Thursday, 18 September 2014

52 weeks in public health research, part 37

Posted by Jean Adams

The seminar room and cafe in our building are often used for small conferences by groups from around the university. I snapped this at about 7pm in the evening when one such meeting had well and truly turned the corner from conference to social. We never have beer, tobacco and biscuits at public health meetings. Honest.

This is the 'famine wall' on Beinn Dearg near Ullapool. This part of it is more than 1000m above sea level. It runs for many miles and is more than 8ft wide and 8ft high in places. It was constructed in the 1840s by farmers whose harvest had failed in return for money, or food. There are remnants of many of these 'make work' projects all over the north of Scotland (and I presume Ireland too). It would have been considered unseemly just to give starving people money (as per the modern welfare state). Instead, humanitarian landlords thought up projects such as these to keep their tenants occupied and fed. You can see that it was a beautiful day when we were there, although you can't see the chilling winds strong enough to knock us over at times. The conditions up there are likely to be dreadful more often than not. Despite the problems with the current welfare state, I still think it's better than having people build useless walls at 3000ft in Scottish mountain weather.

I took this picture of lemon cake at afternoon tea time at the recent meeting of the World Public Health Nutrition Association. I was fully intending of making the usual comment about the ironic placement of unhealthy food at a public health nutrition meeting. Turns out most of is was left at the end of the tea break.

This is an interesting development that I noticed at a petrol station recently. It was quite a substantial promotion on Coke Life - sweetened with stevia and with about two-thirds of the calories of red Coke. There's an interesting discussion of the 'natural' and 'low(er) calorie' claim here. Personally, I think two-thirds of the calories of red Coke, is still a lot of calories.

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Just to remind you:

Each Thursday of 2014 we’ll try and post around four pictures on the Fuse blog that capture our weeks in public health research, from the awe-inspiring to the everyday and mundane. Given that more of the latter than the former exists in my life, I foresee problems compiling 208 images worth posting on my own. So this is going to have to be a group project. Send me an image (or images) with a sentence or two describing what aspect of your week in public health research they sum up and I’ll post them as soon as I can. You don’t have to send four together – we can mix and match images from different people in the same week.

Normal rules apply: images you made yourself are best; if you use someone else’s image please check you’re allowed to first; if anyone’s identifiable in an image, make sure they’re happy for it to be posted; nothing rude; nothing that breaks research confidentiality etc.

Tuesday, 16 September 2014

Haste ye back?

Posted by David J Hunter, Professor of Health Policy and Management, Durham University and Fuse Deputy Director

Many in the North East will be wondering how their region will fare if Scotland decides to go its own way on Thursday.

Some may be heard to say: ‘if you’re going can we come with you’?  Others might sullenly fear the worst, with our region caught between a hungry new nation impatient to prosper and chart a different course on the one hand, and an England which seems captive to the huge suction pump that is London hoovering up all before it and drawing in talent and resources from across the UK – or what was the UK.   

Where might health policy figure in the scheme of things post-referendum?  Will it fare better under independence? Or will things remain much the same or possibly deteriorate?

Financially, the Scottish NHS has always fared better than its English counterpart, enjoying higher per capita funding.  But spending on health services is not the only factor affecting health status.  Despite the extra funding, Scotland’s health remains stubbornly poor and generally inferior with higher mortality – hence the label the ‘sick man of Europe’.

Of course, with less funding for health care it might be worse.  But it’s more complicated than that. 
Perhaps liberated from the shackles and centralising tendencies of the UK (or London to be more precise), Scotland will be able to restore the public realm or invest in ways which will demonstrate that an austerity economic model can be replaced by a social model of development.

We know from Marmot’s work and WHO’s health strategy for Europe, Health 2020, that tackling the social determinants of health demands a whole of government and whole of society approach. 

Being able to achieve such joined up thinking and work across a whole system is much easier (in theory at least) in a small country.  And there are certainly signs that Scotland wants to be innovative and tackle health differently with its recently departed Chief Medical Officer, Harry Burns, extolling the virtues of asset based approaches and talking about wellness rather than ill-health.           

The Scottish government has been something of a cheerleader in public health policy having been quick to follow Ireland’s lead on banning smoking in public places long before England.

More recently, it took the lead in introducing a minimum unit price for alcohol although whether the policy will survive the EU single market rules remains to be seen. But where England dithers, Scotland appears willing to take bold action.

The real issue is whether an independent Scotland can do more to improve health and tackle inequalities than it can under current devolved freedoms and from others to come which are promised following a No vote.  

The answer is complicated.  After all, what does independence actually mean in our global world where paradoxically everything is interdependent at a time when nations and regions seek greater freedoms.  Are these opposing forces reconcilable?   Or will independence prove to be a chimera with Scotland even less able to realise its social justice aspirations?

Those voting with their heads will endeavour to weigh up the pros and cons and bring evidence to bear on their decision-making.

Those ruled by their hearts will not be swayed by an evidence base which is fiercely contested and offers no definitive answers.  They will be tempted to take the risk believing they have nothing to lose with the status quo and retention of a 300 year old Act of Union holding little appeal. 

But will the politics and the policies be so different in the end or just their packaging and presentation?   Can an independent Scottish government shake off the neoliberal embrace to which all governments since, and including, Thatcher have been enthral? 

In a global economy, no country is an island and to keep at bay, never mind hold to account, the rapacious transnational conglomerates, including the big consultancies and ‘advisers’ and lobbyists that are busy hollowing out the public realm in England, demands both vigilance and political courage of a kind that will tax the most socially enlightened politician.  

This is the true nature of the experiment underway in Scotland regardless of whether it achieves formal independence after the referendum or some form of ‘devo max’.

Can Scotland break with the Anglo-Saxon tradition and replace it with an ethos marked by collectivism, reciprocity and a commitment to public services? 

Or will it buckle under the pressures of global capitalism and dance to its tune?                

Yes or No, Scotland promises to be a fascinating laboratory for years to come for health policy-watchers.

Thursday, 11 September 2014

52 weeks in public health research, part 36

Posted by Simon Howard and Jean Adams

From Simon Howard: after the photo of the Messi Pepsi can, I thought this one I took on holiday in Naples took the biscuit - the Napoli football team as tins containing chocolate chip cookies! Judging from the end product, I'm not sure they thought too hard about the aesthetics, let alone what the public health consequences might be!

From Jean Adams: In October we are moving to Cambridge and we've been using our East Coast rewards points to house hunt in style. But all that time spent searching property websites during the week means that we are making use of the peace and space of first class to catch up on work.

From Jean Adams: I was in London earlier in the summer at one of those meetings that looks like you are being invited to contribute your expertise, but is actually someone very politely asking you to stop making so much fuss. The meeting ended early and I took the opportunity to visit the V&A's Disobedient Objects exhibit before my train. This Nicholas Klein quote made me feel just a little alone and ignored.

From Jean Adams: the 'big move' means that I have finally had to find the time to clear out my desk and cupboard. After ten years of not looking at any of them once, I am parting with my PhD notes. Both a little bit gut wrenching and a little bit liberating.

------------------
Just to remind you:

Each Thursday of 2014 we’ll try and post around four pictures on the Fuse blog that capture our weeks in public health research, from the awe-inspiring to the everyday and mundane. Given that more of the latter than the former exists in my life, I foresee problems compiling 208 images worth posting on my own. So this is going to have to be a group project. Send me an image (or images) with a sentence or two describing what aspect of your week in public health research they sum up and I’ll post them as soon as I can. You don’t have to send four together – we can mix and match images from different people in the same week.

Normal rules apply: images you made yourself are best; if you use someone else’s image please check you’re allowed to first; if anyone’s identifiable in an image, make sure they’re happy for it to be posted; nothing rude; nothing that breaks research confidentiality etc.

Tuesday, 9 September 2014

You can't ever win

Posted by Jean Adams

Brian McNeil sings a song called Sell you labour not your soul. The chorus goes: “Young and old, true and bold/ Sell your labour not your soul/ Solidarity's your goal - join the union”. It invariably involves a lot of audience foot stamping and fist waving.

I was reminded of this song during a conversation with my ‘leadership mentor’ a few months ago. NIHR sent a guy up to Newcastle to watch me at work, feedback on my leadership style, and discuss my career direction with me. My mentor had worked with lots of people funded by NIHR, so when he asked which UK academics I really wanted to be like, he knew the names I reeled off. “If you want to be like them,” he said, “you’re going to have to work more hours”. Then he laughed at me when I told him the university already got enough of my soul and said, “well you know the old saying: ‘if you’re not a socialist by the time you’re 20, you haven’t a heart; if you’re still one by the time you’re 40, you haven’t a brain’”. I still have a few years left to make the full transition.

All the images on work:life balance were cheesy. But I thought you'd be impressed by this photo of Brian McNeill playing the double-kneck bouzouki
There are people at the university that I strongly feel don’t get paid enough to work more than their contracted hours. But that’s not me – I get paid plenty well enough. And it’s not that I don’t feel passionate about (most of) what I do, or find myself enjoying thinking about it when I’m running or climbing hills, or sometimes get so engrossed in it that I’m still at my desk way past home time. I just think there should be more to life than work. That my life, and work, are both better for there being more to life than work.

I know there are many, many people working in public health research (and in lots of other areas) who work more than their contracted hours. In fact, my contract is a little vague about what my ‘contracted hours’ might be. Sometimes it seems like working all the time is the only way to be successful – somehow ‘good’ means ‘lots’. There seems no way to do everything that you want, or have, to do without working all the hours.

Academia is inherently a competitive venture. There is no absolute benchmark of good enough – it’s only ever relative to what other people manage. When one person starts churning out twice as much as anyone else by working longer and longer hours, it puts pressure on the rest of us to do the same. To keep up. Before you know it, you feel guilty every Sunday afternoon you don’t spend at your laptop.

But I have also come across well respected, and undoubtedly successful, academics who tell me how important it is to them not to start work before 8.30am, and not to leave the office after 6pm. Not just because it makes their lives better, but because this is the role model they want to be to those around them. These are not people who are doing sneaky work at home that they don’t let on about. They just seem to be focused in what they agree to do, to do it efficiently, and then to go home and do something else.

It is this type of person that I really want to be like. For me, the challenge is the focus and efficiency, not finding the energy to stay at my desk until midnight – although I would also struggle with that. Every Sunday afternoon that I spend at my laptop I feel that I have failed. I promise myself that next week I will focus more and be more efficient. I list the ways that I waste time and the things I should never have agreed to do. Instead of feeling guilty when I’m not working, I feel guilty when I am.

You can’t ever win.

Thursday, 4 September 2014

52 weeks in public health research, part 35

Posted by Martin White

Editor's note: Yes, it is possible that we skipped 4 weeks of this project. But I'm making the rules and I say that's okay. 

I am attending a national research leaders course funded by NIHR and hosted by Ashridge Business School in Hertfordshire periodically during this year and some of next. The course itself is very good (the role play on 'difficult conversations' was particularly educational), as is getting to know the class and faculty (some extraordinary people at the top of their game), and the food (!). But the venue and its setting, dating from the 14th century in parts, in the custodianship of the National Trust, is quite special. It feels like a real privilege to spend a few days once a quarter in these surroundings.

During the World Cup it seemed like everyone jumped on the marketing opportunity bandwagon. I'm not sure whether Krispy Kreme was indulging in this opportunity (the picture was taken during the tournament), or whether this marketing at a service station off the A9 in Scotland was aimed at travelling football fans or teams. Whatever, they clearly know how to sell more than one doughnut at once. These babies weigh in at an average of 363 calories (kcal) each (equivalent to 418 kcal/100g), so the exhortation to 'share' these with your team mates might not be such a bad idea.

This Playground Code is probably familiar to many of you as parents, and perhaps as children. I saw it when attending a ceilidh in a school hall to celebrate a very special birthday. I thought we could substitute 'work' for 'play' and, with a little further adaptation, make the world a better place. Just saying...

I seem to be travelling to London a lot more than I used to. I thought I had it all down to a fine art - leaving home 20 mins before my 07.11 train departs from Morpeth Station. I had not reckoned on some of our local farmers herding their sheep into the yard at this time of the morning. Fortunately, I made the train, which was a couple of minutes late.


------------------
Just to remind you:

Each Thursday of 2014 we’ll try and post around four pictures on the Fuse blog that capture our weeks in public health research, from the awe-inspiring to the everyday and mundane. Given that more of the latter than the former exists in my life, I foresee problems compiling 208 images worth posting on my own. So this is going to have to be a group project. Send me an image (or images) with a sentence or two describing what aspect of your week in public health research they sum up and I’ll post them as soon as I can. You don’t have to send four together – we can mix and match images from different people in the same week.

Normal rules apply: images you made yourself are best; if you use someone else’s image please check you’re allowed to first; if anyone’s identifiable in an image, make sure they’re happy for it to be posted; nothing rude; nothing that breaks research confidentiality etc.

Tuesday, 2 September 2014

What's happened to your local?

Posted by Mark McGivern, Specialty Registrar in Public Health, Balance, Registrar in Public Health, Balance

[Editor's note: this post was first published by Balance. Thanks for letting us repost it here.]

I was recently undertaking some research on behalf of Balance into the volume of alcohol promotions in supermarkets. Whilst doing this that I stumbled upon another interesting area which led me to do some further investigative work into the locations of some of these shops.

The Turnpike in Westerhope, before and after
My original research involved visiting 48 of the 90 convenience stores operated by Tesco and Sainsbury’s across the region. As I was going from store to store I realised that many appeared to be buildings that, in previous lives, were once pubs. It was apparent just by looking at some of these shops that they used to be pubs but others weren’t quite as easy to spot due to extensive renovation work and extensions being added to the original building.

My interest was already piqued and so I decided to take to the computer to do some online investigation. By locating each site on Google maps and looking at historic photographs my suspicions were confirmed at seven of the stores I visited. While that may only be around 15%, I’m certain that number would grow if I were to visit the remainder of the 90 stores in the region.

The seven stores I identified as converted pubs were:

• The Honeysuckle, Coatsworth Road, Gateshead - now a Tesco Express

• The Broadway, North Shields - now a Sainsbury’s Local

• The Turnpike, Westerhope - now a Tesco Express

• The Black Horse Inn, Windy Nook - now a Tesco Express

• The Station Hotel, Seaton Carew - now a Sainsbury’s Local

• The Lodge, Neville’s Cross - now a Sainsbury’s Local

• The Black Swan, Morpeth - now a Sainsbury’s Local

The Black Swan in Morpeth, before and after
It feels strange, as a member of the public health community, to be advocating to save pubs. However, this is a wider problem, with two key issues. Firstly, communities need to feel like they are being listened to when it comes to decisions being made in their villages, towns and cities. Secondly, it’s about the fact that supermarkets make cheap booze more readily available, increasing competition and making it difficult for small community pubs to compete. 

Pubs used to be not just a place for drinking, but for socialising with friends and family. In terms of local history, some of them also used to be impressive local buildings too, which have now been anonymised by the standard, uniformity of the supermarkets branding.

It’s no secret that community pubs up and down the country have suffered in recent times, but this latest trend has resulted in questions being asked of the current law which allows supermarkets to convert pubs without the need to apply for a change of use.

With such loose laws around these types of premises it’s no surprise that former pubs – that were likely once hubs of their communities – are seen as such appealing opportunities for supermarket giants.

CAMRA (Campaign for Real Ale) has spoken out against the loophole and called on government to amend the law so communities can have a greater say in whether local pubs can be converted into these types of convenience stores.

Labour appeared to have listened to these calls and earlier this year shadow small business minister, Toby Perkins, said he wanted to see local authorities and communities involved in the decision making process over planning decisions that centre around pub conversions.

These types of discussions can only be a good thing. It’s important for the issue of local decision making to be addressed at a high level, particularly with party conference season on the horizon and an upcoming general election. However, it’s also important to link it to the wider issues around price and availability of alcohol, particularly the cheap, strong alcohol. Alcohol is 61% more affordable today than it was in 1980 and measures such as minimum unit pricing would not affect sales or prices within local pubs, but would save lives, reduce crime and help cut the £21 billion that alcohol misuse costs the UK each year.

I’m sure there will be many more instances of pubs being converted into convenience stores throughout the region that I haven’t picked up on. If you’re aware of any then next time you’re out and about take a picture of the shop in question and send it to us with details of the location to info@balancenortheast.co.uk or tweet it to @BalanceNE.

Thursday, 31 July 2014

Holidays!

Is it holidays yet? Oh thank goodness.

The blog has spent the last few weeks hanging on to every scrap of work-related motivation it can find for dear life. It seems like everyone apart from the blog is on holiday. Facebook is full of holiday snaps. Twitter is packed with advice from Public Health England on how to cope with hot weather. But the blog has been diligently heading into work every day, ploughing through the to-do list, keeping the in-box under control.

But now it's holiday time!

The blog has a couple of friends who've rented a flat near Chamonix for the summer and the blog's off to join them for a month of rock, glaciers, ropes, crampons, snow in summer, and painstaking deciphering of French weather forecasts.

See you in September.

Photo by Matthieu Lienart