Tuesday, 24 May 2016

Why England could get knocked out in the quarter finals

Posted by Clare Bambra, Fuse Associate Director & Professor of Public Health Geography, Durham University

If Euro 2016 was based on how healthy each nation is, there would be some surprising results. England would get knocked out in the quarter finals of Euro 2016 if the tournament was based on how healthy each nation is. Based on health statistics, Switzerland would walk away as European Champions for the first time in the competition’s history, narrowly beating Iceland on penalties in the final. 

Our analysis of differences in life expectancy for men in the 24 countries taking part in the forthcoming football tournament shows huge health divides across Europe and highlights the links between where you live and how long you live.

The European Health Championship is an accessible way to shed light on these stark differences. It scores each nation’s football team based on the country’s male life expectancy at birth for 2013. From these scores, the winners and losers of each group are decided as well as the results of the games in the knock out stages.

England, with a male life expectancy of 79 years, would be winners of their group by beating Russia (63 years), Slovakia (72 years) and Wales (78 years). England would then beat Czech Republic (75 years) in the round of 16 knockout stage but would lose to Iceland (81 years) in the quarter-finals. Likewise, Wales and Northern Ireland, with a male life expectancy of 78 years each, would be beaten by Austria and France (79 years each) in the round of 16 knockout stages. Switzerland and Iceland both with male life expectancy of 81 years meet in the final, with Switzerland winning on penalties because female life expectancy there is 85 years compared to 84 years in Iceland.

The European Health Championship also reveals a clear east-west gap with worse health in the countries of Eastern Europe compared to those in the West. For example, in the host country France (the runners-up in group A), baby boys are expected to live up to 79 years old whilst in Ukraine, who finish bottom of group C, it is just 66 and in Russia (bottom of group B) it is a mere 63 years. Spain and Italy also fare well with men expected to live up to 80 in those countries.

But what explains these differences in health across European countries? Why do some countries perform so much better in health terms than others? Geographical research suggests that the answer is twofold: the health of places is determined by the population composition (who lives here) and the environmental context (where you live).

Who lives here? The demographic, health behaviours and socio-economic profile of the people within a place influences its health outcomes. Generally speaking, health deteriorates with age, women live longer than men, and health status also varies by ethnicity. Levels of smoking, alcohol, physical activity, diet, and drugs – all influence the health of populations significantly. Indeed, research has strongly linked Russia’s comparatively low life expectancy amongst men with the high levels of alcohol consumption in the country particularly since the collapse of communism. The socio-economic status – or social class in “old money” – of people living in a country also matters as those with higher occupational status (e.g. professionals such as teachers or lawyers) have better health outcomes than non-professional workers (e.g. manual workers). So differences in the characteristics of people in the countries of Europe will contribute to these country level differences in life expectancy.

However, research also shows that where you live matters. The economic environment of a country, such as poverty rates, unemployment rates, or wage levels can influence health. Countries with lower poverty rates, for example Switzerland or Iceland, do better than countries with higher poverty rates such as England. The social environment, including the services provided within a country to support people in their daily lives such as child care or health care and welfare, can also impact on population level health. The physical environment is also important determinant with research suggesting that proximity to waste facilities and brownfield or contaminated land, as well as levels of air pollution can negatively affect health. So countries with worse economic, social or physical environments will have worse health outcomes.

The underlying research to the European Health Championship and these links between health and place are explored further in Professor Bambra’s forthcoming book Health Divides: where you live can kill you. Reducing health inequalities between and within the countries of Europe is also the focus of HiNEWS, an international project led by the Department of Geography at Durham University. It is funded by the New Opportunities for Research Funding Agency Co-operation in Europe (NORFACE) which is a partnership of European research councils including the Economic and Social Research Council (ESRC).

Thursday, 19 May 2016

Dementia: not drowning but waving

Posted by Mark Parkinson, Post Graduate Student at Northumbria University

It's Dementia Awareness Week in England as part of Alzheimer’s Society’s ongoing campaign to raise public awareness of this disease. It also affords us the opportunity to take stock of just how far we have progressed since the dark days of the 1980s. Back then a mood of extreme pessimism surrounded dementia amid stark warnings that this ‘rising tide’ represented an unstoppable tsunami-like force that would engulf the UK. Attempts to avert the coming disaster were seen as futile and hopeless, akin to King Canute holding back the sea. The prevailing mood of despondency was ‘justified’ by nine fallacies of dementia emanating from a general lack of knowledge and understanding about dementia.

The Great Wave off Kanagawa
  • Fallacy No.1: Dementia was commonly perceived to be part of ‘normal ageing’. Dementia is now widely acknowledged as a clinical condition characterised by neurobiological abnormalities that distinguish it from so-called ‘normal’ ageing. The public perception of dementia as a disease that is separate from ‘normal’ ageing is increasing in the UK but campaigns such as Dementia Awareness Week are still necessary.
  • Fallacy No.2: Dementia is unavoidable. Protective factors that help guard against vascular dementia in particular include our lifestyle choices, including smoking cessation, regular exercise, adherence to a healthy diet and avoiding becoming obese. The identification of potential triggers for dementia paves the way for future interventions that might mitigate the onset of dementia entirely, including monitoring for catalysts for dementia such as cardio-vascular disease, obesity, diabetes and depression. Intervention programs targeting at-risk groups have demonstrated success in preventing dementia, e.g. FINGER (a two-year programme that focuses on diet, exercise, cognitive retraining and monitoring and treating vascular risk). Latest research also highlights further candidate triggers for dementia such as interleukin 33 (IL-33) protein deficiency which may be remedied via injections to prevent dementia.
  • Fallacy No.3: Dementia is irreversible. Although this remains the case for now, the development of treatments such as Galantamine have been shown to at least moderate the effects of dementia.
  • Fallacy No.4: Dementia is untreatable. The search for a cure for dementia remains ongoing and we have moved into an era where the potential discovery of better treatments and an eventual cure has never been so high. For now though prevention via identification of key triggers remains the main option in the absence of a cure.
  • Fallacy No.5: Dementia is a diagnosis to mortality within seven years. Dementia related diseases such as Alzheimer’s now have a typical duration of 10 or more years and evidence suggests that, in general, people with dementia are living longer. The challenge continues to be ensuring they live as well as possible.
  • Fallacy No.6: Dementia is too varied and unpredictable to treat. Greater understanding of the different sub-types of dementia, their different causes and symptoms, combined with improved ability to detect them makes treatment for dementia a more viable possibility.
  • Fallacy No.7: Dementia is only detected when it is already too late to act. This remains a key issue; however, improved diagnostic tests and screening have improved early detection of the disease.
  • Fallacy No.8: Dementia is too expensive to treat. Recent interventions such as Cognitive Stimulation Therapy (CST) can be delivered to people living with dementia via just 14 hourly sessions. CST has demonstrated equivalent but more sustained effects compared to relatively expensive drug treatments.
  • Fallacy No.9: The number of those with dementia will increase exponentially in the future. Recent comparisons between CFAS1 (Cognitive Function and Ageing Studies) (1991) and CFAS2 (2015) conducted by Cambridge University reveal that dementia prevalence in the UK has actually declined by 22 per cent over this 24 year period. Those born in the latter part of the 20th century exhibit a lower risk factor for dementia than those born earlier. The tsunami warnings of the 1980s have been proven wrong.
Importantly, all this does not signal a time to relax. The need to raise awareness of dementia and the challenges associated with it remains as urgent as ever. In the 1980s a sense of urgency towards tackling dementia provided a much needed catalyst for change. Today a key difference is that this urgency is no longer fuelled by impotent fear but by renewed hope and optimism that galvanises fresh impetus to all our endeavours to beat the disease.

With acknowledgement to the inspired presentation on 25 April, 2016 at the first Gateshead Dementia Conference by Dr.Daniel Collerton (Clinical Psychologist associated with dementia care at The Queen Elizabeth Hospital, Gateshead).

Thursday, 12 May 2016

The 'Wow' moments

Posted by Rosemary Rushmer, Professor of Knowledge Exchange in Public Health, and Dr Peter van der Graaf, AskFuse Research Manager, Fuse and Teesside University

From the 26-28 April, Fuse hosted the Third International Conference on Knowledge Exchange in Public Health in Newcastle-Gateshead. The conference explored “Evidence to Impact in Public Health" in partnership with Tranzo (Dutch Scientific Center for Care and Welfare) and the World Health Organization (WHO), Regional Office for Europe. More than 160 participants from five continents descended upon the Quayside to discuss the latest research and evidence on knowledge exchange practices through papers, posters, interactive workshops and soapbox sessions – and continued these deliberations during the conference reception and dinner, organised walks and yoga sessions.

How do you sum up a conference like this? We are used to filling in ‘happy sheets’ when we attend conferences, giving our scores on the speakers, the accommodation, and if the food was hot…but what about the ‘Wow!’ moments that participants share with each other in the informal spaces?

Below are a few of those hidden moments:

(Day 1: Keynote speaker Professor Bev Holmes, Vice-President, Research
& Impact at the Michael Smith Foundation for Health Research, Vancouver)

‘Wow, she has a lovely way of asking really difficult questions in such a nice, unthreatening way…’

(Day 2: Keynote speaker Professor Hans Van Oers,
Professor in Public Health, Tranzo, Tilburg University)

‘Wow, how did they manage to carry out that research against all that opposition and yet laugh about it now… you can have a good time, be funny, and serious as well…’

(Day 1: Keynote speaker Professor Kieran Walshe, Professor of
 Health Policy & Management, Manchester Business School)

‘Hmm, we can learn about innovation in public health from the car industry and Amazon…’

‘(Sigh) Is that how much we spend on pharmaceutical research and how little we spend on working together to get evidence used. That needs to change…’
(Day 2: Keynote speaker Claudia Stein, Director of the Division of Information,
 Evidence, Research & Innovation, World Health Organisation (WHO))

‘Wow’ it’s that last presentation of the conference and the room is still full.’
(Day 2: Professor Peter Kelly, Director of Public Health
& Adult Social Services, Stockton Borough Council)

‘Goodness! Your Directors of Public Health (DsPH) have taken time out to chair sessions and present…’ (When I fed this back to one DsPH, to show the planning committee’s appreciation of their participation, he was surprised at the delegates surprise… ‘What on earth happens elsewhere…?’ he said.

Maybe we, in Fuse, do have a ‘special relationship’ with our policy and practice partner that makes Knowledge Exchange in public health easier in the North East of England. We, the organising committee, were wowed by the enthusiasm and engagement of all participants during the conference. Discussions were lively with active and positive contributions from not only researchers but in particular public health practitioners and policy makers. Their engagement in the conference is the real evidence of how far we have come with knowledge exchange in the North East and the impact we are having together on public health and local wellbeing, and this is being noticed internationally.

Here's to the next conference!

Visit the Fuse website to find out more about the conference: www.fuse.ac.uk

Thursday, 5 May 2016

You are now reading the award winning Fuse blog

Posted by Emma Dorée and Mark Welford, Fuse Communications team, Teesside University

You may recall that in January we used this platform to make a shameless plea inviting readers to vote for the Fuse blog in the UK Blog Awards and a month later you may have heard the news that we had been shortlisted in the categories of Education, and Health and Social Care.

Well… (drum roll) …. We only went and won!  That’s right, you are now reading an award winning blog – fancy contributing?!

Last Friday (29 April), we took the Fuse blog monster on a road trip to the big smoke, that there London, where the streets are paved with, well… paving stones to attend the awards ceremony, in eager anticipation.

The awards ceremony was held at the swanky Park Plaza Hotel in Westminster, London and it is safe to say that it more than exceeded our expectations.  The invitation advised that we ‘dress to impress’ but some of the attire on show would have made Lady Gaga and James Bond feel underdressed.

We were welcomed to the event, themed on Roald Dahl’s The BFG with free drinks and canapes (not to mention all the frogsquinkers, buzzwangles, and bugwhiffles we could handle), while we networked with other bloggers and even the Big Friendly Giant himself. The most exciting part however was still to come: the awards ceremony itself.

Tech Reporter Kate Russell (you might know her from BBC show Click) hosted the evening and provided a great commentary, making every blogger there feel very welcome.  Her quirky comments worked to relax the atmosphere and ease frayed nerves.

Each category had two blogs that were highly commended by the judges, followed by an overall winner.  As the Education category came up on screen, we watched in anticipation - the Fuse Blog wasn't announced as Highly Commended - oh well there was still the other category - but then to our surprise as the overall winner of the category!

Having let out a little scream of excitement (and possibly the odd expletive), we went up onto the stage to collect our trophy – a rather lethal looking glass affair - and have our photograph taken with Kate and the judges. It was a surreal moment and very much unexpected with a dash of relief as there were no speeches.

Obligatory award selfie
Once the presentations were over, we were invited to have our photograph taken with the other winners. After which it was time to celebrate properly with more free prosecco (consumed in moderation), posh food and of course a little bit of disco dancing.

This was a great event to be a part of and the venue made it feel even more special and exciting. As the night drew to a close and we collected our certificate and goody bags (with complementary BFG themed dream jars), the fact that we had actually come away as winners had not yet sunk in - it still hasn't now to be honest!

Dream jars - also good for storing ginger biscuits
 This is a fantastic achievement for Fuse, as more than two thousands blogs were submitted. There were more than seventy eight thousand votes in total and it is great to think that the Fuse Blog has such a loyal following and a lot of support.

A special thank you must go to Jean Adams who founded the blog in 2011 and to everyone who has contributed over the years.  The posts have sparked great discussion and helped our readers learn what it is really like to work in public health.  Our many writers make the Fuse blog what it is.

We really hope that you will continue to enjoy reading our posts and don’t forget, if you would like to contribute to the Fuse Blog then please do not hesitate to get in touch.

If you would like to discuss a potential blog post or have something already written then please get in touch with Emma Dorée (E.Doree@tees.ac.uk).

Thursday, 28 April 2016

An overseas institutional visit to Australia: expectations and initial experiences (part 1 of 3)

Guest post by Stephanie Morris, PhD Candidate at Durham University

Yesterday I sat in Perth’s Botanical Gardens in the Kings Park looking out over the city scape. As I sat and enjoyed the shade of a Eucalyptus tree I noticed a trio of children playing with a Frisbee barefoot on the grass in the sunshine. They stepped to throw and leapt to catch the Frisbee all within view of their parents who sat further up the incline. At one point one of the girls threw the Frisbee high in the air; it landed in the branches of another Eucalyptus tree (thankfully). The tallest boy then reached up to rescue it from where it was lodged so they could continue playing their game. At that point I began thinking about how different these children’s lives seemed to be in comparison to some of the boys I worked with in the North East of England during my ethnographic PhD fieldwork on daily physical activity. I remember images of some of the boys kicking a football down a back alley between terraced houses avoiding wheelie bins, broken glass and rubbish at the sides. Sometimes a ball would get kicked into a yard so one of them would climb over the wall or gate to fetch it. There were no bare feet on grass. There were no eucalyptus trees. But there were young people engaging in unstructured physical activity. I start to wonder about differences and similarities in contexts within and between Australia and the UK, and what exciting insights I will gain from others whilst I am here on the other side of the world.

This is my second full-day in Perth at the start of my seven-week Overseas Institutional Visit (OIV) to Australia. As part of this scheme I am writing a three-part Fuse blog to share my experiences, insights learnt and reflections on my visit ‘down under’. The OIV scheme is funded by the North East Doctoral Training Centre (NEDTC) and Economic and Social Research Council (ESRC), giving me the opportunity to visit the University of Western Australia, the University of Wollongong and the University of Queensland. These institutions are home to researchers who are at the forefront of applied and critical research on young people’s physical activity; I am going to be meeting some of the key academics I am citing (often time and time again) in my PhD thesis. Pretty big deal.

So what am I going to be doing during this visit? Firstly, I will be giving presentations about my PhD research to different groups of researchers at the three Universities all with an interest in health and physical activity. From these presentations I hope to gain feedback and discuss key ideas that are forming the discussion chapters of my thesis. Secondly, I am having meetings with various researchers and experts in my field; I hope to learn more about new and innovative current research projects, get new ideas for my own future research and uncover many pearls of wisdom about publishing and how to succeed in academia post-PhD. Thirdly, I’m going to shadow my hosts at certain points, attend events and get involved in any ongoing research projects they are involved with. I want to find out what it is like to work in these institutions, their research groups, and their small and large scale research projects.

I clearly have high hopes about the several weeks to come as well as, I must admit, a few fears. This is my first time in Australia, my first time giving presentations to people who are the experts in my field, and my first experience in any University other than Durham(!). So far my host Hayley at the School of Population Health here in Perth has given me an incredibly warm welcome; my first week has an exciting line up, including attending a launch event where the Department for Sport and Recreation are announcing the future strategic directions in Western Australian Sport and Recreation Industry. Until next time, all the best from ‘Down Under’.

Thursday, 21 April 2016

Successfully reuniting planning and health

Posted by Tim Townshend, Fuse Associate and Acting Head of School, Director of Planning and Urban Design at Newcastle University

On Thursday 7 April I chaired an event that was jointly a Fuse Quarterly Research Meeting (QRM) and the fourth in the ESRC funded seminar series entitled ‘Reuniting Planning and Health’. It was the culmination of quite a few months of preparation and though it’s not the first such event I’ve organised it’s always a bit nerve-racking on the day – will all the speakers arrive? Will the participants enjoy themselves? Will lunch be any good?! As it was I needn’t have worried about a thing.

The day kicked off with a great overarching review of the need for planners and health professionals to work more closely together from Laurence Carmichael, Head of WHO Collaborating Centre for Health Environments – showing that while there is a lot of momentum behind the initiative there is much work still to be done. We then went north of the border with a presentation from Etive Currie, Glasgow City Council, who has been working on healthy planning initiatives for many a year – Etive’s presentation was full of amusing anecdotes about how local communities are not always initially receptive to such ideas! However there were also lots of really good news stories about individual lives that had been turned around. This was followed by Lee Parry-Williams, Public Health Wales, who gave a very informative overview of progress with Health Impact Assessment (HIA) in Wales – and also some insights into how political rivalries can stand in the way of real progress!

After a short coffee break, we had three further keynotes, Prof Ashley Cooper, University of Bristol – gave an excellent presentation setting out the complexity of linking children’s activity patterns to the built environment – it clearly demonstrated that for planning to deliver environments that are more supportive to healthy lifestyles, the research behind interventions needs to be extremely robust. Lesley Palmer – Chief Architect, Stirling University’s Dementia Services Development Centre, gave a really thought provoking presentation on how to design with dementia in mind – highlighting sufferers’ altered sense of reality – while showing elegant design solutions that could be incorporated into any environment that seeks to be age-friendly. The final presentation came from Gary Young, Director at Farrells, exploring the NHS Healthy Towns Initiative – including some of the initial housing at Bicester – a great talk to end with as it brought together so many key strands.

In the afternoon there were four interactive workshops – ‘The Casino’ a theatre based workshop run by local group Cap-a-Pie, explored how a proposed regeneration project for a run down seaside resort might impact a local community by actually asking participants to step into the shoes of the community themselves – an experimental methodology – it seemed extremely well received by those who took part. Jane Riley, Joanna Saunders and Carol Weir a team based at Leeds Beckett University gave a great workshop on the ‘total systems approach’ to obesity prevention – with participants asked to think about how they could make a real difference in their own work – quite a challenge! Douglas White of the Carnegie Trust did an excellent presentation on the Trust’s ‘Place Standard’ tool – which I’m sure participants will be using in future projects. Finally Pete Wright’s team undertook a kind of speed dating event so that participants could become familiar with various aspects of the MyPlace project based at Newcastle University’s OpenLab.

I observed all for at least a short time and was really impressed as to how participants became quickly absorbed – all the workshops were clearly thoughtfully prepared – the feedback overwhelmingly positive – so my huge thanks to all the organisers.

All round it was a fantastic day and all ran very smoothly – thanks very much to Terry, Ann and Peter the Fuse support team for all their help! And to The Core – it’s an excellent venue.

Thursday, 14 April 2016

'Inappropriate' A&E attendance: One out of four ain't bad

Guest post by Dr Simon Howard, Associate Lecturer in Public Health, Northumbria University

Last week on the blog, Emma Dorée wrote about a statement from South Tees NHS Foundation Trust urging people not to attend Accident and Emergency departments for stomach aches caused by excessive consumption of Easter Eggs. Emma explained that one in four A&E attendances is considered inappropriate, and highlighted the NHS Choose Well campaign which helps people to select the right place to take their symptoms.

Photo attribution: www.thepoke.co.uk
This made me wonder… is one in four A&E attendances being ‘inappropriate’ really so bad?

Clearly, the NHS is stretched at the moment, and nowhere more so than A&E, where only 83% of patients are seen and sent on their way within four hours, as compared with a target of 95%. It is natural for us to want to see performance improve, and waiting times are doubtless inflated by ‘inappropriate’ attendees.

Of course, we should wonder what is meant by ‘inappropriate’ in this context. There are many possible classifications. Of course, attending A&E seeking treatment for a sick dog is undoubtedly inappropriate. But is it inappropriate to attend for ‘hangover help’? What if the symptoms of your hangover are difficult to distinguish from the symptoms of meningitis? The final diagnosis and healthcare provider’s perspective is not necessarily the best viewpoint from which to determine ‘appropriateness’.

Even if we assume that one in four attendances truly is inappropriate, it’s reasonable to question whether that is so bad. Considering the problem in terms of sensitivity and specificity, it is vastly preferable that the self-triaging process is sensitive (i.e. all people who really need A&E attend A&E), even if that’s at the expense of a degree of specificity (i.e. some of the people who don’t need A&E still attend A&E). As a doctor, I want everyone who has a life-threatening emergency to attend A&E, not for one or two to go to their local pharmacy, and I’m willing to accept that making that happen might mean that some less urgent cases also slip through the net.

People presenting to services inappropriately is anything but a new problem. Writing in The Lancet in 1849, Joseph Hodgson - the founder of what is now known as the Birmingham Midland Eye Centre - complained of the “growing evil” of “the indiscriminate admission of out-patients to charitable institutions”. His problem was, perhaps, a little different: people referring themselves to charitable hospitals even though “one half of the patients can afford to pay the surgeon his fee”. In order to avoid detection, many of his patients chose to “dress shabbily, and even borrow their servants’ bonnets and shawls”.

To my mind, the root of the modern problem is that we expect people, most of whom rarely use the health service, to self-triage between six (or more) levels of care. This is not sensible. Campaigns admonishing people for making obviously incorrect choices don't help this core problem, and may even counteract campaigns like Be Clear on Cancer, which encourage people to consult health services with symptoms which they may not recognise as ‘red flags’.

One solution to this problem is to introduce professional triage. Back in 1849, Hodgson suggested that “each applicant be compelled to bring a note of recommendations from the clergyman”; perhaps not quite such a useful recommendation for the 21st century. NHS Direct, and its successor NHS 111, were perhaps intended to provide the modern equivalent of the clergyman’s note, but do not enjoy a high degree of public or professional confidence. This is probably because triage over the phone is very difficult, even if it has been shown in research to reduce A&E demand. Perhaps options such as embedding GPs within A&E, as proposed by South Tees CCG, will provide an answer.

For now, here’s the bottom line: even as someone working in the system, I couldn't tell you where I'm supposed to take myself if I develop an unclear symptom. Telling me how inappropriate other people’s attendances are don’t help signpost me to the right place if I have, for example, sudden hearing loss or eye pain. Like very many other people, in situations of uncertainty, I am likely to err on the side of accessing a higher level of care, as I would not want to delay urgent treatment. Though I probably wouldn’t turn up wearing my servant’s bonnet.