As the old year makes way for the new, it’s time to reflect on some of the topics we’ve been covering on The Knowledge Exchange blog over the past twelve months. We’ve published over 70 blog posts in 2019, covering everything from smart canals and perinatal mental health to digital prescribing and citizens’ assemblies. We can’t revisit them all, but here’s a quick look back at some of the stories that shaped our year.
Tomorrow’s world today
Artificial Intelligence was once confined to the realms of science fiction and Hollywood movies, but it’s already beginning to have a very real impact on our personal and working lives. In February, we looked at the pioneering local authorities that are dipping a toe into the world of AI:
“In Hackney, the local council has been using AI to identify families that might benefit from additional support. The ‘Early Help Predictive System’ analyses data related to (among others) debt, domestic violence, anti-social behaviour, and school attendance, to build a profile of need for families. By taking this approach, the council believes they can intervene early and prevent the need for high cost support services.”
However, the post went on to highlight concerns about the future impact of AI on employment:
“PwC’s 2018 UK Economic Outlook suggests that 18% of public administration jobs could be lost over the next two decades. Although it’s likely many jobs will be automated, no one really knows how the job market will respond to greater AI, and whether the creation of new jobs will outnumber those lost.
Tackling violent crime
One of the most worrying trends in recent years has been the rise in violent crime. Figures released in January found overall violent crime in England and Wales had risen by 19% on the previous year.
As our blog reported in March, police forces around the country, along with health services, local government, education and the private sector have been paying close attention to the experience of Glasgow in tackling violent crime.
Glasgow’s Violence Reduction Unit (VRU) was launched in 2005, and from the start it set out to treat knife crime not just as a policing matter, but as a public health issue. In its first ten years, the VRU helped to halve the number of homicides in the city, with further progress in subsequent years.
In March, our blog explained that the VRU takes a holistic approach to its work:
“…staff from the VRU regularly go into schools and are in touch with youth organisations. They also provide key liaison individuals called “navigators” and provide additional training to people in the community, such as dentists, vets and hairdressers to help them spot and report signs of abuse or violence.”
Protecting the blue planet
Environmental issues have always featured strongly in our blog, and in a year when people in larger numbers than ever have taken to the streets to demand greater action on climate change, we’ve reported on topics such as low emission zones, electric vehicles and deposit return schemes.
In August, we focused on the blue economy. The world’s oceans and seas are hugely important to the life of the planet, not least because they are home to an astonishing variety of biodiversity. In addition, they absorb large amounts of carbon dioxide emissions. But they are also a source of food, jobs and water – an estimated 3 billion people around the world rely on the seas and oceans for their livelihood.
Pollution is having a devastating impact on the world’s oceans, and, as our blog reported, governments are finally waking up to the need for action:
The first ever global conference on the sustainable blue economy was held last year. It concluded with hundreds of pledges to advance a sustainable blue economy, including 62 commitments related to: marine protection; plastics and waste management; maritime safety and security; fisheries development; financing; infrastructure; biodiversity and climate change; technical assistance and capacity building; private sector support; and partnerships.
A sense of place
The ties that bind environmental factors, health and wellbeing are becoming increasingly clear. This was underlined at an international conference in June on the importance of place-based approaches to improving health and reducing inequalities.
One of the speakers was Sir Harry Burns, Director of Global Public Health at the University of Strathclyde. His research supports the idea that poverty is not the result of bad choices, but rather the absence of a sense of coherence and purpose that people need to make good choices:
“People who have a sense of purpose, control and self-esteem are more positive and secure about the places they live in, and a greater ability to make the right choices. Ask people to take control of their lives, build their trust, and people can make choices that support their health. We must create places that do that”.
While it sometimes seems as if our society has made great strides in stamping out prejudice and supporting minority groups, at other times the stark reality of discrimination can shine a light on how far we still have to go.
In June, we marked Gypsy, Roma and Traveller (GRT) History Month with two blog posts that aimed to raise awareness of the many issues faced by GRT communities in the UK today:
“Research by Travellers Movement has found that four out of five (77%) of Gypsies, Roma and Travellers have experienced hate speech or a hate crime – ranging from regularly being subject to racist abuse in public to physical assaults. There is also evidence of discrimination against GRT individuals by the media, police, teachers, employers and other public services.”
But our blog also highlighted work being done to address these issues and to spread the word about GRT communities’ rich cultural heritage:
“Today, organisations and individuals such as The Traveller Movement, Friends, Families and Travellers, and Scottish Traveller activist Davie Donaldson strive to promote awareness of and equality for the GRT community. The recent Tobar an Keir festival held by the Elphinstone Institute at Aberdeen University sought to illustrate traditional Traveller’s skills such as peg-making.”
Back to the future
Since first launching in 2014, The Knowledge Exchange blog has published more than 700 posts, covering topics as varied as health and planning, education and digital, the arts, disabilities, work and transport.
The key issues of our times – climate change, Brexit and the economy haven’t been neglected by our blog, but we’ve looked at them in the context of specific topics such as air pollution, higher education and diversity and inclusion in the workplace.
As we head into a new year, the aims of The Knowledge Exchange blog remain: to raise awareness of issues, problems, solutions and research in public policy and practice.
We wish all our readers a very Happy Christmas, and a peaceful, prosperous and healthy 2020.
The rainfall that has inundated the North of England is the latest in a long line of flood events that are becoming the country’s new normal. Indeed, across the world, flooding is expected to become more frequent and more extreme as the planet heats up.
Building robust flood defences and modelling vulnerable areas is crucial if we are to avoid loss of life and livelihoods from these devastating weather events. But our new research reveals that the capacity of rivers to keep water flowing within their banks can change quickly – and in failing to acknowledge this, some flood models and defences may be under-equipped to deal with the consequences when they do.
Many assume that flooding is due to heavy rainfall. This is true, but only part of the explanation. Floods also occur when the amount of water running off the land exceeds the capacity of rivers to carry that flow – as was the case when the River Don breached flood defences in the Sheffield area recently. So, floods are partly caused by the amount of rain falling, partly by the moisture that is already in the ground, and partly by the capacity of rivers to contain water within their channels.
This means that if the capacities of river channels change, then two identical rainfall events falling on similarly wet ground can cause flooding of very different severity.
Most rivers are forever changing. They are shaped by the sediments and water they carry. Humans have modified most of the world’s rivers in some way. In some cases this is through direct influence, such as dam construction or river engineering. Other influences are indirect – building on nearby land reduces the capacity of ground to absorb water, agriculture draws water from rivers, and deforestation leaves more water to flow elsewhere.
Rivers respond to changes in climate as well. During drier periods, less water flows through river systems. This means that there is often less energy to move the sediments at their beds, so riverbed levels may progressively rise, decreasing the capacity of the river. Abundant plant growth within the channel can also reduce a river channel’s capacity by slowing the flow.
But it is not always easy to predict how rivers will change. Extreme shifts in channel shape and capacity can occur very rapidly. After a recent flash flood in Spain, one river rose almost a metre as huge volumes of sediment from upstream were displaced and dumped further along. In tropical river systems, which tend to carry more sediment than temperate rivers, these changes can be several metres.
Unfortunately, such changes are typically ignored by flood engineers and modellers, who generally treat the channel as a fixed feature. If rivers actually change their capacity in space and time, then estimates of flood probability may be incorrect, putting people and property at risk.
Motivated by these concerns, we investigated the pace at which channel changes occur, and to what extent these alterations might be driven by climate. We began with a simple conceptual model: climate controls rainfall, rainfall affects river flow, and river flow shapes channel capacity.
Direct observations of this link were lacking in river systems over short timescales. So, we took 10,000 measurements of the capacity of 67 rivers in the US, covering a period of nearly 70 years. We also gathered rainfall and river flow data, to assess how climatic changes affected the capacity of the rivers.
We discovered that temporary shifts in river capacity, lasting years to decades, were far more frequent than had previously been assumed. Overall, river capacity tends to increase during periods that are wetter than average due to greater erosion of river channels, and decrease in drier periods.
We also found that multi-year climate cycles that affect regional precipitation patterns – such as the El Niño Southern Oscillation – can cause channel capacity to expand and contract too, perhaps on a global scale. Armed with this knowledge, we may eventually be able to predict how the capacity of rivers changes, and hence better understand flood risk.
In temperate regions such as the UK, where rivers tend to be vegetated, heavily engineered and relatively stable, delicate changes in channel capacity are hard to detect and unlikely to be life threatening. However, in river systems that carry high volumes of sediment, or in parts of the world where rainfall varies considerably during the year, sudden reductions in river capacity may dramatically increase flood risk for nearby settlements. For example, the Ganges-Brahmaputra river in India and Bangladesh falls under this category. Its capacity is already changing, and its floodplains are some of most densely populated in the world.
Unfortunately, we still have very poor understanding of the nature and causes of channel capacity changes in most regions – and it is the most at-risk places that tend to have the least data. To better understand what’s happening, we need to use satellite imagery to monitor how fast rivers are responding to changes in the climate. What we can’t yet do though is monitor river adjustment in real time. Developing technologies that do this would greatly improve our understanding of how changes in river shape and capacity affect flood risk across the world.
Until this information becomes apparent, flood models and defence structures should build this uncertain risk into their designs. Doing so could make all the difference for those living in vulnerable areas.
Louise Slater, Associate Professor in Physical Geography, University of Oxford; Abdou Khouakhi, Research Associate, Climate and Weather Data Analysis, Loughborough University, and Robert Wilby, Professor of Hydroclimatic Modelling, Loughborough University
Further reading from our blog:
How can we ensure Scotland’s roads are fit for the future? That was the challenging question facing a panel of experts at this year’s Traffex Scotland exhibition. The exhibition – held for the first time at the SEC in Glasgow – attracted a large number of contractors, consultants, manufacturers and suppliers involved in the design, management and maintenance of Scotland’s roads and bridges.
Future-proofing the roads network was one of several seminars at the exhibition covering highway maintenance and development. The speakers on the panel were: Eddie Ross and Andy Thomson from BEAR Scotland (which maintains Scotland’s roads), Mark Arndt from Amey (a leading supplier of consulting and infrastructure support services both in the UK and internationally) and Evan Ferguson from Scotland Transerv (which manages and maintains more than 600 kilometres of trunk road and motorway network across South West Scotland).
The panel highlighted the challenges facing road maintenance engineers in assessing the current state of Scotland’s road network, and agreed that one of the key factors driving successful future development was to gain an understanding of the travel habits of the future. Gathering and sharing data will form the backbone of this understanding, enabling traffic managers to model, monitor and control the effects of travel as well as reducing congestion.
But the basics of road maintenance will always apply. Scotland has a diverse road network, and while trunk roads in the north of the country are often single carriage, requiring considerable improvements, elsewhere the challenges relate to capacity. Maintaining those roads, developing them for the future and ensuring minimum disruption to travellers and the economy are all exercising the minds of traffic engineers.
The climate and the weather are also important drivers of change. The panel wholeheartedly agreed that water is the road engineer’s enemy, and the increasingly wet weather experienced by Scotland can often lead to disruption for travellers.
The Scottish Government’s recent consultation on its National Transport Strategy highlighted extreme weather events, such as 2018’s “Beast from the East”, which cost the UK economy at least £1 billion per day as gridlocked roads, along with no trains and no buses meant many workers were unable to access employment.
The Traffex panel welcomed the National Transport Strategy as a good first step in future-proofing Scotland’s roads network. It highlights the need to enhance the resilience of the transport network, to enable new transport projects and policies to deal effectively with the predicted changes in climate and to adapt existing networks to allow for increased rainfall and extreme temperatures.
The panel also discussed some of the technological advances that are set to revolutionise travel patterns in the coming years. One notable development is the emergence of autonomous vehicles (AVs).
AVs need roads without impediments, and therefore need clear and well-maintained road surfaces, as well as road markings that are kept at high standards. At the same time, the ways in which AVs use roads may be different from conventional traffic, and this will have significant effects on the resilience of road surfaces.
With only 20 minutes to cover the future of Scotland’s roads, the panel had their work cut out. But they ended, as they began, by stressing the need to understand the travel habits of the future. There was widespread agreement that the travelling public will be open to innovations such as AVs and electric vehicles, but will also expect improvements in connectivity options, including cycling and public transport.
Our road engineers will have a vital role to play in maintaining the roads network, while being flexible and open to new developments to keep Scotland moving.
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It might come as a surprise to learn that Scotland’s creative industries make up the country’s second biggest growth sector, after energy. But as well as making significant economic contributions, the creative sector is important on its own terms, with practitioners deploying their imagination, skills and expertise in a wide variety of sub sectors, from architecture and advertising to design and music.
Last month, The Glasgow School of Art (GSA) hosted a conference focusing on the ambitions of Scotland’s creative community. The organisers chose the perfect setting for the conference: for the past 20 years The Lighthouse in Glasgow has been a beacon for Scotland’s creative industries. As well as serving as Scotland’s architecture and design centre, the building has a direct connection to one of Glasgow’s cultural heroes. Designed in 1895 for the Glasgow Herald, The Lighthouse was the first public commission for Charles Rennie Mackintosh.
Scotland’s creative community has a lot to be proud of, but as well as acknowledging success stories in television, computer games and the visual arts, the conference also addressed the shadows that threaten to undermine Scotland’s creative sector.
Defining design and the challenges of precarity
One of these issues was raised by Janice Kirkpatrick, founding director of Graven, one of Scotland’s most successful design studios. Janice observed that the creative community’s difficulty in defining creativity has made it hard to communicate its work to the wider world. This is important, especially when trying to attract young people into the sector. She noted that in England between 2000 and 2018 there was a 79% fall in the number of people studying design. The situation in Scotland isn’t quite as bleak, with a 16% increase in design students. But Janice argued that there is a need to introduce children to art and design at a much earlier stage in their lives so that they can regard the creative sector as a serious career option.
Katrina Brown, founding director of The Common Guild, agreed that schools have a vital role to play in nurturing an affinity for and awareness of the arts. She observed that other countries have adopted a different approach, noting that a friend living in France had complained that their daughter’s school organised visits to art galleries just once a month.
The Common Guild is a dynamic visual arts organisation in Glasgow, and Katrina referenced her experiences to highlight the precarity of the sector. The arts have not been immune to the impact of austerity following the global economic crisis. Galleries have closed, programming has been reduced, and opportunities for artists, invigilators, educators and technicians have shrunk. This matters, Katrina argued, not only because the arts have such positive economic effects, but they also enrich our health, wellbeing and quality of life.
Despite the harsh economic climate, many public bodies recognise the value of the arts, and Katrina offered the example of Dundee Contemporary Arts (DCA), which has become a world class centre for contemporary art and culture. The University of Dundee has demonstrated the importance of supporting the cultural life of the city by investing in DCA, which supports individuals in their artistic endeavours, but also provides them with an income through jobs in the centre’s café and cinema.
Place makers: Glasgow’s Meanwhile Spaces
The conference’s title – Places of Creative Production – took on a special resonance during a presentation by Richard Watson, Commercial Lead at City Property Glasgow, a subsidiary of Glasgow City Council. Like many UK cities, Glasgow’s city centre has been struggling to cope with the impact of online shopping and out-of-town retail centres. Closures have hit the city harder than any other in Scotland, with an alarming rise in the number of vacant properties. In response to these challenges, City Property Glasgow has been working with the council and other agencies to create ‘Meanwhile Spaces’ from empty shops in the city’s High Street and Saltmarket. After being made structurally safe and ready for new tenants, a new leasing strategy was developed, offering the properties for one year, rent-free (all other service, utility and business rates charges still apply).
Since June of this year, the first Meanwhile Space tenants have been moving in, and many of these are members of the Scotland’s creative community, including:
SOGO: a Scottish based bi-annual lifestyle and arts magazine, which promotes and provides a platform for Scottish creative industries and communities.
WASPS: the UK’s largest non-profit studio provider for artists, which will use a Meanwhile Space to support activities in which creators can prosper.
SALTSPACE: a new co-op launched by students and graduates from Glasgow School of Art to support young creatives in their transition from art school into professional practice.
Although the project is still at an early stage, Richard explained that the response of tenants and local residents has been positive, and City Property Glasgow is already working on plans to create Meanwhile Spaces in other parts of the city, and to develop longer-term spaces.
The conference heard a variety of voices and experiences, giving participants the opportunity to learn about a rich diversity of creative activities in Scotland and beyond:
- Professor Andrew Brewerton from Plymouth College of Art, described the establishment of a free school specialising in the creative arts;
- Video games artist and lecturer Andrew Macdonald compared his experience of working in Sweden’s games industry with the games sector in Scotland;
- Writer and broadcaster Stuart Cosgrove explained the approach taken by the Glasgow team in forming a successful bid to become one of Channel 4’s creative hubs.
Closing the conference, Professor Irene McAra-McWilliam, Director of The Glasgow School of Art, said that the GSA would be happy to organise further events that might build on the ideas arising from the day’s conversations. And she reminded participants that although Scotland’s creative community faces significant challenges, it also has the skills, experience and passion needed to meet them.
Further reading from The Knowledge Exchange blog on culture and creativity:
Would you eat a burger if you knew it contained almost 6,000 calories? Some would gladly tuck in while others would recoil in horror. But if you have calories on the menu, at least you know what you’re biting into. And as our latest research shows, menu labelling, as it is called, may be a powerful way to change the nation’s eating habits.
Research shows that the British public is increasingly eating out and ordering takeaways, rather than preparing food at home. Our earlier research estimates that a quarter of UK adults and a fifth of children eat at a restaurant or order a takeaway at least once a week. Food that isn’t prepared at home tends to be less healthy, more calorific and higher in fat, sugar and salt than food prepared at home. While eating out is a triumph for a large and important commercial sector, it is also contributing to the obesity crisis and the increase in diseases such as type 2 diabetes and cancer.
Still not mandatory
Unlike nutrition labelling on pre-packaged food, which has been around for years and mandated under EU law since 2016, menu labelling is still not mandated in the UK. The government included voluntary menu labelling in its Public Health Responsibility Deal in 2011, and several establishments have since introduced menu labelling.
Of the top 100 chain restaurants in the UK, we recently found that 42 publish nutritional information on their websites, and of these, 14 voluntarily provide menu labelling in their establishments. A proposal for mandated menu labelling was included in the UK government’s Childhood Obesity Plan, and a public consultation closed last December, but no announcement on a final policy has been made so far.
Labelled menus mean healthier food
We found that food and drink sold at the top largest UK chain restaurants whose menus display energy information are lower in fat and salt than those of their competitors.
Menu labelling has often been touted as a way to provide information that helps people choose healthier dishes, but several reviews, including a recent Cochrane review, found only modest, poor quality evidence of an effect of menu labelling on purchasing and consumption. Our evidence suggests that the benefit of menu labelling may not necessarily be in helping consumers make healthier choices, but in incentivising restaurants to serve healthier food and drink. Without nutritional information, it is difficult to know where improvements are needed.
Nutritional information is only helpful if it is accurate. A 2018 study on the views of Irish food-service businesses towards voluntary menu labelling found that key barriers to implementing it included concerns about potential inaccuracies in calorie information and the lack of training on how best to provide quality calorie information.
If food outlets are mandated to provide menu labelling, they will need greater support and training to do so. But it may also increase the demand for more accurate, efficient and accessible methods of data collection (typically laboratory or electronic database analysis), promising easier ways to account for the nutritional quality of what’s on restaurant menus.
Should nanny stay at home?
Mandatory labelling will not be popular in all corners. After all, who doesn’t enjoy blowing out at the occasional all-you-can-eat buffet? The challenge is that eating out is not occasional anymore. It is has become habitual.
Fortunately, as we increasingly ditch the kitchen for the restaurant and takeaway, government has found that there is strong public support for menu labelling. Through the Childhood Obesity Plan, the government is exploring many ways to help make it easier for us all to make healthier choices and menu labelling should be considered as one of many policies, not as a silver bullet.
The 6,000-calorie burger is an extreme example. But think about it, when you last ate out, did you know how many calories you were consuming?
Read more: further reading on food from The Knowledge Exchange blog
Wayfinding has been variously described as:
- spatial problem-solving
- systems that assist people to find their way from one place to another
- a way of helping people engage seamlessly in a built environment
An effective wayfinding system consists of signs, maps and other visual clues to help guide people to their destinations. But as well as providing directions, good wayfinding systems can also promote health and wellbeing, tourism and economic development.
Way back wayfinding
The first recorded use of the term ‘wayfinding’ was by urban planner Kevin Lynch in his 1960 book ‘The Image of a City’. But wayfinding has been around as long as people have been on the move. In the ancient world, people learned to navigate by reading signs in nature, such as the sun and ocean currents. When the Romans built thousands of miles of roads, they also created stone markers to show destinations and distances. Later, the development of the motor car required street signs and road markings. More recently, wayfinding designers have been applying their skills for pedestrians and cyclists in cities, and in places with complex navigational challenges, such as airports and hospitals.
The benefits of wayfinding
Effective wayfinding systems have environmental social and economic benefits. Signage can inform pedestrians and cyclists about the availability of safe routes, and convey information about distance. Wayfinding signs can also act as visual prompts to encourage people to walk or use more sustainable forms of transport. And wayfinding signage may persuade people to explore urban areas, visit attractions and make use of local services such as shops and cinemas.
Uncovering the legible city
Beyond their directional functions, wayfinding systems can be used for creating a sense of place and showcasing an area’s unique history. In recent years, urban planners, designers and architects have been working with communities to develop Kevin Lynch’s idea of ‘the legible city’.
Bristol led the way with a network of direction signs, on-street information panels, printed walking maps and public arts projects. The project created a consistent visual identity, countering impressions of Bristol as a collection of fragmented, undefined and unmemorable places.
Bristol’s Legible City project is now entering a new phase, including a major upgrade of on-street map units to incorporate high-quality illuminated mapping, and the integration of communication equipment into the map units to provide visitors and residents with useful data about the city’s streets and spaces.
Bristol’s pioneering approach has been adopted by other cities, including London, Glasgow, Manchester, Moscow and New York, as well as smaller cities such as Inverness. Some have used wayfinding as part of a wider strategy. Vancouver, for example, is fostering a walking culture, and so its wayfinding system is geared towards ensuring people make smart transportation choices. Meanwhile, in Moscow, a wayfinding system for the city’s metro stations is part of its efforts to create a world-class transportation system.
London’s Legible City project set out not only to provide directions, but to engage with pedestrians by using storytelling as part of the design process. The project team studied how people interact with their environment, and considered their different cultural backgrounds and the kinds of information they need for navigation. The designers also identified distinct environmental and architectural features to create a wayfinding system that was unique to London, and that created ‘journey narratives’ for different types of user, from ‘strollers’ to ‘striders’.
While wayfinding systems are gaining ground, there are some concerns about who runs them and who they are aimed at. As writer and urban historian Leo Hollis explained to The Guardian:
“If the legible city only maps shopping malls, car parks and the police station, this seriously reduces what the city has to offer. This can make parts of the city invisible to the visitor. Someone somewhere has made an arbitrary decision that tourists don’t want to go there, or that place is too dangerous so it should be avoided.”
It’s important that communities – and particular groups within the community –are considered in the process of developing wayfinding systems. In areas with an ageing population, for example, urban planners need to bear in mind the particular needs of older people when designing wayfinding systems.
Wayfinding to Playfinding
Having made its presence felt on city streets, wayfinding has also moved into airports, hospitals, schools and shopping malls. The Dongdaemun Design Plaza in the South Korean capital of Seoul, has 37 shopping malls and 35,000 shops. The wayfinding system for this complex space involves a high level of digital and smart media, with distinctive pathways for shoppers, tourists, design professionals and leisure groups.
Some designers have found inventive solutions to help people navigate interior spaces. At Tokyo’s Narita Airport, for example, the main concourses were redesigned to mimic a running track, the lanes printed with wayfinding symbols directing passengers to departure gates. The idea, celebrating the forthcoming Olympic Games, takes wayfinding into the realm of what is known as ‘playfinding’, where information and directions converge with fun and memorable experiences.
Wayfinding into the future
Increasingly, mobile applications, digital displays and other wireless technologies are being integrated into the ‘furniture’ of wayfinding systems. In some, mobile apps use QR (quick response) codes on street signs to provide more detailed historical information.
But with so many of us now using maps on smartphones to navigate cities, some are questioning the value of physical signage systems. And as Google moves into mapping the interiors of museums and other public buildings, the shift towards technology seems irresistible.
Even so, proponents of wayfinding argue that focusing on an app can rob pedestrians of the full sensory experience of walking – the sights and sounds, colours and smells of a neighbourhood, the texture of the surfaces, and how the surroundings make them feel.
So, although navigation from one location to another has never been easier, it’s worth remembering that there’s more to wayfinding than simply finding your way.
Further blog posts on urban living include:
Today is the start of Sexual Health Week, which aims to raise awareness about services for the testing and treatment of sexually transmitted infections (STIs). The UK has a strong track record in the provision of STI services. But they are now facing new challenges, including a rise in demand, significant cutbacks in public health funding, and the emergence of infections that are resistant to treatment.
A historical perspective
STIs go back a long way. Syphilis first became widely reported in Europe during the late fifteenth century, while gonorrhoea was first described 3,500 years ago. For a long time, these diseases were incurable, afflicting millions of people and leading to infertility, disfigurement and insanity. Early attempts at treatment with mercury often proved fatal. With the development of penicillin in the 1940s, along with improvements in sex education, the rates of STIs fell dramatically. More recently, new drugs have revolutionised the treatment of people living with HIV.
A growing problem
Today, the instances of STIs are rising. In Australia, rates of syphilis, gonorrhoea and chlamydia are the highest since the 1990s. It’s a similar story in the United States and Canada, while in the European Union reported syphilis cases have continued to grow. HIV remains a major public health concern, with recent data indicating a significant number of new infections in eastern Europe.
In the UK, a 2019 report by the House of Commons Health and Social Care Committee found that overall STIs fell between 2013 and 2017. But more recent figures have revealed worrying developments:
- In 2017 there was a 20% increase in cases of syphilis in England, and a 22% increase in gonorrhoea.
- In Scotland, the number of cases of syphilis recorded has reached a 15-year high.
- Public Health Wales has reported a 79% increase in syphilis cases in the country between 2016 and 2018.
- The number of people in Northern Ireland diagnosed with gonorrhoea in 2018 was the highest on record.
The committee found that the impact of STIs in England is greatest among young people. Men who have sex with men are also disproportionately affected by STIs, while in black and minority ethnic populations, the rates of STI are higher than in the general population.
Along with the rise in the number of infections, the demand for sexual health services is increasing. At the same time, sexual health services say they are facing unprecedented threats from government cuts to local authority public health budgets.
In 2017, a Public Health England survey highlighted the concerns of commissioners of sexual health services. Respondents raised concerns about a decrease in capacity and an increase in demand, in both primary care and specialist services. They believe the consequences could include a worsening of health inequalities and a shift from prevention to treatment.
Debbie Laycock from the Terence Higgins Trust HIV charity told BBC News:
“The number of people accessing sexual health services has continued to rise, demand is on the increase and we’re hearing day-to-day more and more people are saying they’re being turned away from sexual health clinics. When it becomes harder to get an appointment, this is likely to deter people who don’t have symptoms, but just want a routine test. Those routine tests pick up infections at an early stage and stop them being spread to too many other people.”
Services at “breaking point”
There are concerns that this situation will worsen: from April 2020, previously ring-fenced sexual health, drug and alcohol services, which in England are funded by local authorities, will be competing for increasingly scarce funds alongside other council services such as social care.
The Health and Social Care Committee argues that budget cutbacks are not only bad for individuals’ health, but also increase overall costs to the NHS:
“Cuts to spending on sexual health, as with other areas of public health expenditure, are a false economy because they lead to higher financial costs for the wider health system. Inadequate sexual health services may also lead to serious personal long-term health consequences for individuals and jeopardise other public health campaigns such as the fight against antimicrobial resistance.”
This last point refers to a worrying new issue in the treatment of STIs. In recent months, several cases have been reported of new infections that have developed resistance to antibiotics.
Dr Tim Jinks, head of Wellcome’s Drug Resistant Infection programme, believes that increasing resistance to antibiotics will make treating and curing STIs harder:
“Untreatable cases of gonorrhoea are harbingers of a wider crisis, where common infections are harder and harder to treat. We urgently need to reduce the spread of these infections and invest in new antibiotics and treatments to replace those that no longer work.”
Some health professionals, such as Duncan Stephenson from the Royal Society for Public Health have warned that sexual health services are already at breaking point:
“With continued increases in rates of STIs such as syphilis…and the future threats posed by issues such as drug resistant gonorrhoea, the government is rolling the dice with the public’s sexual health.”
Sexual health services for people with disabilities
This year, Sexual Health Week is focused on people with disabilities, who often face barriers that prevent access to information and support. To overcome these obstacles, sexual health services need to make changes, such as providing longer consultation periods for people with learning disabilities, and training for health professionals in advising and treating patients with special needs. With sexual health services already under pressure, the challenges of meeting the particular needs of people with disabilities are all the greater.
In its report, the Commons Health and Social Care Committee recommended that Public Health England should collaborate with the sectors involved in commissioning and providing sexual health services to develop a new strategy. The report’s authors believe that this strategy:
“should help both providers and commissioners in their attempts to deliver sexual health services to a high quality and consistent level, in the face of the challenges of fragmented structures and reduced funding.
The committee also identified priority areas to be addressed by the strategy, including:
- the provision of services which meet the needs of vulnerable populations
- testing for the full range of sexually transmitted infections
- access to pre-exposure prophylaxis (PrEP) for those at risk of contracting HIV
- preventative interventions within all aspects of sexual health
Sexual health is an important part of physical and mental health, as well as ensuring emotional and social well-being. Modern, rapid testing can reduce the rate of onward transmission, and ensure that patients receive the right care, leading to long and healthy lives. Ensuring that those benefits continue will be the greatest challenge facing sexual health services now and in the future.
Effective clinical management for sexual health services
Effective record-keeping is an understated, but fundamentally important element of sexual health services. Increasingly, sexual health clinics are turning to electronic systems to maintain records, improve services and deliver cost savings.
Lilie is a clinical management software system specifically designed by Idox Health for sexual health services. Its electronic patient record (EPR) system provides fast access to patient information and greatly reduces administrative functions.
The system also provides sexual health services with a range of options, including:
- patient communication via SMS
- modules for contraceptive and reproductive health, chlamydia screening, HIV, and prescribing services
- laboratory test results automatically received and entered into the electronic patient record
This market-leading software is now in use in more than 140 sites.
Further information about Lilie is available from Idox Health.
Most parents are aware that physical activity is good for children – as it can help to improve their sense of self and have a positive impact on their mental health and well-being. But it’s less well known that being fit and active can also help to boost children’s academic performance.
Our recent review of primary school children from Stoke-on-Trent, England, shows that children who are more active perform better in key stage one results in reading, writing and mathematics than less active children – achieving grades that were either average or above average for each subject.
We also looked at how the children’s weight and height changed over the school year in our enjoy exercise. All the children gained weight, but less active children appeared to gain weight at a steeper rate than active children. This may mean these children – who currently have a normal weight and body mass – may be at risk of becoming overweight or obese in the future.
Not enough exercise
A report from Sport England shows that children who enjoy exercise, have confidence in their physical abilities and understand why exercise is important, are more likely to be active regularly. The same report also shows that these children do, on average, twice as much physical activity compared with children who don’t enjoy sport and exercise.
The Department of Health recommends children do at least 60 minutes of physical activity every day – but many children fail to meet these recommendations. This is in keeping with national figures that show only 17.5% of English, 38% of Scottish, 51% of Welsh and 12% of Northern Irish children meet the recommended minimum exercise levels.
But inactivity is not just a problem in the UK. Levels of childhood physical activity have recently been described as a global crisis by the World Health Organisation. Increasing urbanisation, changing patterns in transport, increased use of technology and high levels of poverty are considered to be reasons for the decline.
Of course, not all children naturally love exercise – and many dread PE lessons. Indeed, research shows that children who get regular encouragement and who have access to affordable facilities are more likely to be and stay active.
Be a role model
Given that our research shows the impact physical activity can have on academic performance and growth, it’s clear that children need to be encouraged to be active and given time to play regularly at home, in school and in the local community.
Children should walk more, run, cycle, use their scooter, go to their local playgrounds, dance, swim and play sports. Children should also be encouraged to travel to school on foot or by bike where possible and sit less often and for shorter periods of time.
This is important because children who are active regularly during childhood are more likely to develop into adults who are active and exercise. And adults who exercise regularly are more likely to live happier and healthier lives than those who do not.
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Science tells us that improvements to our air quality bring real health benefits – fewer heart attacks, strokes and premature births, less cancer, dementia and asthma, and lower incidences of premature deaths.
Better health because of cleaner air has been a strong driving force behind efforts by local and national government to keep highly polluting vehicles away from city centres, where air quality can be especially poor.
Earlier this year, we blogged about initiatives to improve the air quality of cities by banning the most polluting vehicles that emit dangerous levels of nitrogen dioxide and poisonous particulate matter.
Driving out diesel
There have also been important policy announcements to underline how seriously national and local authorities are taking the issue of air pollution. In July 2017, the UK government announced plans to phase out the sale of new diesel and petrol cars by 2040, with all fuel-powered vehicles to be banned from the roads entirely by 2050. Shortly afterwards, the Scottish Government unveiled plans to ban new petrol and diesel vehicles by 2032 – eight years ahead of the proposed deadline set out by the London government. These moves replicate measures introduced by France and cities such as Amsterdam, and Hamburg.
As diesel and petrol cars are phased out, alternatives, such as battery electric, plug-in hybrid electric and hydrogen-powered vehicles are moving in. These have a lower environmental impact and could also help the UK to meet its target of net zero carbon dioxide emissions by 2050.
At present, electric-powered vehicles make up a small part of the UK car market – just 0.9% of new cars are electric. But sales of electric cars have been rising – in June 2019 there was a 61.7% increase in battery electric vehicles registered in the UK, and in July electric car sales continued to accelerate (meanwhile, diesel registrations fell for the 28th consecutive month). This trend is set to continue as car manufacturers in the UK and overseas invest more in electric vehicle production.
Diesel and petrol cars could be phased out much more quickly if more drivers could be persuaded to go electric. But many are still reluctant to make the switch due to concerns about the distances that electric cars can travel between charges (the electric Volkswagen Golf, for example, needs recharging every 120 miles) and the availability of a robust charging infrastructure. But for most drivers, the leap in costs of switching to electric has proved the major stumbling block.
In the UK, the government has cut subsidies and grants for some hybrid and electric vehicles, leading to a slump in hybrid sales. By contrast, Norway’s government is leaving no doubt that they want drivers to turn away from diesel and petrol cars. The Norwegian government has backed up its ambitious goal to stop selling new gas and diesel passenger cars and vans by 2025 (15 years ahead of the UK government’s target) with incentives to go electric. These include tax breaks for electric cars, access for electric vehicles to fast-track bus lanes, plus discounts on parking and charging. Drivers are getting the message: in April 2019, almost 59% of all cars sold in Norway were electric.
Other countries are also joining the electric vehicle bandwagon, including France, the Netherlands, Germany and the world leader in electric mobility, China.
Meanwhile, in 2018, the House of Commons Business Select Committee said the UK government’s plans to ban diesel and petrol emitting vehicles were “vague and unambitious”. The committee was also critical of the subsidy cuts and the lack of charging points.
Putting the brakes on: the downside of electric vehicles
Electric vehicles have the potential to bring significant benefits to the UK economy, and many believe that Britain could become a world leader in electric car production. But this would require large-scale lithium-ion battery cell plants facilities. There are currently no plans for these in the UK, while China and Germany are setting the pace on battery production.
Although electric vehicles have been heralded as an environmental good news story, manufacturing their batteries requires raw materials such as cobalt, the mining of which has considerable environmental and human costs. At the same time, the electricity used to charge the vehicles is largely generated from fossil fuels. And, just like petrol and diesel vehicles, electric cars produce large amounts of pollution from brake and tyre dust.
Green for go?
Despite the drawbacks, electric vehicles are on the move. Manufacturers are launching new ranges to meet increasing demand and to comply with EU rules on carbon dioxide emissions limits. The International Energy Agency predicts there will be 125 million electric vehicles in use worldwide by 2030.
In Britain, the charging infrastructure is already growing, and set to improve, further. The UK government is also proposing that all new-build homes should be fitted with charging points for electric vehicles. The Scottish Government has announced plans to make the A9 Scotland’s first fully electric-enabled road, and the city of Dundee is already making progress on zero-carbon transport. Meanwhile, in London Mayor Sadiq Khan has pledged that all London’s taxis and minicabs will be electric by 2033.
But, as a July 2019 report from the Centre for Research into Energy Demand Solutions (CREDS) warns, electric vehicles will not address the problems of congestion, urban sprawl and inactive lifestyles. The authors recommend that governments should be doing more to discourage people from driving, and shifting the focus of travel to more sustainable modes, such as walking and cycling.
Electric cars may help clear the air and bring subsequent health benefits. But they won’t drive away all of the challenges facing our motor-centric cities.
If you’d like to read more on this subject, take a look at our previous blog posts…