Tackling COVID-19: Dr Emma Williamson

Dr Emma Williamson

As part of the University of Bristol’s #BristolUniWomen campaign to mark International Women’s Day 2021, we’re spotlighting women from the School for Policy Studies who have been using their expertise to tackle the pandemic by carrying out world-class research. 

Dr Emma Williamson, a Reader in Gender Based Violence and former head of the Centre for Gender and Violence Research, has been working with Women’s Aid to highlight how the pandemic has affected those experiencing domestic violence.

 

 

Your research has focussed on the impact the Covid-19 pandemic has had on domestic abuse. Could you tell us a little more?

We were aware quite early on that any lockdown was likely to have an impact on those experiencing domestic abuse. So we worked quickly and closely with Women’s Aid to look at how they could collect data in order to influence policy. A report called ‘A Perfect Storm’ came out in the summer based on a number of surveys with support services, victims and survivors. We found there was an increase in coercive control, with perpetrators using the restrictions as a tool to stop victims from leaving or seeking help. Many people didn’t realise that domestic abuse was an exemption, so they were worried they would be arrested if they left. This, coupled with a stark increase in homicides during the first six weeks of lockdown, showed there was a major issue. Some of our data was used in a Panorama documentary and we were able to feedback these crucial insights to policy makers.

What have been the biggest challenges or triumphs for you during the pandemic?

The biggest triumph for me was when Boris Johnson announced the second national lockdown and explicitly said that domestic abuse was an exemption. That was amazing and so important. It felt like we’d come a long way from it not being mentioned or discussed, to it being said to the nation by the Prime Minister. That’s testament to the hard work of people in the sector, collecting data and ultimately presenting evidence to the government to show what’s happening on the ground.

What is it like being a woman in academia? Have there been times when you have either faced inequality or had to challenge it? 

There have definitely been times when I’ve been sat in a room as one of the most senior people and there’s been an automatic assumption that I am more junior. I tend not to get it in my day-to-day work thankfully. Because of my area of research, I work with a lot of really great senior women and professors.

I think a lot of female academics experience discrimination, especially those with children. Take lockdown: there’s a lot of evidence that suggests women have picked-up more of the caring responsibilities so I expect we’ll see fewer publications from women because their research activities have been put on the backburner. The gender pay gap is one example, but there are other inequalities in academia that the sector needs to deal with, particularly around ethnicity. Although I think we have come quite a long way, there’s still a long way to go.

Which women have inspired you in your career?  

When I was doing my PhD in the mid-1990s, I travelled to London two or three times a year to attend meetings of the British Sociological Association’s Violence Against Women Research Group. It allowed me to meet the women whose work I’d been reading – the big names in our field of research such as Marianne Hester, Liz Kelly, Betsy Stanko amongst others. I feel lucky that over the years I got to know them and ultimately work with them.

Our PhD students here at Bristol always inspire me. Many are from overseas and have chosen to come to Bristol because of the expertise in the Centre for Gender and Violence Research; they want to take what they’ve learnt here to bring about positive change in their home country. The risk to them as individuals can be quite high but they’re absolutely determined to make a difference. I enjoy learning from them and vice-versa!

And, ultimately, I’m inspired by the bravery and courage shown by every single one of the victims and survivors who I’ve ever spoken to as part of my research.

What advice would you give to your 13-year-old self? 

Not to worry about things you can’t change. When we’re younger, we spend a lot of time when we could spend that energy on other things. It’s easy to get frustrated by everyday things but sometimes you have to accept them and focus on the things that really matter, the things that you can change.

What are you most proud of? 

I’m proud of what myself and colleagues have achieved in the Centre for Gender and Violence Research. Domestic abuse can be a tough area to work in but we know our research makes a difference. The Centre was due to celebrate its 30th birthday in the first lockdown, which obviously didn’t happen, and I guess ultimately it would be nice if our work was no longer needed. But for every step forward, a new challenge presents itself and we need to keep listening to the voices of people who experience domestic abuse and try to make a difference to their lives.

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Tackling COVID-19: Dinithi Wijedasa

Dinithi Wijedasa

As part of the University of Bristol’s #BristolUniWomen campaign to mark International Women’s Day 2021, we’re spotlighting women from the School for Policy Studies who have been using their expertise to tackle the pandemic by carrying out world-class research.  

Dinithi WijedasaSenior Lecturer at the Children and Families Research Centre is surveying the mental health of children in State Care in England through the COVID-19 pandemic

 

 

 

1. Your research has focussed on the impact the Covid-19 pandemic on the mental health of children in care. Could you tell us a little more? 

Understanding whether COVID-19 has had a disproportionate effect on more vulnerable child populations, such as children in care, has been identified as a national-level priority by the SAGE committee.   

At any given time in England, there are nearly 80,000 children being looked after by the State (also referred to as children in care). Although high prevalence of mental illness in children in care is widely acknowledged as a serious concern, the current evidence base lacks understanding of long-term mental health trajectories and mental health service provision for children in care. Before the pandemic, we had already started two research studies funded by the ESRC and the Nuffield Foundation to answer these two questions.  

We were already planning to carry out a survey of children in care in 2020 for the ESRC funded study. This therefore provided a real-time opportunity to collect information on mental health and wellbeing of children in care during the Covid-19 pandemic. We were also able to collect information on other aspects of children’s lives, which have previously been associated with mental health such as the strength of their relationships with carers; their feelings about school; social work support; friends; access to green spaces; access to support; and their wishes and feelings. These are aspects in children’s lives that would have also been impacted by the pandemic.  We are currently analysing the data from the first wave of data collection where we had responses from 930 children in care from 18 local authorities. I am pleased that we also received further funding through the UKRI Covid-19 call to extend this survey to a longitudinal survey so that we can collect this information two more times to look at mental health of children in care over a period of 18 months.  

Our other research project, funded by the Nuffield Foundation, is a collaboration with colleagues at the Bristol Medical School where we are working towards creating a new national-level linkage between the national pupil data held by the Department for Education and national mental health service data held by the NHS. As mental health service data on children are collected monthly, we are hoping that a successful linkage will enable us to establish a new and relevant evidence base on the characteristics of children in care who are referred to mental health services, their prognosis and pathways through Child and Adolescent Mental Health Services (CAMHS), and the impact of the current COVID-19 pandemic on mental health of children in State care. We are currently working closely with the Department for Education and NHS-Digital to agree the way forward as we are using new legal gateways and data sharing processes to access and link national-level inter-Departmental datasets.  

 2. What have been the biggest challenges or triumphs for you during the pandemic? 

The biggest research challenge was having to adapt our methodologies to suit the restrictions that came about due to the pandemic.  

All research fieldwork was stopped by the University as well as Government Departments as we went into the first lockdown. This had a drastic impact on the research timelines. We had to pause recruitment for the survey on the ESRC funded project and pause all project activities on the data linkage project as the Governmental Departments that we are working with paused all research activities to prioritise the Covid-19 response. All of us in the research teams were also working alongside extra pressures brought on by the pandemic such as adapting to homeworking, home-schooling and illness within the team. It was also a steep learning curve for us all in digital engagement and communication 

 For me, it is a triumph that despite all these challenges, we have been able to support each other with empathy, kindness, and trust through 352 days of home working and teamworking (as you can see, I have not been counting!). Not having face to face meetings has not been a barrier to team working. It is a triumph that the University was able to switch swiftly and provide us the right digital platforms so that we can continue with our research activities. Despite the setbacks at the beginning of the pandemic, it is a triumph that we have achieved and celebrated research milestones such as receiving NHS ethics clearance for the data linkage project with no amendments and having 18 local authorities and 930 children and young people opt-in to our research! 

 It is a triumph that I am working with such hard-working colleagues who share the same vision as me to make real change with research. There is a huge responsibility placed on us to give timely and accurate information on this vulnerable group of children, which we hope to deliver throughout the next two years.  Although it is extra pressure on the teams to report continuously rather than publishing end of project reports, we believe that sharing timely research information is important. We are continually engaging with local authorities at grass-roots level as well as well as the Governmental Departments at policy level and we will directly feedback our results at policy and practice levels so that we can help enable positive change in the mental health management and  service provision for children in care.  

 

Links to the research studies: 

https://gtr.ukri.org/projects?ref=ES%2FR006482%2F1 

https://gtr.ukri.org/projects?ref=ES%2FV015699%2F1 

https://www.nuffieldfoundation.org/project/mental-health-service-provision-children-in-state-care-england 

 

 

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Tackling COVID-19: Angeliki Papadaki

Dr Angeliki Papadaki

As part of the University of Bristol’s #BristolUniWomen campaign to mark International Women’s Day 2021, we’re spotlighting women from the School for Policy Studies who have been using their expertise to tackle the pandemic by carrying out world-class research.  

Dr Angeliki PapadakiSenior Lecturer in Nutrition, has been Exploring the experiences of community service providers delivering meals to self-isolating adults during COVID-19

 

 

1. Your research has focussed on the impact the Covid-19 pandemic has had on the Meals on Wheels service. Could you tell us a little more? 

 At the beginning of the first national lockdown, around 1.5 million people were instructed to shield and around 17.7 million adults aged ≥65 years, who were also at increased risk of infection, were instructed to stay at home as much as possible. Many of these people might not have had support from carers and community resources and/or enough money to be able to access food, nor the ability to prepare meals for themselves. So we realised early on the impact that the pandemic and this lockdown would have on these people accessing nutritious meals. But we also realised that this increased demand for meals will have an impact on Meals on Wheels services (local authority services delivering meals to older, vulnerable and housebound individuals). So we worked closely with different partners to explore this important issue.   

We just submitted evidence to an inquiry by the Public Accounts Committee on ‘COVID-19: Supporting the vulnerable during lockdown’, on why Meals on Wheels should be supported by the Government to ensure the wellbeing of older, vulnerable, and self-isolating adults during lockdown. This was based on our qualitative research findings with service providers (drivers who deliver the meals, service coordinators and managers) in two local authorities in South West England. We found that Meals on Wheels exert important benefits to clients (by conducting welfare checks, encouraging independence and identifying and addressing isolation and loneliness), service providers (via a sense of pride, giving something back and developing reciprocal relationships with clients), but also the wider community (by reducing pressures on carers and the need for residential care). The pandemic brought many challenges, such as an increase in service users, concerns with sourcing food, increased demand on human resources, and uncertainty about how the service will cope in continuous lockdowns.  Although the service went above and beyond to continue supporting the most vulnerable, time to interact with clients decreased and there were concerns about clients’ wellbeing because of this. I specifically remember a driver sharing that for some clients of the service, he is the only person they see on any given day. So the importance of the service was even more profound during the national lockdown.  

As Meals on Wheels have been facing funding cuts and closures both globally and nationally, these findings are extremely important and provide crucial insights to policy makers for the need to protect, enhance and financially support the continuation of the service, in order to protect the most vulnerable during national lockdowns, and beyond.   

 2. What have been the biggest challenges or triumphs for you during the pandemic?  

 During the first few weeks of the first national lockdown, and while we were all adapting to the new restrictions and working from home, I was trying to think of how I can use my skills and research experience to make a difference to people’s lives. I met with a colleague and after a long discussion, he casually suggested I do some reading on Meals on Wheels and establish what the evidence is in this field. I blocked my calendar for two days, read and researched. Within two weeks, we had together a team of four University of Bristol academics, a research associate, two local authorities who agreed to support the project, one national charity to help disseminate the findings, two collaborators from Brown University with expertise in the field and direct links to Meals on Wheels America, a grant application to the Elizabeth Blackwell Institute and noted ideas for future research on this important service. I consider it a triumph that we all met under challenging circumstances but discovered we have a common vision and developed this important piece of research to help the most vulnerable.  

3. What is it like being a woman in academia? Have there been times when you have either faced inequality or had to challenge it? 

I have often felt that being a woman, and a non-British woman, can be a challenge. In the past, I have had colleagues talk sarcastically about my ideas in public and in front of me. I also find that more males than females ‘are in love with their own voice’ and barely leave time for you to speak during meetings. You have to learn how to be thick-skinned! Although these are challenging situations to be in, I have learnt to overcome it by acknowledging my weaknesses, but also reminding myself of what I’m worth. Nobody is perfect, but we all have our unique skills, strengths and personalities that are valuable in academia. We all need to remember this more often.  

4. Which women have inspired you in your career?  

I think the first woman who inspired me was my PhD supervisor, who was the most supportive but in her own way inspired my confidence, showing initiative and taking ownership of a project. I cannot pay this forward enough!  

A more recent female colleague, and her saying ‘you have two eyes, two ears, and one mouth; use them in this proportion’; showing me that keeping silent and digesting information before you speak does not indicate weakness as many think, but indeed the opposite.  

All my official and ‘unofficial’ mentors throughout the years, whose advice helped me look deep into myself, reflect on my strengths and weaknesses, speak out when necessary, and realise that we all have something valuable to offer. 

 5. What advice would you give to your 13-year-old self? 

To be patient. To keep eyes and ears open as opportunities might arise from literally everywhere. To listen to your gut feeling. That’s it’s fine to not know where you want to go just yet, and that following the flow can also lead you to great things.  

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Tackling COVID-19: Karen West

Karen West

As part of the University of Bristol’s #BristolUniWomen campaign to mark International Women’s Day 2021, we’re spotlighting women from the School for Policy Studies who have been using their expertise to tackle the pandemic by carrying out world-class research.  

Karen West, Professor of Social Policy and Ageing, has been looking at the impact the Covid-19 pandemic on bereavement in retirement communities.

 

 

 

1. Your research has focussed on the impact the Covid-19 pandemic on bereavement in retirement communities. Could you tell us a little more? 

We have been working with the ExtraCare Charitable Trust and Cruse Bereavement Care for three years now on a project that is about developing a volunteer peer bereavement support programme and general ‘grief literacy’ for staff and residents in the retirement villages run by the Trust.  When the pandemic came, we weren’t able to continue the face to face field work that we had planned.  On the other hand, Covid presented us with an opportunity to try out some different methods of data collection and we applied for funding from the Elizabeth Blackwell Institute to collect diaries of the experience of supporting people through bereavement.  This turned out to be a great method for gaining the kind of real-time insight into the work and thoughts of the volunteers that we hadn’t really been able to capture before. We learned a lot about the challenges that people are facing when they have limited connection to the support of families and friends and when funerals and memorial events are very restricted.  On the other hand, we also learned that for many who are grieving, lockdown brings a kind of relief at not having to put on a smile and a brave face every day and to be able to manage sorrow at their own pace.  We also learned how the residents had been really creative in organising their own social-distanced memorial events.

2. What have been the biggest challenges or triumphs for you during the pandemic? 

The biggest challenge has been that of all researchers who do ethnographic field work – not being able to face to face field work. On the other hand, we’ve learned to be creative  in developing other methods.  This is also true of another Covid project on collaborative housing (funded by NIHR SSCR) that I have worked on.  Above all,  I feel so lucky to have been able to work with excellent teams of researchers.  Our regular Zoom meetings have really given a shape and purpose to my working week that I may not have had otherwise.  Oddly, I think my working with relationships with these colleagues has strengthened during the pandemic.

You can read about the projects here:

https://www.cruse.org.uk/sites/default/files/default_images/pdf/Documents-and-fact-sheets/J0339%20Cruse_Lockdown_Diaries.pdf

https://www.housinglin.org.uk/_assets/Resources/Housing/Support_materials/Viewpoints/HLINViewpoint_104_CollaborativeHousingPandemic.pdf

 

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Social Policy PhD topic explored – Menstruation stigma

Kate is a School for Policy Studies student, currently studying a PhD in Social Policy.

In this blog she argues that menstrual stigma is the major stumbling block to achieving menstrual equity. She also examines policies and attitudes towards periods. 

Menstrual stigma and menstrual equity

Period products are now freely available in state-schools, Relationships and Sex Education has been revamped and the government has established a Period Poverty Taskforce. These developments are worth celebrating. However, more needs to be done to dismantle menstrual stigma.

What’s the problem?

Menstrual stigma involves periods being considered shameful. Period taboo is widespread:

  • Plan International UK’s 2017 survey with a representative sample of 1,000 14-21 year old UK girls found that:
    • 48% of girls were embarrassed by their periods
    • 64% of girls had missed a PE or sport lessons because of their period, of which 52% had made up a lie or excuse
  • Menstrual stigma can also be problematic for trans and non-binary people who feel that they must keep menstruation secret.
Photo by Josefin on Unsplash

Policy

The government has introduced policies to improve access to products and education about periods. These are steps in the right direction. However, these policies will not end menstrual stigma.

All state-schools can now request free period products using an online portal. This momentous policy development means that products are accessible to young people who cannot otherwise afford them.

However, the policy has faced implementation issues and these appear to be, at least partly, explained by menstrual stigma. The scheme continued during lockdown, but Plan International UK’s survey with a representative sample of more than 1,000 14-21-year-old girls found that during this time:

  • 30% of girls had issues accessing products during lockdown
  • 42% of these girls did not know where to get hold of free products
  • 30% felt too ashamed to seek out a source of free products

Furthermore, the BBC report that only 40% of eligible schools are signed up to the scheme. If young people are too ashamed to ask their schools for support and the government is not tackling taboos and promoting free products, the opt-in scheme will struggle.

From this year, Relationships, Sex and Health Education (RSE) is compulsory in all schools. Statutory guidance for teaching RSE has also been updated for the first time since 2000 and states that young people should learn about “menstrual wellbeing” and that schools should help girls manage periods.

The government has also released additional non-compulsory RSE teacher training and advice, which includes information about periods. However, neither the statutory guidance nor training mention tackling stigma.

Furthermore, the DfE’s bizarre advice that schools should not use resources produced by organisations that take “extreme political stances” such as anti-capitalism may undermine effective RSE and menstruation education. This advice is non-compulsory and it is unclear whether schools ever use anti-capitalist RSE resources. However, as Shout Out UK highlight, it is unclear how “schools are to facilitate a sufficiently diverse dialogue” on RSE topics (e.g. gender, periods and taboo) “without limiting themselves unnecessarily for fear that the resources they wish to use could be interpreted as being in breach of the guidelines.”

Advertisements

Advertisers’ portrayals of menstruation appear to be shifting. As Camilla Mørk Røstvik points out, many contemporary period product advertisements are designed to appeal to modern consumers who care about social justice. For instance, THINX were the first menstrual product company to feature a trans man in an advertisement.

It is encouraging to see companies taking these steps, but it would be naïve to ignore conflicts of interest. Companies aim to make sales and still promote products that hide periods. It therefore seems unlikely that advertisements alone can end menstrual stigma.

Steps forward

Critiquing menstrual stigma should be part of the every day. Policy makers should work with education practitioners and young people to capitalise on the opportunities presented by compulsory RSE and free period products. Menstrual stigma is a widespread, damaging problem that needs to be solved.

Kate’s PhD topic focuses on menstruation stigma, discourses in advertising and Relationships and Sex Education.

For more information on our PhD in Social Policy click here.

 

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A graduate’s perspective: Top tips for thriving in your postgraduate studies

We caught up with Lucy Bull; recent MSc Nutrition, Physical Activity and Public Health graduate to get some top tips on how to get the most out of your postgraduate study…

Hello there, would you mind telling me a little bit about yourself?

“I’m Lucy, I’m a 40-year-old mum of three children and I NEVER thought I could do an MSc! I run a nursing home in Devon with my mum but wanted to build my own expertise to support my work. The umbrella of Nutrition, Physical Activity and Public Health seemed to be a good fit, serving as a platform for future specialism. It seemed like a good course that would fit alongside the expertise of our nurses in the home.

Why did you choose University of Bristol, for your studies?

“My background is the arts; I worked for the BBC for many years. This MSc meant I could commute from Devon, retrain my artsy brain into a science one and gain expertise. My love of Bristol now encompasses a deep loyalty to the University of Bristol, for its amazing facilities, sublime course content and world class teaching staff.”

Talk about a project/initiative you’ve got involved in whilst studying here?

“My dissertation dovetailed my media experience with my newfound scientific thinking, as I analysed the media coverage of recent physical activity guidelines. I discovered that there is a real lack of confidence in media skills within academia. Because this MSc is so good at developing research skills and scientific writing, I now feel more competent at searching out niche areas of research.

How has completing your MSc helped with your career or further education?

My knowledge base is much stronger, and I can research key topics exceptionally quickly. This has been crucial during Covid to pull together evidence-based guidance for the nursing home. I can speak more authoritatively to the team and they have confidence that I know what I am talking about!

And finally, do you have any advice or tips for people who are thinking about undertaking a Masters, or continuing their education?

“Yes! I wrote a twitter thread about it. I felt a bit at sea when I started and wanted to help others feel less lost.

 

  1. Try and find your people, whether you are learning online or in person. Reach out, through whatsapp or uni email; most will be happy to hear from a friendly soul. Be kind to the silent ones.

2. Find your lecturers on Twitter, learn who they follow and why. #academictwitter is a fascinating, useful rabbit hole.

3. If you like a lecture, tell the lecturer. You never know when your paths may cross in the future.

4. There are NO stupid questions. Every answer helps someone. 

5. Embrace statistics and if you don’t understand a stat, don’t use it. Push your limits of statistical comprehension. Chances are you’ll understand more than you thought.

6. Get to know your librarian, use their knowledge. Learn Endnote or Mendeley and their capacity to help your referencing. Choose one and learn it. 

7. Get to grips with the Assignment template in Word and how to use it. Do it sooner than later.

8. If you’re new to scientific writing, don’t be scared. There’s a wealth of resources at your fingertips. University of Bristol Study Skills run some incredible courses. Use your personal tutor and always ask for feedback after assignments.

9. You’re about to step into a world of fascinating study led by world experts in their field. Use their intellect, ask questions, don’t let imposter syndrome silence you! Your teachers are clever, brilliant people but above all they are kind and they want you to flourish. This is your springboard, to new friends, jobs and opportunities.

Thank you Lucy for your wise words! I’m sure this will help maybe new students navigate their way through postgraduate life.

If you are interested in studying a postgraduate degree with us, join us at our Virtual Postgraduate Open Weeks in November.

Click here for more information on MSc Nutrition, Physical Activity and Public Health.

To follow Lucy on twitter click here.

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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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The impact of COVID-19 on sex workers

Dr Natasha Mulvihill, lecturer in Criminology at the School for Policy Studies and member of the Centre for Gender and Violence Research has published work on prostitution and sex work, domestic abuse, honour abuse and sexual exploitation. In this blog she talks about impact of COVID:19 on sex workers. 

Sex workers, like the majority of society, have suffered from the effects of austerity – and COVID-19 has left them even more exposed. Dr Natasha Mulvihill, argues that legal and welfare reform are needed to enable choice and reduce harm.

In 2019, I co-authored a Home Office-commissioned report with colleagues at the University of Bristol on the nature and prevalence of prostitution and sex work in England and Wales. As part of that research, we heard from over 500 individuals involved in selling sex, and followed up with more than 40 within that group to learn more about their experiences. Since the COVID-19 pandemic and lockdown, I have been thinking about our participants in that research and how they are managing.

demo
A 2009 demo in support of sex workers’ rights in London. Photo: Hannah Nicklin via a CC-BY-NC-SA 2.0 licence

The challenges facing those who sell sex both in the UK and around the world during the pandemic have been articulated in academic journals, by organisations working with and representing sex workers (including NUM, ECP, Changing Lives, Beyond the Streets, SWARM and One25) and on news and social media. Of course, many of those selling sex are unaffiliated to any group or support organisation: they work alone in privacy or remain outside the public and media gaze, through choice or otherwise.

There is stark commonality, but also diversity across the sex industry. Most are working in-person, providing sexual services, including full sex either at home, outdoors or in another venue such as a brothel, parlour or hotel; others are working through phonelines or online, webcamming or making clips to order, for example. Given the lockdown, there has been some movement to online, but many will have continued to work in-person. Most sellers are women, including trans women. There are also a significant number of male sex workers, as well as those who identify with other genders or none.

Some are successful entrepreneurs, running their own websites, operating from dedicated premises, registered as self-employed and paying tax. A proportion of these may therefore have met the criteria to apply for the UK Self-Employment Income Support Scheme set up in response to the lockdown. However, the Home Office research suggested that the majority of those selling sex are either doing so temporarily, intermittently or long term to make ends meet, including as a supplement to other paid work. Many are caring (often solo) for others, including children, partners or parents; some are managing long-term physical illness or mental health issues; many are migrants, some with insecure status; some are students; some involved are victims of partner abuse, or are misusing drugs or alcohol. Some may register their earnings formally; most will not. I would term this majority as ‘sex workers’ or ‘individuals engaged in survival sex’ (see Mulvihill, 2019), and it these groups that are the focus of this commentary. There are also a significant number of mainly women and girls who are coerced into, and abused by others through, ‘prostitution’ – which, while recognising the overlap and movement between categories, I would rather term ‘sexual exploitation’.
The COVID-19 crisis has brought into sharp focus two issues for those engaged in sex work and survival sex in the UK: the inadequacy of the legal environment, and the inadequacy of the welfare safety net and public provision.

In England and Wales, it is legal to sell and to buy sex. However, myriad activities around the sale of sex are illegal, such as pimping, kerb-crawling, soliciting on the street or working with one or more other people from a premises, as this constitutes a ‘brothel’. These laws have been layered piecemeal over decades and are unevenly enforced, more so given tightening police resources. They are ostensibly aimed at preventing exploitation, but stem as much from a concern to keep such activity out of public view.

Whether you understand selling sex as a job like any other or as an outcome of patriarchy and other inequalities – or both – most can agree that sex workers should not be criminalised. Governments should seek to allow sellers to work together in a small-scale and self-managed way. Such brothels already exist up and down the country, but sex workers risk inconsistent policing, depending on where they are located. The illegal status of brothels places barriers to reporting violence or other crimes against sellers. Those selling sex on the street should not be criminalised. Equally, the concerns of communities in relation to both indoor and outdoor sex work need to be recognised and negotiated. Rather than seeking to manage outdoor sellers, far more resource should be invested in tackling the drivers for street sex, which are well documented (see for example, Matthews et al., 2014; Sanders, 2007).

The legal status of sex workers links to the second issue of access to welfare and collective provision. The UK, like other liberalising economies, has seen a steady erosion of the welfare safety net. The threshold for eligibility is ever higher and the benefit received ever lower. State dependence is stigmatised and personal responsibility prized (though inheritances and other financial support from one’s family are encouraged). Sex workers, like the majority of society, are vulnerable. Not vulnerable in the sense of helpless or lacking resourcefulness, ability or graft, but rather vulnerable through exposure to changing individual circumstances and unforgiving welfare and legal contexts. Many of us can face this sudden exposure when we find ourselves caring for others, made unemployed, discriminated against, migrate or become ill. Surveys in the US and UK suggest that at least a third of millennials, for example, have no savings put by; and another third would only have three months pay if their income stopped. So a safety net, whether that is short or longer term, is crucial both to uphold human dignity but also to avoid the future multiplier costs to the state of economic and social exclusion.

Yet austerity and the difficulties in accessing Universal Credit have pushed many into exchanging sex for money. How ironic that now the COVID-19 crisis is affecting mainstream workers, the government has adopted a ‘pay now, verify later’ approach to Universal Credit – and that borrowing, minimised for a decade in favour of austerity, has reached unprecedented levels in order to stave off a depression. Had we prioritised spending after the 2008 financial crisis to invest in a fairer safety net and more robust public provision, we might have been better equipped to meet the challenge of the pandemic.

Around the world, those who sell sex (including those who add significantly to national income through the tourism and leisure industries) have found that they either have no access to government income support (France, Thailand, Japan or Kenya) or minimal access (Brazil or Mexico). In New Zealand, by contrast, where sex work is decriminalised, applying for help has been more straightforward.

The pandemic has temporarily allowed us to see alternatives to the current order. It is possible to hold quite divergent views on prostitution and sex work, yet at the same time agree that punitive criminal justice or welfare measures appear only to harm those who sell sex – indeed, harm all those exposed by social inequity or a change in circumstances. By lifting those selling sex out of social, economic and legal grey zones and giving them the resources to stand in equality with others, they can determine their own futures.

This article represents the views of the author and was first published on 8 June 2020 in LSE COVID-19 Social Policy, a blog by the London School of Economics and Political Science.

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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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