Marvin Rees: Leading a city in turbulent times

Marvin Rees, the Mayor of Bristol, was recently invited to speak to our current MSc Public Policy students on the theme of ‘Leading a City in Turbulent Times’. In this blog, student Isabella Bennett summarises the key points from the lecture.

As the COVID-19 pandemic continues to tear through the globe, the mainstream media focuses on what international leaders are doing. It is very rare that city governance level is analysed in response to various crises thrown up. From this backdrop, Rees suggests that leading a city in turbulent times is just as important as centralised governance.

Turbulence

Rees highlighted that when we define turbulence, it is when it affects wealthy people. Certainly, issues that throw lives into turmoil are continuing to be swept under the rug, until the white, straight, middle-to-higher class man is impacted. For example, the COVID-19 pandemic heavily impacted trade and finance; thus, the news cycle was dominated with stories about the turmoil caused by COVID-19 on trade. In comparison, long term themes of racism, homelessness and domestic violence (key issues spanning generations) are not considered as key points of turbulence until direct attention is paid to them. However, the effects of these issues are felt across large sways of the public.

It is from this that city governance can aid individuals in overcoming turbulence in their lives. Centralised government is increasingly not equipped to deal with these challenges, as the policy cycle is constantly moving. Rees also draws on how an institution can look strong, and resistant to tension, but will crumble when turbulence is introduced. This was the case in the 2008 financial crash, as the previously strong financial market crumbled. Certainly, disinvestment in a service increases its fragility. Indeed, we all have seen that COVID has led to instability in the NHS, as we continue to stay home; and this is felt no stronger than at the local level.

Leadership

It is from these points of turbulence, that we look at city-level leadership. Leadership, Rees commented, takes two forms: short term — responding to immediate crisis, and long-term — building a city that is resilient to future shocks. Certainly, we have seen that the world has become increasingly globalised. Goods, services, ideas and workforces are able to move across the globe at a greater speed than ever before. It is because of this that city leadership is important both nationally, but also internationally. Too often, cities are discussed, but not given an equal footing in policy discussions, yet the policy impacts how the city functions and the lived experiences of its citizens. This was certainly the case during the pandemic, as sovereignty was seated in Westminster to make decisions on lockdown restrictions and tiers.  Rees states that leadership needs to go beyond boundaries as the nature of policymaking changes.

Future planning

In times of turbulence, it is understandable that trust is diminished. Thus, Rees made a point that being clear on values brings trust, and this trust becomes an important commodity when making plans. Certainly, a loss of trust comes from politics impacting how the people respond to systems. Rees directly mentions the impact the media has on this trust, as many people’s interaction with politics is through journalistic interpretation. Thus, a key aspect of planning comes from restoring trust from the public, through the media. Future plans, when leading a city do not have to be concrete, but it is important to be adaptable to changing contexts and respond to how this may change ideas for the future. Rees draws on the One City Plan for 2050, and how this has been changed due to the COVID-19 pandemic, and the stalls on industry due to lockdowns.

What can be taken from this?

From Rees’ points above, we can see that city leadership takes a back seat in the discussions on key points of turbulence in our lives. This is despite the citizens living in the city, and their lives being thrown into difficulty. As a result, city leadership must focus on supplying a clear message for the citizens, to instil trust for the future. Moreover, Rees calls for city leadership to play an increased role on the international stage, citing the examples of New York’s mental health policy and Helsinki’s functional city policy on how we can learn from city governance to deal with the long-term issues facing citizens. This is coupled with a lack of trust in centralised government over their handling of the COVID-19 pandemic.

Find out more about MSc Public Policy and BSc International Social and Public Policy at the University of Bristol.

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The importance of self-identification for trans older adults in the UK

Authors: Dr Paul Willis (Head of the Centre for Research in Health and Social Care, School for Policy Studies, University of Bristol), Dr Christine Dobbs and Dr Elizabeth Evans (Centre for Innovative Ageing, Swansea University).

Recently The Sunday Times broke news that the UK Government would scrap proposals for legal reform to allow trans citizens to self-identify their gender. A consultation on proposed changes to the Gender Recognition Act 2004 in England and Wales (first proposed in 2016) included whether individuals should be given the right to self-define their gender rather than having to prove this through the current medicalised measures embedded in the 2004 Act. A response from the UK Government to the consultation is yet to be released publicly, although the story in The Sunday Times suggests a step away from this proposed action.

Importance of inclusive and gender-affirming environments
Running alongside this proposed U-turn in policy direction have been intensely debated concerns about the ‘threat’ that trans people, namely trans women, represent to single sex spaces for women. This is not the first time that trans individuals have been misrepresented in media press as a threat to the rights of others. Within the title and text of the article published in The Sunday Times the increased recognition and rights for one group (trans citizens) is presented as oppositional to the rights of others (in this case women seeking safe spaces in women-only facilities).

It’s as though we can’t talk about the extension of rights for one group without compromising important safeguards for another. It also secludes the material reality that some trans individuals will require access to safe women-only spaces and services when experiencing abusive relationships. The two groups are not mutually exclusive.

This comes at a time when trans citizens in the UK more than ever need safe, supportive and gender-affirming services. Findings from a recent national survey of 100,000+ LGBT citizens highlight socio-economic disparities between cisgender (individuals whose gender matches the sex assigned to them at birth) and trans respondents. For example, trans respondents were more likely to have left education after secondary school and to earn less, and were less likely to have had a paid job in the 12 months prior to the survey.

The findings bring acute attention to the safety concerns of trans citizens: over two thirds of trans respondents stated they avoided being open about their gender out of concern for negative responses from others. They reported higher rates of verbal, physical and sexual harassment and violence than cisgender respondents. In parallel, hate crimes perpetrated against trans citizens increased by 32% in England and Wales between 2016-17 and 2017-18. This represents crimes that are reported to the police so is likely to be an underestimate.

Trans ageing and care in later life
Trans individuals in mid to later life will be no strangers to debates about the extension or erosion of equal rights and recognition for trans citizens in the UK. They have lived through multiple decades of change to equality and human rights law and social and healthcare policy and provision. Older trans adults are frequently invisible in public discussions about legal and social reform and healthcare provision for trans citizens, with much greater attention being given to the needs and interests of children and adolescents. Receiving good, inclusive healthcare will become more of a priority for many trans adults having to manage multiple health conditions in later life or to those providing care to significant others experiencing health-related changes.

Our recently published paper brings attention to the ageing-related concerns and expectations of trans and gender non-confirming individuals in mid to later life. We report key findings from a research study into the health and social care needs of older trans people in Wales, UK. The study culminated in the creation of practice guidance for healthcare professionals and social workers and the production of four short digital stories. These stories capture the ageing experiences of trans individuals living in Wales and were produced by trans filmmakers Fox and Owl from MyGenderation.

In our new article we highlight the key turning points trans individuals experience in mid to later life that trigger decision-making about seeking to transition socially and medically. A central theme is the notion of ‘trans time’ and the ways in which trans individuals experience the passage of time as non-linear. For some individuals later life has been experienced as a new life-chapter and return to young adulthood, partly stemming from gaining access to gender-affirming and supportive healthcare services.

For others later life was overshadowed by a sense of running out of time as they experienced frequent delays and hurdles in seeking to transition through medical means. This was often a result of systemic problems with the provision of gender-affirmative healthcare services by public bodies in England and Wales. We are happy to report that since we completed the study a new Welsh Gender Service for adults has been launched by NHS Wales. We hope this leads to a much-improved service for Welsh residents. However, there is still much more to be done.

Being able to change gender legally without having to rely on medical diagnosis and treatment would make older age a much more positive experience for many trans individuals seeking to transition in later life. Less time and energy would be spent on having to navigate through a complicated healthcare system; this is particularly important for older individuals who have ongoing concerns about their health and wellbeing and want to experience older age as a new lease of life and receive full recognition for who they are. Older age is too often understood through a biomedical lens of physical and mental decline and impairment – the biomedical lens of old age can eclipse recognition of older people’s social identities, life-experiences and life-history. Untangling medical intervention from gender transitioning and legal recognition would be a step closer to a more positive ageing experience for many trans individuals. Finally, not all people taking part in our study sought to transition through medical means, further highlighting the importance of separating legal recognition from medical requirements.

Self-identification, dignity and maintaining autonomy are important dimensions to positive ageing for older adults; the proposed law reforms would help extend this for older trans individuals.

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Email: paul.willis@bristol.ac.uk

The paper is available to read online as open access: Willis, P., Raithby, M., Dobbs, C., Evans, E., & Bishop, J. (2020). ‘I’m going to live my life for me’: Trans ageing, care, and older trans and gender non-conforming adults’ expectations of and concerns for later life. Ageing and Society, 1-22. DOI: https://doi.org/10.1017/S0144686X20000604

Visit the Trans Ageing & Care website to view the digital stories and other resources. The study was funded by the Dunhill Medical Trust, 2016-2019 (Grant no. R416/ 0515). A summary of the study can be read here.

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Lockdown lunches

Written by Dr Laura Johnson and Dr Zoi Toumpakari

Family life has been transformed by lockdown. Since schools closed on 23rd March many families have had to create classrooms at home and juggle home-schooling with home working. But what has happened to school food at home? Are packed lunches still the norm or are family meals now the dish of the day?

Campaigners like the Food Foundation (@Food_Foundation) have already identified the most vulnerable children and are working hard to ensure that free-school meals are maintained for 18% of families with children eligible. Under half of these families have been given vouchers to buy food, another third has had food prepared for collection or delivery by schools, so provision, to some extent, has continued. But worryingly a third have not had anything. Furthermore, out of necessity food provided is often highly processed to ensure it lasts for a week or more at a time, suggesting that compared with food served in canteens, where school food standards apply, food quality may have dropped. But what about the other 82% families? Are meals worse across the board? Or is it possible that for many children lockdown lunches are a healthier option than the norm?

According to a YouGov poll in April, over half of households haven’t noticed a change in what they eat, but 1 in 3 have reported cooking from scratch more often; 1 in 5 think their diets are healthier since lockdown but 2 in 5 think they are eating more. Straw polls of families we know have reported diverse reactions. Some are more aware of what their children eat, have more control, are providing more fruit or eating meals as a family. Others have been fending off relentless biscuit requests (not always successfully). For some kids it’s meant a switch from cooked school dinners to more packed lunch type fare at home. But is that a problem? What do we know about school food pre-COVID19?

A review of studies up to 2007 comparing the nutritional quality of packed lunches to school dinners found that more energy, sugar, saturated fat and salt was in packed lunches. Back then both school dinners and packed lunches were pretty poor. However, school food standards have been in place in England since 2006 to raise the nutritional quality of food provided by schools. Around the world, as in England, the introduction of school food standards have generally improved the quality of meals provided in schools. Although intakes of vegetables and nutrients like fibre and iron still need attention, fruit intake is up, fat intakes are lower (especially saturated fat) and less salt is being consumed from school canteens.

Improvements in school-meals is great news, a real win for public health, but now the gap in the quality between school dinners and food brought from home has widened and the spotlight is firmly on packed lunches as a key area for action. Food from home still makes up 40% of meals eaten in UK schools. Recent times have seen small changes in how often sweets and how much sugary drinks are packed in lunches, but protein is lower and vegetables remain sparse, at just half a portion a day. Multiple interventions aiming to change packed lunch quality have been tested but with little success to date.

Our work on the National Diet and Nutrition Survey has used the detailed reports of what teenagers ate over 4 days to identify the key differences between meals at home vs. school. We found that most eating (two thirds) happens at home, and only 1 in 8 meals are consumed at school. Nearly 3 out of 4 school eating occasions included foods high in fat and sugar, compared with 2 out of 3 meals at home. We found that when eating at school, foods high in fat and sugar were not only eaten more often but also in larger amounts. We estimated that teenagers ate an extra 59 calories of foods high in fat and sugar in school-based meals compared with a similar meal at home, the equivalent of half a bag of Wotsits.

The kinds of foods high in fat and sugar eaten at school are similar to those eaten at home, including crisps and savoury snacks, biscuits, sugary drinks, cakes and chocolate. But there were some key differences between eating at home and school. Predictably, eating at school occurred primarily at lunchtime (about 50% of all eating) but it was also common in the morning too (40% of eating). In contrast, meals at home happen throughout the day, with around 50% occurring after 5pm (i.e. dinner time). Eating at school is more often with friends whereas at home eating is as likely to be alone (33%) as it is with family (39%).

We also went to talk with teenagers directly about what they thought influences their eating. For most teens, food choices when away from home are a result of many different factors working together. But they told us that they enjoyed eating most when they were with their friends, one said “I tend to prefer to eat at school because I’m with my friends and it’s more sociable really than with my family.”. Social drivers are clearly important. Therefore, creating social school environments that enable and actively promote healthy choices could be an element of achieving positive change in school food future. An interesting challenge in our new socially-distant world.

Many schools are opening up more widely today, what might the lifting of lockdown mean for children’s diets? Some schools, to prevent spreading the coronavirus, have banned packed lunches. In other schools, ensuring a safe school food service is a concern so packed lunches are mandated. Social distancing may limit the kind of interactions kids used to enjoy about lunch times at school, will that affect what they eat now? Times are changing fast, new normals are being created and this may be an opportunity, in the longer-term, to reset the system for the better.

About the authors

Written by Dr Laura Johnson and Dr Zoi Toumpakari, Centre for Exercise, Nutrition and Health Sciences in the School for Policy Studies at the University of Bristol. Dr Johnson is a member of the GENIUS network, funded by the UK prevention research partnership, which aims to build a community of school staff, policymakers, food providers and researchers to generate fresh insights into the challenge of ensuring healthy food in schools and reducing inequalities. Follow us in twitter @GeniusSFN

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Combatting loneliness in a climate of self-isolation for older housing residents

By Paul Willis, Ailsa Cameron and Brian Beach.

In the current climate of self-isolation, keeping social and staying in touch with others is vital to our health and wellbeing. This is even more important in later life when people’s social networks may start to shrink in size.

Older adults can experience feelings of loneliness due to the loss of intimate connections, such as the death of a spouse or relationship separation, and the transitions associated with later life, such as retirement, the onset of chronic illness, or changes in living environments. We also know that social isolation (being separated from the company of and contact with others who are important to us) over a protracted period of time can trigger feelings of loneliness and have an adverse impact on older adults’ emotional and mental wellbeing.

The current government policy response requiring older housing residents aged 70+ to self-isolate during the COVID-19 pandemic can potentially exacerbate feelings of loneliness. Below are some key messages for those providing support to older residents in housing with care schemes [1]. These messages have been distilled from research projects led at the University of Bristol over the last four years on extra-care housing, loneliness in later life, and social inclusion in housing schemes for older adults.

1) Supporting residents to maintain daily contact with significant others, such as through telephone calls or online messaging, is essential. Many older residents in housing schemes will live alone in their homes. While living alone does not mean every resident will experience loneliness, residents may be missing regular face-to-face contact with family (e.g. adult children and grandchildren) and good friends within the same scheme and the wider community.

Housing staff need a good understanding of each resident’s social networks – who is important to them and who do they call on for practical and emotional support when needed. For example, we know from previous research that older LGBT+ people may regard friends as close family members and hold close friends in equal esteem as biological kin. Supporting residents to maintain the connections that matter to them is really important during this time of self-isolation.

2) We know that some older adults may equate loneliness with thoughts of being socially discarded, not having a purpose, and being no longer valued by others. Now more than ever, residents may value having a clear role they can play to contribute to the lives of others and the scheme where they live. While volunteering outside the scheme is not a viable option, residents could be supported to help other residents, such as keeping in daily telephone contact with those who lack social contact or experience illness or poor health. Other ways of contributing could be through gardening or maintenance activities around the scheme where tasks can be completed solo.

3) While some older residents may already use social media on a regular basis and be confident to extend their use into new media such as community-based WhatsApp or Facebook groups, we should remember that many will have no access to the internet and as a result may become more isolated over the coming weeks and months. For example, preliminary findings from our DICE project suggest that around a third of housing with care residents never use the internet, in contrast to over half using the internet at least once a week.

Our recent research into older men’s experiences of loneliness with Age UK highlighted how much older men who were single or living alone valued social connections with other people through groups, whether that be through clubs, societies, sports groups, or learning with others. While some men were online, it was routine, face-to-face contact outside of the home that was valued and helped keep loneliness at bay. Where feasible within public health guidelines, staff may explore ways in which residents within schemes can meet together each day for a short period of time while maintaining social distancing, for example in open courtyard spaces or gardens.

4) Our previous work with older people living in housing with care settings illustrates how the impact of austerity had already exacerbated older people’s experiences of isolation and loneliness because of a lack of public funding to support social engagement. For these older people, calls to self-isolate may reinforce their sense of isolation and marginalisation from wider society; regular resident contact with housing and care staff is critical more than ever.

In addition, as a result of the new Coronavirus Bill 2020, many local authority obligations bestowed under the Care Act 2014 (for example, in relation to assessing an individual’s needs, determining an individual’s eligibility for services, and care planning duties) have been suspended. As a result, care and support staff will need to be attentive to the additional care and wellbeing needs that residents may have, and housing with care providers may have to provide additional care and support to those older people in need without local authority involvement.

Concluding messages: Other groups have recently commented on the many problems of adopting blanket policy approaches based on chronological age (e.g. see the British Society of Gerontology’s recent statement). We echo these concerns about the ageist assumptions within this policy approach, while recognising that the mortality risk from COVID-19 is associated with age. More than ever, older adults need support to keep in regular social contact with others. If that must be in their homes, they will need assistance to access online technology to facilitate this, and it should not be assumed that digital resources and broadband access are automatically available to them. At the same time, maintaining face-to-face contact, at the recommended physical distance, is equally important and should not be underestimated or forgotten.

[1] By ‘housing with care’ we mean housing schemes that support older adults with independent living while providing care and support if needed, for example extra-care housing, sheltered housing and supported living schemes.


About the authors:

Paul Willis and Ailsa Cameron are Senior Lecturers at the University of Bristol and Senior Research Fellows of the NIHR School for Social Care, England. Brian Beach is a Senior Research Fellow at the International Longevity Centre UK. For more information contact: paul.willis@bristol.ac.uk

Related research:

The Provision of Social Care in Extra Care Housing, 2015-17, University of Bristol, funded by NIHR School for Social Care Research. More information: https://www.housinglin.org.uk/_assets/Resources/Housing/OtherOrganisation/ECHO-summary.pdf

Older Men at the Margins: Addressing older men’s experiences of loneliness and social isolation in later life, 2016-2019, University of Bristol with Age UK, funded by NIHR School for Social Care Research. More information: https://www.ageuk.org.uk/our-impact/policy-research/older-men-at-the-margins-how-men-combat-loneliness-in-later-life/

Promoting social inclusion in housing with care and support for older people in England and Wales (the DICE study), 2019-2021, University of Bristol with ILC-UK and Housing LIN, funded by the Economic and Social Research Council. More information: https://www.bristol.ac.uk/sps/research/projects/promoting-social-inclusion-in-housing-schemes/

Isolation: The emerging crisis for older men. A report published by the International Longevity Centre UK in 2014. https://ilcuk.org.uk/isolation-the-emerging-crisis-for-older-men/

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Secondary Trauma and Researchers

Drawing on new research based on the experiences of a research team working on a project exploring gender based violence, Dr Emma Williamson discusses the negative emotional impact that can arise for researchers working on traumatic issues, their coping mechanisms and calls on funders and Universities to look at positive ways to address this.

The Centre for Gender and Violence Research has been conducting research on gender based violence (gbv) for 30 years.  Over that time researchers have collectively interviewed hundreds of victims-survivors of different types of abuse: domestic violence (dv), sexual abuse, rape, FGM, (so-called) honor based violence, bride price, dowry related abuse, family violence, child abuse, and child exploitation. We have also read, and written, thousands of articles on this subject and analysed thousands of case files in social care, child protection, police, criminal justice, health, housing, welfare, and third sector support agencies.

We have learnt many things over the years and contributed to knowledge and understanding globally about gbv. We also know, first hand, the difficulties faced by researchers themselves when trying to work in this emotionally difficult and draining environment.

Many of us have worked in other sectors, as advocates or professionals. We have, in those arenas, had access to clinical supervision.  As researchers we routinely do not. This is in spite of the obvious impact that working in this field has. In response to these issues we recently published an article1 which looks at the impact of working in potentially traumatic areas on researchers. That article, in the Journal of Academic Ethics, looks at the wider context of secondary trauma; the impact on researchers in the gbv field; considers both individual and collective coping mechanisms; and makes recommendations for policy in this area.

The researchers highlight the different ways that interviews, case file analysis, and literature reviews on difficult topics can have a profound impact, as one researcher stated:

Reading through police case files could be just as depressing and upsetting in some of the worst cases and especially the cases involving child victims of rape and family abuse. The police files /child sex abuse cases were particularly hard because of the language and detail of information I was reading – very matter of fact descriptions of the physical sexual acts/ abuse (which I didn’t hear generally during the interviews with victims-survivors). There was also a time when I was collecting data on a DV case and there was a warning attached to the victim’s file which said *DEAD* so I had read all about her history of domestic violence, family abuse, drug and alcohol abuse and then found out that she had actually been found dead 2 weeks after the latest incident and her partner had [previously] been arrested on suspicion of her murder but no further action had been taken (when you could see the pattern of abuse she had suffered and was obviously extremely vulnerable) – that made me gasp out loud in the open plan (and quiet) office I was in (embarrassing) and made me incredibly sad. I cried on my drive home that day.

As well as many incidents of negative impacts of this work, the paper also highlights why researchers continue to work in these traumatic fields and the many healthy and unhealthy coping strategies they adopt when conducting fieldwork. These strategies included:

Definitely mindfulness, meditation, and running (not at the same time!). Spending time with family. Counting my blessings. Also wine, chocolate and binge TV watching.

One of the main conclusions of the paper is a call for funders and Universities to look at whether a form of academic clinical supervision should be automatically funded and made available to successful research projects dealing with traumatic issues. We believe that current provision is generally reactive, rather than proactive, and the minimal additional cost would allow researchers to make choices about whether the negative impacts of such research is sustainable for them, outside of the normal line management structure. With researchers struggling to fit their existing costs within the parameters of funding calls (particularly in some disciplines where funding is lower) we believe ring fenced additionally provided resource for clinical supervision also ensures that researchers who recognize this as an important issue are not penalized in the application process.

As such, we call on funders to address this issue.  At a time when health and well-being are clear objectives in research council priorities, it is surprising that this is not being discussed in terms of the research community already.

Having 30 years experience of working in this area, the Centre for Gender and Violence Research is well aware of the support researchers need to conduct this type of work, we call on others to join us to address this issue and look at positive ways to minimize the negative impacts of working in this area.  As one researcher said:

You think it would get easier over the years, but it doesn’t. The fact that we keep having to have these conversations is in itself depressing on top of the nature of the issues we are dealing with.

If we want to continue to develop researcher’s skills in difficult areas then addressing the ways in which traumatic research can negatively impact on them is, in our view, essential.

1Secondary Trauma: Emotional Safety in Sensitive Research in the Journal for Academic Ethics.
Williamson, E., Gregory, A., Abrahams, H. et al. J Acad Ethics (2020). https://doi.org/10.1007/s10805-019-09348-y

See also: Call to fund counselling for researchers in traumatic subjects in the THE.

 

CGVR 30th Anniversary
The Centre for Gender and Violence Research will be holding a day conference event and wine reception on 13th May 2020 to celebrate it’s 30 year anniversary. For more details please keep an eye on the School for Policy Studies event page.

 

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Baby box: child welfare experts say use of sleep boxes could potentially put infants’ lives at risk

Baby box: child welfare experts say use of sleep boxes could potentially put infants’ lives at risk

The baby box in Finland is embedded as part of the maternity system.
Kela

Debbie Watson, University of Bristol; Helen Ball, Durham University; Jim Reid, University of Huddersfield, and Pete Blair, University of Bristol

Having a baby can be expensive. So it’s maybe not surprising that many retailers around the world have cottoned on to the success of Finland’s baby boxes – a package aimed to set up new parents and their bundle of joy. The Finnish boxes include baby clothing, sleep items, hygiene products and a parenting guide –- as well as a “sleep space” for the baby.

Many retailers around the world are now offering similar boxes for expectant parents. Indeed, research conducted at the University of Tampere in Finland suggests there are variants in over 60 countries. This includes Scotland’s baby box scheme – with all newborn babies getting a free baby box from the Scottish government.

But as a group of child welfare experts, we believe imitations of the Finnish boxes could be placing babies at risk. This is because it has become common to believe that if babies sleep in these boxes, it will help protect them from sudden infant death syndrome (SIDS). Unfortunately, the research does not back this up.

Mother and fathers in Finland are given a baby box from the state that functions a bit like a starter kit. The box includes 64 items and is estimated to cost around €140 (£119). It comes as part of a wider maternity package in Finland, in which parents are also required to register for a health check before the fifth month of pregnancy.

They can opt for a cash alternative of €170 instead of the baby box, although most choose the box. The maternity package has been offered by the Finnish government for over 50 years, and initially arose as a response to poverty and high infant mortality rates.

The Finland baby box for 2019.
Kela

What’s the problem?

To some extent, retailers in other countries have tried to copy the Finnish model. In the UK, new parents can choose between paying for bigger baby boxes or a free box with some basic items if they engage in an online course. The course doesn’t have much professional oversight, however, and these boxes certainly don’t contain as much as the Finnish version.

But there is a danger that parents might view the boxes as a safe sleep space that will help reduce the risk of SIDS. This sort of belief appears to be based on the fact that the SIDS rate in Finland has fallen over the years – but this does not appear to be because of the boxes.

The same reduction has been found in neighbouring countries such as Norway and Sweden, where baby boxes are not used. The handful of observational SIDS studies conducted in Finland do not mention the box and largely attribute the lower mortality rates to “a reasonably high standard of living, good educational level of mothers, well organised primary maternal and child health services, and the rapid advances in obstetric and neonatal care equally available and regionalised”. All three Scandinavian countries have in place a well supported welfare system that looks after vulnerable families.

As far as we can see, there is no evidence to support a belief that the box can be used as a safe space to reduce infant death. There are also already safe sleep spaces for babies, with cots and Moses baskets that have a safety kite mark readily available.

And with baby boxes being sold by private companies – and public health messaging moving into private hands as a result, the risk is that the impact of government risk reduction campaigns that have saved thousands of young lives in recent decades are forgotten.

What new parents should do

All the evidence-based guidance that has emerged over recent decades delivers clear messages about safe sleeping practices, while also acknowledging that parenting practices can be culturally diverse – in many cultures, for example, co-sleeping is the norm until children are weaned.

The importance of robust evidence must be a key priority. This is why we believe governments and health providers should consider these factors before assuming that baby boxes are the solution to ongoing tragic unexplained deaths of infants.

Look for the kitemark when buying a sleeping space as it confirms that the British Standards Institution has tested a product and found it meets a particular standard.
Monkey Business Images/Shutterstock

Crucially, research is needed on the ways in which parents use existing baby boxes, in what circumstances and contexts they might be beneficial, and whether it is the box, or the programmes around them that benefits families.

As a response to this need, we are starting to work with vulnerable parental groups and health providers in Scotland, Finland, Zambia, Vietnam and Kenya to find out whether baby boxes or alternative devices that can be brought into the parental bed can improve infant safety and survival.

The hope is that our combined research should enable low cost, appropriate solutions to be designed with the people who will benefit – and to improve the health and wellbeing of infants and mothers.The Conversation

Debbie Watson, Professor In Child and Family Welfare, University of Bristol; Helen Ball, Professor of Anthropology and Director of the Parent-Infant Sleep Lab, Durham University; Jim Reid, Senior Lecturer, Department of Education and Community Studies, University of Huddersfield, and Pete Blair, Professor of Epidemiology and Statistics, University of Bristol

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

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