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.


If you liked this, you may also be interested in other articles exploring policy lessons from other countries:

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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

“For many children we are the first point of contact”: supporting children’s mental health in schools

A 2018 evidence review from Public Health England reported that one in 10 young people have some form of diagnosable mental health condition. This, the report suggests, equates to as many as 850,000 children and young people with a diagnosable mental health disorder in the UK. It also reported that half of all mental health problems emerge before the age of 14, and children with persistent mental health problems face unequal chances in life.

Research has also highlighted the impact of “key factors” like poverty and adverse childhood experiences (ACEs), including emotional trauma, abuse or neglect (which people living in higher areas of deprivation are more likely to experience) on an individual’s chance of developing a mental illness. However, an additional factor often cited in surveys around child mental health and wellbeing is the impact of school, including exam stress, and bullying. Mental ill health has also been found to have an impact on attainment, behaviour and a child’s ability to learn. As a result, teachers are often part of the front line of supporting adults for children who are suffering from mental ill health, with increasing pressure being placed on teachers and schools to identify and signpost children to other services.

Schools, as well as teachers,  are increasingly becoming a focus for the delivery of Child and Adolescent Mental Health Services (CAMHS) in their community. Often schools are at the centre of their local community, so it is logistically convenient to coordinate services there; it can for some be a less intimidating or stigmatising environment than attending a clinic at a GP surgery, for example. School is the primary developmental space that children encounter after their family, and children’s learning and development and their mental health are often interrelated, so it makes sense for teachers to take an interest in terms of attainment and progress in learning. In December 2017, the Department of Health and Department for Education (DfE) published the Green Paper Transforming children and young people’s mental health provision which highlighted the role of schools as key in promoting a positive message about mental health and wellbeing among school age children and young people.

Good work is already being done, but how can we do more?

Research has shown that there is already a lot of good and effective practice being done in schools around children’s mental health. Many schools already work in partnership with local health teams to provide in house CAMHS support in the form of mental health nurses and social workers who are posted on site for children to access. One of the major recommendations in a 2018 Audit Scotland report on child mental health in Scotland was to encourage more of this type of partnership working. The report stressed the importance of joint working between public services if child mental health is to be improved, and where possible to include as wide a spectrum of public services in the delivery of CAMHS support, including criminal justice and housing practitioners, as well as health and social care and education staff.

In some schools senior pupils and designated members of staff are being offered mental health first aid training, and wear lanyards to help students identify them should they ever need to talk to someone. While it is important – particularly for students who participate in mental health first aid programmes – to be made aware of the challenges the role may entail, it can be a rewarding experience for young people to participate in and can also be a vital in-road to support for some students who would otherwise feel uncomfortable talking to a member of staff.

Other programmes like those developed by the Anna Freud National Centre for Children and Families, Centre for Mental Health and the ICE PACK and Kitbag tools (which have been used widely in UK schools) look at resilience building  and promoting coping mechanisms among young people, as well as encouraging the creation of trusting relationships which focus on nurturing and normalising mental illness to encourage children and young people to feel comfortable discussing their feelings and thoughts. These programmes also integrate early intervention and prevention approaches, hoping to identify children and young people who are suffering from mental illness as early as possible and signpost them to appropriate support.

The specific role of teachers

Teachers need to remember that they are not health or social care professionals and that – as much as they would like to completely solve all of the problems of their students – they can only do what they can, and that is enough.

It is also very important for teachers to practise what they preach in as much as teacher self-care is as important as signposting children and young people who are struggling with mental health issues. A 2016 survey by the National Union of Teachers (NUT) found almost half of teachers had sought help from their doctor for stress-related condition. Teacher stress and burnout and those leaving the profession due to conditions like stress do not help to create an environment that is supportive of good mental health in the classroom. Teacher wellbeing is so important and building their own resilience is one way that teachers can start to embed good mental health in their practice. If you are doing it yourself it will be easier to help and show children how to do it if they come to you for advice!

Teachers simply being there and offering a safe space and first point of contact for many children is important. Listening and signposting can be so valuable for those pupils taking the first step and teachers should not be put off by any personal perception of a lack of expertise in mental health – a small amount of knowledge or understanding of what to do next is more than enough. In some respects, teachers should feel almost privileged that a student has chosen to come to them, someone they feel they can trust and talk to.

A poll conducted as part of a webinar held for educational practitioners found that rather than requiring more information about mental illness, what teachers actually wanted was more practical examples of how to apply support in the classroom and how to embed mental health into their teaching and the learning of their students.

A unique opportunity

Schools and teachers are on the front line of public services and have a unique opportunity through regular contact with children to help to build and promote resilience among pupils, and embedding this within the whole school can be an effective way of ensuring pupils feel the benefit without being singled out. Taking nurturing approaches to learning and teaching, and promoting the creation of trusting relationships is key to some of the already effective practice going on in schools. Sharing the learning and best practice that is already happening will be vital to ensuring that support for children suffering from mental ill health improves and adapts to changing needs in the future.


If you liked this article, you may also be interested in reading:

Writing and recovery: creative writing as a response to mental ill health

Addressing social mobility through education – is it enough?

The Changing Room Initiative: tackling the stigma of poor mental health in men through sport

Follow us on Twitter to find out which topics are interesting our research team

Reeling in the year: a look back at 2018

It’s been another busy year for The Knowledge Exchange Blog. We’ve covered a variety of subjects, from housing and the environment to education and planning. So as the year draws to a close, now’s a good time to reflect on some of the subjects we’ve been blogging about during 2018.

Bibliotheraphy, walkability and family learning

We started the year with health and wellbeing in mind. Our first blog post of 2018 highlighted the increasing application of “bibliotherapy”:

“The Reading Agency’s Books on Prescription scheme has been running nationally in England since 2013 and since it started has been expanded to cover Books on Prescription for common mental health conditions, Books on Prescription for dementia, Reading Well for young people and Reading Well for long term conditions. 635,000 people are estimated to have benefited from the schemes.”

In February, we blogged about family learning, where parents engage in learning activities with their children. This can involve organised programmes such as Booksmart, but activities such as reading to children or singing with them can also be described as family learning:

Research from the National Literacy Trust, suggests that “parental involvement in their child’s reading has been found to be the most important determinant of language and emergent literacy”.

In recent years, growing numbers of cities and towns have introduced “shared spaces”, where pedestrians, cyclists and drivers share the same, deregulated space. As we reported in March, the practice has proved divisive, with supporters claiming that shared spaces can improve the urban environment, revitalise town centres, and reduce congestion, while opponents believe that shared space schemes – particularly the removal of kerbs and crossings – are dangerous and exclusionary for vulnerable groups of pedestrians, people with disabilities and those with reduced mobility.

In April, we took the opportunity to promote the Idox Information Service, highlighting a selection of the hundreds of items added to our database since the beginning of 2018. All members of the Idox Information Service have access to the Idox database, which contains thousands of reports and journal articles on public and social policy.

Voters, apprentices and city trees

Local elections in May prompted us to blog about the voting rights of those with age related degenerative mental conditions such as dementia and Alzheimer’s.

“Many people with dementia still hold strong political feelings, and know their own opinion when it comes to voting for political parties or in a referendum. However, the process of voting can often present them with specific challenges. It is up to local authority teams and their election partners to make the process as transparent and easy for people with dementia and Alzheimer’s as possible. Specific challenges include not spoiling the ballot, and the ability to write/ see the ballot paper and process the information quickly enough.”

A year after the launch of the government’s Apprenticeship Levy in June, we highlighted a report from the Reform think tank which suggested that significant reforms were needed to improve England’s apprenticeship system. Among the recommended changes were a renewed focus on quality over quantity, removal of the 10% employer co-investment requirement and making Ofqual the sole quality assurance body for maintaining apprenticeship standards.

The shortage of affordable housing continues to exercise the minds of policy makers, and in July we blogged about its impact on the private rented sector:

“In many cases people view the private rented sector as being a stop gap for those not able to get social housing, and not able to afford a deposit for a mortgage. Although in many instances they may be right, the demographic of those renting privately now is changing, and becoming more and more varied year on year, with many young professionals and families with children now renting privately.”

The long, hot summer of 2018 was one to remember, but its effect on air quality in urban areas underlined the need to combat the pollution in our air. In August, we blogged about an innovation that could help to clear the air:

“Designed by a German startup, a City Tree is a “living wall” of irrigated mosses with the pollution-absorbing power of almost 300 trees. A rainwater-collection unit is built into the City Tree, as well as a nutrient tank and irrigation system, allowing the assembly to water itself.”

Planning, polarisation and liveable cities

September saw another highly successful Scottish Planning and Environmental Law conference. It opened with a thought-provoking presentation by Greg Lloyd, professor Emeritus at Ulster University, and visiting professor at Wageningen University in the Netherlands, who challenged delegates to consider what might happen if the current planning system were to be abolished altogether, to clear the way for a new and more fit-for-purpose planning system.

In October, we focused on the ever-increasing job polarisation affecting the labour market:

In the EU, data shows that between 2002-2014 medium skilled routine jobs declined by 8.9%, whilst high skilled roles rose by 5.4%, and low skilled jobs grew marginally (0.1%). As a consequence, wage inequalities have grown.”

More than half the world’s population now lives in urban areas, presenting significant challenges to local authorities who have to try and make their cities work for everyone. In November, we reported from The Liveable City conference in Edinburgh, which showcased ideas from the UK and Denmark on how to make cities more attractive for residents and visitors:

“A great example of the reinvention of a post-industrial area came from Ian Manson, Chief Executive of Clyde Gateway, Scotland’s biggest and most ambitious regeneration programme. When it comes to recovering from the demise of old industries, the East End of Glasgow has seen many false dawns. As Ian explained, when Clyde Gateway was launched ten years ago, the local community were sceptical about the programme’s ambitions. But they were also ready to engage with the project. A decade on, the area has undergone significant physical generation, but more importantly this has taken place in partnership with the local people.”

Although much has been made of the government’s claim that austerity is coming to an end, many local authorities are still struggling to provide services within tight financial constraints. One of our final blogs this year reported on local councils that are selling their assets to generate revenue:

“In a bid to increase affordable housing supply, for example, Leicester City Council has sold council land worth more than £5m for less than £10 as part of deals with housing associations.”

Brexit means….

Overshadowing much of public policy in 2018 has been the UK’s decision to leave the European Union. Our blog posts have reflected the uncertainties posed by Brexit with regard to science and technology, local authority funding and academic research.

As we enter 2019, those uncertainties remain, and what actually happens is still impossible to predict. As always, we’ll continue to blog about public policy and practice, and try to make sense of the important issues, based on evidence, facts and research.

To all our readers, a very happy Christmas, and our best wishes for a peaceful and prosperous new year.

The Changing Room Initiative: tackling the stigma of poor mental health in men through sport

It’s shocking that 12.5% of men in the UK are suffering from one of the common mental health disorders (estimated by The Men’s Health Forum). And men are as much as two and a half times more likely than women to die by suicide each year, with one of the most at-risk groups being men in their 40s to early 50s.

Other key statistics which show the scale of the problem include:

  • three in four deaths by suicide are by men
  • the highest suicide rate in England is among men aged 45 to 49
  • men living in the most deprived areas are ten times more at risk of suicide than those living in the most affluent areas.

Despite this, men are significantly less likely to access mental health services than women. The Mental Health Foundation found that 28% of men had not sought medical help for the last mental health problem they experienced, and 35% of men had waited over two years or have never disclosed a mental health problem to a friend or family member. Another survey, from the Men’s Health Forum, found a majority of men would take time off work to seek medical help for physical symptoms, but less than one in five said they would do the same for anxiety (19%) or feeling low (15%).

It’s clear, then, that there are strong cultural barriers facing men in relation to mental health diagnosis. Perceived stigma and ideas of masculinity can cause them to avoid seeking help or fail to acknowledge mental health issues.

Changing attitudes in changing rooms

We’ve written previously about the success of Men’s Shed projects in providing a safe, social space for men’s mental health issues to be addressed. We were interested, therefore, to hear about another scheme which is also using a community-based approach to explore men’s health.

The Changing Room Initiative is a two year pilot project which sees the Scottish Professional Football League (SPFL) Trust and Hibernian (Hibs) football club working in partnership with the Scottish Association for Mental Health (SAMH) to engage men in their community around issues of mental health and wellbeing. The project uses football and sport as a tool to encourage men to discuss their mental health and wellbeing and to help direct them to additional support and services within their community.

The initiative is part of a wider program from SAMH which is using sport to improve equality and reduce stigma around mental health. In February 2018, SAMH launched Scotland’s mental health charter for physical activity and sport. Signatories of the charter include Sport Scotland, SPFL Trust, Jog Scotland and Glasgow Life.

In October 2018, following the success of the initial pilot scheme, SAMH announced a second changing room initiative was due to be rolled out at another Edinburgh football club, Heart of Midlothian FC (Hearts).

Using sport to engage and improve mental health

There is a lot of research available which highlights the links between positive mental health and physical activity. Even low-level physical activity has been found to have a positive impact on our mood and general wellbeing. Activities like walking, cycling or gardening have been shown to reduce stress improve self-esteem and have a significant positive impact on depression and anxiety. However, research has also shown that people with mental health issues are also more likely to have poor physical health, and often face additional barriers to participating in sport and becoming active.

The Get Set to Go programme was launched with the support of Sport England and the National Lottery in July 2015 to help people with mental health problems benefit from being physically active. An evaluation of the project published in 2017 showed that physical activity has an important role to play in building resilience, enabling and supporting mental health recovery and tackling stigma and discrimination.

New support networks

There is a continuing push among healthcare and third sector professionals to stress that mental health is just as important as physical health. However, funding for mental health is comparatively low and research shows people are far more willing to acknowledge or accept help for physical illness.

With the roll-out of projects like the Changing Room Initiative to promote mental health in familiar environments, it’s hoped that those struggling with poor mental health will receive the support and treatment they need.


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Free access to Social Policy and Practice … only available this November!

Social Policy and Practice is the only UK-produced social science database focused on public health, social care, social services and public policy. It is exclusively available via Ovid – the internationally-recognised leader in medical information services – and this November they are offering librarians and researchers the chance to test drive it for free!

UK-focused evidence and research

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

  • Centre for Policy on Ageing
  • Idox Information Service
  • National Society for the Prevention of Cruelty to Children
  • Social Care Institute for Excellence

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 the ability to take 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).

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.

Tackling health inequalities: what does the data tell us and how can it help?

Health inequalities in Scotland are significant. Every year we hear about how Scotland has some of the biggest gaps in the health and wellbeing of the poorest and richest in society. In some cases, Scotland has the largest gaps in equality in the whole of Europe. And in many instances, they are rising. Scotland also has the lowest life expectancy of all UK countries.

A number of studies and research projects have been commissioned to try to identify the key indicators and factors that are creating and reinforcing these inequalities, and what sorts of interventions would work best to try and reduce or eradicate them altogether. It is hoped that by conducting research, and compiling data, policymakers can use this to identify groups and geographic areas where health inequalities are significant, and to intervene to reduce them, with data to help back up and evaluate the effectiveness of these interventions. In Scotland, work is being done by a number of organisations including the Scottish Government, Glasgow Centre for Population Health (GCPH) and Public Health Innovation Network Scotland (PHINS).

What indicators and factors are being measured?

Income inequality has a related impact on health inequalities, and the scale of low pay is significant. The relationship between health inequalities, poverty and household income is one which has been explored at length and is often highlighted as one of the main factors which influences health inequalities. Studies which look at income, and also at relative levels of deprivation can provide useful comparison points, with comparable datasets on employment status and income readily available at a national and local level. Data also considers trends over time, comparing pre- and post-economic crash data, as well as relative earnings and expenditure relative to inflation and the rising cost of living. Other factors include age (those under 25 and earning a lower minimum wage for example) and by gender, with more women in lower paid, lower skilled and part time or insecure work.

How usable is the research being created?

The research which examines health inequalities explores a whole range of interrelated factors, and highlights just how complex the landscape of inequalities is. Creating a clear and holistic picture of all of the factors which contribute to health inequalities is not easy. Many studies, while detailed and effective, are niche, and focus on a very limited number of factors across a limited demographic source. As a result, questions have been raised about the utility of this research and its applicability and scalability at a national level. In an attempt to tackle this, combined data sets are being produced which provide opportunities for comparison across data from a range of studies.

The “Triple I” tool from NHS Health Scotland is designed to help policy designers to create effective interventions to reduce health inequalities. A second edition of the tool is due to be released in 2018/19. Triple I aims to provide national and local decision makers with practical tools and interpreted research findings about investing in interventions to reduce health inequalities in Scotland. It does this by modelling the potential impact of different interventions and policies on overall population health and health inequalities.

 

What can be done to act on the data?

While the research being produced is high quality, and thorough in relation to findings, the real question is what can actually be done with the research, and what steps can policymakers and practitioners take to use the findings to inform their own practice.

There are, researchers suggest, significant opportunities presented by the recent research which has been done on income inequality. In particular, they cite the public sector and public sector pay as a key way to reduce the income, and therefore the inequality gap, particularly among higher earners and those who would be considered “working poor” or “just about managing”. In Scotland, significantly more people are employed in the public sector than in any other part of the UK, and there is, researchers suggest, an opportunity to better align and increase low wages to help to reduce the gap.

The adoption of new initiatives, such as the “housing first model”, which is due to be rolled out in Glasgow to help homeless people break the cycle of homelessness, are also opportunities not only to address inequalities, but to ensure that long term help and support is in place to prevent any relapse into chaotic or risky behaviour. In relation to housing first, the savings on front line services such as emergency admissions to hospital, or contact with the police after committing a crime are significant, and while more in depth research is needed to create a full cost benefit analysis model of the scheme and its effectiveness, early studies show that the impact on health and wellbeing on those who had previously been homeless is huge in terms of reducing inequalities and improving wellbeing. However further data on homelessness in Scotland shows how far we have to go, and that housing first is only one mechanism which can be used to begin this process of reducing inequalities among the most and least deprived communities in Scotland.

Alternatively, some have suggested a more radical overhaul of how we distribute welfare and wealth within the country. Research has been coming thick and fast on the subject of a “citizens basic income”, particularly following the trial which was rolled out in Finland (the findings of which have not yet been published). Research on how this could impact on inequalities is not widespread yet, as pilots have been small scale, However, it is suggested that a total overhaul of welfare, replacing it instead with a citizen’s basic income would be a more effective way to reduce inequalities across the board, including in health.

Summing up

Health inequalities are significant in Scotland. Much of the research focuses on the impact of deprivation, poverty and low income on health inequalities and how, in order to tackle health inequalities in Scotland we must also tackle some of the other significant social problems within our communities, including low income and insecure work, and the impact of homelessness or chaotic lifestyles on health.

Data can be used in a number of ways to help inform policy decisions, some more radical than others. But creating a complete understanding of inequality in Scotland is challenging. It is up to researchers and policymakers to work together to create a better understanding of the conditions and factors which contribute to inequality, and what can be done to help tackle systemic and entrenched inequalities in our communities through policy levers and evidence based policy making.

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Creating caring places: placemaking in our town centres

What do caring places look like? How can planners, developers and project organisers contribute to the discourse around creating caring places? And what responsibility do they have to communities to help develop places that put people at their heart?

They are just some of the questions being increasingly raised by organisations in Scotland, trying to identify if there is a new way to focus on place and wellbeing in Scotland’s towns. Projects such as Carnegie Trust’s Kindness, Scottish Towns partnerships’ Town Centres First, or Architecture and Design Scotland’s Creating Caring Places are all exploring the importance of the quality of a place to the wellbeing of people who live there. But what does this mean for people who actually plan these areas, and what could they consider in the future to help develop more caring places?

The 3 P’s: place, people, practice

Many of the discussions around creating places which foster wellbeing and wellness centre around 3 key concepts:

Place: Understanding place and the impact that it has on wellbeing is a significant part of this agenda. The environment in which people live day-to-day has a significant impact on individuals and can be both a positive or negative influence. It can help to facilitate positive community interaction, creating stronger community ties and helping organisations and people to feel more valued within their community.

In order for places to be caring a number of factors have been identified, and these are common across research done by a number of organisations including Architecture and Design Scotland and the Carnegie Trust. These include: a sense of support (from people); a sense of purpose (stuff to do); a sense of place (familiar surroundings); and a sense of worth (feeling wanted).

People: Loneliness or social isolation has the same impact on health and mortality as smoking 15 cigarettes a day. Traditionally, it has often been assumed that older people are most often victims of social isolation (as they are less mobile and less willing or able to participate in community activities). Recently however more research has been produced which highlights the growing isolation of younger people. Understanding the nature of isolation, which impacts across the whole community, can help us to identify effective solutions which benefit and engage multiple groups.

Practice: This particularly relates to care within communities. The process of deciding where and how we care for the old or ill is a vital part of how we function as a society. Effective care extends far beyond the physical act of caring for someone, although this is obviously a key element. It also includes creating more and better jobs within the sector, and encouraging people to enter the profession as a worthwhile career choice; shifting the focus from acute to primary care settings and away from hospital-based emergency care; and giving people greater choice about how and where they receive care through increasing and improved personalisation of services.

There is a responsibility on both spatial and community planners to identify need and to create places which facilitate wellness, choice and care at home. This could be through the building of new infrastructure or more effective transport, or it could be through the creating of a community centre which offers recreational classes to someone who would otherwise have no contact with the outside world. Putting place at the centre of discussions provides an opportunity for a community approach to wellbeing, with strategies on placemaking being linked to other approaches such as asset-based, or strengths-based, planning.

Thinking about people like we think about the environment

Even as little as 10 years ago, the prevalence of environmental impact assessments for development projects was limited. Now we take for granted that we measure the impact of a project on the environment. What if we thought about people and in particular the risk of isolation, in the same way during planning processes? What if developers, planners and project organisers considered the “isolation impact” of a project, how it would impact the people of a local area, and whether it would specifically impact one group more than another (either for good or for bad), and reported on the steps they were taking to mitigate any adverse impact?

It is a striking notion, but creating a set of criteria to measure the social impact of developments, may be hugely useful if we are trying to place an increasing emphasis on inclusion and community within our town centres.

In fact, planners are beginning to realise the critical role they play in connecting services to people, and the necessity of understanding which services are needed in an area and how to make them as accessible for the whole community as possible. And while it is down to the community to use the resources they are given by planners to create connections and networks that help to combat things like poor mental health and social isolation, the decisions that planners make about how and where to plan in services and infrastructure can be the difference between someone leading an active and engaged life, and someone living a life where the only human contact they have in a day is a carer.

Planners can and should recognise the significant role they can play in making someone’s life more livable.

Final thoughts

Creating caring places for people to live and grow old in is vital to the success of our communities. Effective and thoughtful decisions on investments such as infrastructure and community planning projects can have a significant positive impact on wellbeing and reduce loneliness not only among older people, but throughout the community.

Increasingly, policy makers in Scotland are being asked to consider the human element of planning in their work. Creating places that allow people to feel safe, valued and happy is key for planners to help bridge the gap between the creation of places, and the wellbeing of people who live in them.


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City trees: green infrastructure to help cities clear the air

This long, hot summer has certainly been one to remember. But while many of us have enjoyed the sunshine, the soaring temperatures have had a critical effect on air quality, particularly in urban areas. In London and some other UK cities, pollution warnings were issued during the July heatwave.

The hidden killer

Air pollution in Europe is a bigger killer than obesity or alcohol. In the UK, 40,000 deaths a year are attributable to the effects of poor air quality. During the summer months, cities become heat islands that push air pollution to ever more dangerous levels. This summer has seen reports of increased numbers of people, particularly children, admitted to hospital with breathing difficulties, which many have blamed on air pollution.

As we’ve previously reported, in 2017 and 2018, national, regional and city authorities are acting to improve air quality, and around the world urban planners are trying out innovative ideas to combat the heat island effect. Last year, we blogged about Milan’s Bosco Verticale – a ground-breaking project that installed thousands of plants on the balconies of two residential tower blocks. The towers absorb 30 tons of CO2 a year and produce 19 tons of oxygen a day. Noise and heat are also reduced, and the buildings provide habitat for more than 20 species of birds.

Another innovative product, Voyager, has been developed by Idox Transport to enable road users to monitor travel information, including air quality and road accidents. The comprehensive travel information system helps drivers avoid congestion hotspots and takes the stress out of planning a journey.

Clearing the air

One important way of improving urban air quality is to increase the number of trees and plants in towns and cities. But all too often the barriers to tree planting in urban areas can be hard to overcome.

Which is why the “City Trees” project is so significant. Designed by a German startup, a City Tree is a “living wall” of irrigated mosses with the pollution-absorbing power of almost 300 trees. A rainwater-collection unit is built into the City Tree, as well as a nutrient tank and irrigation system, allowing the assembly to water itself.

Berlin, Paris, Amsterdam and Oslo were among the first European cities to install City Trees, and in the UK they’ve appeared on the streets of NewcastleGlasgow and London

There is evidence that green infrastructure can have significant effects on air quality. However, recent studies have indicated that, while vegetation and trees are beneficial for air quality, they cannot be viewed as a solution to the overall problem of poor air quality. That requires a coordinated approach to tackling the causes of air pollution, including diesel emissions from transport.

City Trees may not have all the answers to tackling the hidden killers in our air, but they are helping to blunt the impact of air pollution, helping us all to breathe a little more easily.


You can read more about efforts to tackle air pollution in our previous blog posts:

Idox Transport provides a range of products and services to support strategic and localised transport control. Its solutions are designed to ease congestion, improve air quality, detect and manage incidents and promote ‘green wave’ travel.

Science in the city: applying neuroscience to urban design

Cities have long been considered primarily in terms of their buildings and infrastructure.  However, in recent years, a more ‘human-centric’ view has been adopted – focusing on the people who inhabit the city, and how they perceive and respond to the city that surrounds them.

Research from a variety of disciplines agree that buildings and cities have a significant impact upon the people – from their physical and mental health, cognitive development, and wellbeing to their levels of productivity.

Neuroscience offers a new way to further explore this impact – and by doing so, help urban design professionals to create places that promote human health and wellbeing, whilst mitigating the negative impacts of the city environment as far as possible.

 

What is neuroscience?

But what exactly is neuroscience?  And how does it relate to urban design?

A recent report by FutureCatapult looks at how neuroscience can be used to improve the design of urban places, and thus increase human wellbeing and productivity.

It defines neuroscience as “a multidisciplinary branch of biology and is the scientific study of the brain and nervous system, including its interaction with the other parts of the body”.

There are various ‘scales’ or ‘levels’ of neuroscience – from cognitive psychology, right down to the study of individual cells in the brain.  Each level of neuroscience studies different aspects of how the brain functions, and thus offers different ways to explore and understand how humans perceive, respond to and are affected by their surrounding environments.  It has many applications in real life – and one such application is informing city strategy, design and policy.

 

Applying neuroscience research to urban design

Take mental health, for example.  It is a prime example of an area in which neuroscience can be used by city planners and policymakers to help improve human wellbeing.

As FutureCatapult point out in their report, cities have a greater prevalence of mental health problems than rural areas.

They note that several factors associated with cities have been found to contribute to mental health problems. These include certain toxins (produced by traffic, industrial parks), environmental stressors (noise and light pollution), climate conditions (urban heat islands) and social conditions (isolation).  Neuroscience offers a greater understanding how these factors impact on human health and wellbeing, thus creating an evidence base for the design of healthy places.

There are many other ways in which neuroscience research can inform city design.  For example, it has been found that:

  • poor air quality has serious detrimental effects on the natural developments of children’s brains
  • social isolation can accelerate cognitive decline in older people
  • an increase in noise decreases worker productivity
  • light influences brain function during specific cognitive tasks, especially those requiring sustained attention

Such findings can help inform the decisions made by city planners and policymakers, and help create cities that maximise human health, wellbeing and productivity.

Research into the brain’s ‘wayfinding’ processes – that is, how the brain processes visual information and makes sense of unfamiliar environments – is also of interest.  For example, how do people choose which paths to follow?  Are they influenced by street size, shape, colours, noise, or the number of cars? Such information could be used to inform the design of streets and places that are easier to navigate. This is of growing importance given the drive towards the design of inclusive and dementia-friendly places.

Relatedly, neuroscience offers a way to gain a deeper understanding of how non-neurotypical brains process and respond to different environments – for example, people with dementia or autism.  Understanding these different perspectives and responses is key to the creation of spaces that are truly inclusive.

 

Neuroscience in action

But how exactly does one go about examining how brain cells respond to an urban environment?

There are a variety of neuroscience tools that may be used to gather information about human’s experience of the city.

A key tool is mobile electroencephalography (EEG).  Previously, EEG involved equipment that could only be used in a laboratory.  However, technological advances have seen the development of mobile EEG ‘headsets’ that can be worn as research participants navigate different streets and environments of the city.

Mobile EEG enables researchers to measure brain function and activity, as well as the responses of the autonomic nervous system (heart rate, skin conductivity, endocrinological levels).  This can be used to understand how individuals experience urban environments.

For example, mobile EEG has been used to help understand the urban experiences of people with visual impairments.  Other mobile EEG studies have looked at whether using quiet, low traffic streets has a different effect on pedestrians than using streets busy with shops, traffic and other pedestrians.

Eye tracking machines are another tool providing research findings of interest to urban designers.  They study gaze behaviours and cognition, which are in turn related to attention, memory, language, problem solving, and decision making.  Eye tracking can help researchers to understand which features catch and hold attention, visual preferences and experiences. For example, one eye-tracking study found (perhaps unsurprisingly) that humans prefer lush greenery in urban environments.

As these neurological research and related technologies advance, their application will undoubtedly become more sophisticated and widespread.

 

Building upon evidence

The urban population around the world is expanding rapidly and finding solutions to the mental and physical health challenges that cities present is crucial.

By understanding the insights that neuroscience can provide, city planners, policy makers and others involved in urban design can access a growing evidence base upon which to build future cities that are healthy, attractive and inclusive places to live.


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