Tag: research

Poverty in paradise

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Shailen Nandy, Research Fellow in the Centre for the Study of Poverty and Social Justice at  the School for Policy Studies discusses poverty in the PacifShailenic Islands

“I wish I could tell you about the South Pacific. The way it actually was. The endless ocean. The infinite specks of coral we called islands. Coconut palms nodding gracefully toward the ocean. Reefs upon which waves broke into spray, and inner lagoons, lovely beyond description. I wish I could tell you about the sweating jungle, the full moon rising behind the volcanoes” (Tales of the South Pacific by James A. Michener)

What images come to mind when you think of the islands of the Pacific? Sun-kissed beaches, turquoise seas, balmy climes? Amazing rugby players? How about poverty? No? Well, you might be surprised.  Poverty, however it is measured, is a very real problem among the Pacific Islands, Countries and Territories (PICTS).  It has also been frequently overlooked.  Data from Oxfam New Zealand spells out in grim detail just how bad things are.  Around one third of the region’s population, about 2.7 million people, lack sufficient income to meet their basic human needs. Rates of child and maternal mortality are high, and large proportions of the region’s children either never enter school or do not complete primary education.  Adult literacy is low, at only 65% in the Solomon Islands.  Basic service and housing provision is poor, with 15% of the population of Papua New Guinea (around 120,000 people) living in informal urban squatter settlements.  These overcrowded households lack access to improved sources of water and forms of sanitation, and are subjected to the spread and effects of debilitating and deadly diseases, which drive child malnutrition and mortality.  These, and other, conditions contribute to a climate with high levels of gender violence, with over half of women in Samoa and the Solomon Islands reporting experiencing physical and/or sexual violence.  Paradise for many maybe, but certainly not for all.

The United Nations identifies 57 countries as Small Island Developing States (SIDS).  Located around the world, they share similar development challenges, including having small populations, limited resources, vulnerability to natural disasters and climate change, and being geographically remote.

The lack of attention and research on poverty in SIDS, like the PICTS, has impeded some governments from developing the strong and effective anti-poverty policies that are needed.  Conventional monetary poverty assessments cannot give a true picture of the extent of the problem, especially in countries where people may use bartering or reciprocal exchange instead of cash purchasing, and where families live together in extended households, pooling and sharing material and social resources.  In addition, in some PICTS, many households receive remittances in cash and as durable goods from relatives living and working abroad and these can be very difficult to measure accurately.  In such instances, assessing poverty needs a more sophisticated approach, with less reliance placed on traditional measures like an individual’s or household’s income.

Bristol’s Townsend Centre for International Poverty Research has an international reputation for poverty research, analysis and anti-poverty policy development.  Members of the Centre have advised governments, the United Nations and many international organisations around the world on how best to identify, assess and ameliorate poverty.  Recently its work, through the ERSC-funded Poverty and Social Exclusion in the United Kingdom project, informed the public, national media, and policy makers about the true extent of poverty in the UK at the height of the recession.  What made the project so important were its use of methods and techniques which are recognised as being State of the Art for poverty research.  The project used the Consensual Approach, which has been developed over 30 years.  It takes into consideration the opinions of the general public about what items and activities they consider to be necessary for an acceptable standard of living, from which no one should be excluded due to a lack of resources.  Importantly the approach introduces a democratic element into the definition and measurement of poverty enabling populations, rather than just academics or politicians, to determine what constitutes poverty and thus how it should be tackled.  The approach is increasingly being used in a growing number of countries, including many in the European Union, South Africa, Australia, Hong Kong, Japan and even low income African countries, like Benin.  Bristol researchers have been involved with most of these studies, and there are now plans to expand use of the method more widely, across the twenty-two Pacific Islands Countries and Territories (PICTS).

In November 2014, Bristol PhD student Viliami Konifelenisi Fifita demonstrated to representatives of regional statistical offices the potential of the Consensual Approach for assessing poverty in the PICTs.  This trip was funded by a travel grant from the Alumni Foundation and the School for Policy Studies.  He showed how, as part of his PhD looking at poverty in Tonga, the method was well suited for use in a Pacific Islands context.  As Government Statistician for the Kingdom of Tonga, Viliami developed a survey module for Tonga’s national Demographic and Health Survey, which he is using to make the first scientific assessments of poverty in Tonga.  His presentation so impressed delegates, that by the end of the meeting a draft module had been drawn up and was being considered for inclusion in other national surveys.  At least four PICTS will run surveys containing the module in 2015, with other countries set to follow in 2016 and 2017.  The data generated will change, and improve, the measurement of poverty in the region, providing researchers and policy makers with new data with which to develop better anti-poverty policies.

Viliami’s efforts to enthuse his colleagues to adopt and apply the Consensual Approach, has begun a process of collaboration between Bristol academics and PICTs statisticians and governments.  One aspect of the SIDS – their small size and close-knit communities – holds considerable potential for policy development and implementation, in that policy changes can be made relatively swiftly, with benefits and improvements to people’s lives following quickly.  Of particular interest in the region is the fact that the Consensual Approach captures important non-monetary aspects of poverty, which until recently have not formed part of regional poverty assessments.  In March 2015 Viliami travelled to the Solomon Islands, to begin training survey enumerators in the method.  Funding for this important work was provided at very short notice by an ESRC Impact Travel Award, the Centre for the Study of Poverty and Social Justice, and the School for Policy Studies.  The use and application of methods and techniques developed at Bristol, and provision of training and assistance to PICTS statistical offices and governments by Bristol researchers will, in the years to come, make a meaningful impact to the lives of people living across the entire Pacific region.

 

 

 

Mayors at a gallop: the national influence of local leaders

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In collaboration with the Institute for Government and the University of the West of England, researchers at the School for Policy Studies hosted a debate featuring the directly elected mayors of Bristol and Leicester. Tom Gash, from the Institute gives his thoughts on the debate in a post that was first published on the Institute’s blog.  Tom Gash-136

Elected in 2011 and 2012 respectively, George Ferguson (Bristol) and Sir Peter Soulsby (Leicester) have been working hard to show what mayors can do for our cities. At a recent event hosted at the Institute for Government, Tom Gash heard them raise two questions that any government after May 2015 will have to answer. Should we have more mayors? And should they have more powers?

Elected mayors were first established in England following the election of the Mayor of London in 2000. Later that year the Local Government Act paved the way for votes to set up mayors in a number of other local authorities. Eleven more mayors had been introduced by 2002. The Coalition gave the model another push in 2010 but voters in nine English cities rejected the idea in another series of referendums in 2012. There were yes votes in Bristol and Salford, however, and Leicester and Liverpool have adopted the model. Ferguson was elected as an independent for the job in Bristol. Soulsby got the job in Leicester after giving up his seat as Labour MP for Leicester South.

Sir Peter Soulsby and George Ferguson

George Ferguson and Sir Peter Soulsby speaking at the event

At the event Ferguson and Soulsby were persuasive, passionate advocates for the extra power mayors can wield. Soulsby described the extra influence he’d acquired since stepping down as an MP. “I haven’t missed the life in Westminster,” he said. “Now I’ve got a proper job.” Ferguson spoke with infectious energy about his passion for raising Bristol’s profile and attracting investment.

Both have gained national recognition since taking on the mayoral role. Ferguson’s trade-mark red trousers are recognised well beyond Bristol’s boundaries, and he has quickly gained a national profile that no council leader in the city has previously enjoyed. Soulsby may not have the red trousers, but that didn’t stop him being accosted on his way to the event by a man wanting to thank him for his work in the city. “I was council leader for 17 years,” he said, and “no one said that”. They didn’t in his six years as MP, either.

Of course, there are plenty of people who are less complimentary, but there is no doubt that mayors enjoy greater public recognition than council leaders. According to Dr David Sweeting of the University of Bristol and Professor Robin Hambleton of the University of the West of England, who are conducting research on the impact of the mayoral model, polls show that the proportion of Bristol residents who say that the city has visible leadership has grown from 24% to 69% since Ferguson took charge.

For Soulsby, the key difference between mayors and council leaders lies in their accountability. He outlined how council leaders were elected. “You don’t win it on the doorstep; you don’t win it on the pages of the Leicester Mercury… you win it by getting the support of your fellow councillors,” he said. He then held up a copy of a local newspaper. Its headline, referring to recent gridlock on the city’s roads, asked ‘who’s to blame?’ The question was a direct challenge to Soulsby, the mayor, to find out who should be held to account. Soulsby said that this accountability to the public had led to greater ambition. There had been, he said, a “whole load of risks I am able to take that I wasn’t able to take as a council leader”.

Ferguson pointed to the ability of mayors to act as a figurehead to attract investment. “You don’t invest in people you don’t know…we don’t have very good football teams [in Bristol] so we have to do it another way,” he said. And Soulsby said he enjoys far better access to secretaries of state than he had as an MP. As mayor he can also convene local public service leaders to sort out problems requiring co-ordination. Certainly, the two mayors’ belief in the power of the model chimes with previous Institute for Government research.

But it’s clear that not everyone is enamoured with the model. Ferguson, as an independent mayor, has had to overcome considerable resistance to the model from councillors who resent a perceived reduction in their powers – or in some cases simply dislike his policies. Much opposition has been “very civilised”, he said, but some “unbelievably vicious”. Soulsby spoke of his difficult relationship with Leicestershire’s Conservative Police and Crime Commissioner, Sir Clive Loader. In response to questions, Ferguson reflected openly on some early mistakes in his stance towards councillors – in particular, referring to scrutiny by councillors as a “medieval process”.

However, he now feels he has built stronger, more collaborative relationships. Ferguson’s Cabinet of five councillors comes from four different parties, and Ferguson said he “couldn’t do the job without them”. He is also looking into how he can empower councillors in the city’s 14 neighbourhood partnerships. Soulsby claimed that scrutiny has become “very much more healthy… and effective” in Leicester since the change of model. Both agreed that the introduction of mayors does require a rethinking of the councillor’s role but did not believe that it would become less attractive in future. Soulsby spoke of “really quite good” candidates still coming forward for election in Leicester’s 2015 local elections.

The audience’s questions were mainly focused on the future. Some questions related to how the model of cities could be improved. Here, both mayors wholeheartedly supported the idea of greater proportional representation in local elections. Soulsby was clear that such a system would dramatically reduce his party’s power in Leicester but still believes the system would be far more functional.

Other questions focused on how cities could win further powers from Whitehall and Westminster and how the next government should think about and support city-regional government in England after May 2015. Ferguson pointed to his work bringing together Bristol with three neighbouring councils: “We call it CUBA… the County that Used to Be Avon.” He argued that the area is ready to take on transport powers similar to Greater London. Ferguson also appears to hope that walking the walk will accelerate devolution to the region. “I travel a lot,” he said, “and when I’m abroad I’m mayor of the city region” – not just selling Bristol, but Somerset and other neighbouring areas too. Soulsby wants local government to take on responsibilities from police and crime commissioners too. “I’m not quite sure what they’re meant to do,” he said. Both pointed to Greater Manchester, recent recipient of these powers as well as control of health, as the example to emulate in the next parliament.

They freely admit, however, that – though all parties have promised to devolve further after the election – no one knows what will happen next. Ferguson said further devolution to cities is “not inevitable” – a sensible view given broken promises in the past. And both recognised that gaining further powers is no more important than doing well with the powers they already have.

After all, come May 7, Peter Soulsby will face Leicester’s verdict on his first term as mayor. George Ferguson has a year longer to wait for the electorate’s judgement. And both may wait longer still to find out whether the mayoral model about which they are so passionate grows stronger and expands across England.

Further information
The event was hosted by the Institute for Government, the University of Bristol and the University of the West of England.
Event video
Twitter roundup

From Bristol City to Mexico City: New challenges for obesity research

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In this blog, Simon Sebire from the Centre for Exercise, Nutrition & Health Sciences and three PhD students reflect on new avenues of research into childhood physical activity and obesity in Low and Middle Income Countries and the opportunities and challenges this work presents.

New ideas emerge in the least likely places. As I listened to Professor Andy Gouldson present his research to the School for Policy Studies in spring 2014, I was inspired to sketch connections between some of Andy’s concepts (economic development and environmental issues) and my own (the psychology of motivating people to adopt healthy behaviours like being physically active). After the talk, I shared my scribbles with my colleague Prof. Russ Jago, only to find that he had an almost identical set.

Our thoughts had independently been transported from Bristol to Mexico and musings about the potential associations of urban development and rural-urban migration on the lifestyle behaviours of children and their families. This international perspective is not something either of us had previously pursued is but clearly had prompted some scribbling! The Mexico connection was inspired by three CONACyT-funded students, from Mexico, who at the time were studying our MSc in Nutrition, Physical Activity and Public Health and were considering PhDs.

Nearly 1 year on the three students (Ana Ortega Avila, Maria Hermosillo Gallardo and Nadia Rodriguez Ceron) are now PhD students in the School for Policy Studies Centre for Exercise, Nutrition and Health Sciences supervised by Prof. Russ Jago, Dr Angeliki Papadaki and I. They secured further funding from CONACyT to pursue their programme of research to study how various social, psychological and environmental factors might be related to physical activity and nutrition behaviours in children adolescents and their families in Mexico.

The causes of and response to increasing levels of obesity in low and middle income countries have been the focus of a recent Guardian Global Development Podcast. The podcast draws on the experiences of children, families, health practitioners and campaigners from South Africa and Mexico. In Mexico 73% of men, 69% of women and approximately 35% of adolescents are obese or overweight which is higher than in the USA. It is clear that there is much to be done to both treat those who are already overweight and prevent the development of obesity in young people. However, extrapolating our existing research and knowledge of what we think drives obesogenic behaviours in places like Bristol to the context of people’s lives in Mexico presents a number of challenges.

Ana, Maria and Nadia have a wealth of experience from previously working in Mexico as nutritionists or within the food industry, so I asked them to listen to the podcast and share their insider’s view of the challenges ahead:

Maria referred to the potentially damaging effects of families in Mexico aspiring to an American lifestyle dominated by unhealthy foods and sedentary behaviour:

The blog says that processed foods and junk food are one of the main causes of overweight and obesity increasing in Mexico, which is partially true, but I think it has to do a little bit more with what I call “junk behaviours”. For example, how mums from rural areas prefer to give their children processed foods instead of home-made meals because they heard somewhere that people from USA consumed them, and because Americans always choose right (at least that’s the belief in some parts of Mexico); junk food and processed foods are the way to go for feeding their children.

Ana suggested that this influence may be strongest in regions closest to America and highlighted the broader problems associated with researching an issue which is geographically diverse:

Mexico is among the largest countries in the world geographically and demographically (118 million people); where differences in dietary pattern exist between rural and urban areas or between north, central and south regions.I have always lived in the northwest and the influence of the U.S.A. is visible in a lot of aspects in our life compared to the centre or south of the country. Our dietary patterns are based on American food choices and less on the Mexican traditional diet.

Ana, Maria and Nadia all added that the potential mismatch between perceptions of wealth and health may be making being overweight an aspiration:

Ana: In my experience as a nutritionist there are a number of cultural misconceptions among population when it comes to healthy nutrition. For example, being a little overweight still means you are healthy and well-nourished whereas being thin means you are unhealthy or sick. People don’t see overweight as a problem, on the contrary, they see it as something normal.

Nadia suggested that such perceptions may prevent parents from identifying obesity as a potential health problem in their children:

I think the healthy body image is distorted as family, friends or in the streets, the most common thing is to see someone obese; and that is really concerning because how will they do something to improve their health if they don’t even think there’s a problem. 

Ana, Maria and Nadia reflected on the challenges of applying our physical activity and nutrition research findings which are largely based on evidence from developed countries such as the UK or USA to the context of middle income countries such as Mexico. A good example is parents’ perceptions of safety when letting their children play outside of the home. In UK research, including some in Bristol by my ENHS colleagues, we tend to focus attention on the presence of traffic or children’s risk of injury while unsupervised. In contrast, perceptions of safety in Mexico are measured nationally with questions including those related to the risk of kidnap, existence of violent gangs in the neighbourhood, armed robbery and frequency of firearms shootings. 73.3% of the participants in the 2014 National Survey on Victimization and Perception of Public Safety (ENVIPE) in Mexico reported not feeling safe in their local areas. In addition to the safety implications of conducting research in this context, it is clear that current measures of parents’ perceptions of their child’s safety to be active outside the home will not be sufficient and Nadia has plans to develop a new tool.

In addition, the political landscape challenges us to consider different ways in which our research may be best able to impact on health policy:

Ana: The political context in Mexico is complex, the government is dealing with high levels of insecurity and corruption, events that prevent the government from focusing on other matters such as the implementation of new health policies.

Maria believes that more is needed to be done to educate policy makers in addition to the public: There is a huge educational barrier, both governmental and individual, which makes difficult to take seriously the obesity and overweight problem.

Nadia: All those factors are completely different to high-income countries, and makes the context a complex matter to understand when almost all the research has developed in a completely different contexts with a wider range of opportunities to change or create policies that have a real impact in the population’s health. 

In summary, over the last year or so, I have been transported from Bristol city to Mexico City thanks to a fortuitous combination of research daydreaming and inspiring MSc (now PhD) students.  As a supervisor, my initial conversations with our new students has forced me out of my research comfort zone, an experience which has been echoed and reported by researchers in the International Physical Activity and the Environment Network in Latin America. Undoubtedly, our success in co-producing research which could have international impact will require us to work together to combine our collective knowledge to understand the context and key drivers of obesity-related behaviour change in Mexico.

Thanks to Ana Avila Ortega, Maria Hermosillo Gallardo and Nadia Rodriguez Ceron for their contributions.

  • Ana’s PhD focusses on the development of a social media intervention to reduce consumption of sugar-sweetened beverages in  Mexican older adolescents
  • Maria is studying the associations between urbanicity in Mexico and lifestyle behaviours and the influence of the rural urban transition on family health.
  • Nadia’s PhD focusses on the environmental and social correlates of physical activity in children in Mexico City.

Dr Simon Sebire is Lecturer in Physical Activity & Exercise Psychology in the Centre for Exercise, Nutrition & Health Sciences (ENHS) in the School for Policy Studies.The results of the 2014 Research Excellence Framework (REF) confirm the Centre’s international reputation for research excellence within the field of physical activity, nutrition and health. ENHS was rated 1st overall in the UK.

 

Informing the debate on directly elected mayors

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David-SweetingDavid Sweeting

Recently George Osborne announced the creation of a ‘metro-mayor’ for Greater Manchester. In doing so he has joined a long line of heavyweight politicians who have endorsed the idea of directly elected mayors as at least part of the solution to issues in urban governance in English cities. From as far back as Michael Heseltine in the early 1990s, via Tony Blair, and through David Cameron the idea of a single figure to govern our cities has resonated strongly in Whitehall. In the press release on Manchester’s metro-mayor, Osborne is quoted as saying: ‘This will give Mancunians a powerful voice and bring practical improvements for local people, with better transport links, an Oyster-style travelcard, and more investment in skills and the city’s economy.’ The prospect of other cities introducing similar figures is clearly back on the agenda – whether on existing city boundaries or across a city-region.

One of the frustrations in the debate around directly elected mayors is the lack of empirical evidence around which to base judgements on their impact. Competing camps tend to paint over-idealised or over-pessimistic scenarios, depending on the position they wish to advocate. The pro-camp points towards the creation of a powerful central focus for urban governance. A leader of place rather than the council, this figure increases interest in civic affairs and is able to use their profile for the good of their areas, joining up diverse interests, and is firmly held to account at the ballot box every four years. The anti-camp tends to warn of the dangers of centralisation, with a directly elected mayor able to have free rein over the electoral cycle, yet with no reason to suppose that this figure is better able to work with diverse interests than traditional council leaders in their areas, often with concerns about the ‘wrong’ sort of person being elected.

In 2012 Bristol introduced a directly elected mayor, based on the city council area of Bristol. The Bristol Civic Leadership Project is analysing the introduction of the new system, drawing on empirical data from before and after its institution, both from members of the public in Bristol, and from different sectors involved in the governance of the city. We have reported our most recent analysis in our Policy Briefing, published via Policy Bristol.

Here I discuss two findings that are likely to be of interest in the debate around the introduction of mayors in other cities. The first is that there has been a dramatic increase in the proportion of citizens who agree with the statement ‘the city of Bristol has visible leadership’. It has risen from 24.1% in 2012, before the introduction of the mayoral system, to 68.6% in 2014. This is a startling rise, and provides a boost to those who argued for the introduction of a mayor in Bristol on the basis that existing city leadership lacked sufficient public profile. The second is that there are very different views on the introduction of the mayor in different sectors of governance in the city. Our survey of civic leaders in 2012, before the introduction of the mayoral system, found that, on the whole, councillors were much less positive about the introduction of a mayor than other respondents from the public, private, and third sectors in the city. This is significant because directly elected mayors are often advocated on the basis that they will facilitate positive relationships across the city beyond the council chamber. Our research suggests that this may well be the case, but there clearly would be work to be done to convince councillors of the benefits of the system.

Our project in Bristol is ongoing, and in future we will be able to report a much larger, more rounded set of results. As we have data from both before and after the introduction of the mayoral system in the city, our work is well placed to shine light on claims about profile and visibility, or relationships between sectors, as a result of changing the system of governance, as reported above. Of course, there are limits to these claims, both as a result of methods used, and as a result of the complex nature of urban governance. For example, survey research is not sophisticated enough to disentangle the impact of the change in governance system and the change in political leader. There are also limits to the transferability of these results beyond the Bristol context. In relation to ‘metro-mayors’, for example, there is the issue that the mayoral system in Bristol was introduced on existing city boundaries, whereas, for example, the Manchester proposals are across the sub-region. This inevitably adds a layer of complexity when establishing new governance structures that are both effective and democratic. We nevertheless hope that other cities considering a variant of the directly elected mayor model of decision-making will find these results very useful in thinking through the consequences of introducing mayoral governance in their cities.

David is Senior Lecturer in Urban Studies in the School for Policy Studies at the University of Bristol

The Bristol Civic Leadership Project is being carried out by researchers at the University of Bristol, and the University of the West of England, Bristol, and has benefitted from ESRC Impact Acceleration Account funding.

This piece was originally posted on the LSE British Politics and Policy blog

Understanding Gender Based Violence within national and international contexts

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GG NANadia Aghtaie and Geetanjali Gangoli from the Centre for Gender and Violence Research in the School for Policy Studies introduce their new book

The endemic, universal and multifaceted nature of gender based violence is what drives the work of the Centre for Gender and Violence Research (CGVR), at the School for Policy Studies, University of Bristol. Through our recent book (Aghtaie, N. and Gangoli, G. eds (2014) Understanding Gender Based Violence. National and international contexts. Routledge), we aim not only to contribute to scholarly debates on gender and violence,  but also to showcase some of the pioneering and original research conducted by members of the CGVR.  All the chapters in this book have contributions from current and former members of staff or post graduate research students attached to the CGVR.

While the Centre was formally created in 2009, members of the Centre have a long history of researching gender based violence at a local, national and international level, and feeding this into policy and practice. The CGVR grew organically from the Violence Against Women Research Group (2003) that emerged from the Domestic Violence Research Group (1990).All the members of the CGVR identify as feminist, and have a personal passion to end GBV, and our research has always originated from this desire.018

The CGVR works on all forms of GBV and interventions challenging it, and explores how violence, gender and power operate within intimate partner, interpersonal and structural violence, for example in the context of domestic abuse, prostitution and trafficking for sexual exploitation of women and girls, rape and sexual violence, domestic violence and disabled women and gender based violence for BME communities, young people’s experiences of intimate partner violence, online and offline,  same sex domestic violence and abuse, and international and comparative research on gender based violence, in a variety of contexts.

Based on the varied research conducted by members of the CGVR, the book aims to highlight the continuing, pervasive and varied nature of gender based violence in a range of countries and contexts, such as the UK, India, Iran, Rwanda and China. The chapters in the book focus on the importance of context and structure both nationally and internally The book both builds on, and expands on existing research, theories and methodologies on the issue; as well as, enters into some under researched geographical areas; and issues, such as children’s and young people’s experiences and attitudes to gender based violence and disability and domestic violence.

The book gives a taste of the many projects, studies, international reach and contributions to theories and practice of the CGVR. The Centre is now one of the largest research centre on gender based violence in Europe. Ultimately we believe and hope that the work done by the Centre does and will contribute to a more egalitarian society, where women, men and children, are free of the pressures to ‘do gender’ and are free of violence and abuse. This is, in our view, the core of feminist research.

The book will be launched on the 3rd December 2014 at the Common Room, 8 Priory Road, Bristol.  All welcome – book here!

 

Patricia Lucas explains why the School for Policy Studies is researching dental decay

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Lucas

Data released by Public Health England on 30 September 2014 has shown what many interested in health in the early years know already.  Over 80,000 3-year-old children in England – about 12% – suffer from a completely preventable disease.  Dental decay is painful, the treatments are unpleasant, and decayed, missing and filled teeth affect appearance.  Oral disease can have very serious consequences: in Bristol alone 721 children aged 0-19 years (of whom 155 were under 5) were admitted hospital for extraction of decayed teeth in a one year period (2012/13).

Tooth decay is of importance for us in the School for Policy Studies because while rates have reduced dramatically since the 1970s, there remain important and significant inequalities.  Closer examination of

data suggests geographical and social disparities in oral health.  Children from more disadvantaged backgrounds are significantly more likely to have early tooth decay and to need teeth extracted under general anaesthetic.  In Bristol, while the rate of child dental decay was on a par with the UK average in 2008, the DMFT (decayed, missing, filled, in teeth) index for children in South Bristol, an area of high deprivation, is currently twice the city average.  Ashley and Lawrence Hill wards experience nearly three times as many dental fillings in under 5 years old, compared to neighbouring Bishopston and Redland wards.

The Public Health England (PHE) report points out that the most important cause of dental decay is sugar in diet, and the most important preventive action is fluoride (in toothpaste or water).  The response from PHE focuses on the former, but it is important not to ignore the latter, and to understand the policy context for this.  Despite clear evidence that very small amounts of fluoride in water supplies reduces dental decay, few water supplies are fluoridated in the UK.  Water supplies are a shared resource, and public and legislative barriers mean addition of fluoride seldom happens.  In the absence of this, use of fluoridated toothpaste and fluoride varnishes by dentists are the next line of defence.

One difficulty for local policy makers is that we don’t have good enough data on oral health in childhood.  The new PHE Survey is important, but sampled just 211 3 year olds in Bristol.  We need better local data to really understand what is happening to have a reliable estimate of the local rate, including how this varies between areas.

Our study, which is part of the BoNEE project, will improve our understanding of oral health inequalities among children in Bristol.  We will do this by looking at dental hospital records of who is attending for dental extractions, by understanding better what happens when children do visit the dentist, and by gathering parents views and experiences of oral health services in Bristol.

This project is in collaboration with colleagues at University Hospitals Bristol NHS Foundation Trust, the University of Bristol’s School of Oral and Dental Sciences, and Bristol City Council.

Patricia is Head of the Centre for Research in Health and Social Care in the School for Policy Studies at the University of Bristol.