Rolling the dice with sexual health? New challenges for STI services

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.

Final thoughts

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.

Daily exercise can boost children’s exam grades – new research

Guest post by Michael McCluskey, Keele University

 

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.

Playing outdoors can help children to develop creative thinking Rawpixel.com/Shutterstock

Importantly, children also need to have positive role models. They need to see parents, family members, teachers and members of the community, enjoying being physically active on a regular basis.

 

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.The Conversation

Michael McCluskey, Lecturer in Physiotherapy, Keele University

This article is republished from The Conversation under a Creative Commons license. Read the original article.


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A road less travelled: celebrating Gypsy, Roma and Traveller History Month – part 2

June is Gypsy, Roma and Traveller History Month (GRTHM), which aims to raise awareness of and promote GRT history and culture.

It is widely recognised that raising awareness of different cultures is a key part of addressing prejudice and discrimination.

In this post – the second of two for GRTHM – we look at the inequalities and discrimination that GRT face across education, employment and health.  We also highlight work to address these inequalities and raise awareness of GRT communities’ rich cultural heritage.

GRT communities experience many educational and health inequalities

The recent House of Commons report, ‘Tackling inequalities faced by Gypsy, Roma and Traveller communities’, sets out a comprehensive review of the available evidence across a range of areas.

In education, Gypsy and Traveller children leave school at a much earlier age and have lower attainment levels than non-GRT children, and only a handful go on to university each year.  They also experience much higher rates of exclusions and non-attendance.

There are many reasons for this – from discrimination and bullying, to a lack of inclusion of GRT within the educational curriculum. There are also cultural issues to be addressed within the GRT community itself.

Scottish Traveller activist Davie Donaldson has spoken about the discrimination he faced in school where a teacher refused to “waste resources” by marking his homework because he was a Traveller, who she assumed was “not going to do anything with his education anyway”.  He also discusses how many Travellers within his own community felt he was betraying his roots by attending university. This clearly illustrates the multi-faceted nature of the issue of supporting GRT children in education.  The Traveller Movement addresses this and other related issues in their recently published guide to supporting GRT children in education.

Health outcomes for GRT communities are also very poor compared to other ethnic groups.  Their life expectancy is 10 to 12 years less than that of the non-Traveller population.  Maternal health outcomes are even more shocking – with one in five Gypsy Traveller mothers experiencing the loss of a child, compared to one in 100 in the non-Traveller community.

Poor health outcomes can be partially attributed to the difficulties that many experiences when accessing or registering for healthcare services due to discrimination or language and literacy barriers.  There is also a lack of trust among GRT communities which can result in a lack of engagement with public health campaigns.

Historic fear of engagement with public services

Indeed, there is a historic wariness of public services among many in the GRT community.

In the 1800s, many Travellers had a well-placed fear of the ‘burkers’ – body-snatchers looking to provide the medical schools with bodies for dissection.  Travellers felt particularly at risk because they lived on the margins of society.  There are many Traveller stories about burkers that have been passed on from generation to generation.

Similarly, a fear of social services intervention also exists, following the forced removal of children from Traveller families.  Some were taken into care, and others were deported to be servants in Canada or Australia.

Being aware of these cultural issues, along with the historic criminalisation and continued discrimination that GRT communities face, can help health and social services to understand and empathise with the GRT community when reaching out to them.

Poor employment outcomes and a lack of target support

Gypsies and Travellers were an essential part of the economy in the 19th Century and early 20th Century.  Many were skilled tinsmiths, silversmiths, basketmakers or other crafters.  They also played an important role as seasonal agricultural workers – for example, in the berry fields of Blair and farms of the north east of Scotland.  They moved from place to place, and bringing news and selling and trading their wares.  In the days before roads and motor vehicles, they were a lifeline for rural crofting communities who may have been many days travel away from the nearest settlement.

Time has rendered many traditional Traveller occupations redundant, and today employment outcomes for GRT groups are generally poor.

While more likely to be self-employed than the general population, the 2011 England and Wales Census found that Gypsies and Irish Travellers were the ethnic groups with the lowest employment rates, highest levels of economic inactivity, as well as the highest rates of unemployment.

However, unlike other minority groups, there has been no explicit government policies that support Gypsies or Travellers to enter employment or to take up apprenticeships and/or other training opportunities.  Many Gypsies and Travellers have also reported being discriminated against by employers, making it more difficult for them to find and stay in work.

A lack of robust data

There is a lack of robust data about the different GRT groups in the UK – even something as seemingly simple as how many GRT people there are.

This is because most data collection exercises – including the Census and in the NHS – do not include distinct GRT categories.  If an option exists at all, often it conflates the different GRT ethnicities into one generic tickbox, with no way to differentiate between the different ethnic minorities.  This is an issue that is being increasingly addressed and there are plans to include a Roma category in the 2021 census.

However, there are also issues with under-reporting.  Many people from GRT communities are reluctant to disclose their ethnicity, even when that option is available to them.  This stems both from a lack of trust and the fear of discrimination.

So, while the 2011 Census recorded 58,000 people as Gypsy/Traveller in England and Wales, and a further 4,000 in Scotland, it is estimated that there are actually between 100,000 to 300,000 Gypsy/Traveller people and up to 200,000 Roma people living in the UK.

Raising awareness of GRT culture

While this all may make for some pretty depressing reading, there are some promising signs of progress.

From Corlinda Lee’s Victorian ‘Gypsy Balls’ – where the curious public could pay to come and see how a Gypsy lived and dressed, to Hamish Henderson catalysing the 1950s Scottish Folk Revival with the songs and stories of Scottish Travellers – there have been attempts to promote Gypsy and Traveller culture among the settled population.

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, and there is a wonderful Traveller’s exhibition – including two traditional bow tents – at the Highland Folk Museum in Newtonmore.

There are even more events planned for GRTHM – including an exhibition of Travellers’ art and photography at the Scottish Parliament.

The hard work may be beginning to pay off – just last week, the government announced a new national strategy to tackle the inequalities faced by Gypsies, Roma and Travellers.

Using knowledge to fight prejudice

While there is without doubt an urgent need for practical measures to address the inequalities that the GRT community face – such as an increase in the number of authorised sites available – addressing the fundamental lack of awareness and knowledge of GRT culture is a key step towards eradicating prejudice towards GRT communities.

As well as raising awareness among the general public, there is also a need to for people working in public services – from health and social services to education and even politics – to have a better awareness and understanding of Traveller culture and history, and how this affects their present day needs and experiences.

Gypsy, Roma and Traveller History Month is an ideal opportunity to address the huge gap that exists in society’s collective knowledge about the GRT way of life, their history, culture and contribution to society. All of which can help to combat the prejudice and discrimination that they continue to face.


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A road less travelled: celebrating Gypsy, Roma and Traveller History Month – part 1

Traditional Scottish Traveller bow tent at the Highland Folk Museum, Newtonmore

This month is Gypsy, Roma and Traveller History Month (GRTHM).

GRTHM aims to celebrate and promote awareness of Gypsy, Roma and Traveller (GRT) history, culture and heritage, and the positive contribution that GRT groups have made and continue to make to society.  It also seeks to challenge negative stereotypes, prejudices and misconceptions associated with GRT groups.

Over the next two blog posts, we will raise awareness of the many issues faced by GRT communities in the UK today, and highlight some lesser known aspects of GRT culture and heritage.

Gypsies and Travellers are not a homogenous group

One common misconception is that Gypsies, Travellers and Roma are a homogenous group.

In fact, GRT is a term which encompasses many distinct ethnic groups with their own cultures, histories and traditions.

This includes Romany Gypsies, who today are generally of English or Welsh heritage.  Gypsies first arrived in Britain in the 16th Century. The term ‘Gypsy’ was coined due to a common misconception that Gypsies originated from Egypt. However, recent DNA studies suggest that they actually originated from the Indian subcontinent.  Some Gypsies may prefer to be known as either English Gypsies or Welsh Gypsies specifically.

Irish Travellers are Travellers with Irish roots, however, a recent DNA study suggests they have been genetically distinct from the settled Irish community for at least 1000 years. Irish Travellers have their own language – Shelta (also known as Cant).

Scottish Gypsies/Travellers are indigenous to Scotland.  Their exact origins are uncertain, but it is thought that they may be descended from the Picts, and/or the scattering of the clans following the Battle of Culloden in 1746.  Certainly, Scottish Travellers tend to share many of the same Clan surnames – including Stewart, McMillan, McPhee and McGregor.

Scottish Travellers also have their own language – the Gaelic-based Beurla Reagaird.

European Roma are descended from the same people as British Romany Gypsies, and they are Gypsies/Travellers who have moved to the UK from Central and Eastern Europe more recently.  Some have arrived as refugees and asylum seekers. While they face many of the same issues as Gypsies, Irish and Scottish Travellers, they are also subject to a number of additional challenges.

There are also other groups that are considered ‘cultural’ rather than ‘ethnic’ Travellers.  These include Occupational Travellers such as fairground and circus owners and workers and New Age Travellers – individuals who have chosen a travelling lifestyle for ideological reasons.

Distinct ethnic minorities protected by law

Whilst there are some similarities between GRT groups in terms of lifestyle, economic, family and community norms and values – and certainly in terms of the discrimination and poor outcomes that they experience – there are clear genetic differences between each of the groups.

As such, Gypsies, Irish Travellers and Scottish Travellers are each considered ethnic minorities in their own right and protected as “races” under the Equality Act 2010.  Migrant Roma are protected both by virtue of their ethnicities and their national identities.

However, despite this protection, GRT groups are still subject to high levels of discrimination.

‘The last acceptable form of racism’

Indeed, prejudice and discrimination has affected GRT groups throughout history.

In the 16th century, any person found to be a Gypsy could be subject to imprisonment, execution or banishment.  Even after anti-Gypsy laws were repealed, discrimination continued.  In the 19th and early 20th centuries, it was not uncommon for doctors to refuse to attend to Travellers.  And despite Travellers’ strong Christian beliefs, churches would often refuse to bury their bodies within their grounds.

And today, GRT people have the worst outcomes of any ethnic group across a huge range of areas, including education, health, employment and criminal justice.  They have the poorest health and the lowest life expectancy of any ethnic group in the UK, and are subject to high levels of racism and hate crime.

GRT groups still face barriers to accessing health services.  As part of a mystery shopper exercise by the Friends, Families and Travellers (FFT) charity, 50 GP practices were contacted by an individual posing as a patient wishing to register without a fixed address or proof of identity. They found that almost half would not register them, despite NHS guidance to the contrary.

And while racism towards most ethnic groups is now seen as unacceptable and less frequently expressed in public, racism towards GRT groups is still common and often overt – even among those who would otherwise consider themselves ‘liberal’ or ‘forward thinking’.  This had led it to be termed “the last acceptable form of racism”.

The 2015 Scottish Social Attitudes Survey found that over 30% of people in Scotland would be unhappy with a close relative marrying a Gypsy or Traveller, and 34% felt that Gypsies or Travellers were unsuitable as primary school teachers.

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.

Prejudice and discrimination against GRT groups is not limited to the public – there is also evidence of discrimination against GRT individuals by the media, police, teachers, employers and other public services.

Even politicians have openly displayed anti-GRT sentiment.  In 2017, the Conservative MP for Moray Douglas Ross, stated that he would impose “tougher enforcement against Gypsy Travellers” if he were Prime Minster for the day.

His remarks were widely criticised.  Amnesty International’s Scottish director, Naomi McAuliffe, said “When our elected leaders use this sort of blatantly partisan speech, they set a terrible example that only serves to foster further discrimination and prejudice.”.

A lack of sites has led to a ‘housing crisis’

Mr Ross’s remarks reflect another common misconception about GRT communities – that they all live in caravans, purposefully choosing to set up on unauthorised sites.

The truth is that while Gypsies and Travellers have traditionally lived a nomadic life, living in bow tents, wagons – and even caves – over 70% of Gypsies and Travellers no longer live in caravans, having chosen, or being forced for one reason or the other – disability, old age, lack of suitable sites – to move into traditional ‘bricks and mortar’ accommodation.

For those who do still live in caravans, it is widely recognised that they face a ‘housing crisis’ – an urgent shortage of authorised sites to set up on, which threatens their travelling heritage.  It is this shortage that drives much of the use of unauthorised sites.

Of those sites that do exist, quality has been raised as a key issue.  Many sites can lack even the most basic amenities, and some are sited near recycling plants or in other undesirable locations.  Poor conditions and sanitation contributes to poor levels of health, exacerbating existing health inequalities.

Further inequalities

In our next blog post, we will look in more depth at the inequalities that GRT communities face – in health, education and employment.  We also highlight work to address these inequalities and raise awareness of GRT communities’ rich cultural heritage.


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Helping people to reconnect: positive projects for people with dementia

This Photo is licensed under CC BY Via Microsoft Word images

Every three minutes, someone in the UK develops dementia. Over 850,00 people in the UK are currently living with a form of the disease; 40,000 of these are people under the age of 65.  This week (20th– 26th May) is Dementia Action Week 2019. This year the focus is on encouraging people to talk about dementia, and to talk to people with dementia in order to help tackle loneliness and isolation among those who suffer from the condition, as well as to raise awareness and improve understanding around the condition and the impact it can have.

The power of music

You may have recently come across the BBC programme featuring Line of Duty’s Vicky McClure Our Dementia Choir (if you haven’t you should try and find a copy).  The documentary follows a group of people who suffer from varying degrees and types of dementia and highlights in sometimes painfully sad detail the changes and challenges that can occur when someone develops the disease. However, it also shows the great joy and relief that music brings to dementia sufferers and their families. We blogged a few years ago about the benefits of music therapy in dementia care – and since then the literature and research on its usage in different settings has only grown.

Research shows that music, in various forms can help encourage participation and trigger positive associations which can be really helpful for people suffering from dementia, particularly if they feel like a lot of other things may have changed. In our previous blog we highlighted a Care Inspectorate backed scheme called ‘playlist for life’ which encourages care homes to integrate music into their care for patients with dementia. Moving beyond just allocating a time to place headphones onto a patient and leaving them to listen alone (although at times this may be helpful too), the aim is for music to be a vehicle for connected care. It allows carers to use music as a tool to find out more about the person they are caring for and encourage them to engage through the music.

Tackling isolation with art, culture and the natural environment

Research has shown that it is not only music that can have a positive impact on quality of life for people with dementia. Painting and drawing, making use of the natural surroundings by encouraging gardening or light walking in safe spaces, and games like dominoes and draughts can all help in their own way to improve the quality of life for people living with dementia and provide an opportunity for loved ones to re-connect.

In a 2014 study researchers examined the experiences of people with dementia and their carers when they participated in an 8 week programme based in an art gallery designed specifically to tackle social isolation and improve quality of life for both the person suffering from dementia and their carer. The study found that while the impact in terms of qualitative measures was negligible, participants were unanimous in their enjoyment and satisfaction with the programme. They highlighted that the interventions at the galleries helped to foster social inclusion and social engagement, enhance the caring relationship between the carers and people with dementia, and stimulate cognitive processes of attention and concentration. In a similar study, looking at the impact of art and gallery settings and programmes delivered within these settings, similarly positive emotional effects on study participants were found.

In Liverpool, they are making the most of their city landscape and the fact that specific locations, building and objects around the city can act as positive triggers for people who suffer from dementia, stimulating memory and interest. Those individuals who are mobile enough can participate in “memory walks” (different from the Memory Walks convened by the Alzheimer’s Society, which are sponsored walks designed to help raise money and offer a public show of support for people with the illness). This not only helps to improve physical activity, it can also be an opportunity for people with dementia to connect with other people as the walks are usually carried out in small groups, they are also linked to befriending schemes across the city to help reduce social isolation among multiple groups.

Similarly, many care homes now also promote interaction with nature and outside spaces for residents with dementia, with many developing specifically landscaped “sensory” gardens for residents, while other innovative supported living accommodation projects have gone a step further and created entire villages on site, which allows residents to perform tasks such as shopping or visiting a hairdresser. (This project is based in the Netherlands, but there are suggestions that a similar scheme could also come to the UK in 2020.)

VR and creating virtual experiences for people

Using digital technologies has also become increasingly popular, particularly in care homes. Apps and VR headsets which allow people to be immersed in an experience they perhaps once enjoyed, such as flying (if for example they had previously been a pilot or air crew) or driving have been shown to have a significant positive impact on people’s wellbeing allowing them to reconnect with their past and memories and freeing them from the sense of being trapped and losing their independence which can sometimes come with moving away from home into supported accommodation.

Tablet computers and touchscreen technology can also sometimes be easier for people with dementia to use as they do not require the same level of dexterity as writing. Apps have been developed which can help with word association or use pictures which can be helpful in allowing people with dementia to communicate when their use of language becomes more of a challenge. While the technology its self is relatively new, research has shown definite scope and benefit of further development of this in the future, as well as relevant training for staff and carers on digital literacy to help support users.

A support to clinical interventions

Dementia is a cruel illness – 1 in 3 of us in the UK will develop a form of the condition at some point in our lives. As yet there is no cure and as the population ages, and life expectancy improves more generally, the number of cases is expected to rise dramatically in the coming years. However, where science is trying to cure, art and culture is trying to supplement and support the clinical interventions and, where possible, provide opportunities to improve the quality of life for people suffering with the condition and provide opportunities for people to re-connect with loved ones.

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Museums as facilitators of health and wellbeing in communities

GNM Hancock, Newcastle

Great North Museum Hanckock, Copyright Rebecca Jackson

It’s estimated that there are over 2500 museums in the UK, ranging from world-famous collections in major cities to small local ones on niche themes. Over 50% of adults have visited a museum or gallery in the last year and there were an estimated 7.5 million visits by children and young people under the age of 18 to the major museums in England.

As well as their educational and leisure value, and their role as drivers of the tourism economy, there is a growing body of research which is considering the wider societal role of museums and in particular, their potential positive impact on health and wellbeing.

Museums and the rise of social prescribing

Within health and social care, we have seen increasing recognition and interest in the role of psycho-social and socio-economic determinants on health and wellbeing. Treatments now often look at the whole person and their lifestyle, not just at the specific medical condition to be treated. This awareness of the impact of lifestyle has led us to view spaces like museums and theatres in a new way and consider how they can be used as a tool to help people to live well.

March 14th was social prescribing day in the UK. And Museums on Prescription is one of a number of culture-led projects which encourage people to use assets in their local communities such as museums, galleries and theatres to help manage conditions linked to depression and social isolation, in combination with traditional clinical medicine.

Arts-for-health settings can have an impact across a number of different areas, including supporting children who have been exposed to trauma and abuse, helping communities integrate and improve social cohesion through the co-production of exhibitions, and helping support people with mental or cognitive illnesses, as well as those who suffer from dementia and Alzheimer’s.

V&A Dundee

V&A Dundee, Copyright Rebecca Jackson

Helping people feel better

As the number of projects increase so does the evidence of positive benefits. There is a growing body of literature highlighting examples of how cultural experiences are supporting both physical and mental health.

A report from Art Fund looking at the calming impact of museums and galleries found that 63% of people surveyed have (at some point) used a visit to a museum or gallery to ‘de-stress’, however, only 6% visit a museum or gallery regularly (at least once a month). Over two thirds of survey respondents (67%) agreed that taking time out for ourselves and choosing to pursue a leisure activity is good for our personal wellbeing and this is where museums and galleries, along with a whole host of other providers like theatres, music venues, public gardens and parks can step in.

Funding is a challenge

A report (2018) from the English Civic Museums Network highlights that services often deemed  “non-essential” (like museums and libraries) actually encourage and foster personal and communal resilience: they stop the crime, the illness, the loneliness from happening in the first place.

However, despite the significant and positive preventative role that participation in cultural activities can play, over the past five years spending on culture in England and Wales has fallen by over 30%, and this has had an impact on museums and the services they can provide.

Natural History Museum, London

Natural History Museum, London, Copyright Rebecca Jackson

Galleries and museums must keep striving to do more

The growing realisation of the potential of museums and galleries to have a positive impact on the health and wellbeing of communities presents a significant opportunity for them to develop programmes and exhibitions which reflect the diversity of experiences within communities and look to develop new ways to engage new audiences. Ensuring that people feel represented and that exhibitions appeal to a broad base of the community is also important in making sure people feel they are able to visit exhibitions and can feel the benefits of doing so.

In their 2015 report, the National Alliance for Museums, Health and Wellbeing, led by UCL, outlined the priorities of the alliance and showcased some examples of the work being done by partner organisations. In February 2019 it was announced that some schools in London are planning to give pupils “theatre vouchers” which entitles them to one free theatre visit per year. Museums themselves are also trying to do more to help engage members of the community and encourage them to engage with new exhibitions.

Are healthy people more culturally active, or does being culturally active make people healthier?

Museums and galleries have the potential to make an enormous contribution to improving people’s lives and enhancing physical health and mental wellbeing. The body of research around the role cultural activities like attending museums can have on health and wellbeing is growing, but there is still scope to do more, and work is ongoing with a number of high profile museums across the UK to promote the link between cultural activities and health and wellbeing.

The question of which comes first – being well initially which allows you be more culturally active, or cultural activities facilitating wellbeing in their own right – will be discussed and disputed by academics and clinicians. But the existing studies highlight the significant positive impact that engaging with museums and exhibitions has had on study participants, particularly those who suffer from mental ill health or degenerative cognitive diseases like dementia.

Museums and galleries, it is clear, have a far greater communal role to play and can evidence their value far beyond being a source of knowledge transfer or a leisure activity. Museum curators and funders need to recognise this as they prepare and plan for exhibitions and outreach projects in the future and clinicians need to be aware of the potential positive impacts for patients when considering care and treatment plans.


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This April get free access to the Social Policy and Practice database!

Social Policy and Practice is a database supporting the smarter use of evidence and research within the UK. The key strengths of the database lie in the area of health and social care – it’s not a medical database, but instead examines social issues such as health inequalities, care of the elderly, children and family social work, and community health.

Social Policy and Practice is exclusively available via Ovid – the internationally-recognised leader in information services – and this April they are offering librarians, academics and researchers the chance to trial it for free!

UK-focused evidence and research

Social Policy and Practice is produced by a consortium of key organisations within the UK:

  • Centre for Policy on Ageing – Originally established in 1947 by the Nuffield Foundation, the Centre has a long and distinguished record as an independent charity promoting the interests of older people through research, policy analysis and information sharing.
  • Idox Information Service – Set up 45 years ago to support the use of research within local government, it now works with government and the private sector to increase understanding of public policy issues.
  • National Society for the Prevention of Cruelty to Children – The UK’s leading children’s charity, campaigning and working in child protection in the United Kingdom and the Channel Islands.
  • Social Care Institute for Excellence – A leading improvement support agency and independent charity working with organisations that support adults, families and children across the UK, by supporting the use of the best available knowledge and evidence about what works in practice.

A valued resource

Social Policy and Practice has been identified by the National Institute for Health and Care Excellence (NICE) as a key resource for those involved in research into health and social care. And importantly, it supports a holistic approach to improving outcomes, by covering social issues such as poor housing, regeneration, active ageing, resilience and capacity building.

Social Policy and Practice was also identified by the Alliance for Useful Evidence in a major mapping exercise in 2015, as a key resource supporting evidence use in government and the public sector.

Unrivalled scope

Social Policy and Practice covers all aspects of public health and social care. It is a must-have resource for anyone interested in the following topic areas:

  • Social work and social care services
  • Children and young people
  • Adults and older people
  • Families and parenting
  • Safeguarding
  • Health promotion
  • Health inequalities
  • Community development
  • Physical and mental health
  • Education and special educational needs

It also offers a holistic view of wider policy areas that impact on health, such as homelessness and deprivation.

The database brings together research and evidence that is relevant to researchers and practitioners in the UK. A large proportion of material relates to delivery and policy within the UK and the devolved nations of Scotland, Wales and Northern Ireland, but the database also covers material that is transferable from Europe and across the world.

Social Policy and Practice boasts over 400,000 references to papers, books and reports and about 30% of the total content is hard-to-find grey literature.

The importance of geographical focus

Research studies have shown that people searching for social science evidence tend to neglect the question of geographical and coverage bias within research sources. And that the geographical focus of databases is a potential source of bias on the findings of a research review.

In the last ten years many UK-produced databases have ceased – funding has stopped, publishers have closed or databases have been taken over by international publishers (which reduces the balance of UK content and the use of UK-relevant keywords).

So as a UK-produced database, Social Policy and Practice is uniquely placed to provide relevant results for UK-based researchers.


To see for yourself why so many UK universities and NHS bodies rely on Social Policy and Practice as a resource, visit Ovid Resource of the Month for instant access.

To find out more about the history of the database and the consortium of publishers behind it, read this article from 2016 which we have been given permission to share.

Banning fast food outlets near schools: have takeaways had their chips?

A number of organisations – including the Academy of Medical Royal Colleges, Public Health England and the Royal College of Paediatrics and Child Health – have called for the creation of ‘fast food exclusion zones’ – banning fast food outlets from opening within 400m of schools and other places where children congregate.

In this blog post, we consider the arguments in favour of restricting the growth of such fast food outlets near to schools, and whether the evidence supports this.

More children becoming obese, earlier and for longer

The UK is now ranked among the worst in Western Europe for childhood obesity. Not only are more young people overweight or obese, they are also becoming obese at earlier ages and staying obese for longer.

Indeed, recent statistics show that nearly a quarter of children in England are obese or overweight by the time they start primary school aged five, rising to one third by the time they leave aged 11.

Increased risk of social, psychological and long-term health problems

In addition to the social and psychological problems associated with obesity, obese children are at a greater risk of developing serious diseases, including coronary artery disease, high blood pressure and type 2 diabetes.  They are also 20% more likely to develop cancer as adults than those of a healthy weight.

There is also a financial incentive for addressing obesity in both adults and children – recent estimates suggest that obesity-related conditions cost the NHS around £6.1 billion per year.  The total estimated cost to society is even greater – at least £27 billion per year.

Indeed, the annual spend on the treatment of obesity and diabetes is greater than the amount spent on the police, the fire service and the judicial system combined.

Deprived areas have greater levels of both obesity and fast food outlets

There are also strong reasons to address obesity from an equalities angle.

Recent data compiled by Public Health England shows that there is a strong association between area level deprivation and the density of fast food outlets.  Some areas, such as Blackpool, and parts of Manchester and Liverpool, have up to five times more fast food outlets than more affluent areas.

The evidence is generally clear that deprivation is associated with higher levels of overweight and obesity, and lower levels of vegetable consumption.

The evidence suggests that the food environment does influence food choice

During the past 10 years in the UK, there has been a significant increase in the number of fast food outlets, and the consumption of food away from the home has increased by 29%.

Researchers and policymakers have sought to understand whether unhealthy food environments – such as those with a high density of fast food takeaways – may encourage unhealthy food choices, and thus contribute to obesity.

Last year, the Scottish Government published a research paper on the link between the food environment and the planning system.

In relation to the link between the food environment and obesity in general, the report concludes that while the evidence is mixed, “overall the evidence would suggest that increased exposure to outlets selling unhealthy food increases a person’s likelihood of gaining weight”.

In relation to the effect of the food environment around schools on children and young people specifically, the evidence is less clear cut – with some research showing a link to obesity while other research does not.

Interestingly, there was evidence that access to outlets selling healthy food decreased the odds of being overweight or obese.

Research by Brent Council, involving seven secondary schools – four of which were within 400m of a fast food outlet – found that 27% of students said they would not bother going out at lunch if they had to walk more than 8 minutes.

It does seem like common sense – make fast food less readily obtainable and children will be less likely to consume it.

Prof Russell Viner, of the Royal College of Paediatrics and Child Health, has said “This food is tasty and cheap – it’s easy to blame the individual, but humans, particularly children, will find it hard to resist tempting food.”

England already making progress, Scotland likely to follow

In England, the National Planning Practice Guidance (PPG) outlines the role that planning can have in reducing obesity by limiting over-concentration of fast food takeaways, particularly around schools.  It also encourages planning authorities to limit takeaways in areas with high levels of obesity, deprivation and general poor health, and in areas with over-concentration and clustering of outlets within a specified area.

Similarly, the Child Obesity Strategy commits to developing resources to support local authorities who want to use their planning powers to restrict fast food takeaways, and providing up to date guidance and training for planning inspectors on the creation of healthy food environments.

A number of councils have already implemented 400m exclusion zones.  Some notable examples include St Helen’s Council, Sandwell Council, Dudley Council, and Milton Keynes.

Sadiq Khan has included proposals for a 400m exclusion zone around schools in the new Draft London Plan, and plans to limit the number of fast food takeaways near schools in Luton were approved in 2018.

At present, there are no powers to restrict fast food outlets on health grounds in Scotland – however, it is likely that this will change in the near future.

As well as the aforementioned research project, last year, the Scottish Government published the consultation, ‘A Healthier Future’, which commits to exploring the opportunity for the planning system to contribute to an improved food environment:

We will research precedent, evidence and good practice on the relationship between the planning system and food environment, including exploring how food outlets in the vicinity of schools can be better controlled, with a view to informing the review of Scottish Planning Policy”.

In the December 2018 issue of Scottish Planning and Environmental Law (SPEL), Neil Collar of Brodies LLP concludes that:

Taking account of Action 2.12 in ‘A Healthier Future’ and the research project, it seems likely that the draft National Planning Framework, expected to be published by the Scottish Government in 2019, will contain policies to control hot food takeaways and the food environment around schools. An evidence base to justify controls in local areas will be important”.

Creating a robust evidence base is crucial

Children have a right to grow up in an environment that supports them to attain the highest possible standard of health – and the planning system has a key role to play in facilitating this.

Of course, the planning system cannot address obesity on its own, and the causes of obesity are far wider and more complex than just the food environment.

Other approaches are also being put in place – including supporting food outlets to provide smaller portions and healthier options – some of which have been very successful already.

The creation of a robust evidence base upon which to make informed decisions regarding the location of fast food takeaways and the creation of healthy environments is essential.

There are already a number of useful datasets available for local authorities to use, including the Food environment assessment tool (Feat) and guidance on the creation of healthy food environments.

As more local authorities make use of their powers to restrict fast food outlets, it will be interesting to see whether more evidence emerges of the link between fast food and childhood obesity. We at the Information Service will, of course, be watching this with interest.


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Treating violence as a disease: can a public health approach succeed?

Knife crime, especially deaths of young people, has been making the headlines in recent weeks. And an approach which has a proven track record in Glasgow is now being adopted by the GLA, MOPAC and the Met police to try to tackle the growing levels of violence being seen on London’s streets. Learning from the experience in Glasgow, the police and other agencies are being encouraged to see violence as a public health issue, related to poverty, wellbeing and social deprivation and which, if identified and tackled early, can be prevented.

Contagion: a new way to think about violence

The Violence Reduction Unit was pioneered by Strathclyde Police (now part of Police Scotland), working with health and social care practitioners. Launched in 2005, the approach aims to make earlier identifications of those at risk of becoming involved in violence, and to take a more holistic view of the reasons for violence of all types. The long-term strategy looked at more social and wellbeing interventions to tackle gang violence in Glasgow, which at the time was among the worst in Europe.

The VRU in Glasgow took its inspiration from a scheme in Chicago, which sought to use a World Health Organisation (WHO) approach to tackling the spread of disease but applied it to communities in the hope of curbing the significant rise in homicides in the city. The approach was three-pronged: interrupt transmission, prevent future spread, and change group norms.

In addition to changing the approach to tackling violent crime, the VRU also used a multi-agency approach, involving social services, health care, housing and employment support, to give people a route out of violence and opportunities to find work or training opportunities. One of the key elements to ensuring the VRU is successful are the relationships these people build with individuals in communities.

Identifying young people at risk

Another important aspect of the VRU strategy is to intervene early to identify children and young people who are at risk of joining gangs or becoming involved in gang violence. Research supporting the creation of the VRU suggested that violence (like a cold) is spread from person to person within a community, that violence typically leads to more violence, and that one of the key identifying factors in someone becoming a perpetrator of violent crime is first being the victim of violent crime themselves.

In order to prevent this, 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.

There is also a broad view of what a culture of violence is. Work in schools focuses strongly on contemporary issues such as sexting, bullying and gender-based violence. It challenges the attitudes and beliefs that underpin such violence, and encourages young people to recognise and reject these.

A new approach to drug abuse too …?

In November 2018, the Scottish Government launched its new drug and alcohol strategy. One of the notable additions to the strategy was the acknowledgement that (like violence) drug abuse and addiction should be seen, not as a crime, but as a public health issue – an illness which people need support and treatment for.

Looking at how drug abuse is tackled within the criminal justice system and the interactions of addicts, policymakers have identified that many have had adverse childhood experiences, are exposed to drugs and/or alcohol at a young age, and are also at significant risk of being unemployed and homeless.

Creating a holistic package of support which seeks to identify those at risk and directs them towards a range of services to tackle not just the addiction but other trauma or socioeconomic barriers earlier, will, in a similar way to the VRU, give people a sense of purpose and value, and help them to see an alternate route that will allow them to contribute positively to society and improve their own outcomes.

A new way to tackle social issues in the UK?

Tackling the spread of violence through communities is not an easy task, nor is breaking the cycle of crime that many find themselves trapped within, often as a result of family allegiances or geographic location. It is often the case that either you participate, or you become the next victim yourself. More and more young people are feeling the need to carry knives for protection, due to the high levels of fear of becoming a victim.

Identifying those young people who are at risk of turning towards a life of violence at the earliest possible stage is difficult, but has been shown to be effective in helping to tackle violent gang-related crime. Although it is not the only tactic available to police, used effectively in conjunction with other outreach programmes it can be an effective tool in preventative policing, helping to keep communities safe.

The outcome in Glasgow has been largely positive, following the roll out of the Violence Reduction Unit programme. Whether this approach has the same success in London, operating on a larger scale, with different economic and social variables, and in a very different budget climate, remains to be seen. In particular it is worth noting that the Glasgow approach recognised there were no quick fixes, and was based on long-term planning covering ten year periods.

It is to be hoped, though, that changing the way we think about violence within communities may offer a route to tackling it.


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Zoning in on air pollution: low emission zones to tackle our dangerously dirty air

Image by Mike Malone

At the start of this year, the World Health Organisation (WHO) announced that air pollution posed the greatest threat to global environmental health in 2019. The UN’s public health agency estimates that nine out of ten people worldwide breathe polluted air every day.

Most of the pollutants in our air today come from traffic. Nitrogen dioxide and microscopically small particles emitted by motor vehicles can penetrate respiratory and circulatory systems, heightening the risks of heart attacks, lung cancer and respiratory conditions.

In the UK, poor air quality is estimated to cause the early deaths of 40-50,000 people each year, while in London 9,500 are believed to have died prematurely in 2010 due to air pollution.

The road to cleaner air

Across Europe, national and local authorities have been responding to the health risks posed by air pollution with measures to tackle emissions from vehicles. Many have introduced low emission zones (also known as clean air zones). These regulate vehicles with higher emissions, banning the most polluting vehicles from entering the zone and requiring them to pay a fee if they enter the area.

In various countries, low emission zones have different rules according to the type of vehicle and whether it meets EU emissions standards. In Germany, for example, there is a national framework of low emission zones affecting all motor vehicles except motorcycles. In Denmark, a similar framework applies to all diesel-powered vehicles above 3.5 tonnes. In Paris, all vehicles entering the low emission zone are required to display a sticker according to their emissions standards. The most heavily polluting vehicles are not allowed in. In addition, any vehicle can be refused entrance to the city centre in response to high levels of pollution on a given day.

A growing number of UK cities, such as Leeds and Birmingham have been working on the introduction of low emission zones, and some have already been implemented in Norwich, Oxford and Brighton.

In Scotland, the Scottish Government plans to create low emissions zones in the country’s four biggest cities by 2020, and the first of these is now up and running in Glasgow. The first phase was launched in January, targeting buses, which are among the most polluting vehicles. Glasgow’s biggest bus operator, First Bus, has purchased 75 new buses fitted with low emissions systems complying with the EU’s Euro VI standards. The scheme will be extended to other vehicles in stages.

London’s LEZ and ULEZ

Since 2003, when the congestion charge was launched, London has taken the lead with measures to tackle what Mayor of London Sadiq Khan calls the city’s “filthy, toxic air”.

In 2008, London created a low emission zone, and in 2017 a Toxicity Charge (T-Charge) introduced a surcharge for the most polluting vehicles entering central London. But levels of pollution in the capital remain stubbornly high, and so new measures have now been developed.

From 8 April 2019, an Ultra Low Emission Zone (ULEZ) will be in place in London, imposing tighter exhaust emission standards. The ULEZ will cost £12.50 for diesel cars manufactured before 2015, as well as most pre-2006 petrol cars cars, motorcycles and vans up to 3.5 tonnes. Vehicles over 3.5 tonnes will have to pay £100 to enter central London. These charges are on top of the £11.50 congestion charge. Failure to pay the ULEZ will result in fines of £160 upwards.

By 2021, the ULEZ will be extended to the north and south circular roads, taking in more London boroughs, including Brent, Camden, Newham, Haringey and Greenwich. By that time, it’s expected that 100,000 cars, 35,000 vans and 3,000 lorries will be affected per day.

There have been mixed responses to the incoming ULEZ. Health organisations such as the British Heart Foundation and the British Lung Foundation, have welcomed the measure, and environmental bodies also see the ULEZ as a step in the right direction. Sustrans, the sustainable transport organisation, commended the Mayor for “showing welcome leadership on tackling toxic air pollution.” Friends of the Earth welcomed the expansion of the ULEZ as “a promising step towards clean air in the city centre”, and called for further moves to protect the health of people living in Greater London.

However, motoring organisations voiced their concerns about the new zone. The RAC has argued that expansion of the ULEZ into residential areas will hit those on low income backgrounds hardest:

“…many now face the daunting challenge of having to spend substantial amounts of money on a newer vehicle or face a daily charge of £12.50 to use their vehicles from October 2021.”

The Road Haulage Association has voiced its opposition to the early application of the ULEZ to Heavy Goods Vehicles, claiming that the measure will have limited impact on improving health and air quality in central London.

Final thoughts

Striking a balance between environmental, health and economic pressures was always going to be a challenge. Even in London, which has led the way in tackling poor air quality, longstanding policies aimed at reducing air pollution have failed to bring it below legal levels. The new ULEZ may go some way to doing that, but it might also antagonise drivers faced with ever-rising costs. Cities on the journey to cleaner air are in for a bumpy ride.


Further reading on tackling air pollution