Aims: This report investigates the role of creative health assets in addressing health inequalities across Stoke-on-Trent and Staffordshire. The project aimed to map and align arts-based interventions delivered by voluntary, community, faith and social enterprise (VCFSE) organisations with public health priorities and to explore how these assets respond to hyperlocal needs and contribute to community health and wellbeing. Methods: A scoping exercise was conducted from January to May 2024 as part of a Transdisciplinary Placement (TDP) within the National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR). The methodology included a literature and strategy review, analysis of public health data and two online engagement sessions with the NIHR SPHR’s Public Health RESearch for Health (PHRESH) Public Advisory Committee (PAC). Through desk-based research and network engagement, over 100 creative health assets were identified, with Stoke Creates being a key partner and stakeholder. Results: Findings revealed the prevalent but under-recognised and underutilised landscape of creative health assets, including arts organisations, charities and cultural networks. PAC members highlighted the benefits and barriers to engagement, including financial constraints, cultural competency gaps and limited visibility of opportunities. Strategic disconnects between cultural and public health policies were identified, alongside opportunities for future integration. Overall, these assets play a vital role in promoting mental and physical wellbeing, fostering social cohesion and addressing social determinants of health. Conclusion: Creative health assets and arts-based interventions offer significant potential to reduce health inequalities and improve public health outcomes in Stoke-on-Trent and Staffordshire. Greater recognition, investment and strategic alignment are needed to embed creative public health approaches within local governance and health systems. Future work will focus on comprehensive asset mapping including associated health outcomes and impact, research on the role of heritage and green-blue infrastructure, and the development of a creative health network for the region.
AIMS:Globally, young people face escalating rates of mental health concerns, while traditional services often remain inaccessible. An emerging body of research suggests that participating in the arts, from everyday engagement to creative arts therapies, may benefit youth mental health, yet gaps persist in equitable access and youth perspectives. This research aimed to better understand young people's definitions of mental health and their perspectives on the role of the arts in supporting their mental health. METHODS:This mixed-methods international study included an online survey, ups, qualitiative focus groups, dyadic interviews with youth aged 16-25 (N = 8) and poetic inquiry. Quantitative data were analyzed descriptively (n = 56), while qualitative data from open survey responses and group discussions underwent Reflexive Thematic Analysis (N = 36). Recruitment prioritized diversity in age, geography, and lived experience, with ethical approval from New York University (NYU). RESULTS:Survey respondents revealed broad engagement across art forms, especially visual arts, literary arts, and music, as well as creative arts therapies. Arts participation was frequent, with 40% of respondents engaging daily. Among respondents who reported perceived mental health benefits (n = 44), 82% reported improved mood and 80% reported stress-management benefits. A combined 86% of respondents (n = 32/37) viewed youth voice as either very important or extremely important. Eight focus group participants further enriched the qualitative data. They associated mental health with being flexible and adaptable. Thematic analysis revealed core themes across the focus group and survey: the role of the arts in mental health promotion; art for social connection; personal development through the arts; young people believe art is essential; art leads to transformative experiences; and they identified barriers, enablers, and policy recommendations. Youth identified limited access and competitive environments as barriers, while low-barrier modalities, such as music-listening, fostered inclusion. CONCLUSIONS:Young people across diverse contexts view participating in the arts as essential to mental health and wellbeing, emphasizing that the arts should be embedded in public health and clinical care. They advocate for youth-led, culturally responsive, and multimodal arts initiatives embedded across schools, communities, and healthcare systems. Findings align with WHO youth mental health and country-specific recommendations, calling for greater investment in accessible, youth-driven programming, arts integration, and robust evaluation to capture health and social outcomes. This study reinforces the value of participating in the arts and creative arts therapies as a vital component of youth mental health promotion, prevention, and treatment, offering safe, expressive, and culturally resonant pathways for coping, healing, and thriving.
AIMS:To understand (1) how collaborative governance for creative health is being enacted in different health and social care systems across the UK and (2) why collaborative governance for creative health was needed in these systems and the factors that enable it to be effective. METHODS:Qualitative interviews with creative health stakeholders within UK health and social care systems (n = 16) to develop realist-informed initial programme theories (IPTs) about the purpose and efficacy of creative health collaborative governance approaches. FINDINGS:Collaborative governance describes arrangements where one or more public agencies and non-state stakeholders engage in collective decision-making through formal, consensus-oriented and deliberative processes. We identified eight IPTs in relation to collaborative governance for creative health. Two of these IPTs relate to why collaborative governance is needed and are associated with the need to secure buy-in from senior stakeholders within the health and social care system to secure access to the resources needed for creative health provision to be sustainable. The remaining six IPTs cover how participants in the creative governance initiatives suggest it could be effective. These include mechanisms such as building trust between key actors and institutions, providing opportunities to develop the creative health workforce, gathering and disseminating evidence about the efficacy of creative health, being responsive to lived experience perspectives, having clearly defined lines of accountability and ensuring alignment with and between key policies and strategies. CONCLUSIONS:Collaborative endeavours for creative health should focus on relationships, trust building and accountability mechanisms first and foremost. These will provide a platform for further collaborative activities with a focus on sustainability, workforce development, evidence, lived experience and alignment with key policies and strategies. Collaborative priorities should be based on an appreciation of local strengths and gaps and recognise that 'what works' in one area is not guaranteed to work in another.
AIM:Dark kitchens - technology-enabled commercial kitchen(s) operating primarily for delivery, to fulfil remote, on-demand, consumer online orders of food for immediate consumption - are a contemporary addition to the food environment. There are growing concerns around the impact of these food businesses on wider determinants of health, with a paucity of guidelines, regulations and oversight of the dark kitchen sector. This work explored the perceptions of dark kitchens from multiple stakeholder perspectives. METHOD:This study recruited key stakeholders (consumers, those working in local authorities and dark kitchens) and applied mixed-methods approaches to explore the definition, identification and regulation of dark kitchens. RESULTS:Results show confusion and inconsistencies in the way that consumers, local authority departments and other stakeholders define, identify and regulate dark kitchens, resulting in current regulation being difficult to implement. Where local authorities worked cross-departmentally, a more consistent approach to regulating dark kitchens was observed. CONCLUSION:The potential risks of dark kitchens to food safety, food hypersensitivities and public health agendas are not fully known and warrant further research and policy development.
Aims: In the UK, Sudden Unexpected Death in Infancy (SUDI) clusters among priority families (those experiencing multiple and complex problems) where universal infant sleep safety guidance is least effective and alternative multi-agency approaches are required. This project implemented and evaluated multi-agency Eyes on the Baby SUDI prevention in Northumberland, a large rural English county. Methods: A Steering Group comprising diverse organisations oversaw the programme. The multi-agency workforce was grouped by job roles into three training strands based on frequency and type of contact with priority families. Online training was accessed individually or in teams. Normalisation Process Theory (NPT) supported engagement and embedding SUDI prevention into practice. Pre- and post-training surveys assessed staff knowledge and confidence with SUDI prevention. Follow-up surveys captured staff feedback and engagement at 2, 4 and 12 months post-training. Results: Staff in 187 roles across 25 services were recruited; 607 of the 1007 staff registered completed training. SUDI-prevention knowledge and confidence increased across all strands; knowledge remained high 2 and 4 months after completion. Commitment to SUDI prevention was sustained over time. SUDI-prevention champions helped embed learning into everyday practice. At 1 year, 95% of the 73 staff who responded to follow-up remained actively engaged in SUDI prevention. Staff with limited contact with priority families were the least likely to sustain engagement. At the project conclusion, Northumberland County Council adopted the programme for their pan-Northumberland training platform. Conclusions: Eyes on the Baby can train and sustain staff engagement in multi-agency SUDI prevention. Key stakeholders with diverse experiences of SUDI prevention oversaw the programme. A Steering Group-led implementation approach encouraged staff to accept SUDI prevention within their roles and was reinforced by team leaders. Early adopters rapidly identified their contribution and engaged enthusiastically as SUDI-prevention champions. One year after training, staff remained engaged, although some roles required additional support.
Positive epidemiology, an approach that promotes the study of protective factors, aims to measure and communicate protective factors alongside risk, therby reframing narratives toward empowerment and well-being.
Aims: Encouraging leisure-time physical activity has proved to be a hard-to-solve complex problem. Underpinning this complexity is the range of determinants of sedentary behaviour. We report on a participatory actor mapping exercise which sought to understand the people and organisations in the local system in which a novel exercise referral scheme in a suburban/ semi-rural region of England has been introduced. Methods: The participatory actor mapping exercise was conducted in two phases in September 2023. The first phase generated a draft actor map visually illustrating the key organisations and individuals (actors) that make up the local physical activity promotion system. The map was aligned to a socio-ecological model in which actors were positioned within a category of determinants. In the second phase, the draft actor map was refined during two workshops with participants (n = 30) representing the key local organisations who sought to promote physical activity. Findings: The process of mapping revealed several factors influencing physical activity promotion: (1) differing views on the determinants of physical inactivity, and hence, a hesitancy towards addressing sedentary behaviour through a strategic systems approach; (2) an emerging system of actors with interdependent roles which sometimes act independently; (3) local commitment to encouraging increased leisure time activity but supported via a generalised approach to physical activity promotion; and (4) a peripheral role of the studied exercise referral scheme in the system for local physical activity provisions. Conclusion: The process of a participatory approach to actor mapping highlighted both opportunities and challenges for physical activity promotion. Although there were challenges around differing actors' perspectives on sedentary behaviour and a lack of connection between actors, opportunities included an improved shared understanding of the complex issues of physical inactivity, and actor mapping provided a useful step towards adopting a systems approach with a common vision.
AIMS:A Joint Strategic Needs Assessment (JSNA) is the process through which health and wellbeing boards in England assess the needs of their local populations to identify inequalities in health and its wider determinants and inform both commissioning priorities and a Joint Local Health and Wellbeing Strategy. We sought to determine how and to what extent JSNAs address the needs of LGBTQ+ people in England. METHODS:The local authorities in receipt of a Public Health Grant in 2024 were identified and their websites searched for current (i.e. published in 2020 or later) JSNAs. Those which referenced LGBTQ+ health and wellbeing were assessed against pre-specified methodological and content criteria indicative of LGBTQ+-inclusive practice (e.g. LGBTQ+ community involvement in JSNA development). Counts and percentages described the frequency with which each criterion was met across the eligible JSNAs, and choropleth maps illustrated patterns of inclusion across England. RESULTS:Of 142 local authorities with an eligible JSNA, 108 referenced LGBTQ+ health and wellbeing at least once. However, few local authorities considered the diversity within LGBTQ+ communities or the impact of intersecting marginalised characteristics. Most disaggregated data for LGBTQ+ people concerned mental illness, sexually transmitted infections, HIV, and substance use. CONCLUSIONS:Currently, English JSNAs do not adequately characterise the needs of local LGBTQ+ communities and disproportionately focus on highly stigmatised behaviours and conditions.
This article is an opinion paper which reflects on the recently published Food Strategy for England and how it frames the food system in the context of social and cultural factors, which is explored in relation to young people. In relation to outlining these issues, the authors draw out the implications for public health practice in local government.
AIMS:This research analysed the lived experiences of tattoo artists in response to clients' mental health-related disclosures. The aim was to explore the potential public mental health function and impact they might have and the impact on them in providing this. METHODS:Narrative interviews were undertaken with tattoo artists, inviting them to tell their stories in relation to working as a tattoo artist and responding to disclosures about mental health. Fifteen participants were successfully recruited and interviewed, and their audio-transcribed interviews were subjected to thematic analysis. RESULTS/FINDINGS:Among the rich data available from the stories, five themes emerged: tattoo therapy, tattoo artist and client relationship, tattoo studio environment, impact on tattoo artists, and training opportunities. CONCLUSION:The results indicate that tattoo artists are spending large amounts of time and emotional labour in talking about mental health with their clients, serving as an under-appreciated public mental health resource. Tattoo artists are often lacking training and support to manage these disclosures and their own emotional responses.
