of academics which recently completed an umbrella systematic review (‘review of reviews’) which aimed to understand the effects of public health policies in high-income countries. You can read about the research in a handy two-page Fuse research brief. As part of the Health inequalities in European welfare states (HiNews) project, we found evidence of 29 reviews (comprising 150 unique primary studies) which detailed the evidence of how fiscal (government revenue), regulatory, education, preventative treatment and screening approaches can be used by governments to influence health inequalities across eight key domains.

Conceptual framework of population-level preventative public health policies to reduce health inequalities

Our review highlighted 13 key interventions which were demonstrated to reduce health inequalities. These include taxes on unhealthy food and drinks; food subsidy programmes for low-income families; incentive schemes linked to immunisation status; proof of immunisation for school admission; tobacco advertising control measures; traffic calming measures; oral health (water fluoridation and tooth brushing campaigns); some nutritional and cancer education programmes; universal and targeted vaccinations for indigenous populations; and targeted and population screening interventions.

Worryingly, we also found evidence of interventions that were shown to increase health inequalities – potentially leading to so-called 'intervention generated inequalities’ (Lorenc et al., 2013)2. For instance, lowering alcohol tax by 33% was shown to increase inequalities in rates of death amongst disadvantaged groups in Finland. Environmental interventions, including 20mph and low emission zones, were also shown to increase inequalities in cycle accidents and rates of death between more and less deprived neighbourhoods.

Our research also demonstrates that for some potentially important interventions, such as for policies to control alcohol, there is a lack of robust evaluations highlighting the effects on different groups of people.

Given the volume of literature we found on the effects of government-led policies on health overall, it was disappointing that we could only identify 29 reviews that reported data on health inequalities. Going forward, those tasked with evaluating such policies must report how health outcomes differ for specific interventions by subgroup as standard. Furthermore, reviews should incorporate sufficient information on how the intervention was implemented and enforced to be useful for policy makers thinking of adopting such approaches. We also found many of the reviews and their primary studies were US-based, which could potentially limit the transferability of interventions from one country to another.

Undertaking a systematic review is not without its challenges. When published, the article reads like a definitive narrative when in reality it comprises a multitude of subjectivities – which reviews to include? Which primary studies are relevant? Which outcomes are most appropriate? And how to summarise the state of evidence in a particular field given multiple studies/reviews? The methodology is designed to be systematic, but as it uses human interpretation there is always an element of judgement. Umbrella reviews assess the state of the evidence across a wide area of interest, and are therefore worth the blood, sweat and tears which goes into producing them.

Upstream public health interventions involving state or institutional control offer great hope to improve health for all. However, a comprehensive understanding on the effects of different interventions is a necessary first step to ensure policies have an equitable benefit for all members of society and therefore are worthy tools at the disposal of governments tasked with improving health.


The Health inequalities in European welfare states (HiNews) project is a collaboration between the universities of Newcastle, York, Trondheim, Siegen and Harvard and funded by the New Opportunities for Research Funding Agency Cooperation in Europe (NORFACE).

References:

1. Hawe, P., Potvin, L., 2009. What is population health intervention research? 100, I8-I14.
2. Lorenc, T., Petticrew, M., Welch, V., Tugwell, P., 2013. What types of interventions generate inequalities? Evidence from systematic reviews. Journal of Epidemiology and Community Health 67, 190-193.

Photo: © Albert Bridge (cc-by-sa/2.0)

Putting the 'occupation' in Occupational Therapy and debating its role in Public Health

Guest post by Andrew Graham, Registered Occupational Therapist and PhD Candidate, Teesside University

Having recently made the move from NHS clinician into academia (I started my PhD at Teesside University in December 2017), I arrived in Belfast for the Royal College of Occupational Therapy Annual Conference with an appetite to hear new and interesting research in the profession.

In my welcome pack, I received a copy of the RCOT’s Strategic Intentions which represent the leadership response to the challenges of the changing landscape of health and social care. The principle that stood out for me was to ‘position the Profession, and our members, for the 21st century’.

With my background in amputee rehabilitation I have seen first-hand the impact of socio-economic inequalities and lifestyle trends on amputation rate in North East England. For example, the amount of amputations due to diabetes, and more shockingly intra-venous drug use, has spiked in the past 10 years or so. As an Occupational Therapist (OT), I view the person holistically and always try to take into account the social and psychological not just physical barriers they will need to overcome post amputation. My focus will always be on what the person needs and wants to do. The person’s meaningful activities (occupations).


The pledge tree

During the conference, we were asked to make a pledge about how we would do our part to ensure the new strategic intentions are met. The pledge tree seemed to have a recurring theme of ‘ensuring occupation is central to my work’.

My own pledge was to better explain ‘occupation’ and its meaning within occupational therapy to a range of audiences.

So, my attempt at articulating ‘occupation’? I’ll go with ‘doing things that we need to do and want to do (meaningful activities), which enable a sense of self-meaning and improved health and well-being.

I feel as a profession we are experts in using occupation as a goal (top down approach) and/or a means (bottom up approach) to ensure provision of high-quality, client centred services. Utilising the OT process from information gathering to evaluation we strive to enable growth, confidence and self-meaning.

Despite OTs generally being able to better define what they do and what the outcomes can be, it was a bit of a shock to see that the debate at the conference highlighted that the profession is still unsure about its stakeholders. The topic up for discussion was ‘This house believes that Occupational Therapy needs to be predominately based in public health, not in secondary or tertiary services’.

From my experience, this issue had been debated and answered years ago. My pre-registration training saw me working in the NHS, community mental health teams, a special needs school and a charity. The OTs all had a prominent and effective role in these sectors, so as intrigued as I was to hear the debate, I knew which way I would be voting!

For the purpose of this blog I’d like to highlight the case for OTs working in Public Health. A starting point would be the statement by the professional body, which points out that the Public Health Agenda has been of increasing importance and relevance for occupational therapists, who facilitate health promotion through working with people of all ages to enable their participation in meaningful occupations (RCOT 2004).

The evidence base is also pretty strong. A systematic review of Allied Health Professions and Health Promotion (Needle et al 2011) reviewed 28 studies related to occupational therapy and Public Health, and found related interventions in the areas of mental health, arthritis, pain and fatigue, pulmonary rehabilitation, stroke, drug and alcohol problems, and falls prevention.

Not only are OTs already working with people on aspects of Public Health and health promotion activity, but there is an expectation that this focus will form part of the delivery of all occupational therapy interventions in the future. For example, I remember reading about the ‘make every contact count’ campaign when working on an acute stroke ward and making sure I asked about smoking and drinking habits as part of my OT assessment.

So, it was with no surprise that the result swung against the motion at the conference. A particularly convincing rebuttal speech was given by Professor Diane Cox and Dr Jenny Preston, clearly showing the professions ability to address Public Health matters but also reach a wider audience through demonstrating outcomes in secondary and tertiary services.

Overall, I left the conference with a sense that the profession has strategically positioned itself to demonstrate that it is making a difference and will continue to make a difference to the health and well-being of people in the 21st century. It is time for OTs working in Public Health and other services to be proud. In my favourite quote of the conference….‘we are not the jack of all trades, rather we are the masters of human occupation’.


Andrew Graham is investigating ‘Sensory Discriminating Training for Phantom Limb Pain’, as a PhD candidate in the School of Health and Social Care at Teesside University.

Game of Thrones: King in the NoRTH… Workshop is coming… but has anyone actually read the books?

Dr Sonia Dalkin, Senior Lecturer in Public Health and Wellbeing, Northumbria University

Unless you’ve been living in a box since 2011, it’s likely that you will have heard of the series Game of Thrones. For those of you still in your boxes – Game of Thrones is fantasy drama television series created by David Benioff and D. B. Weiss. It is an adaptation of A Song of Ice and Fire, George R. R. Martin's series of fantasy novels, the first of which is called A Game of Thrones. The series has been acclaimed for many things including its acting, complex characters, story, scope, and production values. Notably, it has also received praise from both The Guardian and The Times for what is perceived as a sort of medieval realism. Here, I want to talk about a different type of Realism, that of Scientific Realism, or more specifically Realist Approaches to Research.

What is realist research?

Just as Martin’s novels rely on believable characterisation and relatable motivation to create enough suspension of disbelief to enter a world of dragons and sorcery, realist research focuses on social interventions to explain not only whether an intervention works or not, but for whom and under which circumstances. The focus therefore embraces and explains the complexity of social interventions. It aims to understand the responses people have to programme resources, therefore understanding the reasoning and motivations behind their actions. In order to do this, we focus on programme theory and utilise context, mechanism and outcome configurations. It provides rich findings, explaining why interventions work in some contexts, but not in others. For example – why is Daenerys impervious to fire when others are burnt? Because she’s a decedent of House Targaryen. Context is important, people! Alongside context is its trusty friend mechanism – similar to Ghost (an albino dire wolf) and Jon Snow – they go hand in paw. Mechanisms can be referred to as a combination of intervention resources and participant reasoning. More information is available on mechanisms here.

Altogether, the analytical tools of realist evaluation described above are used in the following way: Intervention resources are introduced in a context, in a way that enhances a change in reasoning. This alters the behaviour of participants, which leads to outcomes.

The methodology is not without its difficulties. Often realist researchers describe feeling that they are in a ‘realist swamp’; going down different alleyways, trying to understand and explain how a programme works, for whom and in which circumstances, but not getting too far. Often in this phase, realist researchers are similar to the White Walkers (an ancient race of humanoid ice creatures who really aren’t too friendly), in both looks and temperament. This phase can be frustrating, but like Arya against The Waif (acolyte of the Faceless Men), in most projects there is a sudden moment of clarity, where the dark alley becomes your friend, it all comes together, and you come out fighting.

Here at Northumbria University we have engaged in many projects using realist methods and want to help other realist researchers beat The Waif as quickly as possible, where possible. In order to do this, we’ve engaged a three-pronged approach as sharp as Arya’s sword, ‘Needle’:

1. Realist research Team Hub (NoRTH)

We felt it was time to highlight ourselves as key players in the realist game and to create a hub of realist research. What does every hub need? An acronym! We are now the Northern Realist research Team Hub (NoRTH).

NoRTH’s priorities will be to: advance the implementation of the methodology; collaborate with others focusing on realist research; contribute to and host realist education platforms; support PhD students in realist research; and continue to offer methodological expertise to those who seek it.

One thing of importance to note here is that we don’t feel we are the only big players in the North in terms of realist research – The Starks (University of Leeds) are obviously the long term true Kings of the North, with Professor Ray Pawson at the helm (our Jon Snow) for many years, and Nick Emmel, Joanne Greenhalgh, and Ana Manzano (Bran, Sansa and Arya) now fighting strong. But being ‘Northumbria University’, the acronym NoRTH seemed too good to resist… please take this blog as a token of our affection and don’t give us a fate like that of the Red Wedding!

2. Winter’s coming… along with a workshop in realist approaches

Winter is coming and soon we’ll have dark nights and frosty mornings, but never fear; alongside winter we have a brilliant offer of a Realist Approaches Workshop. Like Daenerys, mother of dragons, we wanted to educate others and decided one way to do this would be to provide a workshop. Whilst we can’t promise dragons, rebirths in blood and fire, or steamy scenes with Jon Snow, we can offer a fantastic line up of realist researchers, ready to take you on an exciting methodological journey.

Day 1 of the workshop will focus on Basic Principles of Realist Research, whilst day two will focus on contemporary developments such as realist ethnography and realist economic evaluation. To find out more and to book, check out the website.

3. ‘Doing Realist Research’ – a new book

As much as a lot of people claim to be Game of Thrones fans, how many of them have actually read the original books? TV series and films can bring whole worlds to life before our eyes, make characters into living people, but books take you into the detail, the nooks and crannies of the story. For example, the maps in Martin’s book displaying the geography of the mythical Kingdom aren’t as well portrayed in the TV series, despite efforts in the opening titles. Books provide the details that are often overlooked yet important in really understanding the overall story or the characters. Thus, if interested in realist research, I would like to suggest you read the new book ‘Doing Realist Research’, available to pre-order now), which provides much more detail on realist approaches, covering topics such as: realist review problem-solving, literature searching for realist reviews and mechanisms at higher levels of abstraction.

Edited by Nick Emmel, Joanne Greenhalgh, Ana Manzano (The Starks), Mark Monaghan and myself, this book celebrates the possible ways in which realism can contribute to researching complex social puzzles, providing practical advice on the ‘how to’ of realist methods.

Similar to Game of Thrones, so far, it’s received rave reviews, like that from Professor Kieran Walshe, (University of Manchester): “I wish all social science researchers would read this book”. Best of all, it has absolutely no Game of Thrones references – and that’s a promise (similar to that of Ned Starks to Lynna Stark in the infamous Tower of Joy Scene)…



Acknowledgements

Many thanks to Dr Phil Hodgson (Northumbria University) for helping me in identifying so many obvious Game of Thrones parallels with realist research…


Image: "Game of Thrones. Xbox One. 1080.P. 😁 Gameplay Part.04.-06. On my YouTube Channel 😁 https://youtube.com/playlist?list=PLwsjII0MclEGZnmdii3LZb9FZLby_iP4Q 😁 by Rob Obsidian via Flickr.com, copyright © 2015: https://www.flickr.com/photos/65092514@N08/18679295525

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.

Image: "Seeing My World Through a Keyhole" (4592429363_292aec80c9_z) by Kate Ter Haar via Flickr.com, copyright © 2010: https://www.flickr.com/photos/katerha/4592429363

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:

1. Find out where the action is (‘actors’) 
2. Learn the rules (‘institutions’) 
3. Learn the language/ currency (‘ideas’) 
4. Build trust and form alliances (‘networks’) 
5. 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.

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

© 2018 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.

© 2018 Imperial College London

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.

© 2018 Imperial College London

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:

1. https://www.imperial.ac.uk/news/186390/michael-gove-launches-governments-clean-air/
2. https://www.imperial.ac.uk/news/186406/air-pollution-england-could-cost-much/
3. http://www.who.int/airpollution/en/
4. https://www.rcplondon.ac.uk/projects/outputs/every-breath-we-take-lifelong-impact-air-pollution
5. https://consult.defra.gov.uk/environmental-quality/clean-air-strategy-consultation/user_uploads/clean-air-strategy-2018-consultation.pdf   
6. https://unearthed.greenpeace.org/2017/04/04/air-pollution-nurseries/
7. http://www.insight.mrc.ac.uk/2016/10/14/braking-perceptions-of-traffic-pollution/
8. http://www.who.int/healthpromotion/frameworkforcountryaction/en/
9. https://ec.europa.eu/transport/road_safety/specialist/knowledge/pedestrians/pedestrians_and_cyclists_unprotected_road_users/walking_and_cycling_as_transport_modes_en
10. https://www.isglobal.org/en/ciudadesquequeremos

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.

Prevention by any other name would smell as sweet

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

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

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

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

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

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

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

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

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

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

Public health isn’t good politics

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

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

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

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

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

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

An image from Steven Hoffman's presentation

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Getting physical activity research moving

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

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

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

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

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

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

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

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

As #FusePAW, we have a responsibility to ‘do

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

Watch this space for findings!


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


Just a few of our amazing cast of presenters

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

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