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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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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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

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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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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Top research resources for social care and social services

The news in June that the Government’s Green Paper on social care will now be delayed until the autumn (having already been deferred since 2017) brought sighs of weariness rather than real surprise from the sector.

The recent focus on NHS funding, and the NHS’s 70th birthday, has also highlighted ongoing concerns that the funding crisis in other areas, including social care, mental health services and public health is being pushed to the sidelines.

What is clear, is that the need for evidence-based interventions, and proven value for money, is only getting stronger as budgets continue to be stretched.

The value of research

So, what’s the role of research knowledge within social work and social care? The Social Care Institute for Excellence has suggested that research can help practitioners and decision-makers to understand:

  • the social world in which those who use services live
  • why positive and negative events occur in the lives of some and not others
  • the relative success of interventions and their impact on these events
  • the role of the social care practitioner in relationships and interventions with service users
  • how social policies impact on the lives of people using services.

Studies such as cost-benefit analyses or randomised controlled trials are also part of the evidence base although they are less common in social care/social services than in health contexts.

Research takes place in different ways, with different aims. And the outcomes of research can be communicated in different ways. Blogs such as our own at the Knowledge Exchange aim to signpost readers to recent research on particular topics. Other good sources of accessible discussion of research findings include The Conversation blog and Community Care.

Meanwhile, database services such as the Idox Information Service or Social Policy and Practice will provide more comprehensive coverage of issues, bringing together research studies from other parts of the world which are transferable.

Social Policy and Practice

Many NHS Trusts and councils subscribe to the Social Policy and Practice database as part of their package of support for learning and development.

Recent feedback from users has highlighted its strong coverage of many current priority issues in public health, such as:

  • dementia care
  • delayed discharge
  • funding of long term care
  • safeguarding of both children and adults
  • supporting resilience and well-being
  • tackling obesity
  • asset-based approaches

As a UK-produced database, Social Policy and Practice also includes information on topical policy issues such as minimum alcohol pricing, sugar taxes, and the possible impact on the health and social care workforce of Brexit.

The database is produced by a consortium of four organisations: Social Care Institute for Excellence, Centre for Policy on Ageing, Idox Information Service and the National Society for the Prevention of Cruelty to Children.

Idox Information Service

With a wider range of topics covered, the Idox Information Service has been identified as a key database by the Alliance for Useful Evidence. Cross-cutting issues which impact on health and social services, such as poverty, housing, and social exclusion are covered in depth. It also covers management and performance topics.

The Idox Information Service also offers a range of current awareness services and access to a team of expert researchers, in addition to the database. The aim is to support the continuing professional development of hard-pressed frontline staff while also supporting the sharing of research and evidence across the sector.

Meeting the needs of the social care sector

Both Social Policy and Practice, and the Idox Information Service aim to increase the social care sector’s capacity for evidence-informed practice.

As battle lines are drawn over government funding, it’s clear that these will continue to be financially challenging times for public services and that demand for services will carry on growing. Investing in learning and development is one way to ensure that staff are equipped with the skills and tools to be the best that they can be. This in turn will ultimately improve performance and outcomes for the most vulnerable in our society.


To find out more about the history of the Social Policy and Practice database and the consortium of publishers behind it, read this article from 2016 which we have been given permission to share. Trials of the database can be requested here.

Read more about the unique support offered by the Idox Information Service. More information on subscriptions can be requested via the online contact form.

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

 

“You don’t put yourself into what you write, you find yourself there.”
Alan Bennett

Mental illness, for so long regarded as secondary to physical health, is now being taken more seriously. Media stories about loneliness, anxiety and depression have highlighted increasing concerns about mental ill health, and the issue has also been rising up the political agenda.

In 2017, a survey by the Mental Health Foundation found that only a small minority of people (13%) reported living with high levels of good mental health, and nearly two-thirds of people said that they had experienced a mental health problem.

Prescribed medication is one response to mental health problems, and it’s been reported that the NHS is prescribing record numbers of antidepressants.  But while psychiatric drugs can be of real value to patients, especially those whose condition is very severe, the mental health charity Mind has suggested that alternatives, such as physical exercise, talking therapies and arts therapies, are often more beneficial.

Last month, a conference at the University of Glasgow explored ways in which creative writing is being used to respond to mental ill health, and discussed what makes writing interventions helpful for coping and recovery.

Voices of experience: coping and recovery through writing

“Making and consuming art lifts our spirits and keeps us sane”.
Grayson Perry

Several speakers at the Glasgow conference testified to the effectiveness of writing in dealing with mental ill health and in finding a way to recovery.

In 2012, James Withey experienced a set of circumstances which brought him close to taking his own life. In the darkness of his depression, James felt that he might never recover. But after spending time at Maytree, the UK’s first “sanctuary for the suicidal”, he found that writing about what he was going through offered an antidote to the lies being spun by his depression.

He started a blog, and when he posted a letter to himself, beginning “Dear You.” James found that writing the letter gave him space to express his feelings and to listen to himself.

Before long, readers of James’s blog were responding with their own “Dear You” letters. The word spread that the letters offered a different perspective on recovery, and in some instances, had prevented suicide.

Today, The Recovery Letters project is still going strong, with a website, one published book and another in the pipeline. James is realistic about the project:

The letters are not a cure for a chronic illness, but they do provide support in helping sufferers of depression accept where they are.”

Policy positions: the view from Wales

“If poetry and the arts do anything, they can fortify your inner life, your inwardness.”
Seamus Heaney

Another speaker at the conference was Frances Williams, a PhD candidate at Manchester Metropolitan University, where she is studying arts and health. In her presentation, Frances explored some of the policy frameworks and public discourse surrounding the field of therapeutic writing in Wales.

She highlighted a recent report, Creative Health, The Arts, Health and Well-being, which  makes a case for the healing power of the arts in many different healthcare and community contexts.  In this report, a creative writing tutor explained some of the ways in which writing can help people experiencing bereavement, including keeping a journal, writing unsent letters, describing personal belongings and resolving unfinished conversations:

“Writing can be a valuable means of self-help, with the page as a listening friend, available any time of the day or night, hearing whatever the writer wants to say. The results of this can be powerful, and include people being able to return to work and adjust more effectively after their loss, acquiring skills for their own self-care which will serve them through the rest of their life.”

Frances also noted that the battle of priorities between impact and value-for-money has driven advocates of arts therapy programmes to defend them in terms of cost effectiveness and social value.

A mapping project by the Arts Council of Wales has taken this to heart, producing in 2018 an audit of the principal arts and health activities currently taking place in Wales.

Writing to the rescue

“By writing, I rescue myself”
William Carlos Williams

The Glasgow University conference underlined the health-giving properties of creative activities and the potential for creative writing to support people suffering with mental ill health. There was no pretence that writing offers a quick-fix solution. As James Withey noted, “…writing is just one element in a toolkit of responses to mental ill health.”

The All-Party Parliamentary Group on Arts, Health and Wellbeing fully supports this concept, and has recommended that policymakers recognise its importance:

“…the arts can make an invaluable contribution to a healthy and health-creating society. They offer a potential resource that should be embraced in health and social care systems which are under great pressure and in need of fresh thinking and cost-effective methods. Policy should work towards creative activity being part of all our lives.”


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The challenge of engaging with marginalised Traveller, Gypsy and Roma communities

In March 2018, a Northern Ireland Human Rights Commission report found 13 systematic concerns about Traveller accommodation, suggesting that Traveller communities are subject to an “out of sight, out of mind” mentality from local authorities and service providers. You do not have to look far to find more research, from across the whole of the UK, which highlights similar challenges for, and attitudes towards Traveller communities. Attainment, school attendance, unemployment and community cohesion are all shown in research as being consistently lower among Traveller communities.

Research from IRISS shows that Traveller communities are subject to regular racial, social and cultural discrimination and feel isolated within a society that they feel does not respect them in the same way as other minority groups. Some even feel that it is more acceptable to make a derogatory comment about a Traveller than someone who is from another ethnic group.

Commentators repeatedly highlight that there is very little knowledge or understanding of nomadic lifestyles, and that this can contribute to the racism, abuse and stigmatisation of Traveller people. However, some projects are trying to address the view of Traveller communities and improve their treatment and engagement with other members of non-Traveller communities.

An erosion of traditional lifestyles and cultures

A lack of flexibility around housing arrangements means that, to a large extent, Traveller families are often forced to choose between either poor accommodation sites which allow them to maintain their traditional way of living, or giving up this traditional lifestyle (which is not just a way of living, but also an entrenched part of their heritage and culture) to live in mainstream traditional social housing. One major criticism of local authority and central government supported services is that they are very inflexible to nomadic living; health, education, housing and employment support are all usually reliant on a fixed address. As a result, third sector organisations, charities and specific engagement bodies usually end up taking the bulk of the pressure and responsibility for supporting Traveller families, or Travellers are left to fend for themselves. This can lead to them becoming isolated or reluctant to engage.

Those who make attempts to assimilate often do so at the cost of their traditional way of life, with some even commenting that there is a level of cultural erosion and almost cleansing, and that Travellers are being forced to choose between suitable accommodation and living standards, and their heritage and traditions.

Challenges span generations, and create entrenched barriers

Many Traveller families have poor education and health experiences and there are multiple barriers to Traveller families accessing these services. In schools, it has been well documented that Traveller children have lower levels of attendance and attainment, with higher levels of exclusion and a higher incidence of bullying, discrimination and racist abuse while at school.

In social work, Traveller children are more likely to be engaged with a social worker and taken into care. It is clear that professionals working within these environments need to be trained to react and respond to the needs of Traveller children in a culturally sensitive way.

Practitioners need to be sensitive, aware and flexible where possible to accommodate needs, but this is not always the case and it can make Traveller communities reluctant to engage directly with local authorities on issues. However, there is a growing body of research which looks at art and culture-centred practice to try and engage Traveller communities with their wider community, and to enlighten other members of the community in a positive way about Traveller culture.

Could art be the bridge to build understanding between communities?

Many Traveller communities do not readily have access to art and do not participate in “cultural activities” like attending the theatre or museums or using libraries. They also don’t have any relationship to most art produced. There is very little Traveller representation in art, music, theatre or museum exhibitions and it can be the case that Travellers feel art and culture in the mainstream is not representative of them or their culture, which can also hinder them from engaging.

However, using art and art-based interventions can help to break down entrenched stereotypes and can create a level playing field for people to participate and contribute, particularly among children who may not be as effective at communicating using words or language.

Engaging young children (and their families) through play and cultural activities can help break down some of the barriers and mistrust that communities feel towards one another. Community engagement initiatives enhance trust and can improve relations, but this must be done in a sensitive and inclusive manner. Traditional crafts and arts are something that can be shared across the whole community, not just within Traveller communities.

Non-Traveller children also are at a cultural disadvantage from not having Traveller communities portrayed in mainstream cultural activities. Greater representation in art, TV and books would help integration, help to break barriers, reduce stereotypes, increase understanding of a unique culture in Britain and (it is hoped) lead to greater integration and less hate crime.

Art also has the potential to be used as a tool to engage adults within the community. Using art as part of consultation exercises can make the process accessible and can allow people to be involved who may not usually contribute, helping them to feel they have had a say in decisions made within their community. Art can also be a useful strategy in community cohesion and neighbourhood building activities, with people able to express their opinions and fears through other mediums such as painting, drawing or acting – although establishing the initial engagement can be challenging.

Final thoughts

Art-based practice can be an accessible way to engage and create a dialogue between communities, and help to build a level of trust between Traveller communities and local services. However the activities must be culturally sensitive, and staff within local services must be willing to be flexible and creative with how they engage if they are to create meaningful relationships with Traveller communities.


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How low can they go? Cities are taking action to reduce air pollution and save lives

Air pollution is a bigger killer in Europe than obesity or alcohol: nearly half a million Europeans die each year from its effects.

Particulate matter (a complex mixture of extremely small dust particles and liquid droplets) and nitrogen dioxide (an invisible, but foul smelling gas) are particularly harmful to health.  As the New Scientist has explained:

“…nitrogen dioxide lowers birthweight, stunts lung growth in children and increases the risk of respiratory infections and cardiovascular disease. Particulate pollutants like soot cause a wider range of problems, including lung cancer.”

Motor vehicles are the main source of these emissions in urban areas. For this reason, European Union regulations introduced in 2010 set down that nitrogen oxide should average no more than 40 micrograms per cubic metre over a year. These limits are regularly breached. By the end of January this year, London had reached its legal air pollution limit for the whole of 2018. Scientists say that even these limits are unsafe: the 30,000 deaths each year attributed to particulate pollution are due to exposure levels below the legal limit.

Getting into the zone

Many local authorities have been trying to tackle the issue by getting the most polluting vehicles out of their city centres.  As Traffic Technology International has noted:

“From Athens to Aberdeen, and from London to Ljubljana, there is an eclectic smorgasbord of initiatives with over 200 low emission zones (LEZ) around Europe excluding more polluting vehicles, and some cities employing road-user charging to deter vehicles from entering.”

In the UK, Glasgow is set to become Scotland’s first low emissions zone, while Oxford could become the world’s first zero emissions zone, which would exclude all non-electric vehicles from the city centre by 2035.

T Time in London

London has adopted especially ambitious goals to clean up the capital’s air. As of October 2017, older vehicles driving in London between 7am and 6pm have needed either to meet the minimum toxic emission standards (Euro 4/IV for both petrol and diesel vehicles and Euro 3 for motorised tricycles and quadricycles) or to pay an extra daily charge of £10.00 (in addition to the £11.50 Congestion Charge).

Air quality campaigners have welcomed this “T Charge”, but not everyone is happy. The Federation of Small Businesses has voiced concern that the charge will have a negative impact on small and micro-businesses that are already struggling with high property, employment and logistics costs. Shaun Bailey, a Conservative member of the Greater London Assembly, has described the T Charge – and the mayor’s plan to bring forward to 2019 the launch of London’s ultra-low emission zone (ULEZ) – as “vanity projects” that will have little effect on air quality.

National demands and local plans

London’s T Charge is one way of tackling air pollution, but there are other methods, such as retrofitting bus fleets, improving concessionary travel and supporting cyclists. Some UK cities are already taking action, while in Germany and Belgium, even more radical ideas are being mooted.

Last summer, the UK government set out its plan for tackling roadside nitrogen dioxide concentrations. The document made it clear that local authorities have a leading role to play in achieving improvements in air quality.

By the end of this month, local authorities were expected to submit their own initial schemes for tackling the issue, with final plans to be submitted by December. The government promised support for councils, including a £255m Implementation Fund to help them prepare and deliver their plans, and the opportunity to bid for additional money from a Clean Air Fund.

It was hoped that these measures would lower the poisonous emissions. However, last month the High Court ruled that the government’s approach to tackling pollution was not sufficient, and ordered urgent changes. Even if the subsequent plan is accepted, many feel that the only sure way to solve the problem is to eliminate traffic from our cities. Others counter that this will damage the economy.

The battle of Britain’s air quality has only just begun.


Our previous articles on air quality include:

Walk this way- the benefits of walking for people and cities

In a quality city, a person should be able to live their entire life without a car, and not feel deprived” – Paul Bedford, City of Toronto Planning Director (2014)

Improvements to the design and layouts of streets and cities can have a significant impact on encouraging more of us to walk. However, many people living in cities face a significant number of barriers to being physically active where they live, particularly in relation to walking. Pathways and public spaces such as parks and throughways are often unappealing, unsafe, congested, traffic filled, noisy or for some completely inaccessible, which leads to a reliance on vehicular travel and a reluctance to be physically active within the city environment.

Walkable environments consider not only the physical design of routes, but also features and facilities that are inclusive of the widest possible range of needs; for example, places for people to rest along their journeys (including well designed seats and benches), accessible toilet facilities, signage and street design that is sensitive to a range of needs and that can help with orientation and wayfinding. However, the benefits are clear across the board when it comes to trying to make our cities more walkable (and as a result healthier). This blog post outlines a few of these potential benefits, and considers how planners can get involved in realising some of them through effective planning and design in their own cities.

Social benefits
Safe, walkable, environments can provide opportunities for people of all ages and abilities to stay socially connected and engaged. This can be particularly helpful in communities with a lot of children, older people or vulnerable adults. Having areas that are known to be safe can help to encourage people to leave their homes, reducing the impact of loneliness and social isolation, and improving their sense and feeling of community in their local area, which in turn can help with health and wellbeing and community cohesion.

Health benefits
Walking is good for us! In August this year a survey by Public Health England revealed that four in 10 middle-aged adults fail to manage even one brisk 10-minute walk a month. This despite research showing that walking each day can rapidly reduce risk of health conditions such as stroke and heart attack. Promoting active lifestyles through encouraging walking has also been shown to help tackle the growing issue of obesity, particularly among younger people. Walking can also be good for mental health, particularly when it is done as a group. Increasingly, walking interventions are being prescribed as part of social prescription initiatives to help people regain health, fitness and confidence. But in order for these to be effective, spaces and suitable environments for walking need to be made available.

Environmental benefits
For many cities, London, Manchester and Glasgow included, congestion and air pollution are major issues. Creating walkable cities, and encouraging walking, cycling and other more environmentally friendly modes of transport can have a significant impact on the levels of pollution within an area. Reducing vehicle use can also have an impact on noise, water, thermal and light pollution in our cities too. Some attempts are being made to reduce the level of pollution in our cities – vehicles in central London have been subject to a congestion charge for a number of years. However, recent developments and attempts to reduce the high levels of air pollution in the city have led to the introduction of the “T-Charge”. It has been suggested that the money raised from this charge could be used to fund green transport initiatives, and this includes improving cycle and walkways and making streets more easy to navigate on foot.

Economic benefits
Walkable spaces can act as a catalyst for local economic vitality, regeneration and tourism. Research has shown that improving public spaces, and creating an environment which encourages more people to walk safely, (and free from the noise, smell and feelings of claustrophobia that can come with high levels of car traffic) has a significant and positive impact on businesses, resulting in people spending more time, but also more money in shops and town centres.

Creating walkable cities: what can be done to help
Planners and city officials are increasingly aware of the need to promote more open, safe and accessible public spaces in new development areas. However, some cities have already implemented practices that could be taken forward in the future. Organisations like Living Streets have produced road maps and blueprints of how cities can use planning to improve public spaces, make them walker friendly and reduce reliance on vehicles. Consultancies like Arup have also produced research on the benefits of creating “walkable cities” and in 2014 RTPI launched their own report on the benefits of planning for “healthier cities” (which includes provision for making cities more walkable). In 2017 the World Health Organisation (WHO) published a briefing on transforming public spaces to promote physical activity in cities. There are a number of ways in which planners and city planning teams can have a positive impact on promoting change to encourage more walking in our cities including:

  • Create walkable neighbourhoods – In Melbourne a “local connectivity plan” was introduced in 2014. The plan was used to build a network of neighbourhoods which had social, leisure and retail facilities within a 20 minute walk of people’s homes.
  • Prioritise walking, and “walkable spaces” in development and regeneration plans – The mayor of London appointed a walking and cycling commissioner in 2017, whose role is to make walking and cycling easier and safer across the capital. The mayor’s new ‘healthy streets’ approach is a commitment to a system of healthy streets and strategies that will help Londoners use cars less and walk, cycle and use public transport more.
  • Make walking safe – Designing walkways and footpaths that incorporate wide, well lit pathways, well signposted and nicely designed and maintained routes has been shown to be one of the main factors in encouraging people to walk more within their local area.
  • Make walking easy (and fun) – Go Jauntly is a new walking app that uses photographs rather than maps to guide users on routes around woods and byways. Walkers can add their own routes, and it is hoped that it the app will “increase the social appeal of people walking together” coming up with new routes within their own neighbourhoods, or areas they like to walk in.

If you found this article interesting, you might also like to read our previous blogs:

It’s a kind of magic: how green infrastructure is changing landscapes and lives

Hidden in plain sight – the value of green spaces

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