Friday, 4 August 2017

Summer is coming

The blog was there at the very beginning, before it became ‘cool’. It’s even read all seven volumes of the book series A Song of Ice and Fire. It’s a self-confessed Game of Thrones geek. But watching the show isn’t enough, so it’s off on an adventure holiday to follow in the footsteps (or flight) of white walkers, wildlings and dragons.

First to Dubrovnik, Croatia and Mdina, Malta to explore King’s Landing, the biggest city in fictional Westeros (with a quick stop off at Lokrum Island - 4kms from Dubrovnik as the dragon flies - to visit the ancient port of Qarth).

Then on to Essaouira, Morocco - Gulf of Grief at Slaver’s Bay (you know, where Daenerys Targaryen - the dragon lady - freed an army of slaves to help her invade Westeros),

Next stop Castle Ward in Northern Ireland - the historic farmyard is the location of Winterfell, the seat of the ruler of the North and the traditional home of House Stark.

Finally arriving in Iceland to see the magnificent Vatnajökull Glacier, the Nordic island nation's largest and most voluminous ice cap to get the full 'North of the Wall' experience.

The blog will return in September.  If you are inspired to write for the Fuse blog in the meantime, please send your posts to m.welford@tees.ac.uk.  More here about who we are and what we're looking for.



Image courtesy of "https://kristina-finds.tumblr.com" via pinterest.co.uk: https://www.pinterest.co.uk/pin/314055773985524526/ 

Friday, 28 July 2017

A week and a day in the life of an embedded researcher

Posted by Mandy Cheetham, Fuse Post doctoral Research Associate and embedded researcher with Gateshead Council Public Health Team

Standing to deliver my presentation at the UKCRC Centres of Excellence conference recently held at the Royal College of Physicians last week, I felt oddly out of place. I was describing my experiences of embedded research in a community centre in an estate characterised by high levels of poverty, health inequalities and persistently high rates of childhood obesity. The contrast between this setting and the auspicious environment of the RCP was marked. The lecture theatre represented an entirely different world.

Presenting at the UKCRC Public Health Research Centres of Excellence Conference

At the pre-conference dinner, I’d had lively discussions with researchers and practitioners from the four corners of the UK about different approaches to, and experiences of knowledge exchange and about advocacy. Presenters earlier in the day were clear that advocacy was not part of their role. And yet, it felt at the heart of my role as an embedded researcher as a way to affect change.

As my presentation began, photos of the community centre, the events and activities I’ve been involved in, beamed on to the enormous screen, and gave a flavour of the different worlds we inhabit as researchers. One of the slides showed a picture of the international athletics stadium near the estate where I’m based. I explained how during the research, local people said they didn’t feel the stadium was for people like them. Some had never been inside, despite growing up on the estate just across the main road.

Back at the community centre on Monday, I talked about the conference. I had invited the stadium manager for community lunch and was full of anticipation about the possibilities of exploring closer links. He arrived, chatted to community members and staff, and stayed 2 hours. He was really receptive and people shared plenty of ideas. It’s the start of a dialogue. Who knows where it will lead.

Working with the community to involve children in cooking and trying healthy options

I love this aspect of my job, the variety, the networking. The rest of my working week involved a focus group with the steering group of the community centre and another with year 4 children from the local school. My role as a researcher is many and varied. The organisation where I’m embedded, and the public health team who commissioned the research, have been extremely receptive and welcoming, open to scrutiny, feedback and learning. Collaboration requires multiple skills, which are not always taught or easily learned, including sensitivity, diplomacy, tenacity and assertiveness, recognising the nuances of the local context and existing relationships in place. Researchers can contribute by offering new perspectives and working alongside existing stakeholders as equal partners.

If we are to make progress in efforts to turn the tide on entrenched health inequalities, I believe we need to work differently as researchers. Embedded research offers opportunities to engage communities who would rarely volunteer to take part in formal university research projects. It involves co-producing public health research with communities and researcher users, sharing knowledge, identifying and generating solutions together, and including children and young peoples’ views as part of that, as experts by experience. As academics, we are not the experts. Children and adults who have participated in the research process are only too aware of what makes us fit and healthy and the constraints on their choices and decisions. The opportunities to act on that knowledge are limited by their environment and sometimes by the assumptions of others. As researchers, I believe we have a responsibility to challenge some of those limiting assumptions and collaborate with others working proactively in community settings to facilitate positive change where we can. By co-producing and combining different types of knowledge we can create meaningful impact, both in communities experiencing health inequalities and in auspicious academic lecture theatres.


Photo courtesy of the National Children's Bureau (NCB) report (p10): 'Working together to reduce childhood obesity' authored by Emily Hamblin, Andrew Fellowes and Keith Clements (May 2017)

Friday, 21 July 2017

Researching holiday hunger

Guest post by the Healthy Living Lab team, Faculty of Health and Life Sciences, Northumbria University

“Summer is here and the living is easy ….” well for most people it might be. However, for many families on low incomes, school holidays are challenging times. Over the past few years, the Healthy Living Lab at Northumbria University has undertaken research into the holiday clubs providing support to these families. We have had the privilege of working with clubs right across the UK from Scotland to the South of England. We have visited clubs based within a range of settings including schools, food banks, church halls and community centres. Research by the Healthy Living Lab is providing a significant insight into the location of holiday clubs, and crucially identifying gaps in provision and the outcomes for families and children attending the clubs.


During the school term, free school meals (FSM) act as a safeguard for children from low income families, but there is no additional state provision for these children during the school holidays. The term ‘holiday hunger’ has been used to describe the hardship that children and families on low incomes face during the summer break; when they do not have access to a free school lunch. Moreover, the increase in financial pressures during the school holidays has a more general impact on the quality of children’s lives, as families lack money for entertainment, socialising and educational or developmental activities (Gill & Sharma, 2004; Graham et al., 2016; Kellogg’s, 2015).

School holiday clubs can help to bridge this gap by providing food, activities and support. Many holiday clubs are staffed by volunteers, who have given up their summer to make sure that something important happens; that children have access to nutritious meals when free school meals aren’t available. There is also a good chance there will be activities happening within holiday clubs, and that the children attending are having a great time.

Research from the Healthy Living Lab team ascertained a need for holiday club provision for families on low incomes (Defeyter, Graham, & Prince, 2015). We have spoken to parents and children at holiday clubs, many of whom live below or just above the poverty line. Our findings highlight that, for many low-income families, the school holidays are difficult, especially the longer summer break. A member of staff at one holiday club breakfast club indicated that it wasn’t just children who benefited from the the holiday breakfast club as well, saying:
“Main thing is for the kids, but I think it’s really benefitted the adults as well, so urm yeah just making sure every-one’s getting food, which is really important ‘cause breakfast, the most important meal of the day (Female staff member; Club 5) (Defeyter, Graham, & Prince, 2015, p.5)
Whilst parents strive to ensure that their children are fed, many find it more difficult to manage during school holidays, as food bills increase and thereby the risk of low-income families experiencing food insecurity also increases. Moreover, we have spoken to staff and volunteers from school holiday clubs, who have told us that their clubs provide food, in addition to social, learning and support opportunities (Graham et al., 2016). Our research shows that holiday clubs not only provide financial support to low income families, through the provision of a free meal, but also provide a social outlet for parents and their children, as well as wider benefits for the community (Defeyter, Graham, & Prince, 2015).

Researching this area is challenging as it involves talking to families about sensitive issues such as their food and financial situation. But, this work is also invaluable as it draws directly on the experiences of parents, children, and holiday club staff ensuring their voices are heard.


The Healthy Living Lab Team is:
  • Professor Greta Defeyter, Faculty Associate Pro Vice-Chancellor (Strategic Planning & Engagement), Faculty of Health and Life Sciences, and Director of Healthy Living
  • Dr Pamela Graham - Vice Chancellor's Research Fellow
  • Dr Louise Harvey-Golding - Senior Research Assistant
  • Emily Mann - PhD Researcher
  • Jackie Shinwell - PhD Researcher


References:
  1. Gill, O., & Sharma, N. (2004). Food Poverty in the School Holidays. London.
  2. Graham, P. L., Crilley, E., Stretesky, P. B., Long, M. A., Palmer, K. J., Steinbock, E., & Defeyter, M. A. (2016). School Holiday Food Provision in the UK: A Qualitative Investigation of Needs, Benefits, and Potential for Development. Frontiers in Public Health, 4(April 2014), 1–8. http://doi.org/10.3389/fpubh.2016.00172
  3. Kellogg’s. (2015). Isolation and Hunger : the reality of the school holidays for struggling families. Manchester. Retrieved from http://pressoffice.kelloggs.co.uk/Going-hungry-so-their-children-can-eat-Third-of-parents-on-lower-incomes-have-skipped-meals-during-school-holidays
  4. Defeyter, M. A., Graham, P. L., & Prince, K. (2015). A Qualitative Evaluation of Holiday Breakfast Clubs in the UK: Views of Adult Attendees, Children, and Staff. Frontiers in Public Health, 3(August). http://doi.org/10.3389/fpubh.2015.00199

Photo courtesy of Children in Scotland: http://www.childreninscotland.org.uk

Tuesday, 4 July 2017

What does a hung parliament hold for the future of Public Health?

Posted by Fuse Senior Investigator David J Hunter, Professor of Health Policy and Management & Director, Centre for Public Policy and Health, Durham University

The June general election threw a lot of things up in the air but resolved little. We are living in a suspended state awaiting resolution of what is clearly an unstable political landscape and a government hobbled by its own tensions and contradictions. Uppermost among these is of course Brexit. This will continue to consume all of government as it has already done for much of the past year. No part of government will be left untouched by it. The upshot is that other domestic policy areas are likely to receive minimal attention. This includes public health which rarely features high on the policy agenda.


Earlier in June, the Faculty of Public Health President, John Middleton, in a British Medical Journal editorial urged the next UK government ‘to make health central to all its policies’ (BMJ 2017, 2 June doi:10.1136/bmj.j2676). He concluded that just as local government had adopted a health in all policies approach, ‘national government must now become a public health government’. There seems little chance of that happening in the current febrile political climate.

Of course one can argue the merits of putting health into all policies as distinct from putting all policies into health which might hold more appeal for those who are suspicious of, or are opposed to, health imperialism. But the central point is valid. Most, if not all, of what government does impacts on the public’s health. Indeed, much of the support for political parties calling for an end to austerity was driven by a perception that the unrelenting assault on the public realm since 2010 was having unacceptably negative consequences for people’s health and wellbeing. It’s a small consolation that what has happened in regard to widening inequalities was predicted by the public health community.

So if we cannot look to national government for public health leadership in the foreseeable future, and that seems a forlorn hope given that the former public health minister lost her seat in the election and her successor is unlikely to make an impact anytime soon, what does the immediate future hold for public health? And where is the action likely to occur?

Having a disabled or incapacitated national government may not be entirely a bad thing if it allows local government and other agencies to go about their business without being subjected to a constant outpouring of policy initiatives and ministerial announcements and directives which invariably offer only distraction.

This suggests a need for the public health community to engage more vigorously than it has done hitherto in driving the 44 Sustainability and Transformation Plans (STPs) in England. Though flawed, deeply so in some cases, and poorly communicated with minimal public engagement, STPs and related developments like Accountable Care Systems (ACSs) offer an opportunity (perhaps the only one for the time being) to put public health centre stage in developing place-based approaches to improving population health.

STPs are underpinned by the Triple Aim (Berwick et al 2008Health Affairs 27(3): 759-69) which comprises: improving population health, focusing on patient-centred care, and achieving more efficient per capita spending. STPs and many of the other health system transformation activities underway, and being actively promoted by NHS England with back-up as appropriate from Public Health England, are aimed at managing demand on health care services.

This is not a new agenda – the Wanless reports from 2002 and 2004 commissioned by the last Labour government eloquently argued the case for making the NHS a health rather than a sickness service – but the drive for a systemic transformation has perhaps never been so evident.

The opportunity to bring about a much needed shift in health policy should not be lost and public health should be at the centre of STPs. They offer the best prospect of taking on the big beasts of the acute hospital jungle and wresting resources from them to put into public health. Yet, as research being carried out by colleagues in the Centre for Public Policy and Health (CPPH) at Durham examining the public health changes introduced in 2013 demonstrates, with few exceptions Directors of Public Health in Local Government and their teams and Health and Wellbeing Boards are failing to provide the system leadership that is urgently needed1,2.

Since New Labour introduced foundation trust status for hospitals, compounded by the Coalition government’s misconceived and unnecessary Health and Social Care Act 2012, the NHS has been bedevilled by fragmentation and an ethos of competition in place of collaboration. STPs and associated reforms including ACSs are an attempt to mitigate the worst features of the various reforms since the turn of the century.

It is vital that STPs succeed and bring about the whole system, place-based approach to health and wellbeing that they promise. But we are some way from reaching that goal and the risks are considerable especially when budget cuts affecting public health make it less likely that the necessary changes can be realised.

However, we must not make too much of the budget cuts invoking them to argue that it demonstrates how misconceived it was to relocate public health to local government. Had public health remained under the NHS, it is almost certain that it would be in an even poorer state than is the case at present. Those who remember the days of PCTs will recall the frequency of raids on public health budgets to offset overspends and prop up hospitals. At least public health under local government control remains visible and there is evidence despite the impact of austerity of authorities making serious efforts to become public health organisations and take health improvement and wellbeing seriously.


References:
  1. Commissioning Public Health Services - Centre for Public Policy and Health (CPPH), Durham University: https://www.dur.ac.uk/public.health/projects/current/cphs/
  2. Evaluating the Leadership Role of Health and Wellbeing - Centre for Public Policy and Health (CPPH), Durham University: https://www.dur.ac.uk/public.health/projects/current/prphwbs/

Photo attribution: "Exactly." by Sam Rodgers © 2017: https://www.flickr.com/photos/samrodgers/34779376735

Friday, 23 June 2017

Automatic academic: working myself out of a job

Guest post by Emma Foster, Lecturer in Public Health Nutrition, Human Nutrition Research Centre, Newcastle University

Since I started working in dietary research I’ve been fascinated by how and why people misreport their dietary intake. Lots of excellent research (by others) has gone into understanding how the hassle of recording food intake, problems with memory and attention (if you are busy doing something else at the same time you may not be paying attention to what you are eating) along with social-desirability bias (am I really going to admit to the nutritionist interviewing me how many doughnuts I ate yesterday!) together tend to result in an under-estimate of energy intake and an over-estimate of those foods seen to be “healthy”.

Much of my research has focused on how we can make it less of a burden and perhaps even an enjoyable experience for volunteers taking part in nutrition research studies. I developed food photographs for portion size estimation with children, so participants don’t need to weigh everything their child eats….and more importantly doesn’t eat but ends up wearing!

Food photographs estimate portion size with children, so participants don’t need to weigh everything their child eats (or ends up wearing!)


More recently I’ve been developing an online 24-hr recall system, which sometimes feels like I’m making myself and other nutrition researchers surplus to requirements! In the “olden days”, when I first joined the Human Nutrition Research Centre at Newcastle University, all dietary data was collected by a researcher who went out to people’s homes to interview them about their dietary intake (something I really quite miss). This was followed by day after day sitting at a computer linking the foods and drinks reported to food composition data and weights (which I don’t miss quite as much!). Now with the online recall we are able to collect the data remotely. We send people a URL and login details and the computer system does the rest. It takes them through the previous day, asking for details on foods consumed, getting people to estimate portion size using photographs and checking for forgotten items like butter on toast or sugar in tea. The system automatically does the linking to the food composition data and the weights consumed and the researcher can download the data as soon as the volunteer has submitted their recall.

More beans please. A screenshot from INTAKE24


But surely it doesn’t do as good a job as a highly skilled nutrition researcher such as myself….right? Well it’s not actually that far off! When compared with a traditional face-to-face interview with 180 people the system was found to underestimate energy intake by just 1% on average and average intakes of protein, carbohydrate, fat, vitamins and minerals were all within 4% of the interviewer-led recall. Perhaps most amazingly people reported enjoying completing the system!

So if you would like to measure food intake as part of your research but can’t afford to employ a nutritionist/dietitian as part of your research team (we’re not cheap) then have a look at our demo on https://intake24.co.uk/demo and drop us an email at support@intake24.co.uk and we can set you up a survey straight away – and it really is free.

Friday, 16 June 2017

400 not out

Posted by Mark Welford, Fuse Communications Officer, Teesside University

This is the 400th post on the Fuse blog and in the spirit of using arbitrary milestones as worthy of note, I thought it was time for some (blog) post-match analysis.

Brian Lara who holds the record for the highest individual score in a Test innings
 after scoring 400 not out against England playing for the West Indies in 2004.

Over the last five-and-half-years, we have had 399 posts, written by 116 authors, and more than 395,000 page views. There has also been a lot of #fuseblog twittering, coffee room chats, and (you surely didn’t think it could be any other way?) blog-related committee discussions.

We even won a UK blog award last year (not that we mention it much!) and were shortlisted in two award categories earlier this year. But shortlisted isn’t winning and on the train back from those awards in April, I contemplated what we could do to improve the blog or - dare I say it - if the blog had run its course, done its job, had its time.

In academia, more than any sector that I’ve worked in (and I’ve worked in a few) you are encouraged to STOP, put down your machete, and climb above the canopy to see if the direction that you’re heading in is getting you to where you want to go. Academics will quite happily interrupt you in mid-flow to ask: ‘so what?’, ‘what impact are we making?’, ‘who are we reaching?’.

Since taking the wheel from blog founder Jean Adams I have enjoyed myself. I have learnt a bit about community and herding cats, I have made some real-life and virtual friends. I have written the odd post, although admittedly not as many as Jean, and I have enjoyed the discipline of having to write 500 -700 words for public consumption (usually when I can’t find anyone else to post).

I think the other writers have enjoyed it too, once they’d got past their initial reservations.

From all of this, I surmise that people value both reading and contributing to the blog. But I don’t have a clear view of who you are. You also seem to be discussing it in some forums. But you aren’t leaving comments on the blog itself. We have had a grand total of 480 comments posted, of which 234 were spam. So that’s 246 sensible comments. From 395,000 views.

So, I would now like to invite you to use the comment box below to post your thoughts on the blog so far. What sort of things do you like? What stuff would you rather we skipped? What would you like more of? Who are you? You don’t need to tell everyone your name, but what got you here? Why are you interested in this blog? What would make you more interested?

It isn’t that tricky:
  1. Depending on how you got to this page, you either start typing straight in the white box, or you need to click the orange link “No comments” at the bottom of the post to get the white box to appear.
  2. After writing your thoughts, click on the “Comment as” pull-down. If you know what any of the branded options mean, select one. If not, just chose “Name/URL” or “Anonymous”. Then do the ‘prove you’re not a robot’ thing and you’re done.
I’ll get an email. If you’re not flogging Viagra or using a barrage of abuse, I’ll approve your comment and you’ll be published.

And, just before you get to work: thanks. Thanks to the writers, the readers, the reviewers, the commenters, the retweeters, and the lurkers. See you all again at the next arbitrary milestone.

Friday, 2 June 2017

Can we achieve a healthy sustainable diet by 2030?

Guest post by Christian Reynolds, Knowledge Exchange Research Fellow (N8 AgriFood project), Department of Geography, Faculty of Social Sciences, The University of Sheffield.

I recently attended the REFRESH Food Waste 2017 conference in Berlin. In the keynote speech of the conference, Vytenis Andriukaitis, (Lithuania's European Commissioner and designate responsible for Health and Food Safety) closed with the remark that Europe’s target is to halve food waste by 2030, and asked the audience if the goal of halving food waste is feasible or a fairy tale promise? 2030 is only 13 years away after all!


Likewise, the sustainable development goals are aimed for 2030, these include: ending poverty, ending hunger, increasing good health and well-being, climate action, and ensuring sustainable consumption and production patterns – the latter encompassing the aim to halve food waste.

Many of these goals require large changes to production methods and systems, modes of consumption, and general societal shifts on a global scale. This got me thinking about the challenge of shifting populations towards healthy, sustainable diets; is 2030 an achievable and realistic time frame?

Over the last couple of years there have been a few studies discussing how the UK, and global diets need to shift to meet healthy sustainable diets, (I will admit that I also have two in peer review at the moment). Some of my favourite studies currently published are Macdiarmid et al (2012), Green et al (2015), and van Dooren et al (2015). I also recommend reading Dantzig (1990) to get a glimpse of how this field of enquiry began.

These studies use mathematical modelling methods such as linear programming to calculate diets that:
  1. are optimised to be sustainable (for most studies this means low in associated greenhouse gas emissions (GHGE));
  2. meet the current healthy eating guidelines; and
  3. are not ‘unacceptable’ to the population.
This final item is a crucial, as if you do not constrain for palatability, the linear programme will calculate diets that are healthy, but only feature the foods with lowest environmental impacts. For example, Macdiarmid et al (2012) found a diet of 7 foods: whole-grain breakfast cereal, pasta, peas, fried onions, brassicas, sesame seeds, and confectionery to be sustainable and healthy. Stigler (1945) on the other hand proposed the following 7 foods: wheat flour, evaporated milk, cabbage, spinach, dried navy beans, pancake flour, and pork liver. Both of these are very ‘worthy’ but not varied enough diets to pass muster with the general population.

With this acceptability constraint in play, diets that are healthy and have lower GHGE are achievable with as little as 20-40% dietary shift resulting in up to 30% reduction in GHGEs (see Figure 3 from Green et al (2015). The majority of the studies include a reduction in animal products. For instance Macdiarmid et al (2012)’s sustainable diet featured 60% of the current intake of all meat for women in the United Kingdom and 48% of the intake of red meat (see Figure 1 from Macdiarmid et al 2012).

Figure 3. Deviations of optimised diets from current average diet, with associated reduction in greenhouse gas emissions from Green et al 2015
Figure 1. Proportions (by weight) of food groups in the final sustainable diet compared with the average current intake
of women in the United Kingdom (National Diet and Nutrition Survey 2008–2010). from Macdiarmid et al 2012





So are these changes in food consumption and purchase reasonable in a 13-year time period? Can we shift towards a healthy sustainable diet in 13 years?

For a quick check I looked up the rate of dietary change in the historic reports of the Family Food Survey. Looking over 13 year periods from 1945 to 2000, I found differing rates of changes in consumption and purchase for each food item (check out these amazing visualisations of Britain’s diet from 1945-2000, or look at the table I provide below).

Within all the 13 year periods between 1945 to 2000, all food groups have at maximum shifted by over 20%. This is good news, and indicates that change is possible for all food items in the British diet. However, what is less heartening is that total consumption and purchase of meat and meat products has only shifted by a maximum of 40%, while beef and veal consumption has only changed by a maximum of 47%. These rates of change need to be this high - if not higher - if we are to successfully shift toward a healthy sustainable diet.

So are healthy sustainable diets achievable or just a goal? Only time will tell. However, for now, here are some things that we can do to help the shift towards healthy sustainable diets:
  1. Focus on the foods that need to shift for both health and sustainability. Studies are finding that we need to increase fruit and vegetable consumption, increase oily fish consumption and reduce red meat and processed meat consumption. These are the main goals that we can work towards across the population.
  2. Pick our battles: focus on the foods that people have an appetite to change. From the table below we can see there are some foods that are easier to shift than others, for example starchy foods (a core of many British diets) have had much smaller rates of change than fruits and vegetables. Our relationship is already used to changing fruit and vegetable consumption, let’s focus there instead. 
  3. Technology and dietary change is our friend, let’s harness it. As society and technology develops, food consumption changes. Look at the changes in consumption of canned vegetables as better quality fresh vegetables were introduced. Likewise, the reduction in flour consumption as ready-made bread and other starches (rice, pasta, etc.) began to appear in the shops. How can we work with modern technology, such as improved food storage and processing technology, faster food transfer, and the advent of online shopping? Can we make online meal deliveries and food box deliveries lead to healthier and more sustainable diets?
Table: Britain’s diet from 1945-2000

Maximum 13 year change in food consumption/purchase 1945-2000Minimum 13 year change in food consumption/purchase 1945-2000
Liquid wholemilk 65.3%4.4%
Skimmed milk 99.0%0.0%
Yoghurt and fromage frais73.0%0.0%
Total milk and cream 27.8%4.5%
Natural cheese 23.0%0.0%
Processed cheese44.3%0.0%
Total cheese 44.1%8.5%
Eggs 67.1%7.5%
Oranges and other citrus fruit 74.0%16.1%
Apples and pears26.9%10.3%
Bananas64.6%9.1%
Total fresh fruit 61.0%13.0%
Fruit juice 88.4%25.0%
Total other 50.4%9.6%
Total Fruit 68.3%11.4%
Potatoes38.8%13.2%
Fresh green vegetables36.8%15.2%
Other fresh vegetables24.5%7.8%
Canned vegetables92.0%11.5%
Frozen vegetables77.3%0.0%
Other vegetables and products 42.9%10.5%
Total vegetables and products22.2%6.9%
Bread33.9%9.4%
Flour63.3%18.7%
Cakes and pastries60.2%12.7%
Biscuits66.0%4.9%
Break-fast cereal55.8%11.4%
Total cereals (excluding bread) 19.9%5.0%
Bread & cereal products 23.1%6.4%
Sugar54.0%8.6%
Preserves 51.9%21.3%
Tea37.9%9.4%
Coffee52.3%15.0%
Total beverages 28.2%6.0%
Fresh white fish49.0%17.2%
Fresh fat fish65.3%32.3%
Shellfish71.7%38.5%
Cooked fish61.9%29.0%
Total fish and fish products 46.2%6.1%
Butter67.5%10.8%
Margarine82.8%24.0%
Lard82.1%9.6%
All other fats 74.0%23.4%
Vegetable and oils64.1%0.0%
Low fat spreads53.8%0.0%
Reduced fat spreads80.0%0.0%
Total fats 37.4%5.0%
Beef and veal47.4%19.5%
Mutton and lamb55.4%17.6%
Pork95.8%27.7%
Bacon and ham68.3%7.5%
Pork, bacon and ham75.9%11.1%
Poultry90.0%15.6%
Sausages38.0%8.6%
Total meat and meat products39.8%8.6%

Christian Reynolds
Email: C.Reynolds@sheffield.ac.uk
Twitter: @sartorialfoodie


Photo attribution: "2006_04_10 Food waste. Peering into a dumpster at the GI Market." by Taz © 2006: https://secure.flickr.com/photos/sporkist/126526910

Friday, 26 May 2017

Postcards from a public health tourist #1: Montréal, Québec, Canada

Posted by Clare Bambra, Fuse Associate Director and Professor of Public Health, Newcastle University

A few of our academics are lucky enough to have the opportunity to travel around the world to speak at conferences or explore collaborations - all in the line of work and the translation, exchange and expansion of knowledge of course.

The least we could expect is a postcard, to hear all about the fun that they're having while we’re stuck in the office watching droplets of rain compete to reach the windowsill…

So here’s the first from Professor Bambra.



Dear Fuse Open Science Blog,

I spent late April and May 2017 as a visiting Professor at the Institute of Research in Public Health, part of the University of Montréal. I was the guest of Professor Louise Potvin who is a leading international researcher in health promotion and the editor-in-chief of the Canadian Journal of Public Health. She was an amazing and generous host.

Me (bottom right) with Louise Potvin (centre) - an amazing and generous host
I had a really enjoyable and fruitful time both intellectually and socially at the Institute. It is an exciting place to be as a health equity researcher. They are leading the field in health equity research in Canada and alongside the other Montréal universities and the municipal public health agency, they have set up the joint Lea Roback Centre which examines health equity. There I was honoured to deliver the annual Paul Bernard lecture on social determinants of health – you can watch a video of the talk here.

I was also an invited speaker at the World Health Summit speaking alongside Ilona Kickbush (World Health Organization Europe) and Connie Clements (Canadian National Collaborating Centre on the Determinants of Health - NCCDH) about the legacies of the Ottawa charter. The NCCDH is tasked with integrating health equity and the social determinants of health into Canadian public health practice. Jane Philpott, the Minister of Health for the Federal Canadian government also gave an inspiring speech at the summit about the importance of the social determinants of health and her journey from being a family doctor to a leading politician.

Montréal experienced unprecedented rain and flooding while I was there
Montréal is an amazing place to visit, an extremely vibrant multicultural bilingual city with great restaurants and a very welcoming feel to it. It was very exciting to be there in 2017 as Canada celebrates 150 years and Montréal celebrates its 375th year. However, weather wise Montréal experienced unprecedented rain and flooding while I was there with many homes and businesses evacuated and the army required to provide emergency support.












Montréal is also an interesting place from a public health perspective, it’s a city with a lot of green spaces and a variety of parks and recreation areas. It’s a very safe place to be, and very walkable - unlike other areas of North America. Public transport costs are low with a flat rate on the Metro and the buses of around $3. They also have a shared bicycle scheme called Bixi - which is free for a cycle ride of up to 30 minutes.

However, Montréal and Canada are of course not without their own public health problems. There was very visible homelessness. The Montréal health gap is 11 years between the most and least affluent neighbourhoods and most significantly, the Inuit and indigenous populations have average life expectancies of only 70 years - 10 years less than the average Canadian. Inuit health is understandably a key focus for health equity researchers in Montréal - including former Fuse associate Mylene Riva. She is now researching the effects of housing conditions and food security on the health of Inuit people in Arctic Quebec.

So a very useful visit for me and I was able to make good future connections for the Fuse Health Inequalities research theme.


Photo attribution:

Friday, 19 May 2017

Beyond ownership: a lifetime of housing and health

Posted by Natalie Forster (Fuse Senior Research Assistant) and Philip Hodgson (Senior Research Assistant), Northumbria University

Last month saw the second ‘Home and Health’ research interest group meeting hosted by Northumbria University and Fuse (supported through the Fuse pump-priming fund). Building on the key message that a greater emphasis is needed on understanding the relationship between housing and health – particularly in the absence of strong public health messages on the subject (such as 5-a-day) – the focus here was on good examples of practice.

It's a race to own a “forever home” but circumstances change with age
Participating in these sessions is continually challenging us to rethink the values that we attach to the idea of ‘home’ in society, and the implications this has for supporting people through housing choices and transitions. The narrative surrounding housing is often singular and fixed – the race to find and own a “forever home”, relocate to a bungalow in retirement and then manage the difficulties of ageing-in-place as ill health and social isolation increase in later life. Yet the reality painted by the examples here posed a more complex problem: how do we identify and sustain a model of housing that allows our homes to reflect and adapt to the wide range of transitions experienced by individuals? The services presented - Safe and Healthy Homes (North Tyneside Council); Housing for older people (Derwentside Homes); Wellbeing and mental health service for adults (Crisis); and Wellbeing for Life Newcastle’s Age-friendly Cities - all reflected the huge range of resources and circumstances people bring to their homes, and the need to be flexible in supporting them. Yet questions remain around how public health approaches can best prepare people to make decisions about the housing which will best support their health in later life, before a crisis occurs. One idea from the meeting was to assess future housing needs alongside the NHS health check.

The second ‘Home and Health’ research interest group meeting
Just as the much-publicised difficulties for younger people to get on the “property ladder” are prompting a shift to much less-settled housing patterns in that age group, the transitions faced in ageing are varied enough to suggest the need for more person-centred thinking. Just as retirement and later life can threaten some with social isolation and ill health, for others it can be a period of vibrant reconnection with their communities. Once again, a lifecourse approach which encourages people to engage with these transitions before they occur (e.g. groups organised by employers to maintain social contact after retirement) may help give them the agency to maintain a healthy home environment throughout their lives. Innovations are emerging which propose alternatives to traditional living arrangements (for example, housing schemes where university students live alongside older people for free, in exchange for undertaking voluntary work). The first Home and Health session illustrated how the lack of equity held by future generations can be problematic, as this cannot then be leveraged to pay for care later on. However, discussion in the second meeting prompted thought about whether present forms of home ownership (and even home design) might be too inflexible, and whether other more innovative practices could allow people a more fluid approach to tenancy.

In focusing on preparing people to make informed housing decisions, it is important not to emphasise individual responsibility at the expense of addressing structural inequalities in the choices people have available to them. Those living in poverty are likely to experience an impoverished range of choices. People are often segregated in housing according to their age and socio-economic status and some groups, such as people experiencing homelessness may ‘settle’ for housing that is inadequate for their needs, as they feel they have no alternative. This led to a ‘lightbulb moment’ for further research from group members – the need to map out the different routes people take through housing options over the course of their lives, and the menu of choices available to them depending on their circumstances at different points in time. Perhaps this will allow services to enable people to have a different form of ownership in housing – the ownership of the housing journey through the transition of our lives, rather than simply owning a building.


Photo attribution: "Home, health and happiness / Bile Bean Manufacturing Co". See page for author [CC BY 4.0], via Wikimedia Commons

Friday, 12 May 2017

Alcohol use in retirement: A silent epidemic?

Posted by Roxanne Armstrong-Moore, Fuse PhD student, University of Sunderland

I was on a course recently and someone mentioned that her parents, since retiring were all about the “three Gs – Gardening, Grandchildren and the Grape”. Laughter ensued from other colleagues, then a sadness dawned on me – she explained that the drinking had gone beyond a social drink with friends and was ingrained in their lives, the glass of wine was getting earlier and earlier and functioning was getting less. It made me think, why is this acceptable once someone has left work? Of course, individuals have worked hard all their lives and they deserve some respite – but should this come at a cost of lessened functioning, higher chance of diseases, premature death and breakdowns in the relationships that have been nurtured over a lifetime?

My PhD aims to develop a strategy for those in, or about to enter retirement, to avoid what seems to be a downward spiral into ill health.

In what is a relatively scarce area of literature, myself and my supervisory team have begun this task by conducting a systematic review of current literature. This is to investigate what we currently know about current interventions and how they can help older individuals to reduce negative effects of alcohol. Six papers were included, all of which were in the United States. Individuals in this age group appear to respond well to interventions, with all interventions showing improvements (a reduction in drinking or, in one case study, improvements in quality of life) in at least one area of alcohol consumption or frequency of consumption. These findings were presented at the European Health Psychology Conference in Aberdeen (2016).

This scarce amount of literature available on interventions shows that older people are currently being neglected in our field. Healthcare professionals may feel it is not their duty to step in and “ruin the fun” but - with predictions that by 2050, 22% of the world population will be aged 60 and over, and that a significant amount of these older individuals will have a “pattern or level of drinking which places them at harm” (Wadd & Galvani, 2014, p. 656)1 - something needs to be done.

But what can be done? Don’t they deserve to have a drink? Are we spoiling their fun? Would they even want an intervention and how would this work? This is where the hard work begins…

Older people are more susceptible to the detrimental effects of alcohol, as tolerance to alcohol lowers with age. Drinking more than five standard drinks per week has been found to quadruple the risk of developing psychiatric problems including depression and memory loss (Stevenson, 2005)2. Cognitive impairment as a result of alcohol use can lead to an increased likelihood of falls, and because older people often have weaker bones, this can lead to hip fractures - one of the highest causes of death in the older population (Mukamal et al., 2004; Merrick et al., 2008)3.4.

While much research has focused on students and younger adults, little has explored the drinking of older individuals. The evidence in this field is growing, however it is still not adequate to inform an intervention in the area.

So, why retirement? Evidence suggests that those who have recently entered retirement are statistically and significantly more likely to drink almost every day compared to those who are still in work, or those who have been retired for a longer time. At the moment, there is limited support and guidance offered by employers, government and the third sector to those who are retiring in the future. The “Easing the Transition” report from the Drink Wise - Age Well project (Holley-Moore & Beach, 2016)5 suggests that for some individuals, this can be a negative time marred with a loss of purpose, periods of ill health or financial difficulties.

So this is where my PhD comes in, at the moment very little qualitative data exists in this area. We are hoping to interview individuals – not only those who have retired recently and those who are due to retire, but also their employers. This data will then be analysed to establish core themes using a framework approach and fitted to an intervention map to really find a tool that could be used to help people going through this (at times) difficult transition.

From data collection, we will use the findings to begin to develop an intervention that can be implemented in the workplace, or after leaving work. This will be the first protocol of its type that uses the information gathered from those who are going through this transition and will hopefully ease the transition between working and retirement and reduce the growing burden on public health.


References:
  1. Wadd, S., & Galvani, S. (2014). Working with Older People with Alcohol Problems: Insight from Specialist Substance Misuse Professionals and their Service Users. Social Work Education, 33(5), 656–669. http://doi.org/10.1080/02615479.2014.919076
  2. Stevenson, J. S. (2005). Alcohol use, misuse, abuse, and dependence in later adulthood. Annual Review of Nursing Research, 23, 245–80. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16350768
  3. Mukamal, K. J., Cushman, M., Mittleman, M. A., Tracy, R. P., & Siscovick, D. S. (2004). Alcohol consumption and inflammatory markers in older adults: the Cardiovascular Health Study. Atherosclerosis, 173(1), 79–87. http://doi.org/10.1016/j.atherosclerosis.2003.10.011
  4. Merrick, E. L., Horgan, C. M., Hodgkin, D., Garnick, D. W., Houghton, S. F., Panas, L., … Blow, F. C. (2008). Unhealthy Drinking Patterns in Older Adults: Prevalence and Associated Characteristics. Journal of the American Geriatrics Society, 56(2), 214–223. http://doi.org/10.1111/j.1532-5415.2007.01539.x
  5. Holley-Moore, G., & Beach, B. (n.d.). Drink Wise, Age Well: Alcohol Use and the Over 50s in the UK. Retrieved from www.drinkwiseagewell.org.uk

Photo attribution:

Friday, 5 May 2017

Star Trekkin' across the (research and quality improvement) universe


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

Does improving the quality of care from health organisations need research? This was the question asked at the Annual Network Event of the Clinical Research Network for the North East and Cumbria. The network has been successful over the last four years in bringing together a wide range of clinical staff across the region and promoting and supporting high quality health research, which was celebrated at the event, but the organisers didn’t shy away from asking some tough questions.

Q (John de Lancie) pictured behind Captain Jean-Luc Picard (Patrick Stewart)
While the network has put a strong focus on numbers, particularly related to regional recruitment targets for patients in trials, its clinical Director, Professor Stephen Robson, acknowledged that this was only part of the story and that it also ignored what happened later in the research process. For instance, how do we ensure that the research findings get adopted by practice organisations? Brilliant studies are useless if they don’t result in changing clinical practice. But how to change this practice?

The event therefore put a renewed focus on quality improvement. How can we help health professionals to improve their practice? One of the network’s partners, the Academic Health Science Network for the North East and Cumbria (AHSN NENC), joined forces last year with NHS Improvement and the Health Foundation to play a leading role in the national roll out of the Q community.

Unfortunately for us ‘Trekkies’, this is not a new Star Trek episode about the famous Q tormenting various Starfleet Captains; instead, the Q community is a force for good that connects health professionals across the UK to improve health and care quality. The community supports members in their existing improvement work and tries to enhance their skills, helps members to share ideas and enable them to make changes in their organisations that benefit patients.

For this episode, Q came out of the 2013 Berwick report, which followed the publication of the Francis Report into the breakdown of care at the infamous Mid Staffordshire Hospital. The report urged health organisations to make better use of members of staff with improvement expertise and made a case for a system devoted to continual learning and improvement. In response, NHS Improvement (with support from the Health Foundation) developed the Q community in 2015, which now has 236 members in the North East (5000+ nationally) and is expected to grow considerably over the next few years.

I unashamedly applied to become a member of this network last year and they were crazy enough to accept me, so I was looking forward to the Q workshop at the annual event, led by Suzy Cook. The workshop looked at the link between research and quality improvement but, to my surprise, focused on the differences and argued that they should be viewed as separate activities with distinct aims, following different processes and timescales. Research was described as a linear and long-term process that is mostly concerned with the effectiveness of existing and new services, while quality improvement was pictured as a more cyclic and shorter term process with linked PDSA cycles (Plan-Do-Study-Act) that focus on the sustainability of services.

This distinction does not do justice to both activities and feels like a rather odd separation: why can’t research inform what practice needs to improve and how? And what about evaluating quality improvement; isn’t research a key component of the PDSA cycle? Luckily, participants in the workshop raised the same objections and an alternative view was provided in the next workshop by Seamus O’Neill, Chief Executive of AHSN NENC.

He argued instead that there was a clear link between research and quality improvement by looking at the adoption of research in the NHS. Quality improvement needs evidence to select the right intervention in the right context. Just sinking money into an innovation because we think it is going to make a difference will not impress funding and commissioning bodies. At the same time, he warned that many quality improving and cost-saving interventions are not used by health care organisations. They are either not aware of them (clinicians do not read journal articles) or they do not know how to adopt them (how can we make it work here?). According to Seamus, this is where quality improvement can come in: using dedicated health professionals, such as the Q community, and their skills to study, plan, do and act on the research evidence.

Researchers and quality improvement professionals need each other, not to put more clear blue water between them, but to make both activities more useful and effective. Even Q in Star Trek perhaps saw the wisdom of this when he remarked: “I look at the universe in an entirely different way now. I mean, I can't go around causing temporal anomalies or subspace inversions without considering the impact it'll have”. (Star Trek: Voyager: The Q and the Grey #3.11, 1996).


North East and North Cumbria - Annual Network Event: Research Matters was held on 26 April at the Stadium of Light in Sunderland.



Photo attribution: “John de Lancie, Denise Crosby (at back), Patrick Stewart, Star Trek TNG, "Encounter at Farpoint," 1987” by Classic Film © 2015: https://www.flickr.com/photos/29069717@N02/20607700773