Impact case study database

Okinawa is one of 47 prefectures in Japan. The population and surface area of its islands comprise about of 1% of Japan’s totals but host over half of the 100,000-plus US military personnel in the country. The research achieved three types of impact:

1. Increasing public understanding in Japan of how environmental sounds can produce acoustic trauma.

The research-based film, Zawawa [3], was screened in seven public venues in Okinawa in September 2017 (3 universities and 4 community centres). The success of the multimodal design for playback was shown in the impact on audiences of the film’s demonstration that natural sounds ‘carry baggage’ related to the war and post-war periods. The broadcast featured an interview with war survivor Tamotsu Tokeshi, whose testimony about the mnemonic aspects of sugar cane featured in the film. He commented that his involvement in the film reminded him of how he associated the natural sound of the ‘whispering sugar cane fields’ with the impending bombardment that preceded the US ground-assault. The clip also showed audiences commenting on the film’s impact, making them hear familiar military aircraft sounds in new ways that reminded them of how disturbing they actually were. This impact was disseminated nationwide on the Japan Broadcasting Corporation (NHK) morning news, regularly viewed by more than 10,000,000 people, in a four-minute TV broadcast ‘Echoes of Life’ (26 October 2017). An international (English-language) version was broadcast more than 10 times in December 2017 on the NHK World’s English-language international channel and watched in 160 countries and regions. In Japan where the mainstream media focus on the noise from the military bases is in terms of current political debates and anti-US activism [A, B], the broadcast created a new awareness of the film’s importance in shaping Okinawans’ understandings of sound and war trauma. Evidence of this is the testimony of [Text removed for publication] in Okinawa’s prefectural government, who said the film and the broadcast created ‘ a new space for dialogue among people’ [B].

The research and methods have had wide appeal, as evidenced by the multiple screenings of Zawawa across Europe and North America in festivals attended by professional practitioners and public arts circles. Its presence at the Jean Rouch Festival (November 2018), a world-leading ethnographic film festival and a major cultural event in France, substantiated the importance of the methods employed and their public value. It led directly to two invitations from the French National Centre for Scientific Research (CNRS) and the School for Advanced Studies in the Social Sciences (EHESS) to present the film, including at the Mucem in Marseilles (January 2020) as part of the Salon des écritures alternatives en sciences sociales, an extra-mural event of the Jean Rouch International Festival. The film has also been described in the Guardian as evidence of the positive and negative effects of noise [C].

The research-based installation Cave Mouth and the Giant Voice [2] was commissioned from Cox and Argyle by Christopher Stewart and Esther Teichmann for the London College of Communication exhibition ‘Staging Disorder’ (26 January to 26 March 2015), and was accepted for the experimental film club ‘INTER #7: Sonic Spaces In Between’ (Glasgow 2016) and the SIEF congress (International Society for Ethnology and Folklore, Gottingen, 2017). It was reviewed in two contemporary art journals ( Photographers’ Gallery and Smiths Magazine).

1. Re-focusing the political issue of the effects of US bases in Okinawa around a broader concept of the sonic environment in policy and legal spheres in Japan.

The impact on policy and legal spheres of the film Zawawa and the associated NHK TV broadcast is evidenced by the testimonies of the [Text removed for publication] Planning Department of Okinawa’s prefectural government. [Text removed for publication] states that the research “ showed how aircraft noise pollution has brought back war memories to Okinawans and caused adverse impact on their health” [B]. He added that he “ learned much from [the] research” when he “ was preparing to make a plan to utilize former U.S. military sites” [B], referring to the long debated and delayed removal of the Futenma base. [Text removed for publication] said the broadcast “ showed the importance of considering the memories of individuals when conducting…environmental measures related to U.S. bases” [D], indicating the need to take into account detailed verbal accounts of sonic trauma alongside environmental surveys.

A further dimension to the re-focusing of debates about the effects of US bases around a broader concept of the sonic environment is that the soundscape concept - as it emerged in the use of multimodal sound design and playback methods to reveal listener perceptions - was apt and precise enough to be used as legal evidence. The Japan Soundscape Association (SAJ) has used the research in contesting an application to Japan’s Patent Office, which seeks to register ‘Soundscape’ as a trademark in Japan. A patent lawyer in Tokyo has advised that the word ‘soundscape’ is not suitable for registration as a commercial trademark because it was coined half a century ago and has been used within Japan as well as internationally to indicate the sonic environment. [Text removed for publication] of SAJ states that Cox’s research is being cited in the legal case as “ evidence of the term’s analytic force and applications” as it shows “ how the concept of soundscape can be part of local, national and international debates about the continued presence and activities of the US military bases in Okinawa by creating a new understanding about how ‘noise’ is constituted and how it effects public health and the environment” [E].

1. Curating cultural heritage in Okinawa: using the preservation and interpretation of sound as an integral component.

The impact of the research on the field of cultural heritage is evidenced by a commission to create the Ryukyu Island Sound Archive (RISA) comprising Cox’s recordings of Okinawan soundscapes (Okinawa is part of the Ryukyu Islands). These recordings are the primary data that underpin the playback and multimodal research methods. A contract for RISA was signed in June 2020 [F] with Alexander Street (AS) (part of ProQuest, the world’s biggest online educational provider). RISA will go live in 2021 as part of the landmark collection ‘Ethnographic Sound Archives Online’, which is one of four online collections in AS’s Anthropology Resource Library. AS has contractually committed to investing GBP220,000 in the collection (which includes an Open Access feature), of which GBP51,800 is specifically assigned to RISA.

The significance of the research and research methods to cultural heritage is highlighted by [Text removed for publication] of the Art Foundation (Okinawa Prefectural University of Arts) who says that “What makes [Cox and colleagues’] research significant is that they have been recording sounds based on the philosophy that sounds are heard by taking account of history. They are not recording sound waves that physically exist but recording sounds that exist in peoples’ memories and in their cultural and spiritual activities. Making such sounds into an art work is an outcome that is successful as a significant achievement in the cultural history of Okinawa”. He strongly believes the Archive “ will become an important resource for Okinawa’s cultural research. It will benefit all the people in the world who conduct research on Okinawa” [G].

The Ryuku Island Sound Archive also garnered the support of [Text removed for publication] the Department of Planning and the [Text removed for publication] at the Okinawa Prefectural Government. [Text removed for publication] believes the Archive will “ show a new understanding of Okinawa’s cultural heritage” [B], while the [Text removed for publication] says he intends to “inform Okinawan people living abroad [of the archive] through the network of Okinawans in foreign countries” [D] . He says, “I have a big hope that this will promote the preservation of our cultural heritage and environment and strengthen the ties of Okinawans” [D]. For the [Text removed for publication] (University of Ryukyus),“ The sound archive developed by Dr Cox and his team…would be an influential effort in the cultural activities of islands as the first attempt in Okinawa to promote preservation and usage of regional cultural heritages through sounds. As it has an open access…we will make use of the resource and inform many other people beyond researchers. I strongly believe that Dr Cox and his team’s research will make an impact on the methodology of conducting research on Okinawa and other islands in the Pacific region. It will also create a new axis to interpret sound as part of a cultural heritage” [H].

[Text removed for publication] of Okinawa Prefectural University of Art s states that the archive is “ an innovative art concept” that “ is significant as it archives sounds that should not be lost, including the sound of sanshin and of Shuri Castle” [I]. Sanshin is a local musical instrument, significant in the memories of Okinawan internees held in US military camps. Shuri, a World Heritage Site, is an old Ryukyu Kingdom palace, almost destroyed in the 1945 Battle of Okinawa and then rebuilt as a university campus, which was severely damaged by fire in 2019, meaning Cox’s recordings in the Castle are a “ precious legacy” [G].

Impact from the research conducted by the NCoB WP and chaired by Edwards [1] has been achieved cumulatively, through diverse channels, and through ongoing collaboration between Edwards and the NCoB. The NCoB report [1] makes 27 recommendations, focussing on both the ‘demand’ and ‘supply’ sides of the cosmetic industry [A]. The recommendations include calls to restrict access to certain procedures to over-18s, for the Royal College of Surgeons and other professional bodies to ensure the certification and necessary training of surgeons, and for the Department for Education to ensure young people have access to evidence-based resources on body image [1]. The research has led to impact in the following three ways:

4.1 Raising public awareness of the health risks of an unregulated cosmetic surgery industry and the need for better regulation of providers, premises and products.

The report [1] was widely publicised on launch in 2017, achieving extensive media coverage, including articles in the Independent, Huffington Post, the Mirror, the Guardian and the Telegraph [B]. Katharine Wright, Assistant Director of the NCoB, explains that “ Jeanette was heavily involved in the media at the time of the launch (including both Radio 4 and regional radio interviews)” [A] , e.g. BBC TV Six O’ Clock News; BBC Radio Manchester; BBC Radio 4’s Today; BBC Radio 5 Live; Radio London and Radio Scotland [B]. International coverage included an interview on BBC World Service’s Health Check, and on BBC World Service TV [B]. The report’s recommendation that social media sites investigate and remove cosmetic surgery apps and makeover games aimed at children was reported by the Guardian, citing Edwards. In 2018, journalist Sonia Sodha wrote a Guardian article critical of the decision of Superdrug to offer botox and dermal fillers in selected high street stores [B]. Sodha confirmed that she had used the NCoB report extensively in writing the article, finding it “very helpful and informative” [C].

Actress and playwright Monica Dolan contacted Edwards after becoming aware of the report in the press. Dolan has drawn on the findings in public discussions of The B*easts, a play about children and cosmetic surgery (which won an award at the 2017 Edinburgh Festival). Representatives of the NCoB participated in a public panel discussion on these issues after a performance of the play at the Bush Theatre, London (where it ran in February and March 2018). Dolan writes that the “report informed the discussion around [the play] …taking it further by inciting Q and As about the interface between the play and the reality out there. It gave the play more credence and certainly helped me to talk about it publicly in a much more informed way” [D] .

Gary Ross, Consultant Plastic Reconstructive and Aesthetic Surgeon, states that there are limits to regulation given plastic surgery is predominately in the private health sector [E]. Of great importance therefore “ is the cultivation of a discerning and educated public who, for example, are aware of good and ethical practice…The work of the NCoB on cosmetic procedures guided by Edwards will continue in the coming years to be valuable in raising public understanding and awareness” [E] .

4.2 Supporting professional bodies in shaping best practice and training

The research has raised awareness amongst practitioners and professionals of the broader social and cultural context that makes cosmetic procedures desirable, leading to improvements in practice and training in the UK. The report featured in outlets aimed specifically at health professionals and was cited in many professional journals [F]. The British Medical Journal published a two-page feature entitled ‘Cosmetic industry regulation is only skin deep’, and a piece appeared on doctors.net.uk (read by 51,000 GMC-accredited doctors per day; subscription-only) [F]. An article in the journal Aesthetics, highlighting links between social media and appearance anxiety, cited Edwards [F]. Drawing on the work of Edwards and the WP, the NCoB also contributed to numerous consultations, including: the Youth Select Committee inquiry on body image (June 2017); the Consultation on Draft Standards, issued in 2017 by the Cosmetic Procedures Standards Authority; the Science and Technology Committee inquiry on the impact of social media and screen-use on young people’s health (March 2018); and the Information Commissioner’s Office consultation on its draft code of practice for age-appropriate design for online services (May 2019) (see [A, H] for full list of consultation contributions).

Following the launch of the report, the NCoB hosted a meeting with Lord Lansley (who has a private member’s bill on the regulation of cosmetic surgery), the Royal College of Surgeons (RCS), the General Medical Council (GMC), and major commercial providers of cosmetic surgery [A] to discuss how to implement the WP’s recommendation that the RCS require all members who practise cosmetic surgery to participate in its certification scheme and have access to appropriate training [1]. Gary Ross, the first surgeon to be certified by the RCS, outlines how “ the GMC has acknowledged the NCoB report in 2017 in its recommendations for a more robust regulatory framework to ensure patient safety and to protect patients against many of the risks from cosmetic procedures” [E]. He explains that, since the report, there has been an increase in the number of cosmetic surgeons applying to the RCS for certification; an increased awareness of the need to assess social and psychological presentation of patients/clients prior to surgery; and a much broader agreement that cosmetic surgery should not be offered to under-18s, unless there are good medical reasons [E].

In February 2019, drawing on findings and recommendations in the NCoB report, (the WP recommended collaborative work amongst social media companies [1]), the NHS Medical Director, Stephen Powis, called for social media companies to ban celebrity ads targeted at children [I]. In July 2019, the Secretary of State for Health and Social Care announced a new partnership between the Samaritans and Facebook, Instagram, Pinterest, Google, YouTube, and Twitter to investigate the health impact of social media on young people [G].

The recommendations of the WP were also cited in the design of the Masters programme in Skin Ageing and Aesthetic Medicine (Faculty of Biology, Medicine and Health, University of Manchester), as defining best practice standards in the ethics of providing cosmetic procedures to patients/clients. The MSc Programme Director, has since been working with the NCoB on developing resources that use key findings of the report [G]. Graham states, “ we have been expanding the teaching materials around the ethical issues surrounding cosmetic procedures. We identified the 2017 Nuffield Council on Bioethics report (Cosmetic procedures: ethical issues) as an invaluable resource” [J].

4.3 Shaping the development of proposals for new legislation

The research findings have also helped shape the developments of proposals for new legislation by informing parliamentarians about implementing age restrictions on access to cosmetic procedures, and the role of social media in promoting cosmetic procedures and the adverse impact of such promotional activities on body image and mental health, especially amongst young people.

The Botulinum Toxin and Cosmetic Fillers (Children) Bill 2019-20 was introduced by Laura Trott MP following a Private Members’ Bills Ballot on 9 January 2020. In the lead-up to the bill, the NCoB report was cited in numerous parliamentary debates. In 2017, the then Parliamentary Under Secretary of State (Mental Health, Inequalities and Suicide Prevention) Jackie Doyle-Price MP invited NCoB staff to discuss priorities for meeting the Conservative Party manifesto commitment to improve regulation of those providing cosmetic procedures. During a Westminster Hall Debate in May 2019 she committed to bringing forward legislation to ban under-18s from accessing cosmetic procedures, in line with current age limits on tattoos and sunbeds, a key recommendation of the report [I]. During the debate, Alberto Costa MP stated that the NCoB “recommended that children under 18 should not be able to have these procedures unless there was an overriding medical reason for them to do so” [G].

A parliamentary question tabled by Clive Lewis MP in September 2017 asked the Minister of State for Health, Philip Dunne, if his Department would implement the recommendations of the NCoB report. In response, Dunne described the report as “ thorough and thoughtful” and said it “ will help to inform our thinking” about “ the effective registration and regulation of those performing cosmetic interventions” [H] . Bambos Charalambous MP sought the NCoB’s support in submitting parliamentary questions on the regulation of cosmetic procedures, and in introducing a debate on this issue [A]. There was also a written parliamentary question in the House of Lords, in November 2017, from Baroness Gould, on the report’s recommendation that the Home Office should clarify the marketing of ‘female genital cosmetic surgery’. She asked what plans the Government have “to issue guidance … clarifying the circumstances under which procedures marketed as "female genital cosmetic surgery" may be necessary for a woman’s physical or mental health and therefore not banned under the Female Genital Mutilation Act 2003” [H].

Sykes’s research into PNG household composition led to the founding of the PNGCC in Cairns, the largest city in the northern regions of Queensland. PNG families do not form an enclave or neighbourhood in Cairns. Instead their residences are widely spread throughout the small towns of the city’s hinterlands. They do not connect by internet in this region where broadband provision is weak, but it is common to meet with other families while shopping in the city. The PNGCC is located in Raintrees Shopping Centre with its affordable shops and medical and dental services. It is a short drive to the government offices of Cairns and very near to St Francis Xavier’s Church where news of the Centre’s activities is shared through the Catholic community and PNGCC directors use the church office facilities to support their work.

Sykes’s research into the wide dispersal of PNG residences was used first to draft a policy for PNG people written by [Text removed for publication], whose ardent interest in the well-being of the Papua New Guineans in Australia shaped his work as a Diocesan priest at St Francis Xavier’s Church. When he relocated from PNG to Australia, he sought support from his Bishop for the large mobile community of unknown numbers of PNGs, now on his doorstep in the north of Queensland. The Diocese of Cairns chose to support the proposal and open a PNG community centre.

Pathways to Impact

Development of the proposal for a PNG Catholic Centre

Sykes shared key research findings over three public presentations in 2014, all to larger groups of PNG men and women who were members of different churches in the area (Catholic, Seventh-Day Adventist, United-Methodist, and Salvation Army). These presentations addressed: a meeting of 30 PNG women who represented various social groups in the region (including popular clubs and sports); a meeting of 8 church leaders working with PNG families; and a meeting of 60 PNG women and men from the wider PNG community. In these meetings, Sykes discussed PNG transnational households and their multi-residential composition across Australia and PNG, and sometimes into the South Pacific, southeast Asia, Europe and North America. She highlighted the ways that people moved between the households, and the urban lifestyle of Cairns and Australia more widely, which created the need for a strong PNG community beyond the immediate family unit.

Additional meetings were held in 2014 to discuss Sykes’s findings in more detail, with aged care providers and several local government civil servants who knew the challenges facing the most vulnerable PNG people, such as the PNG widows of white Australian men who lacked support from their husband’s family and friends, and had only weak or no connections with members of other PNG families. These PNG individuals might ‘fall through the cracks’ between PNG households, and be overlooked by organizations that typically support mostly elderly white Australian women. Sykes’s research created the opportunity to speak about the issues raised by her research more generally and recognise the need for preliminary reports pertaining to the problem of care for the aged. During late 2014, Sykes held three one-to-one meetings with [Text removed for publication] in order to discuss her research findings in more depth. He used these discussions to develop his proposal to the Diocese of Cairns for a PNG Centre. The [Text removed for publication], states that ‘ together [Sykes and [Text removed for publication] ] recognized that the research evidence pointed to a need for a PNG Centre to draw people into a community’ [A] in order to support the wellbeing of all members.

Impact

Opening of the PNG Catholic Centre

The Centre was envisaged as a meeting point for all PNGs in the region. The Diocese’s support included:

1. Allocating a portion of [Text removed for publication] time to assist the PNGCC Director.

2. Dedicating office space and administrative support at St Francis Xavier’s Church to support the Centre; and funding the refurbishment of the physical space at Raintrees shopping mall.

3. Making a formal commitment to the saying of a ‘PNG’ mass once a month to strengthen the spiritual community. The mass is said in Tok Pisin (one of PNG’s three official languages) and is attended regularly by 150–200 people in St Francis Xavier’s Church.

Continuing impact of the Centre for the PNG population

The significance of the Centre is felt today in the role it plays as a physical space bringing PNG families into a community of mutual support. [Text removed for publication] describes the vision of the PNGCC ‘ to help the PNG community more broadly, simply by providing a space to meet for all Papua New Guineans. The Centre supports families who might attend regular events, and other Papua New Guineans who might simply drop in for a friendly chat’ [A]. This significance can be evidenced in various ways:

1. Daily community events hosted by the Centre: Arts and Crafts Groups; PNG Music Groups, PNG Mother’s Group, as well as groups that offer spiritual community (such as Friday rosary). [Text removed for publication] notes that regular attendance is upwards of 40 people in some of these events, but they also welcome drop-in guests. Although the Centre does not keep a formal membership, its Facebook website is followed by 690 members of the community, and is used to share details of events, community discussions, videos and photos [B].

2. The reach of the PNGCC is extended by the work of Centacare, the Social Services agency of the Catholic Diocese of Cairns, whose communications between other service providers and the wider network of PNG families support community building at a wider level [C].

3. For example, project RA Nalisa Neuendorf [F] used the PNGCC to organise a 2018 workshop for the Centacare programme, ‘Our Place’, because it is the only space dedicated to hosting regular PNG community meetings. Neuendorf returns regularly to help out at the Centre, and to support what is now a successful community-building programme [C].

4. The casual style of the PNGCC [B] helps to solidify the PNG families into a community of mutual support. The Centre welcomes anyone that drops by, offering them informal casual conversations and referrals. For example, widowed PNG women began to drop into the Centre for companionship in the different mid-week groups, often on recommendation of funeral directors and health care professionals and workers who knew they needed friends.

The PNGCC nurtures general wellbeing in all these ways. In their work, the Centre’s leaders focus on key issues for sustaining, supporting and building community.

Capacity building

Sykes’s research enhanced the capacities of the community to research its own interests. Each of the two Research Assistants in Cairns completed doctorates and found employment in research and higher education. While working with Sykes, the Research Assistants learned techniques for mapping social networks, as well as interviewing skills. Later they were both re-employed on an ARC grant to study ageing amongst PNG expats in Australia [D]. Vincent Backhaus turned to questions of second-generation migrant socialisation and education, and completed his PhD at the University of Cambridge. He now heads the Centre for Indigenous Education at James Cook University (JCU), having first established a programme to facilitate retention of second generation Indigenous and Pacific Islander students in secondary education [E]. Nalisa Neuendorf received her PhD (JCU, 2020) with Sykes as an external supervisor, becoming the second PNG woman to complete a PhD in Anthropology [F]. Neuendorf worked in the community services sector throughout the project and facilitated community-building workshops for Centacare in Cairns. She is now employed as a researcher at the PNG International Medical Research Institute in Goroka, conducting projects on community-based responses to domestic violence as a health crisis.