Africa's Nutrition Movement: Seizing the Window with Primary Health Care

Africa's mission to eliminate malnutrition is more critical than ever. Bubbling down the high level commitments to strategic programmable goals will be critical at primary health care and community levels.

The continent has made significant progress in recent years, but the COVID-19 pandemic has highlighted the need for sustained efforts to address the complex issues surrounding malnutrition, particularly for women and children as we build traction to meet the sustainable development goals by 2030.

"The year 2025 will also be significant as it marks the end of the UN Decade of Action on Nutrition. N4G Paris will serve as a multi-stakeholder summit, advocating for ambitious financial and political commitments and fostering dialogue among diverse actors from around the world, including governments, international organizations, research institutions, civil society organizations, philanthropies, private sector entities, and more." - #N4G

Connecting dots is a a key imperative as we build Africa's nutrition movement. One of them is viewing nutrition from a programmable health systems lens. Have we given this enough traction ?

"The N4G conference presents a crucial opportunity for Africa to gain traction on its mission to eliminate malnutrition. The conference aims to mobilize ambitious financial and political commitments, foster dialogue among diverse stakeholders, and put nutrition at the center of the sustainable development agenda." - United Nations SDGs Professional Support Group for Africa

One of the key lessons from COVID-19 is the importance of strengthening health systems, particularly at the primary healthcare level. The pandemic has exposed weaknesses in many health systems, highlighting the need for increased investment in health care infrastructure, workforce, and services which will ultimately impact on nutrition delivery at the base of the health system.

The upcoming Africa Primary Health Care Forum , scheduled for Abuja on July 14-15, 2025, will provide a platform for stakeholders to discuss the importance of primary health care(PHC) in achieving universal health coverage (UHC) and health security, as well addressing malnutrition in PHC systems. The forum will also explore the role of digital health, digitised workforce, partnerships and financing in strengthening primary healthcare systems and improving general health outcomes.

More details continued at: https://www.phc.africa/

NOT 'Nanny State': Protection & assurance of the quality of nutrition

The Government needs a plan to fix our broken food system and turn the tide on the public health emergency

24 October 2024

The House of Lords Food, Diet and Obesity Committee demands that the Government should develop a comprehensive, integrated long-term new strategy to fix our food system, underpinned by a new legislative framework. This is the key conclusion of the Committee’s report, ‘Recipe for health: a plan to fix our broken food system’.

Chair's comments

Baroness Walmsley, Chair of the Food, Diet and Obesity Committee, said:

“Food should be a pleasure and contribute to our health and wellbeing, but it is making too many people ill. Something must be going wrong if almost two in five children are leaving primary school with overweight or obesity and so many people are finding it hard to feed healthy food to their families. That is why we took a root and branch look at the food system and analysed what had gone wrong over the past few decades.

“Over the last 30 years successive governments have failed to reduce obesity rates, despite hundreds of policy initiatives. This failure is largely due to policies that focused on personal choice and responsibility out of misguided fears of the ‘nanny state’. Both the Government and the food industry must take responsibility for what has gone wrong and take urgent steps to put it right.

“We hope, given the recent comments from the Prime Minister, Lord Darzi and the Secretary of State for Health, that there is now an appetite to shift towards prevention of ill health. We urge the Government to look favourably on our plan to fix our broken food system and accept that not only is it cost-effective, but that it would lead to a lot less human misery.”

[My emphasis] 

About time! Real action please.

DO NOT DILUTE TO TASTE!

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

Personal responsibility Educational determinants Health literacy My choices Role model Internal - Extrinsic motivation The life chances I am afforded impact my 'health career'.	Environmental/Physical determinants  Ultra Processed Foods Smoking Food & Nutrition Impacts of Obesity Child development Nutritional value of foods
Social determinants public (mental) health information Family economics Social values Sustainable Living	Political determinants 'Nanny State' (political rhetoric) Lobbying - (Food) Industry Business ethics Food poverty Advertising regulation Cost to Government, NHS, Society Security

Spiritual determinants: Values of society, governments, citizens, business . . .

Previously:

Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;5: https://nutrition.bmj.com/content/5/2/358

'nutrition' on W2tQ

https://x.com/search?q=%40h2cm%20%27nanny%20state%27&src=typed_query&f=live

Gambling?

c/o BBC Radio 4: Emergency Foods - the very youngest-vulnerable and eldest

Food is the commodity after water that so many of us are able to take for granted. At the moment in the Horn of Africa a famine is raging. BBC Radio 4's Food Programme this week deals with Emergency Food. This provides great insight into the infrastructures, communications, technologies and developments that are being brought to respond to such crises. This programme takes us beyond the images of sacks being dropped by air, supplies being delivered by truck; chaotic situations that also demand crowd control to the actual foods, their form and content.

For nurses nutrition is a key element on the curriculum, a routine part of ward / community assessment and care delivery. Sadly meeting the nutritional needs of patients is a key nursing care activity that is the subject of marked criticism. How do you draw nurse's attention to nutrition beyond stating the obvious? How do you motivate students and assure competency is signed-off in that final year? Learning is a very personal thing what with self-directed study, lectures and blended learning ...  but it seems the emphasis on basic nursing care that includes nutrition can be lacking.

I know we can argue there is no comparison: the scale.

A few patients on a ward.

A country on the brink of famine - Somalia (BBC).

You know the real images that count: from rust coloured lands, the youngest skins and ravaged lands parched through to those infant's eyes that can still just wonder while so many others are closed.

I wonder if listening to this programme and reflecting on the very youngest-vulnerable might also help engage attention on the older-vulnerable - indeed all our patients?

Isn't increased awareness of nutrition AND global health what 21st century nursing should be about?

DEC: http://www.dec.org.uk/

Chocolate for breakfast? What choice in Gaza?

Individual
|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

What am I doing?	Define: 'nutrition', 'evidence-based policy', and  'food security' ...
What are we doing?	Sainsbury's

The first time - ages ago - I noticed chocolate in cereals, I was shocked, incredulous and yet did nothing. The other day I asked to speak to the manager in Sainsbury's and complained (non-personally) and will in other stores.

The irony now is the choice the people can exercise in Gaza - is food being used as a weapon of war?

https://www.thegrocer.co.uk/hfss/nestle-withdraws-nutritious-claim-in-row-with-henry-dimbleby-over-kit-kat-cereal/678914.article (subscription required)

Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;0:e000254. doi:10.1136/bmjnph-2021-000254

For Dr Wirnitzer's work please see:

The NURMI-Study (NURMI – Nutrition and Running high Mileage)
https://www.facebook.com/nurmistudy

From Science 2 School: Nachhaltig gesund – bewegt & veggie
https://www.science2.school/

Under the SSKIN

Since W2tQ started almost 15 years ago a collection of 250 draft posts have gathered (virtual dust). Many are probably empty - half-baked ideas - with no clear title (reminder - of the contents).

In nursing there are (thankfully) constant reminders, one being: the need to strike a balance between the person, being least restrictive, assumed mental capacity, best interests and high quality care delivery.

Revisiting the threshold concepts, h2cm and deprivation of liberty safeguarding draft paper brings recollection of a draft post and the lesson:

In many nursing situations you cannot assess what you cannot see.

In Nursing Times 29.11.11 a Nursing Practice comment item was titled:

“Compulsory training would help every HCA spot moisture lesions” 

Denise Elson, points to the SKIN (Surface, Keep moving, Incontinence and Nutrition) bundle as a set of very useful principles, and further refined to SSKIN:

SSKIN - Surface: Skin inspection: Keep moving: Incontinence: Nutrition

The Tissue Viability use the principle of SSKIN:

• Surface: make sure you're on a supportive surface 
• Skin inspection: check it isn't discoloured or sore 
• Keep moving: change your position often 
• Incontinence: keep clean and dry 
• Nutrition: eat healthily and drink frequently ( https://www.plymouthhospitals.nhs.uk/tv-sskin )

As a reflective exercise, if needed, think about SSKIN within h2cm - Hodges' model. Not just the physical (SCIENCES) focus but how these relate to the INTRA-INTERPERSONAL, SOCIAL, POLITICAL and the SPIRITUAL. We will revisit this using h2cm.

On the blog's 15th anniversary 20th April, I'll also try and put some numbers together.

Whitlock, J., et al. (2011) Using the skin bundle to prevent pressure ulcers. Nursing Times; 107: 35, 20-23.

See also:
Tissue Viability Society

NEW YEAR: Ongoing support for the 17 SDGs UN

Individual

|

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

security & peace	security & peace
security & peace

See also:
Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;5: doi:10.1136/bmjnph-2021-000254 
https://nutrition.bmj.com/content/5/2/358

 

Source: https://x.com/UNDP/status/2006591346522599746?s=20

See also: 'SDGs' : 'security' : 'poverty' : 'nutrition' : 'water'

v WCCS26: World Conference on Complex Systems 20-22nd April

Day 2 Tuesday 21st April (Revisiting) Keynote Speaker: Abderrazak El Albani - 
Emergence of Intercellular Cooperation: At the Origins of Eukaryotic Complexity
Session Chair: Khawla Tadist

This keynote was fasacinating. As I begin this post on the 100th birthday of Sir David Attenborough, who would have us all see life in the broadest terms, value life and diverse habits, and Earth as our collective and shared home.

Abderrazak El Albani explained the search for LUCA the last universal common ancestor - 3.8 billion years ago. Many dates in the emergence story of humanity, have been progressively pushed back. The first fire, art, languages, our co-habitation and intimate relationships with Neanderthals.

In healthcare, as a practitioner you have to be aware of your scope of practice. At WCCS, scale (as in iv) was ever present across research in complexity, and complex systems. Not just physical size nano-to-mega but temporal too, as we journeyed billions of years. Several of the slides are presented here:

https://www.synchrotron-soleil.fr/en/news/discovery-oldest-macroscopic-planktonic-eukaryotes-contribution-nanoscopium-beamline (with a reference).

There is a video (French): https://www.youtube.com/watch?v=bh3t26cU7xc

I asked a question, which may have been psychological preparation for own presentation to follow. Listening, I could see how the work Abderrazak El Albani and his team are doing, could be readily translated to the search for life on Mars. There has been a 'routine' interchange of planetary material between Earth and Mars over the aeons. Fitting surely that the sedimentary rocks sought lie in  A key lesson, is that light helps us see, but not all lights are equal. Light sources brighter than the sun become incredible scientific instruments. The longevity of the dinosaurs was highlighted, at least 140 million years. There is no comparison with homo sapiens then, even as those dates have been pushed further back in time. Time defeated me as I tried to make the observation that even the dinosaurs did not make it to their first galactic birthday (c.250 million years - and what a carousel). I like the thought (slide) of 'Earth as Memory'. 

What really counted was the expressed concern about what is happening now: in the Anthropocene.

The second keynote:
Nigel Gilbert - Policy in a Complex World: Towards Complexity-Aware Policymaking
Session Chair: Ali Idri 

Was helpful to me, as the dated conundrum of benefits realisation from our technologies, and evidence-based policy still leaves a gap (for me) within the POLITICAL care/knowledge domain of Hodges' model. The illustration/graphic elements of Prof. Gilbert's slides were a brilliant complement to the content:

Prof. Nigel Gilbert - WCCS26 21st April

I wonder if within policy the constant in the equation is continuity and as a quantity it is an unknown? This seems to the case in health policy, across successive governments. You may (also) find this chart informative: https://www.cecan.ac.uk/news/the-visual-representation-of-complexity/

Perhaps, a key factor in complexity is the fact that nothing stays the same, so continuity is nuanced? Michael Quinn Patton's book Developmental Evaluation was noted re. learning while doing. Now I wish I'd held on to Qualitative Research & Evaluation Methods (4th ed.). The discussion of 'obesity system map' and 'whole systems analysis' was appreciated here.*

Since Marrakech and WCCS, I've noticed acknowledgement in the literature that 'research' is currently flooded with AI tools. I'm sure PRSM - Participatory System Mapper is a welcome addition, (as noted in iv) tools to facilitate participation are much needed:

Collaborative Creativity

The Participatory System Mapper (PRSM) is an app that makes it easy to draw networks (or 'maps') of systems, working together collaboratively.'

I will definitely check this resource out; and CECAN. After Prof. Gilbert, the next Track included my contribution, which I will return to. Rather distracted, I have a somewhat blurred slide, with: 'The global tensor of educational research is' then headed 'Learning poverty. Being unable to read and understsand a simple text; with points 1-4.'. I'm not sure which presentation this was, but zeroed in on the literacy theme, and the word tensor. Another slide refers to '6. Topological substitution for Success'. I think it is (writing this is helping recall!):

Harvey Spencer Sánchez-Restrepo, Jorge Louçã, Martha Belén Carmona-Soto and Sofialeticia Morales-Garza
Topological Patterns of Academic Success: Insights from Complex Network Analysis

'Always Label Your Axes' - Zazzle.

Before that there was another model, as the next keynote speaker: Chris Bauch demonstrated during the conference wearing a t-shirt:

Critical Transitions in Coupled Human-and-Natural Systems and their Early Warning Signals
Session Chair: Mohamed Essaaidi  

Previously: 'nexus'


*Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;5: doi:10.1136/bmjnph-2021-000254

Wirnitzer, KC. et al. (2025) Toward a roadmap for addressing today's health dilemma – The 101-statement consensus report. Frontiers in Nutrition. Volume 12.
https://frontiersin.org/journals/nutrition/articles/10.3389/fnut.2025.1676080 DOI:10.3389/fnut.2025.1676080

S. Bettiol, P. Jones, H. A. Onyedikachi, and W. G. Kernohan, (2026) Bridging Gaps in Oral Health Frameworks: Mapping With Hodges' Health Career - Care Domains - Model, Journal of Public Health Dentistry. 1–14, https://doi.org/10.1111/jphd.70034

The naïve approach ii - Seeking / Avoiding a Catastrophe

In addition to Dodson's book I borrowed:

Zeeman, E.C. (1977) Catastrophe Theory-Selected Papers 1972–1977, Reading, MA: Addison-Wesley.

From the mid-1970s I remember catastrophe theory rather bursting on to the science scene. Articles in New Scientist (in a box somewhere?), Scientific American plus a BBC TV episode of Horizon (seeking details - originally aired July 28, 1975, 60 minutes 'Happy Catastrophe')*, that highlighted potential for new insights into the behaviour inside prisons. and other applications in the social sciences.

The CONTENTS reads:

GENERAL INTRODUCTORY PAPERS 

1. Catastrophe theory : Draft for a Scientific American article 1

2. Levels of structure in catastrophe theory 65

 BIOLOGICAL SCIENCES 80

3. Differential equations for the heartbeat and nerve impulse 81 

4. Primary and secondary waves in developmental biology 141 

5. A clock and wavefront model for the control of repeated structures during animal morphogenesis (with J.Cooke) 235

6. Gastrulation and formation of somites in amphibia and birds (Addendum by R. Bellairs.) 257 

7. Dialogue between a Biologist and a Mathematician 267 

8. Brain modelling 287 

9. Duffing's equation in brain modelling 293

 SOCIAL SCIENCES 302

10. Some models in the social sciences (with C.A.Isnard) 303 

11. On the unstable behaviour of stock exchanges 361 

12. Conflicting judgements caused by stress 373 

13. A model for institutional disturbances (with C.S.Hall, P.J.Harrison, G.H.Marriage, P.H.Shapland) 387

14. Prison disturbances 403 

PHYSICAL SCIENCES 408 

15. A catastrophe machine 409

16. Euler buckling 417 

17. Stability of ships 441

MATHEMATICS 496

18. The classification of elementary catastrophes of codimension <= 5 (with D.J.A.Trotman) 497

19. The umbilic bracelet and the double-cusp catastrophe 563 

DISCUSSION 604

20. Research ancient and modern 605 

21. Catastrophe theory : its present state and future perspectives (with R.Thom) 615

22. Afterthought 651 

As an area of contention the subject of catastrophe theory (CT) possibly presents(?) a dual-cusp of contention. Firstly, CT brought with it controversy within academia and mathematics. The book was reviewed by T. W. Barrett, Department of Physiology and Biophysics, University of Tennessee Center for the Health Sciences, Memphis, TN 38163: 

'Catastrophe theory (CT), as a new field in mathematics with many possible ramifications for both the physical and biological sciences, has recently been the subject of much controversy (see [1]-[5]). This controversy, in this reviewer's opinion, has served a valuable purpose insofar as it has stimulated the theory's proponents to refine and delineate their concepts more clearly. Catastrophe theory was developed by the Field prize winner, Rene Thom; but much work has been accomplished by E. C. Zeeman and his group, especially with respect to applications.' pp.609-610. IEEE TRANSACTIONS ON SYSTEMS, MAN, AND CYBERNETICS, VOL. SMC-9, NO. 9, SEPTEMBER 1979. https://ieeexplore.ieee.org/stamp/stamp.jsp?arnumber=4310286 

Stephen Smale also reviewed Zeeman's book; BULLETIN OF THE AMERICAN MATHEMATICAL SOCIETY Volume 84, Number 6, November 1978. 1360-1368. 

https://www.ams.org/journals/bull/1978-84-06/S0002-9904-1978-14580-7/S0002-9904-1978-14580-7.pdf

'To write a review in this environment has a very personal side for me. On one hand my own work on dynamical systems is closely connected to the origins of CT. I have had a long and close personal and professional relationship with both Thorn and Zeeman. More than 20 years ago I was discussing singularities of maps, transversality, and immersions with René Thom. Thom tried to interest me in an early draft of chapters of his book Structural stability and morphogenesis in 1966.

On the other hand I have remained skeptical and aloof from CT, perhaps due to my conservatism in science. While my colleagues and students were showing enthusiasm for CT, I gave critical lectures, one at the University of Chicago in 1974, one at the Aspen Institute of Physics in 1975. More recently I have been quoted negatively in the "Science" and New York Times references above. This is the first time I have written on the subject, and I should warn the reader of this negative bias, far from shared by many of my fellow mathematicians.' p.1360.

Some defenders of CT may accuse me of discussing very special examples not characteristic of the literature of the subject. I feel that the problem of lack of justification discussed above, is also found in Zeeman's other models. Furthermore Thorn's models are even less specific and less developed. On the other hand, Thorn's work in CT covers many subjects; in this connection Zeeman writes in his Scientific American article, April 1976, p. 65: "The method has the potential for describing the evolution of form in all aspects of nature, and hence it embodies a theory of great generality."' p.1366.

The book's introductory papers are somewhat confusing in content, as drawn to 'SOCIAL SCIENCES' it is the introductory section (and Part Two) that includes  'Anorexia nervosa', Example 9 pp.33-52. 

This is the second 'cusp' as the assessment, diagnosis, intervention, outcomes, skilled staff, access to specialised mental health services remains contentious to this day. As a charge nurse on a female acute admission mental health ward in the early 1980s, eating disorders have always presented a 'clinical' challenge. Often within a staff group and for individual staff members too.

Twitter/X is hardly an objective record but it appears today, that people and families affected by eating disorder continue to advocate for appropriate service provision, treatment and recognition. Recognition that can also develop evidence-based interventions. As discussed by Dr. Agnes Ayton, consultant psychiatrist and others in the video below:

A related paper:

Ibrahim, A., Ryan, S., Viljoen, D. et al. Integrated enhanced cognitive behavioural (I-CBTE) therapy significantly improves effectiveness of inpatient treatment of anorexia nervosa in real life settings. J Eat Disord 10, 98 (2022). https://doi.org/10.1186/s40337-022-00620-y [ My source: @AgnesAyton ]

The Zeeman chapter on anorexia nervosa is interesting graphically and conceptually ...

Page 42. Figure 20. The effect of the butterfly factor, d>0.
(Sorry for the image quality)

- but is of course 'from another time' and is clearly not person-centred. Eating disorders affect many people in the UK and are a cause of trauma, distress, disrupted life-chances and mortality. Referring to Hodges' model, such graphics, reinforce the idea that 'solutions' are to be found in the mechanistic and quantitative domains of the sciences and politics (choice, power, services, safety..). Here, maths and theories (seemingly) provide an explanation for people who are ill, and need treatment. As a teenager for most of the 1970s, Hodges' model was not yet a reality. As I have found since 1987-8 looking at the POLITICAL care/knowledge domain, the model's relevance has increased since the start of my nursing career in 1977. Consider for example, the politics of:

• the global phenomena of famine
• - whether or not associated with economic crisis, drought, other natural disaster, or conflict, political crisis
• ultra-processed foods
• obesity pandemic
• weight loss drugs
• appetite stimulants
• appetite suppressants
• eating disorder (anorexia and bulimia) across care sectors - primary, secondary, specialist
• community / in-patient care
• person-centred care
• user involvement in service design
• the availability of treatment modalities - psychotherapy (as in the video)
• the impact on family relationships and peer group (estranged - loss of friends)
• diagnostic blurring - psychosis, borderline personality disorder - the rise of 'anti-psychiatry'

Here then is the purpose of this post, what potential is there to look at nutrition from a situated individual and collective (global) perspective? This could be focussed on nutrition, or eating disorder; or alternately take a collective stance to encompass the global food supply and the industry. Discovering the diffeomorphism, I wonder if there are others, and their respective properties and character? 

INDIVIDUAL

|

INTERPERSONAL : SCIENCES              

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL   

|

GROUP

COGNITIVE THERAPY EMPATHY&RAPPORT LISTENING - MUTUAL ENGAGEMENT MENTAL HEALTH DIAGNOSIS TRAINED / SKILLED STAFF EVIDENCE-BASED INTERVENTIONS* MOTIVATION MOOD MULTIMORBIDITY	RESEARCH EATING DIET NUTRITION NUTRITIONAL VALUE WEIGHT BMI IN-PATIENT UNIT place of safety
PUBLIC HEALTH SOCIETY FAMILY CARERS	Developed nations are collectively and increasingly 'eating disordered' and exporting this 'lifestyle'.

Before I return the book, I will revisit the discussion section.

See also:

Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;5:doi: 10.1136/bmjnph-2021-000254

*I could not find on BBC website. I have contacted the Open University. I did find - 'In this Horizon episode, Rene Thom's mathematical discovery of the catastrophe theory is investigated.' at  https://thetvdb.com/series/horizon/episodes/1385431

The critical pathway leads to ...?

I missed the most salient information on this book's cover - at least for me. My copy is secondhand, but I picked the copy up recalling Dr Walsh's many publications on models of nursing.

The critical pathway for me is plural. It would include, the CPN(Cert.) course when I first encountered Hodges' model in 1987-8. Plus the fact that the pathway is not unidirectional, with some backward steps and reviews, but is multifold. Running the axes of Hodges' model to - pre-op, surgery, post-op, rehab ... we can add the whole corpus of nursing, social, self, and global health care.

The cover is of course illustrative, intended to support the title and suggest an explicit critical pathway. Apart from possibly pointing to collaboration "Mr Jones ... Let us discuss your critical pathway!" what has changed? Since the book's publication in 1997, we need health care services and systems to be sustainable. We are bit late here. Mr Jones is already a 'patient', bedecked in dressing gown and slippers.

This critical pathway needs to be replaced by one informed and oriented towards Mr Jones as self-caring citizen. This is of course easier said than done in policy terms. While governments globally and institutions stress the need for health literacy, informed life style choices, self-care, health promotion and prevention how much progress is being made? Nutrition remains a profound issue.*

The environmental challenges of climate change, pollution and waste disposal are seemingly contested even as the effects and cost of non-action are increasingly obvious.

The policy of 'care in the community' even while incomplete in the community, has provided me with a stimulating, challenging and rewarding career 1985 ... In the 21st century though, we have to ask of the assessment of mobility to follow and effort of the up-hill walk to 'home' begs the critical pathway that is now Planetary Health.

<>

Several points from Walsh (1997):

'Introducing a model to a clinical area is not an easy task to be undertaken lightly, as it involves fundamental changes in the way staff think and work. Luker (1988) has suggested that each nurse carries around their own informal model of nursing which guides their practice. It is probable that a formal model will be significantly different, although these differences can be minimized by full consultation and involvement with staff to ensure that the model chosen reflects their views of nursing as far as possible.' p.36.

Hodges' model can be 'carried around'. In truth it not strictly a model of nursing. Its scope extends beyond nursing and yet the model can incorporate thought about the patient, nurse, environment and what health, illness, recovery and self-care entail. Hodges' model is meta-cognitive and meta-conceptual, and (very) capable of mapping the terrain (p.26) of nursing from these and other perspectives. A nurse's 'views of nursing' will be dictated by the situation presented to them. Hodges' model can be retrospective, prospective and operate in the here-and-now: situated.

'There is a further point, however, that follows on from Luker's observation for expert nurses have an internalized model of care which is unique to them, it is possible that they may have internalized some practices which are outdated, taken for granted or inappropriate (Paley, 1996) but which are never made explicit as their care is not based upon a commonly understood model of nursing. This notion of every nurse having their own model therefore can lead to the situation where outdated rituals can be propagated under the guise of expert practice. Having a series of explicit models whose aims and ideas are common knowledge, shared by all, opens up care to critical scrutiny in a way that is not possible if each nurse has their own private internal model.' p.37.

Hodges' model can be used with other models, conceptual frameworks and systems across disiplines. Hodges' model is not intended to be prescriptive or prospective. It can be utilised for learning and unlearning. As a registered General Nurse who studied in the 1980s this does not mean I would be competent and safe to practice now. Continuing professional development, mandatory training and revalidation of nursing registration are all geared to support professional practice that has currency, validity, and is safe.

If nursing ever needed a commonly understood model ...?

'It will be apparent from the previous sections that use of a model will lead nursing into some new and unfamiliar territory that will involve seeing the patient in a more holistic fashion'. p.63.

'The nurse may find that models start to identify environmental problems whose solutions lie beyond the boundaries of nursing at present. This is particularly true of the community nurse.' p.63.

Walsh's concern here is the immediate community, but we can recognise the prescience of environmental problems here. Plus the need for the POLITICAL domain in Hodges' model:

'On a larger scale still, perhaps some patient's problems have their origins in political decisions made by national govemment or perhaps it is the factory down the road producing unacceptable levels of pollution. If nursing models make us recognize the political and environmental causes of some patient problems, there should ee no logical reason why nursing should not go forward into theee arenas as a legitimate part of nursing intervention.' p.63.

'There are senior NHS managers and health academics in so-called 'policy thínk tanks' who simply do not recognize the value of nursing and see only a collection of simpie tasks which anybody with an NVQ level 2 can perform. Nursing therefore has to demonstrate its worth; it has to evaluate what it is doing for patients.

Here it is important to remember that the care given may be very different from what is written down. Consequently, how a nurse evaluates care mentally may be very different from how this care is recorded in nursing process documentation. ...' p.64.

Hodges' model can (imho) have a role in argumentation for the quality and scope of healthcare, for nursing as a profession, evaluating and assuring nursing's values in the constant that are the demands of complexity and change. The (several) determinants of health are the other constant.

Mike Walsh (1997) Models and Critical Pathways in Clinical Nursing. London: Bailliere Tindall.

Luker K. (1988) Do Models Work? Nursing Times, 84 (5), 27-29.

Paley, J. (1996), Intuition and expertise: comments on the Benner debate. Journal of Advanced Nursing, 23: 665-671. https://doi.org/10.1111/j.1365-2648.1996.tb00035.x

*Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;5: doi:10.1136/bmjnph-2021-000254

Wirnitzer KC, Motevalli M, Tanous DR, Drenowatz C, Moser M, Cramer H, Rosemann T, Wagner K-H, Michalsen A, Knechtle B, Fras Z, Ritskes-Hoitinga M, Marques A, Mis NF, Stanford FC, Schubert C, Goswami N, Leitzmann C, Fredriksen PM, Ruedl G, Wilflingseder D, Lima RA, Kessler C, Jeitler M, Khan NA, Joulaei H, Fatemi M, Knight A, Kratky KW, Palmer KK, Haditsch B, Jakse B, Kofler W, Pfeiffer T, Cordova-Pozo K, Tortella P, Straub S, Lynch H, Schätzer M, Krishnan A, Fathima A. S, Gatterer L, Kriwan F, Abhishek M, Nandgaonkar H, Nandgaonkar S, Adedara AO, Haro JM, Gericke C, Neumann G, Akhtar A, Rashidlamir A, Thangavelu M, Ngoumou GB, Perpék É, Klaper M, Bhattacharya B, Kirschner W, Bessems KMHH, Jones P, Peoples G, Bescos R, Duftner C, Seifert G (2025). Toward a roadmap for addressing today's health dilemma–The 101-statement consensus report., 

Frontiers in Nutrition, Volume 12:1676080. doi: 10.3389/fnut.2025.1676080. https://doi.org/10.3389/fnut.2025.1676080

KT-EQUAL events: inc. Food and Nutrition in Later Life; Meeting the Needs of People Living with Dementia and their Carers ...

Dear KT-EQUAL supporters,
(Several other posts relating to SPARC and KT-EQUAL have been deleted, this has been retained for personal archive purposes. I learned a lot in attending some events organised under the auspices of this research programme, which stemmed from the IDEAS Factory in 2006.)

Hello. Here's an update about some of our activities and other news that may be of interest to you.

-----------------------------------------

Upcoming events programme
You are warmly invited to join our upcoming events:

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Food and Nutrition in Later Life
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When:    8 January 2013
Time:     9.30am - 16.15pm
Where:   University of Reading

The day features talks from experts, as well as an interactive "hands-on" showcase.  The event should be informative and fun, and provide an opportunity to meet and network with others who have personal or professional interests in food and nutrition for older people. The programme has been designed to appeal to a wide audience, including older adults, practitioners from health and social care, academic researchers, industry and charities.

Free to attend with lunch and refreshments included.

For further details and to book: ...

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Thinking outside the box - meeting the needs of people living with dementia and their carers
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When:    24 January 2013
Time:     9.00am - 16.45pm
Where:   The Forum, St James Parade, Bath, BA1 1UG

Dementia is a major challenge facing our health and social services over the next 20 years.  This has now been recognised by the government and significant resources are being directed towards early diagnosis, new treatments and management of people with dementia.

This funding will only be effective if we can develop news ways of supporting and managing people with dementia and there carers.  This will require a multidisciplinary team approach to problem solving and service delivery.  Health and Social Care Practitioners are familiar with the concept of multidisciplinary team working but often lack insights into dynamics of group working. We need to ensure that the interventions are effective and consider outcome measures that are appropriate for a long term neurodegenerative condition that are appropriate for patients and carers.

This event aims:

- to help researchers, health and social care professionals to think differently about meeting the needs of people who are living with dementia
- to consider the range of outcome measures that might be used to assess the benefit of an intervention
- to make researchers aware of the challenges and opportunities of multidisciplinary working
- to inform new researchers of the needs of people with dementia
- to trigger ideas for new research and provide a forum where participants can develop potential proposals

Please note that this event has limited places to ensure that representatives from several disciplines have the opportunity to participate.

Free to attend with lunch and refreshments included.

For further details and to register interest: ...

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Design for Living in Later Life
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When:    31 January 2013
Time:     10.00am - 16.30pm
Where:   The Open University, Milton Keynes

This event brings together the latest research ideas and developments about creating lifetime environments for people of all ages.

Free to attend with lunch and refreshments included.

For further details and to book: ...
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Keeping safe and maintaining independence: older people and sight loss
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When:    7 February 2013
Time:     9.30am - 15.45pm
Where:   Weetwood Hall Conference Centre and Hotel, Otley Road, Leeds, LS16 5PS

This workshop event is concerned with sight loss in later life and how we can enable people to live a quality life despite the difficulties that arise from diminished vision.

This event aims to raise awareness of sight loss and its impact and to increase knowledge and understanding of how to support people with sight loss. The programme will showcase new developments in research and practice that have the potential to inform practitioners.

Free to attend with lunch and refreshments included.

For further details and to book: ...
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New posts on the KT-EQUAL blog which may be of interest to you:

Housing LIN newsletter – Housing with Care Matters, December 2012

This reflects back on some of the successes the Housing Learning and Improvement Network (LIN) had in 2012, including the recent 2nd annual conference attended by over 300 people.

The conference also saw Norman Lamb, Minister for Care and Support Services, announce an additional £40m in this financial year for Disabled Facilities Grants. Details of this and a number of other recent policy and funding announcements to do with housing, care and support are featured in this end of year newsletter along with information on new learning resources from the Housing LIN, important new publications such as HAPPI2, calls for information, and details of Housing LIN forthcoming regional meetings and events.

New dementia website launched: dementiakt.ca

The Canadian Dementia Knowledge Translation Network (CDKTN) and the National Core for Neuroethics are pleased to announce the launch of the online Dementia Knowledge Translation (KT) Learning Centre. This website is targeted towards new and established dementia researchers engaged in KT.

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Invitation to take part in a study

I am sending some details passed onto us by one of our members, based at TRL:

We are currently undertaking a European study regarding older road users and what different countries do about supporting mobility. The aim of our project is to investigate travel patterns and road safety amongst older road users across Europe, see how they are changing and look at what work is being undertaken to support improving mobility. As part of this we are looking to undertake interviews with possible major players as to what they are doing. Would anyone be interested in taking part in a telephone interview with one of our researchers on this topic?

If you are interested please contact Jenny Stannard, Principal Project Manager and Road Risk Consultant.
email: ...

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Recent Highlights

A new BBC film highlights the work of our i-design team in Cambridge: how do older people use technology? http://www.bbc.co.uk/news/technology-20664470

Falling off the Bandwagon: Sustaining digital engagement by older people - a series of consultation events have recently been undertaken exploring potential solutions to the challenges faced by older IT users. A major consultation event took place at St Georges House, Windsor focusing on solutions and how to implement them.  http://www.stgeorgeshouse.org/consultations/social-and-ethical-consultations/recent-consultations/

We were delighted that The Princess Royal presented a keynote address at our recent 'Showcase world class occupational therapy research to meet the needs of an ageing population' event. This event took place at the College of Occupational Therapists where The Princess Royal is Patron. It was a unique opportunity to bring together leading experts to discuss ways of meeting the challenges of an ageing population.
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I hope that this is helpful. It's been a pleasure to meet with some of you over the course of this year - look forward to further developments in 2013. If you have any queries and or comments/suggestions please do not hesitate to contact me.

As this eventful year draws to a close, we would like to thank you for all your continued support and extend seasons greetings.  All the very best for 2013.

Bangar
--------
S Bangar
KT-EQUAL Research Co-ordinator
School of Health and Related Research (ScHARR)
University of Sheffield
Regent Court, 30 Regent Street
Sheffield  S1 4DA

SDG paper published: "Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework"

It has taken an age ... 2017, an invitation to write about Hodges' model, then COVID, transfer from one journal to another, a new invaluable co-author in Dr Katharina Wirnitzer without whom this paper would not have been completed. Many, many thanks are in order!

Dr Wirnitzer also provided the theme of nutrition helping to unify the discussion on the SDGs mapped to Hodges' model.

Dr Wirnitzer's work, projects and colleagues include:

From Science 2 School: Sustainably healthy – active & veggy

https://www.science2.school/

The reference has been added to the blog's bibliography in the sidebar.

I am hoping for news soon on another paper concerned with psychosis, early intervention, psychosocial intervention, research methods and h2cm.

Thanks also to the referees,

Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;0:e000254. doi:10.1136/bmjnph-2021-000254

South Sudan Medical Journal - November 2019

South Sudan Medical Journal

The November 2019 issue is now online here and includes items on Diabetes management, FGM and perineal injuries, Nutrition surveys, Gestational choriocarcinoma, Laryngeal trauma, Tympanic membrane perforation, Acute malnutrition and Overuse of antibiotics.  See details below.


Please send us your feedback on this issue, submit your manuscripts (which we can help you prepare), encourage colleagues to join the mailing list here, follow us on twitter @SSMedJournal and our Facebook Group, and find previous SSMJ articles at African Journals Online (AJOL) and the Directory of Open Access Journals (DOAJ).



EDITORIAL

• Bringing diabetes mellitus into focus on World Diabetes Day Edward Eremugo Kenyi

ORIGINAL RESEARCH

• The effect of Female Genital Mutilation on perineal injuries among women in labour in Dodoma Region, Tanzania Janeth Dickson Sichone, Athanase Lilungulu, Secilia K. Ngwashemi and Agatha Ngowi
• Analysis of trends in SMART Nutrition Survey data from South Sudan between 2004 and 2016 Ciara Hogan, Kate Golden, Regine Kopplow and Elaine Ferguson
• Pattern and causes of tympanic membrane perforation at a private hospital in Dar es Salaam, Tanzania Zephania Saitabau Abraham, Aveline Aloyce Kahinga, Kassim Babu Mapondella, Enica Richard Massawe, Emmanuel Ole Lengine and Daudi Ntunaguzi
• Nurses’ knowledge of the management of diabetic patients at Juba Teaching Hospital Abuk Mayen Deng, Lucia Buyanza and Fekadu M. Alemu
• Abstracts from the Juba College of Nursing and Midwifery: Management of 3^rd stage of labour Deborah Akon Akech; Danger signs of obstetric complications Kiden Harriet Oliver

CASE REPORTS

• Gestational choriocarcinoma at Juba Medical Complex and Juba Teaching Hospital: five case reports Kizza Paul, Kuma Chuol Biel, Anthony Lupai, Changkel Banak, Mirghany Abdallah and Paula Nuer
• Laryngeal trauma at Juba Teaching Hospital, South Sudan Justin Rubena Lumaya, Jino David and Natali Tong

NEWS

• South Sudanese recipients of grants from the Gordon Memorial College Trust Fund (GMCTF) in 2019
• Continuum of care for acute malnutrition in South Sudan
• Public health resources

BACK COVER

• WHO Poster: Misusing and overusing antibiotics puts us all at risk

Kind regards
The SSMJ team

Copyright © 2019 Southern Sudan Medical Journal, All rights reserved.

Boxing 'II'

As young children we may encounter 'boxing' quite early on. This first experience, which we may or may not wholly remember is undoubtedly critical to our personality and subsequent psyche. Such early experiences influence our ability to 'look after ourselves', how we deal with bullies, anxiety, the potential for conflict and develop assertiveness skills. When a 'scrap' happens it can be quite sudden, that total impact of everything out of control, sheer danger and literal impacts. The environment might be nursery, playground, cloak room and the presence of peers as onlookers can be another key factor.

In the late 1960s early 70s I found some old boxing gloves under the stairs at my nan's. I had a handful of uncles on mum's side (just two now - Uncles Tom and Ken!) and the gloves had clearly been swung and jabbed down the line. I don't count myself as a fighter, unless someone tries to push their beliefs - without invitation - down my throat. Then it will be more a case of a reflex action. The 'arc' being comprised of vomit. In the school playground I learned to talk my way out of trouble, resorting to humour at times; as you learn to deploy whatever intellect you might have judiciously. Legs are essential to a boxer:

“First your legs go. Then you lose your reflexes. Then you lose your friends”

Willie Pep

My legs helped me a time or two.

Not too many years ago, so a new generation is in the frame and a nephew had boxing gloves of his very own. He trained with a local club and had some fights. I didn't go watching, but didn't make too big a big fuss either. He doesn't box now as it happens; he's married with family and busy earning a living. Over four decades I've cared for several gentleman, former boxers who developed dementia. Hence, my lack of enthusiasm. (Although the selective literature listed below does not reflect it, women's boxing is of course also well established.) The extent to which boxing caused their dementia is not the point here. It's trying to acknowledge the ongoing debate: the risks, the history (Ancient Greece 688BC), the discipline, sense of belonging and self-respect it can instill. Of course a great many sports can do this. Of course, I listened very attentively as one gent could still relate how perhaps he had been 'used' in terms of the fights and purses back in the 50s-60s. Vulnerable adults of today and yesteryear. Today American Football is concerned about head injuries, in football heading the ball repeatedly is in the news. Technology should be able to reduce the risks even more and protect individuals from injury that is obvious and more insidious in nature.

Some of these points I've considered in Hodges' model as follows:

individual

|

INTERPERSONAL : SCIENCES

humanistic ---------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group

SELF self-awareness Identity self-belief way-finding dementia - cognitive damage personality change aggression tactics  strategy motivation training attitude self-discipline ethics mental health - mental capacity emotions mood Personal safety	boxing technique reflexes speed movement balance punching fitness weight, reach, statistics THE RING stamina nutrition hydration concussion sub-concussive exposure models unconscious knockout Head - Brain injuries physics: force time (duration) momentum technology - sensor equipped gloves Sports Medicine Research Headgear Safety - Evidence Medical risks
OTHER Ethnographics Coaches <-> Boxers Mentors Support network THE STREET personal history-family History sports history trainer friends club Sporting behaviour family friends Socio-	Rules (changes) Conflict Power promotion media finance codification rules Amateur Professional Refereeing Regulating bodies Governance Law Contracts Economics

Selective reading:

Sacha, J. (2017). Fighting Feelings. Sociological Perspectives, 60(1), 77-94.

Erlanger, D. (2015). Exposure to sub-concussive head injury in boxing and other sports. Brain Injury, 29(2), 171-4.

Falvey, &., & Mccrory, P. (2015). Because not all blows to the head are the same. British Journal of Sports Medicine, 49(17), 1091.

Mcintosh, A., & Patton, D. (2015). Boxing headguard performance in punch machine tests. British Journal of Sports Medicine, British Journal of Sports Medicine, 14 July 2015.

http://www.welshboxers.com/quotes/

See related post 2016: 'Boxing' I

ERCIM News No. 118 Special theme "Digital Health"

ERCIM News No. 118 has just been published at https://ercim-news.ercim.eu/

Dear ERCIM News Reader,

ERCIM News 118

This issue features a special theme that provides a vibrant illustration of a sample of the multi-disciplinary research activities which underpin the upcoming revolution of digital health.

Guest editors: Sara Colantonio (ISTI-CNR) and Nicholas Ayache (Inria).

This issue is also available for download in pdf and ePub.

Thank you for your interest in ERCIM News. Feel free to forward this message to anyone who might be interested.

This issue includes:

SmartWork: Supporting Active and Healthy Ageing at Work for office Workers

"“Work ability” has been developed as an important multi-factorial concept that can be used to identify workers at risk of an imbalance between health, personal resources and work demands[2]. An individual’s work ability is determined by his or her perception of the demands at work and their ability to cope with them. The current challenge in using the concept is to establish adequate tools to evaluate and measure work ability continuously, in order to capture the changing and evolving functional and cognitive capacities of the worker in various contexts.  ...

The holistic approach for work ability modelling captures the attitudes and abilities of the ageing worker and enables decision support for personalised interventions for maintenance/improvement of work abilities. ...

The modelling of work ability will consider:

• generic user models (groups ofusers),
• personalised patient models,
• personalised emotion and stress models of the office worker,
• personalised cognitive models,
• contextual work tasks modelling,
• work motivation and values." p.35-36.

WellCo: Wellbeing and Health virtual Coach

"The WellCo European H2020 project (2017-2021), delivers a radical new information and communication technologies (ICT) based solution in the pro-vision of personalised advice, guidance,and follow-up for its users. Its goal is to encourage people to adopt healthier habits that help them maintain or improve their physical, cognitive, mental, and social well-being for as long as possible. Advice is given through behaviour change interventions tailored explicitly to each user. These interventions range from setting social goals to recommending activities around the seven areas defined in WellCo: cognitive stimulation, leisure and entertainment, supporting groups, physical activity, health status, nutrition, and tips (Figure 1). The behaviour change concept leverages the Behaviour Change Wheel model [2]." p.37.

Research and Innovation: A Language for Graphs of Interlinked Arguments

Next issue:
No. 119,  October 2019
Special Theme: Smart Things Everywhere

Peter Kunz
ERCIM Office
2004, Route des Lucioles
BP93
F-06902 Sophia Antipolis Cedex

Thank you to ERCIM and Peter Kunz.

[WellCo reminds me of the efforts of the AffecTech initiative.]