Knowledge mobilisation can improve equality impact assessments

Acas (the UK advisory, conciliation and arbitration service) describes an equality impact assessment (EIA) as “a practical tool to identify discrimination.”  Its managers’ guide to EIAs describes how carrying out an EIA can identify and reduce unintended discrimination and promote equality by removing barriers and improving participation.

Yet all too often an equality impact assessment ends up being a bureaucratic, box-ticking exercise that doesn’t lead to any change.  A quick google search just took me to newspaper articles decrying the waste of tax payers’ money on bureaucratic nonsense and box ticking along with government briefing papers and Local Authority guidance documents which aim to ensure that EIAs are not just about ticking boxes.

So the danger that carrying out an equality impact assessment won’t actually lead to improved services and reduced inequalities is well recognised but, in my experience at least, support to actually do EIAs better is a bit thin on the ground.

That’s why we’ve just produced a briefing paper on how thinking about an equality impact assessment as a process of gathering together what we know to:

  1. Describe an inequality
  2. Understand why the inequality has happened
  3. Prescribe action to tackle that inequality.

The briefing paper shows how our Evidence and Ethnicity in Commissioning knowledge mobilisation tools can help to generate knowledge not only to describe an inequality but also to understand it and to identify effective interventions.  They can also help to ensure an appropriate range of stakeholders are involved.

Do have a look at the briefing paper and if you’re interested in discussing anything in it and in learning with me about how to better move knowledge about ethnicity and health to action, please join my new Community-of-Practice

So what exactly is knowledge mobilisation and how can it help to reduce ethnic health inequalities?

To put it simply, knowledge mobilisation is about closing the gap between what we know and what we do.  In a health context, it aims to make sure that research evidence and other types of knowledge lead to benefits for patients and populations.

In my last blog post I wrote about what I learnt from being involved in the Evidence and Ethnicity in Commissioning research project.  It became clear to me that evidence generated through academic research, about any subject, often doesn’t make any difference to policy or practice or if it does, it can take a very long time.  Other sorts of knowledge like the experiences of people using services or of the staff providing them is also often not used to develop and improve those services.

I particularly like this definition of knowledge mobilisation that was coined in Canada:

“a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the healthcare system.”

Over the last year, I’ve looked at lots of different ways of describing the knowledge mobilisation process and the one the works best for me at the moment is Ian Graham’s map.

Graham's map

A piece of knowledge is created using the funnel process shown in the middle of the diagram and then that knowledge is applied or moved into action. The action cycle is similar to the plan, do, study, act cycle that you might already be familiar with.  This diagram is taken from Ian Graham’s paper which describes and brings together developments in the field of knowledge mobilisation.

In the Evidence and Ethnicity in Commissioning research project we used our findings to identify the key barriers to moving knowledge about ethnicity and health into action and developed some tools to help overcome those barriers.  Some of the tools can be used in a training workshop or by a team carrying out service improvement or commissioning work.  Others can be used by a team or individual while they are doing the service improvement work.

The tools are all available on our EEiC website and link to the different stages ofknowledge mobilisation as in this diagram.

During my fellowship I am going to try out some of the tools in different contexts – more on that in future blog posts and do get in touch if you think any of the tools could be useful in your work.  I’m happy to discuss and help if I can.

 

By Lynne Carter, NIHR knowledge mobilisation research fellow, ScHARR

Previously published at Evidence and Ethnicity in Commissioning

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Congratulations to our summer 2016 PhD Graduates!

Five ScHARR PGR students graduated on Monday 18th July at a ceremony held in the University’s Octagon Centre. Our five graduates were:

Emily Wood PhD – A clinical replication series to investigate if EMDR has the potential to treat clients with long term depression, its acceptability to them and possible mechanisms of change

Sarah Smith PhD – Exploring the potential of touch-screen computer technology in promoting enjoyable activities for people living with dementia: A visual ethnography

Milad Karimi PhD – A mixed methods investigation of methods of valuing health: are preferences over health states matters of taste, complete, and informed?

In ScHARR, we are tremendously proud of the achievements of all our PhD students who have recently completed their degrees, five of whom attended today’s degree ceremony to celebrate.

PROFESSOR PETRA MEIER, DIRECTOR OF POSTGRADUATE RESEARCH

Yagya Bhurtyal PhD – Effects of Male International Migration on Wives Left Behind in Nepal

Ros Haddrill PhD – Understanding delayed access to antenatal care: a qualitative study

Professor Petra Meier (ScHARR’s Director of Postgraduate Research) said, “Not only is a doctoral degree a great personal achievement that involves a fair amount of persistence and sacrifice, our newest alumni have between them contributed to impactful research on topics that range from the effects of international migration to the care for those with depression or dementia and from the valuation of health to access to antenatal services. Well done everyone, all the best for your next steps and we hope you stay in touch!”

Graduation July 2016

Pictured left to right are: Professor Mike Campbell (supervisor and former Chair of the Postgraduate Research Committee), Professor Jon Nicholl (Dean of ScHARR), Emily Wood PhD, Sarah Smith PhD, Milad Karimi PhD, Yagya Bhurtyal PhD, Professor Padam Simkhada (former member of ScHARR staff and supervisor), Professor Petra Meier (current Chair of the Postgraduate Research Committee) and Ros Haddrill PhD.

Well done to all our PhD graduates! To read more about PGR studies at ScHARR, click here.

Click here to watch a live stream of the University of Sheffield graduation ceremonies taking place this week.

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QALYS in public health: what are they?


The National Health Service (NHS), costs incurred by the health system and the need to undertake ‘cost-cutting’ in the NHS are frequent news stories… just currently over-shadowed by the EU referendum! Public health plays an obvious role in maintaining population health and reducing the demands on the health care system. But what evidence is required to support decision-making in the context of competing needs? Economic evaluation provides a framework to compare costs and effectiveness of different interventions in order to aid decision making.

The question then is how decision-makers compare outcomes from medical technologies with public health policies or interventions? The National Institute for Health and Care Excellence (NICE) recommends the use of the quality adjusted life year (QALY) as a key outcome measure in economic evaluations of public health interventions. Jurisdictions outside the UK will frequently report the disability adjusted life year (DALY) which is similar in some respects to the QALY. What is the QALY (or DALY) and why is it a useful measure?

Katherine Stevens, Clara Mukuria and other colleagues  in the Health Economics and Decision Science section of ScHARR have developed a free online course which outlines what the QALY is over 3 weeks from 11th July 2016. The course is an introductory level course that is suitable for anyone with an interest in public health. For more information and to register see: https://www.futurelearn.com/courses/valuing-health #FLValuingHealth #QALYs

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Trends in alcohol consumption and deaths – Must what comes down go back up?

New blog by John Holmes: Is a rise in alcohol-related deaths inevitable as the economy recovers and alcohol duties are cut?

Source: Trends in alcohol consumption and deaths – Must what comes down go back up?

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Public Health Section Newsletter

Welcome to the first of our Public Health Section newsletters. Each edition we will focus on an aspect of what we do in the section, and introduce new members of staff. There will also be space for news and congratulations.
This edition highlights some of the excellent Global Health work that is taking place, along with an introduction to two of our newer members of staff, Mary Crowder and Collette Kearney. You can also read about Kelly’s amazing London Marathon feat, and Carolyn Auma’s beautiful poem that she shared at our recent away day.
Thanks to Karen for all her work in putting the newsletter together. Enjoy reading!

Public Health Away Day

For those of you that were unable to join us at our recent away day on 4th April 2016 held at Inox Dine, we had an enjoyable and productive day. A stand out moment for quite a few of us was the poem that Carolyn Auma, one of our PhD students shared with us for the session “I wish I had known….”.
Looking back at the day Carolyn says “…I am not sure what made me share my poem – maybe it was the open, warm and friendly atmosphere at INOX Dine during the event, or it was just a way for me to reflect on the first six months of my PhD journey“. You can read Carolyn’s heartfelt poem here.

Congratulations

On Sunday 24th April 2016, our very own Dr Kelly MacKenzie lined up with over 39,000 other runners to take part in her first ever London Marathon.
Running to raise money for a cause close to her heart, Epilepsy Action, you can read more about Kelly’s amazing London Marathon experience here.
Viola Cassetti, a former Europubhealth student in ScHARR, has won one of the prestigious University Prize Scholarships for Doctoral Research and will be joining us as a PhD student in September. She will be supervised by Dr Tom Sanders and Dr Katie Powell.
Luke Miller, on being awarded the Senior Fellowship of the Higher Education Authority (SFHEA). The HEA Senior Fellowship recognises staff who lead and manage teaching programmes or modules, mentor and support colleagues who teach (formally or informally), or have advisory responsibilities around learning and teaching more broadly in their department, faculty or professional service.
Joe Clark on recently passing his PhD viva on Global Palliative Care Policy subject to minor corrections. His work is a mixed methods study which explores the scope of existing international research and policy in palliative care, explores policy response to the growing challenges of palliative care, and examines the contribution of key factors in global policy. Joe was supervised by Dr Amy Barnes, Dr Clare Gardinerand Prof Mike Campbell.

Meet two of our recent new starters in Public Health

Mary Crowder joined us in December last year as a Research Associate to work on the SPHR evaluation of a Domestic Abuse Perpetrator programme.

This is a new area of research for me, although for the past 2 years I have worked as a volunteer supporting a peer-research project, led by young people who have been affected by domestic abuse, into the strengths and gaps in domestic abuse services for young people in Sheffield.
I have lived in Sheffield since 1988 when I came here to train as an occupational psychologist with the Manpower Services Commission and complete my masters in occupational psychology at the (then) Social and Applied Psychology Unit here at the University of Sheffield. On completing my training I set up as a self-employed research consultant, trading as ‘Minds at Work’. For over 25 years I have been providing research and evaluation services, primarily to public sector clients but also to private and third sector organisations.  My work as a self-employed researcher has been varied; I have led research projects aimed at understanding learner motivation, evaluated a diverse range of local and national employment and training initiatives for adults and young people, developed training and assessment materials, and  evaluated selection, recruitment and appraisal systems.  I continue to operate as Minds at Work alongside my part-time employment in ScHARR and am currently working on the evaluation of a Lottery funded initiative being delivered by voluntary sector providers in Sheffield. When I am not at work you are most likely to find me on the allotment and, with the exception of the ‘hungry-gap’ in May/June, my partner and I are now pretty much self-sufficient in fruit and veg –an important part of our efforts towards a sustainable lifestyle. I am also proud to be a volunteer with Chilypep – a local children and young people’s participation project that does fantastic work to empower disadvantaged young people to influence decisions that impact on their lives.

Colette Kearney
I completed my undergraduate degree in psychology at the University of Glasgow in 2011. Since then I have worked in Moscow with pre-school children and in the UK with children and young adults with learning disabilities. In September 2015 I graduated with a Masters in Human Nutrition at the University of Sheffield. As part of this I collaborated with the Children’s Food Trust to look at the effectiveness of online training for improving childminder’s provision of food to children in the early years. I began my role as a Public Health researcher in March to pursue my interest in nutrition, appetite and eating habits in young children.

Focus on Global Health

Each issue we hope to bring you articles of interest from different areas of our business.
Here, Dr Julie Balen and Dr Muhammad Saddiq give us some interesting insights into recent work undertaken in Nepal, the Gambia and Nigeria.

Nepal
Dr Simon Rushton (Dept of Politics) and Dr Julie Balen, Public Health, ScHARR recently visited Nepal for their Sheffield Institute of International Development (SIID) funded study on health impacts of the 2015 Gorkha earthquake. They were joined by three other team members: Olivia Crane (ScHARR MPH student 2015-16) who was collecting data for her research attachment, and Nepalese colleagues Prof. Bhimsen Devkota and Ms. Sudha Ghimire (Tribhuvan University). The devastating earthquake that struck parts of Nepal in April last year highlighted major weaknesses in the country’s preparedness policies and also in the government and its partners’ ability to rapidly respond to humanitarian crises. Now, one year later, as reconstruction efforts gear up with the aim of “building back better”, researchers and policy makers are looking backwards to the immediate relief and response phases, as well as forwards towards long-term reconstruction, with the aim of formulating key lessons learnt from this tragic disaster. The Sheffield-Nepal team is exploring the lived experiences of individuals and communities in Gorkha District (the epicentre) in order to provide bottom-up views of health system resilience to the earthquake, and subsequent reconstruction efforts, and to triangulate these with the perspectives of government, NGOs and international agencies. The overall aim is to better understand and incorporate community-level perspectives into future health policy making and implementation at all levels. It is hoped that this will add to current ‘top-down’ policy discussions which appear to fall short on providing a good understanding of what, from the perspective of individuals and communities, makes public health systems more (or less) ‘resilient’ in the face of disaster. Whilst in Nepal the team of researchers conducted 27 in-depth interviews, 3 focus group discussions and an elite-level stakeholder meeting; data analysis is ongoing. This is a pilot study with results feeding into a larger project proposal.  For the first of a series of blog posts detailing the research, see our ScHARR blog.
The Gambia

As part of ongoing collaborative research in The Gambia, West Africa, Dr Julie Balen, Public Health, ScHARR has recently visited in-country partners (MRC Gambia, and Gambia Ministry of Health and Social Welfare) for a new project focussing on reducing malaria transmission in the country. The project is funded by the MRC, Wellcome Trust and DfID Joint Global Health Trials scheme (2015-2019; PI Prof. Umberto d’Alessandro). It is a cluster-randomised trial of a novel community-based approach for controlling malaria in low-transmission settings. The aim of the research is to determine whether treating all household members of clinical malaria cases can reduce parasite carriage and possibly also reduce malaria transmission. In the study intervention arm, malaria patients will be treated according to standard treatment protocols and, in addition, will be given sufficient dihydroartemisinin-piperaquine (DHAPQ) to treat all their household members, who are likely asymptomatic carriers. Primary study outcomes will include incidence of clinical malaria during the transmission season and malaria prevalence at the end of the transmission season. This research project has strong community involvement and draws on the existing health system, particularly during the first year, which is dedicated to formative research relating to the trial. The intervention’s impact, incremental cost and cost-effectiveness will also be determined in order to assess feasibility of scale-up.

Malaria in The Gambia remains a crucial public health issue, despite significant reductions in prevalence over the last decade. A range of control approaches have been pursued, including increased availability and access to long-lasting insecticide-treated bed nets (LLINs), integrated vector control interventions such as indoor residual spraying (IRS), strengthened case management with rapid diagnostic tests (RDTs) and artemisinin combination therapy (ACT), but these have not yet succeeded in interrupting the highly seasonal transmission patterns of malaria in The Gambia. It is hoped that this novel intervention may help move The Gambia closer to the pre-elimination phase.  For more information on the recent visit see our ScHARR blog and for a recent publication in Malaria Journal see Jaiteh et al., 2016.

Nigeria
Patient safety depends on multidisciplinary team of doctors, nurses, pharmacists, laboratory scientists and other clinical and non-clinical staff working as a team. The picture is from a team building workshop facilitated by Dr Muhammad Saddiq, Public Health, ScHARR, and 3 NHS consultants from 3 different hospitals across the UK working in partnership to strengthen preventative capacity in two teaching hospitals in Northern Nigeria. Patient safety has come to the top of the agenda in global health as a consequences of the recent outbreaks of Ebola, Lassa and Zika virus infections. The two partner hospitals for this THET funded project are Aminu Kano and Federal Teaching Hospitals, Gombe.”
Recent Publications
Barnes A, Brown Garrett W, Harman S. Understanding global health and development partnerships: Perspectives from African and global health system professionals. Journal of Social Science & Medicinedoi:10.1016/j.socscimed.2016.04.033
Bissell P, Peacock M, Blackburn J, Smith C. The discordant pleasures of everyday eating: Reflections on the social gradient in obesity under neo-liberalism
doi.org/10.1016/j.socscimed.2016.04.026
Boote J, Newsome R, Reddington M, Cole A, Dimairo M. Physiotherapy for Patients with Sciatica Awaiting Lumbar Micro-discectomy Surgery: A Nested, Qualitative Study of Patients’ Views and Experiences
doi:10.1002/pri.1665/full
Jaiteh F, Dierickx S, Gryseels C, O’Neill S, D’Alessandro U, Scott S, Balen J and Grietens K P. Some anti‑malarials are too strong for your body, they will harm you.’ Socio‑cultural factors influencing pregnant women’s adherence to anti‑malarial treatment in rural Gambia
doi:10.1186/s12936-016-1255-0
Meier P S, Holmes J, Angus C, Ally A K, Meng Y, Brennan A. Estimated Effects of Different Alcohol Taxation and Price Policies on Health Inequalities: A Mathematical Modelling Study
doi.org/10.1371/journal.pmed.1001963
Hassen W S, Castetbon K, Cardon P, Enaux C, Nicolaou M, Lien N, Terragni L9,Holdsworth M,  Stronks K, Hercberg S, Méjean C. Socioeconomic Indicators Are Independently Associated with Nutrient Intake in French Adults: A DEDIPAC Study
doi: 0.3390/nu8030158
Fox N J, Health sociology from post-structuralism to the new materialisms
doi: 10.1177/1363459315615393
Relton C, Strong M, Renfrew M J, Thomas K, Burrows J, Whelan B, Whitford H M , Scott E, Fox-Rushby J, Anoyke N, Sanghera S, Johnson M, Easton Sue, Walters S. Cluster randomised controlled trial of a financial incentive for mothers to improve breast feeding in areas with low breastfeeding rates: the NOSH study protocol
doi: 10.1177/1363459315615393
McLean S M, Booth A, Gee M, Salway S, Cobb M, Bhanbhro S, Nancarrow S A.
Appointment reminder systems are effective but not optimal: results of a systematic review and evidence synthesis employing realist principles
doi.org/10.2147/PPA.S93046
Salway S, Mir G, Turner D, Ellison G T H, Carter L, Gerrish K. Obstacles to “race equality” in the English National Health Service: Insights from the healthcare commissioning arena
doi:10.1016/j.socscimed.2016.01.031
Salway S, Chowbey P, Such E, Ferguson B. Researching health inequalities with
Community Researchers: practical, methodological and ethical challenges of an ‘inclusive’ research approach
doi: 10.1186/s40900-015-0009-4
Glogowska M, Simmonds R, McLachlan S, Cramer H, Sanders T, Johnson R,
Kadam U T, Lasserson D S, Purdy S.  “Sometimes we can’t fix things”: a qualitative study of health care professionals’ perceptions of end of life care for patients with heart failure
doi: 10.1186/s12904-016-0074-y
Sanders T, Ong B N, Roberts D & Corbett M. Health maintenance, meaning, and disrupted illness trajectories in people with low back pain: a qualitative study
doi.org/10.1080/14461242.2014.999399


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Public health champion to lead exercise revolution

  • Leading public health expert joins pioneering national sport and exercise medicine centre
  • Initiative will support people in UK to lead more active and healthier lifestyles
  • Research will identify how exercise and physical activity can improve wellbeing of people with chronic health conditions

One of the UK’s leading public health experts is set to help people across the country lead more active and healthier lives as part of a new role at a pioneering national sport and exercise medicine centre based in Sheffield.

Professor Elizabeth Goyder, Professor of Public Health at the University of Sheffield’s School of Health and Related Research (ScHARR), has been appointed Director of Research at the National Centre for Sport and Exercise Medicine (NCSEM) in Sheffield.

The NCSEM aims to improve the health and wellbeing of the nation through physical activity and was established in 2012 as a legacy to the Olympic Games. The Sheffield-based NCSEM brings together researchers and institutions from across the city who are working to create a culture of physical activity in the region.

Man on exercise bikeThe centre is also aiming to address the chronic burden of disease caused by a lack of physical activity.

The NCSEM is the result of a partnership involving:

  • Sheffield Teaching Hospitals NHS Foundation Trust
  • Sheffield City Council
  • NHS Sheffield Clinical Commissioning Group
  • Sheffield Hallam University
  • University of Sheffield
  • Sheffield International Venues
  • Voluntary Action Sheffield
  • Sheffield Chamber of Commerce and Industry
  • English Institute of Sport
  • Sheffield Health and Social Care NHS Foundation Trust
  • Sheffield Children’s Hospital NHS Foundation Trust

Professor Elizabeth Goyder from ScHARR at the University of Sheffield said: “I’m delighted to be appointed Director of Research at such a ground-breaking initiative that is trying to make a huge positive impact on people’s lives in Sheffield and across the country.

“A lack of physical activity can have a significant effect on our health and wellbeing but we need to do more as a nation to help people become more active.

“Sheffield’s two universities have a unique breadth of expertise that can support innovative research into how best to ensure that everyone benefits from more active lives. We know a lot about the benefits of physical activity for our health and wellbeing, but not enough about how best to support individuals and communities to lead more active lives.”

As part of her new role, Professor Goyder will work with world class researchers from both the University of Sheffield and Sheffield Hallam University to explore innovative and effective ways to help communities become more active.

The position will also help researchers identify how exercise and physical activity can improve the wellbeing of people with chronic health conditions.

Sir Andrew Cash, Chief Executive of Sheffield Teaching Hospitals NHS Foundation Trust said:
“Our aim is to make Sheffield one of the healthiest cities in the UK and as one of the largest NHS organisations we are committed to exploring all opportunities to integrate physical activity into health prevention, delivery and rehabilitation.

“We also want to have a healthy workforce in the city and the work of the NCSEM will provide the research and evidence to help us achieve this. Professor Goyder’s appointment is another important step in our journey.”
Steve Haake, Head of Sheffield Hallam University’s Advanced Wellbeing Research Centre and former Director of Research at the NCSEM, said: “The city of Sheffield, in partnership with the NCSEM, is committed to transforming Sheffield into the most active city in the UK by 2020. Our research looks at how we can make it easier for everyone living in Sheffield to be physically active as part of everyday life.
“We are already well on the way to achieving this through the Move More campaign which seeks to encourage involvement in mass-participation events and I’m looking forward to seeing our work come to fruition under Liddy Goyder’s leadership.”

Professor Goyder added: “Sheffield is in a unique position with the NCSEM as it brings together key partners who can lead a city-wide campaign to encourage people to be physically active.

“Sheffield City Council, the Universities, the NHS, the Sheffield Chamber of Commerce, industry, community organisations and service providers are all committed to ensuring Sheffield is an active city with all the benefits that brings to local communities and the local and regional economy.

“We already have some fantastic community organisations and schemes in Sheffield helping people to be active. The NCSEM is developing some great facilities, at Concorde, Graves and North Active, so I am looking forward to bringing these together to maximise the impact we can have on wellbeing through physical activity for the whole community.”

Professor Goyder is taking over from the previous Director of Research, Professor Steve Haake from Sheffield Hallam University, Professor of Sports Engineering, who is now the Director of the Advanced Wellbeing Research Centre, which is being established in the Don Valley.

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Rebuilding Barpak: resilience and the difficult transition from emergency relief to long-term reconstruction

Simon Rushton, Julie Balen and Olivia Crane from the University of Sheffield were in Barpak with Professor Bhimsen Devkota and Sudha Ghimire, working on a SIID-funded project examining the resilience and reconstruction of the health system following the Nepal earthquake. This is the first of a series of blog posts that the team will be publishing in the coming weeks.

 

On April 25th it was one year since the earthquake that devastated large areas of Nepal. In the village of Barpak in Gorkha District, the village closest to the epicenter of the earthquake, there are signs that the transition from emergency relief to more permanent reconstruction is finally starting. But many difficulties lie ahead.

Almost every house in Barpak was destroyed – over 1200 in total. The historic houses built of local stone and mud ‘cement’ quickly crumbled under the 7.8 magnitude earthquake. 72 people in the village died, crushed in the rubble. Over 200 were injured. Everyone has lost someone they were close to.

In some ways, despite the devastation, Barpak was ‘lucky’ in terms of the post-earthquake relief it received. It was a well-known village before the quake, and its relative accessibility (by Nepali standards, that is: it is a grueling 5-hour journey up a rough dirt road from the District capital) meant that outside help arrived relatively quickly, and in quantity.

A year on, some families are still living under canvas. The vast majority, meanwhile, have built temporary shelters from corrugated iron, erected amongst the rubble of their former homes. After surviving the freezing winter at 2,500m with no insulation, before long they will again be in the heat of the summer.

“Build back better and safer” is the Nepali government’s motto – and that of the international donors. Many of the officials we have spoken to have repeated the refrain that earthquakes don’t kill people – badly constructed buildings do. There are good reasons, then, to encourage people to rebuild their homes to be more earthquake resilient.

The National Reconstruction Authority (NRA) has worked with engineers to develop seventeen standard designs for earthquake resilient housing of various sizes and costs. A government grant of Rs.200,000 (approximately £1350) will be available to those who follow those plans. International and local NGOs are providing training to communities on how to rebuild. An engineer will soon be appointed in each village to provide advice on rebuilding, and to monitor who has rebuilt in a way that makes them eligible for the government grant.

 

earthquake 2a

In Barpak, people are already busy rebuilding. But most are not building earthquake resilient houses: they are rebuilding in mud and stone, just as before. Women and girls as young as four or five carry heavy rocks on their backs, and then sit breaking them into gravel while the men and boys construct the walls. Day by day the houses grow. But it is not an earthquake-proof village that is rising from the rubble.

A lot of the people we spoke to in Barpak have simply given up waiting. The NRA has taken almost a year to publish the earthquake resilient housing designs. Many believe that the long-promised Rs.200,000 will never actually arrive. Even if it does, it would not be enough to build a house – and there is uncertainty about the rules for who will qualify. So rather than spend more months living under their temporary shelters, those with the resources to do so are going ahead in their own way, ignoring the exhortations to build back safer.

Resilience is the mot de jour in the disaster and development community. But what do we learn about resilience from the people of Barpak?

 

earthquake3a

If by ‘resilience’ we mean merely the capacity to cope in the face of adversity, then the people of Barpak are – and have always been – highly resilient. This is an independent and community-minded village whose residents work together to survive and, to the best of their ability, thrive despite the unpromising geography and high levels of poverty. They have lived through the trauma of the earthquake and are now rebuilding their village, mostly without external assistance. A community accustomed to self-reliance, many are deliberately choosing not to wait for government help but are taking matters into their own hands and rebuilding their former homes in their own way.

Yet this very same spirit of independence and self-reliance is undermining a different aspect of ‘resilience’ – the physical resilience of these buildings against future disasters. The community may be strong, but many of the houses we saw people putting up are noticeably weak, calling into question the future safety of those in the village.

earthquake4a

 

– Originally posted at: http://siid.group.shef.ac.uk/blog/rebuilding-barreconstruction/#sthash.MPFJlJvm.dpuf

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British drinking culture mixes moderation and excess, our new study shows

John Holmes, University of Sheffield

One of the most common refrains in alcohol policy debates is that we need to change our drinking culture. Used by politicians, the alcohol industry and, occasionally, public health advocates, it refers to a belief that the society in question not only drinks too much, but also has a problem with how it drinks.

Robin Room, a sociologist of alcohol, described the desire to change drinking culture as an “impossible dream”: a desire, particularly in Northern European cultures for a more “Mediterranean” drinking style, characterised by less drunken disorder and a more sociable approach to alcohol.

In 2005, the British Labour Party fell foul of this approach: promising that the liberalisation of licensing hours would create a new “continental café culture”. It set an unlikely goal, which meant that even where the new regime didn’t make things significantly worse, the policy was still widely viewed as a dismal failure.

Despite the best efforts of policy makers, efforts at cultural change have been viewed as largely unsuccessful. Perhaps one reason for this is that we often have little systematic understanding of what a given nation’s drinking culture actually looks like and even our clearest ideas may be misleading. For example, the widely accepted description of Scandinavians drinking spirits and beer in occasional binges while Mediterraneans sip wine around family meals is largely a description of male drinking. For women, the differences in drinking between these two cultures are much smaller. Moreover, these broad characterisations of Scandinavian and Mediterranean drinking cultures offer few insights into other aspects of the culture, such as why, when, where and with whom Swedes drink wine or Italians drink beer.

A more detailed picture

In our new research published in Addiction, we used a unique resource and a new approach to gain a more nuanced insights into British drinking culture between 2009 and 2011. The data were provided by Kantar Worldpanel’s Alcovision study, a market research dataset in which 30,000 adults a year complete a diary giving detailed information about each time they consume alcohol across one week. We used the data to identify eight types of drinking occasions that are commonly seen in Britain and then describe where, when and why they take place, who is there and what is drunk.


Ol’ London pub.
Inn by Shutterstock

The findings confound descriptions of British drinking culture as one of widespread excess and intoxication. Although overindulgence is certainly there to be seen, half of British drinking occasions involve consuming only modest amounts of alcohol. These tend to be at domestic or family gatherings where people consume one or two drinks over an hour or so.

At the other end of the scale, we see heavy drinking occasions that are widely-discussed in the media, such as young people pre-loading before a night out and drinkers consuming a bottle of wine or more on a weekend night while winding down with their partner.

However, we also see occasions that are commonplace but attract less attention from policy makers and public health advocates. For example, 14% of drinking occasions involved domestic gatherings of family and friends, perhaps at house parties and dinner parties or to watch the football. On average people drank the equivalent of a bottle of wine or four pints of beer on these occasions and, in many cases, they consumed more than this. Yet such occasions are rarely discussed when identifying the kinds of drinking problems that need to be tackled.


How about now?
Party by Shutterstock

This more systematic understanding of Britain’s drinking culture is important for two reasons. First, irrespective of how much is drunk, different kinds of drinking occasion may present different risks. Some occasion types, such as drinking moderate amounts of wine every day, may become habitual and lead to accumulating alcohol consumption over time and increased risk of chronic disease. Others may place drinkers at immediate risk of accidents or violence, particularly if they take place in locations with poor protection against such outcomes. So policy responses may differ for these different drinking practices.

Introducing a minimum price for alcohol and providing drinking guidelines for those deemed lower risk might reduce habitual alcohol consumption, but these policies might do less to tackle heavy drinking where getting intoxicated and letting the hair down is the main motivation and where the location, company and timing are all conducive to sidelining concerns about price and long-term health.

The second reason for developing a better understanding of Britain’s drinking culture is to invite questions: if you want to change it, what exactly do you want to change it to? Can you point to the bits of the culture that do, or do not, need to change? Can you say why – and importantly how – you wish to change them? Unless the answers to these questions can be found, the idea of simply “changing the drinking culture” risks always being an impossible dream: an attractive piece of rhetoric, but not a coherent policy goal.

The Conversation

John Holmes, Research Fellow, Sheffield Alcohol Research Group, University of Sheffield

This article was originally published on The Conversation. Read the original article.

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Nine out of 10 people don’t link alcohol and cancer

Almost 90 per cent of people in England don’t associate drinking alcohol with an increased risk of cancer, according to a new report* published today (Friday 1 April 2016).

alcoholThe study, commissioned by Cancer Research UK and led by researchers from ScHARR , found that just 13 per cent of adults mentioned cancer when asked “which, if any, health conditions can result from drinking too much alcohol?”

Drinking alcohol is linked to an increased risk of seven different cancers – liver, breast, bowel, mouth, throat, oesophageal (food pipe), laryngeal (voice box) but the survey highlighted a lack of understanding of the link between drinking alcohol and certain types of the disease.

When prompted by asking about seven different cancer types, 80 per cent said they thought alcohol caused liver cancer but only 18 per cent were aware of the link with breast cancer. In contrast alcohol causes 3,200 breast cancer cases each year compared to 400 cases of liver cancer.

The report comes ahead of the consultation closing on how well new drinking guidelines proposed by the UK’s Chief Medical Officers in January 2016, are communicated.

These drew attention to the link between alcohol and cancer, and highlighted the need for greater public awareness of this risk.

The findings are based on a nationally representative online survey of 2,100 people conducted in July 2015.
The study also showed that only one in five people could correctly identify the previous recommended maximum number of units that should not be exceeded in a day, as recommended at that time in 2015.

Among drinkers, as few as one in 10 men (10.8 per cent) and one in seven women (15.2 per cent) correctly identified these recommended limits and used them to track their drinking habits.

Dr Penny Buykx, a senior research fellow at The University of Sheffield and lead-author of the report, said: “We’ve shown that public awareness of the increased cancer risk from drinking alcohol remains worryingly low.
“People link drinking and liver cancer, but most still don’t realise that cancers including breast cancer, mouth and throat cancers and bowel cancer are also linked with alcohol, and that risks for some cancers go up even by drinking a small amount.”

Alison Cox, Cancer Research UK’s director of cancer prevention, said: “The link between alcohol and cancer is now well established, and it’s not just heavy drinkers who are at risk. This is reflected in the new guidelines issued by the UK’s Chief Medical Officers that stated that the risk of developing a range of illnesses, including cancer, increased with any amount of alcohol you drink.

“As the consultation closes on how clear and understandable the new guidelines are, it’s concerning that so few people know that alcohol increases the risk of seven types of cancer. If the new guidelines are to make a difference and change drinking habits in the UK national health campaigns are needed to provide clear information about the health risks of drinking alcohol.”

Sir Ian Gilmore, Chair of the Alcohol Health Alliance, said: “The lack of public awareness of the link between alcohol consumption and cancer is extremely concerning. Up-to-date research demonstrates the clear link between alcohol and seven types of cancer, and it is not just heavy drinkers who are at risk – any amount increases the risk.

“The Chief Medical Officers have been clear in their new alcohol guideline that there is no level of drinking which can be considered ‘safe’ from these risks. As the CMOs emphasise, the public have a right to know about the link between alcohol and cancer and other health risks, so that they can make an informed choice about their drinking habits. The Chief Medical Officers are also clear in stating that the government has a responsibility to ensure this information is provided for citizens.

“Consumers have the right to know the health risks of the products they purchase and consume. The Alcohol Health Alliance is calling for health warnings on product labels, along with mass media information campaigns, both strongly supported by the public, to empower informed choice about drinking.”

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Malaria and health systems intervention research in The Gambia

by Julie Balen

Last week I visited my collaborators in The Gambia, a beautiful, small and friendly country known to many as “the smiling coast of West Africa”. We were recently awarded a Joint Global Health Trials research grant from the MRC, Wellcome Trust and DFID. The grant is supporting a malaria control research project, using a multidisciplinary approach that incorporates laboratory research, field epidemiology, social sciences, health systems and health economics.

Map of The Gambia

map of the gambia

In The Gambia, despite high coverage of standard malaria control interventions, such as indoor residual spraying (IRS) and use of long-lasting insecticidal nets (LLIN), transmission of malaria continues and is primarily maintained by carriers of asymptomatic infections (Sturrock et al, 2013a). In areas of low transmission – where prevalence of infection is ≤10% – previous studies have shown that asymptomatic carriers tend to be clustered around clinical malaria cases, within the same households (Sturrock et al, 2013b). This project is thus being implemented in the North Bank region where malaria prevalence is generally low – in 2012 average malaria prevalence as determined by molecular methods was 4.6%, ranging by village between 2.6% and 10.2%.

On route to the village

On route to the village

Our research is trialing a novel intervention that combines the passive detection of clinical malaria cases for identifying transmission hotspots and, subsequently, the systematic treatment of all individuals living around the case. This approach actively involves communities, in particular patients and their household members, and the health system.

Njaba Kunda Health Centre

Njaba Kunda health centre 1Njaba Kunda health centre 2

The purpose of the visit was to set up the trial, which will run in two stages: between June and December 2016 we will conduct formative research which will be used to assess the local response to the intervention and to identify potential constraints and enabling factors for successful implementation (Nichter et al. 2008). As such, the process of, and response to, the intervention will be evaluated, allowing us to optimize the intervention before fully implementing it in the second year of the study (June – December 2017).

A local shop

A local shop

The project draws on a range of collaborators from numerous institutions around the world, including the MRC Gambia, the London School of Hygiene and Tropical Medicine, UK, the Institute of Tropical Medicine, Antwerp, Belgium and the School of Health and Related Research (ScHARR) at The University of Sheffield, UK. It was a brief yet fruitful visit and all collaborators are looking forward to the exciting work that lies ahead. We hope to report on the results in due course.

If anyone is interested in collaborating with partners at MRC Gambia, please contact Julie on j.balen@sheffield.ac.uk

References

Nichter M, Acuin CS and Vargas A (2008) Introducing zinc in a diarrheal control program: guide to conducting formative research. Available at: http://whqlibdoc.who.int/publications/2008/9789241596473_eng.pdf Accessed 03/03/2016.

Sturrock HJ, Hsiang MS, Cohen JM, Smith DL, Greenhouse B, et al. (2013a) Targeting symptomatic malaria Infections: active surveillance in control and elimination. PLoS Med 10(6): e1001467. doi:10.1371/journal.pmed.1001467.

Sturrock HJW, Novotny JM, Kunene S, Dlamini S, Zulu Z, et al. (2013b) Reactive case detection for malaria elimination: real-life experience from an ongoing program in Swaziland. PLoS ONE 8(5): e63830. doi:10.1371/journal.pone.0063830.

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