Impact case study database

Day’s research, presented in On the Game (R1), was integral to the origins, approach and service offered to sex workers attending the Praed Street Project in London. In the 4 years between August 2013-2017 the Praed Street Project provided vital health care services and support for up to 1,800 individuals p.a. before its closure owing to NHS reconfigurations. The Project’s success helped to establish Day as a leading expert in the health and safety of sex workers. Her research has informed national and international policy, practice and advisory services as well as educational courses in top ranking universities.

Shaping Praed Street Project services, August 2013-2017: Day’s research indicated that sex workers do not separate health from other aspects of their lives, such as immigration, welfare, safety, policing and the law. Furthermore, it showed that sex workers will attend services that provide appropriate and integrated support relevant to people working in this industry (R1). The NHS funded the Praed Street Project services on the basis of initial research findings from 1991-2017 and, by August 2013, the Project offered 11 drop-in sessions per week, enabling sex workers to develop health and safety strategies, obtain counselling, referrals, and clinical care. Routinely collected NHS data (2015-2017) shows that the Project attracted women with different backgrounds from all sectors of the industry. The data records 2,339 different coded activities, including sexual and other health care (e.g. addiction, reproductive & mental health, violence), demonstrating the demand for an integrated service where sex workers could access tailored advice on a range of different issues, that are now known (as a result of Day’s research) to significantly affect their health and wellbeing [S1].

The provision of public funding for the Praed Street Project is testament to its perceived significance to service users and for broader STI/HIV prevention. Whilst it is difficult to provide detailed insights into the effect of the Project on the everyday life of individual users (given the nature of the industry and the confidential services on offer), comments collected from social media platforms, including Twitter and the Support and Advice for Escorts (SAAFE) online forum give an indication of how highly valued the Project was [S2]:

29/1/2015: “I’ve been visiting the Praed Street Project for years and the ladies are so lovely not to mention all the great advice and support I get from them”

06/0/2016: “Use them to get our certs*. Excellent service every time”.

08/11/2016: “They have been a god send for me over the years …”

*Some workplaces require certification that sex workers are free of infection.

On news of Praed Street Project’s closure in 2017, service users again took to social media to voice dismay about the loss of integrated, specialist services. Responding to a thread on the SAAFE forum about the closure, entitled ‘sex worker services at Paddington’, commentators reflected, “…I've had bad experiences in the past when I used the clinic for non-sex workers there”; “I might as well just go to my local GUM [genito-urinary medicine]

and not admit to being a sex worker” [S2]. In 2018, a Lancet report suggested parallel concerns, widely shared across health associations and charities including the National AIDS Trust and Terrence Higgins Trust, and a Kings Fund (2018) blog which describes researchers’ and policy advisors’ alarm about the closure of sexual health services. Reflecting on this trend and highlighting the benefits of providing the blend of services on offer at the Praed Street Project, a British Medical Journal blog post (2018) notes that remaining services for sex workers have a less holistic approach that makes them less effective [S3].

Challenging stereotypes and transforming lives through public debate and cultural performances: Day contributed to public debate about sex and sex lives at an event at the Royal Court in 2014 [S4] and advised on the Young Vic’s 2015 Brolly Project, a response to Shakespeare’s Measure for Measure, in which members of the local community drew on their own sex industry experiences. Day’s involvement in the Brolly Project play, called See Me Now, included helping the production team form a relationship with Praed Street Project and recruiting sex workers as creators and performers.

Challenging the stigma associated with their work and the wider policing of sexuality, See Me Now was performed at Latitude and the Young Vic in 2015. Imogen Brodie, former director of Taking Part, Young Vic (2012-2018) and David Lan (former Artistic Director, Young Vic 2001-2018) confirm that Day’s research and involvement in the project benefitted the lives of those involved, helping them gain skills and confidence. For example:

“One member of the group has been accepted into drama school to retrain as an actor, another has created a solo show which was performed at BAC, and another used the money she earned from the run of the show to pay for gender surgery. She describes the show as giving her a chance to live her true life – a chance she’s been waiting for many years. Whilst it is clear that these changes are not solely down to taking part in a play, it is also evident that the creative process had a significant impact on the people involved" [S5].

Brodie and Lan go on to talk of the wider cultural implications of See Me Now on audiences: “It challenged expectations and stereotypes. It illustrated the huge range of people who are sex workers. It shone a light on a section of society which holds great fascination but little understanding.” Comments from the audience on social media further corroborate this impact, “The Brolly Project @youngvictheatre overwhelmingly beautiful. Shattered stereotypes, full of hopeful hearts” [S6].

Informing attitudes to sex workers’ health through evidence provided to Liberal Democrat policy advisory group: In 2015, the Liberal Democrats embarked on reviewing and updating their 1994 Policy on Sex Work and Day was invited to contribute evidence to the Liberal Democrat Working Group on Consenting Commercial Sex Work, Liberal Democrats HQ. In advising the working group, which included an MP, MEP, Peer and other elected representatives, Day provided a historical overview of career trajectories, health provision and treatment of sex workers in the UK. The influence of her research on the working group’s thinking can be traced in the Working Party’s Sex Work: Policy Consultation Paper [126] (2016), including commentary on access to health services (p.17) and questions posed, e.g. Q25; “Is it important to maintain sexual health services separate from GP’s?” (p.31) [S7]. As a foundational source of evidence about the long term health and career trajectories of sex workers, (R1, R4, R6) the influence of Day’s research on the resulting Policy Paper [126]; ‘ A Rational Approach to Harm Reduction’ is reflected in recommendations about stigma and risk, ‘one stop shops’ (7.4.4), and statements which refer to Day’s research findings; “evidence suggests that sex workers are more likely to engage in safe sex than their non-sex worker counterparts” (7.4.5) [S8]. The motion to “decriminalise sex work and provide them [sex workers] with support that will improve their health and help them feel safer ” was passed unamended at the LibDem 2017 conference and contributes to ongoing national debate about the social, cultural and legal treatment of sex workers [S9].

Broadening approaches to health education to improve training for health care professionals: In making a contribution to the broader field of Anthropology and Public Health, Day’s research on sex workers’ health and wellbeing has achieved recognition through the Wellcome Medal for Anthropology as Applied to Medical Problems (2006) and Eileen Basker Memorial Prize, American Anthropological Association (2007). Her book, On the Game (2007) (R1) has become a key educational resource for social and health sciences and between 2014-2020 has been used in pedagogy and health care training in undergraduate and graduate courses at: the Central European, Edinburgh, Johns Hopkins Universities and the Universities of Cambridge, Kent, Surrey and Imperial and University Colleges London inter alia. It is a set text for training social scientists and health professionals about research evidence and its application in the sex industry, which enables a better understanding of health and other social circumstances, individual and population health.

At Imperial College London, the history of the Praed Street Project is used to train health practitioners in research methods and practice, providing an evidence base for services developed with sex workers and in response to emerging issues. Courses such as Society and Health  (350 1^st year medical students, Foundations of Clinical Practice, until 2016) Anthropology in Public Health, Master’s in Public Health (20-40 students, per year to date), Global Health training (undergraduates and postgraduates) incorporate social science approaches to underpin students’ understanding of healthcare. Day and Ward’s teaching and research in this field and the Praed Street Project model, in particular, are used to enable trainees to challenge widespread cultural and medical stereotypes. The majority of students on these courses complete training to practice as doctors and public health professionals [S10].

Tarlo’s research generated a broad range of different types of impact:

1.Changing Public Perceptions of hair through engagement with artists, designers, museums and readers

Tarlo’s research has played a significant role in changing public perceptions of hair. Her book, Entanglement (R1) prompted widespread debate about the global hair trade across the UK, EU, Asia and Africa and was reviewed in over 20 prominent international media outlets and popular blogs, including The New Statesman, TLS, The New York Times, Elle USA, The Oldie, Literary Review, The Australian, Sanlian Lifeweek (Beijing), Grazia South Africa, Bookriot, Goodreads, the Pool and Flavorwire and industry-specific news channels, such as Hairpisodes, Style Yetu, Tangled and therighthairstyles.com. Reviewers commented on their new understanding of hair and the hair trade: “It’s not often that a book gives you new eyes for your everyday world” (The Oldie); “Warning - you will never look at a trip the hairdressers in the same way again” (the Pool); “gives a fascinating insight into the business and the trade of hair which I was completely unaware of” (John Naylor. Goodreads); “I will never think of hair the same way again” (Valerie Steele, Museum at the Fashion Institute of Technology); “Hair is really, really complicated, and I didn't realise just how much until I read this book” (Chocolategoddess, Goodreads); “This book answered questions I didn't even know I had” (Rachel, Goodreads).

The exhibition, Hair! Human Stories (2018) (R5) has further encouraged the cross fertilization of ideas between artists, designers, museum curators and different publics regarding hair’s multiple uses and its potential as an ecologically friendly material for recycling. It was accompanied by workshops for rope making, felting and embroidering using human hair, along with discussions on black hair politics and hair loss. Seventy-five percent of visitors who gave feedback at the events confirmed that their perception had been challenged: “Never before had I thought hair was so important to so many people in so many different ways”; “I will never see hair the same way again”; “This exhibition has opened my mind to what an extraordinary range of things we can learn through hair”; “This has been an incredible learning experience. I have worked in hair all my life but I learned so much…Wow!” [S1a]. Museum publics also engaged with Tarlo’s research through public lectures and round table discussions at Musee de Quai Branly (Paris 2013), Museum Centraal (Utrecht 2016), Pitt Rivers Museum (Oxford 2019), and Somerset House (London 2016). Tarlo extended understanding of the properties and potential of hair as material fibre through dialogue with designer Alix Bizet at the Design Museum (London 2016), participation in the R&D salon on Hair at MOMA (New York, 2019) and an online interview at the Lebenhaus Museum (Munich, 2020) and her expertise in the field was acknowledged in a series of radio interviews [S1], including BBC Radio London (20 mins) and Think (Texas, 48 mins), BBC Radio 4’s Thinking Allowed, (29 mins), The Moncrief Show (Dublin), Word of Mouth (New Hampshire , 20 mins), The World (Boston 4 mins), Tout un Monde (Switzerland, 6 mins), Woman’s Hour (London), BBC World Service Business Daily and Late Night Woman’s Hour (28 mins with 60 mins podcast) [S1b].

2.Informing the development of improved ethical standards through education and engagement with the hair industry

Tarlo’s research highlights the lack of regulation in the hair industry and has stimulated awareness about hair provenance and ethical concerns amongst hairdressers, suppliers and wearers. The book Entanglement was launched through public debate in a hair salon (Ena salon, Covent Garden). Goodreads reviewer and hair extensions specialist, Jenn, writes “this book really amazed me… Even as someone who has made a large percentage of their living as ‘a hair dealer’ I had no idea that hair had such a complex, valuable or mystical quality” [S2a]. Citing Tarlo’s findings, journalist and writer, Krista Diamond writes in Business Insider, “My Hair extensions were a big part of my identity. But after learning how exploitative they are, I’m giving them up for ever.” The media attention to lack of ethical standards in the hair trade led Nigerian-born London-based hair importer, Christina Adesina, to consult Tarlo by telephone in October 2017 before she established her company Fair Care Hair, which campaigns for and promotes industry standards in the hair extensions sector [S2b]. The exhibition Hair! Human Stories (2018) (R5) and associated public events were hosted by INFRINGE and involved collaboration with stylists and clients from Hacketts salon as well as coverage in hair journals, national news outlets including The Financial Times, Le Monde and BBC World Service. Radio discussion on Late Night Woman’s Hour between Tarlo, hairdresser Alex Brownsell and Chidera Eggerue aka the Slum Flower, a young black motivational blogger on social issues, helped to further public debate [S2]. Stimulated by coverage of the book and exhibition and his subsequent interview with Tarlo, Manuel Silva who works for IMPACTT –Making what’s good for workers work for business writes that his research for a UK-based hair supplier on how to mitigate ethical risks in the industry was “particularly enhanced’ by Tarlo’s ‘vast knowledge on the subject” [S2c].

3.Promotion of Religious Literacy and Tolerance

By directly engaging with Jewish communities through Jewish Book Week and through interviews and coverage in conservative and liberal Jewish Media including Ami-Living and Jewish Digest, Tarlo has applied her research findings on religious controversies associated with hair to help promote inter-faith and intra-faith understanding. Rabbi, Aaron Goldstein refers to Tarlo’s research as “enlightening”, commenting in 2017, “Through my reading of ‘Entanglement’ … I realise that I need to do far more listening to Muslim women who wear a hijab and Orthodox Jewish women who wear a shaitel [wig] before coming to opinions” [S3a]. Tarlo participated alongside three orthodox rabbis in an emission of Headlines, a New York-based radio show and podcast specialised in Contemporary religious issues and Halakha (Jewish religious Law). In this 90-minute emission devoted to the sheitel (wig) controversy, she explained Hindu hair practices to orthodox Jewish audiences, challenging common misconceptions and prejudices in what is commonly perceived as a ‘closed and difficult to reach’ milieu [S3b]. The podcast received 7,544 downloads and the debates it generated resulted in a second podcast emission on the topic.

4.Contribution to rabbinical over-ruling of the ban on use of Indian hair for Jewish wigs

In 2004 observant Jewish women were banned from wearing wigs made from Indian hair on the grounds that it was considered idolatrous. In 2017 four rabbis in Israel who wanted observant women to replace wigs with headscarves, campaigned to get all human hair wigs banned, making the false claim that 98% of hair on the global market came from Hindu temples. Tarlo responded to numerous anxious phone calls and emails from members of the Jewish public seeking clarification on hair provenance. In November 2017 she was requested by the head of kosher certification for the Chief Rabbi of Bnei Brak in Israel to write a report on Hindu tonsure practices at Tirumala temple in India to help the Chief Rabbi reassess whether ‘temple hair’ really was idolatrous according to Jewish Law. After writing the report Tarlo received an email from the head of kosher certification, thanking her for the “in depth and informative report” and concluding: “Based partly on the information you shared with me, Rabbi Landa [the Chief Rabbi] was able to deduce that using Indian hair in wigs to be worn by religious Jewish women, does not in any way transgress Jewish Law …. Therefore, all those who supply the hair, produce the wigs and wear them are permitted to do so according to Jewish law ” [S6]. This ruling has major social, emotional and economic impacts, bringing relief to wig wearers, safeguarding the jobs of wig makers and traders and effecting supply chains involving India, China, Brazil, Russia and Ukraine.

5. Combating the social stigma of hair loss

Tarlo’s work opens up debate around the social issues surrounding the taboo topic of hair loss through a short animated film, ‘Its Only Hair,’ made in collaboration with Stacy Bias, and through workshops with school children (T he Big Wig Project, Hereford), hair loss suffers, charities and hair loss professionals [S5]. The animation features on the websites of Alopecia UK and The British Skin Foundation as well as on Vimeo where it has 5717 views, and was used by health care professionals to introduce the Psychology session at the conference, Get Ahead with Hairloss, (Royal Society of Medicine 2018) [S5a]. Dermatologist and organiser of the conference, Dr Sharon Wong and Psychologist Kerry Montogomery were impressed by its educational effectiveness, whilst Marketing Director of Philip Kingsley, Emma Poole, writes that “the video addresses this issue in an impactful, yet sensitive way and helps to educate and remove barriers/taboos we know are associated with people trying to cope with the condition.” Australian journalist, Kellie Scott, who has an Instagram page, @hairlossboss with 19k followers, wrote “I bloody love this video! It’s really rare to find relatable content like this for women with hair loss”.

The Big Wig Project was a Heritage Lottery funded, Rural Media orchestrated partnership between the Little Princess Trust and the Hereford Museum, involving Year 8 Children in Hereford, designed to explore and tackle issues of gender stereotypes and social stigma through learning about the social and historic importance of wigs. Wendy Tarplee-Morris, co-founder of the Little Princess Trust, a charity which since their launch in 2005 have provided thousands of real hair wigs to children with cancer free of charge, writes of Tarlo’s involvement in the Big Wig Project: “On a personal note it was a thrill to meet academic, Emma Tarlo on her visit to the Museum Resource and Learning Centre in Hereford. I am a huge fan of her work and research so to listen to her presentation and then talk about wigs with such an expert was an informative and rewarding experience” [S5b].

The expansion of commercial gambling is an issue of public concern in the UK, Europe, Australia, North America, New Zealand and Asia. Cassidy’s research has had a high-profile role in public debates about the social production of gambling policy, the flaws of the ‘responsible gambling’ approach to regulation, the volume of gambling advertising on television, and the conduct of gambling research. It has been used by: a) parliamentarians seeking to change policy; b) charities seeking to influence policy and public opinion; c) members of the public seeking to resist the expansion of commercial gambling in their locality; d) funders and policy makers seeking to reform the evidence base and e) the media trying to influence policy and public debate.

4.1 Impacts on Government and Opposition Policy:

The ERC project policy report, Fair Game, had its findings incorporated into the House of Commons briefing paper on Fixed Odds Betting Terminals (FOBT) [S1]. In 2018, the Conservative government reduced the maximum stakes on FOBTs from £100 to £2.

In 2017 findings from a paper on the volume, frequency and duration of gambling adverts during broadcasts of English Premier League football (R4) were quoted extensively by members during a debate about children and gambling in the House of Lords, with the intention of changing the outcome of the Government review of gambling policy on gambling advertising [S2]. The paper (R4) was also used by the Labour Party to call for a review of gambling and changes in policy including the creation of a levy to fund research and a ban on gambling advertising on footballer’s shirts, as reported in the Guardian and by BBC and ITV television [S3].

On 20 July 2018 Cassidy wrote to the Gambling Commission reiterating requests made during a meeting earlier that week, asking them to adopt a public health approach to gambling, remove all references to ‘responsible gambling’ from the new strategy, for the Responsible Gambling Strategy Board to be renamed, and for the creation of a data hub accessible to independent researchers. The new National Strategy of Gambling Harm (2019) made all of these changes. A member of the Gambling Commission confirmed: “One area that is likely to feature is the development of a data hub into which operators would be expected to report specified data sets. Researchers would then be able to access that data without the need to negotiate access from operators. Rebecca- you can take credit for planting that seed in my mind!” [S10].

In 2019 Tom Watson, Deputy Leader of the Labour Party and Shadow Secretary of State for Digital, Culture, Media and Sport, gave a speech announcing that the Labour Party would be writing a new Gambling Bill. Cassidy was the only academic referred to in the speech [S4].

4.2 Influencing Government Action:

The Campaign for Fairer Gambling provided copies of Fair Game to all of the parliamentarians they briefed on the triennial consultation on stakes and prizes in 2016. A member of the All-Party Parliamentary Group on Racing described it as “a volcano for the mind”. On 9 April 2014 Caroline Lucas, MP, used the report as the basis for questions to the Government about the independence of funding for gambling research [S10].

After reading Fair Game (R2) in June 2017, Welsh Minister Simon Thomas tweeted a link to the report saying that “@AssemblyWales will soon gain limited powers over #gambling. This report http://www.gold.ac.uk/gamblingineurope/report/ ...@ProfRCassidy shows the work we have to do” [S10] Other examples of Cassidy’s influence on Government include:

• In 2017 Cassidy provided background and reviews for a Parliamentary Office of Science and Technology briefing note on ‘ Researching Gambling’.

• In 2019 Cassidy testified before the cross-party gambling group in Cardiff and worked with Beat the Odds and the Royal College of Psychiatrists, Wales and Deacon University to create the first Welsh youth gambling forum, sponsored by Assembly Member Darren Millar.

• In 2019, Cassidy was appointed Specialist Advisor to the House of Lords Select Committee on the Social and Economic Impact of the Gambling Industry. The committee reported in July 2020.

Cassidy advised the Select Committee to adopt a public health approach to gambling and reject the language of ‘problem gambling’. Experts by Experience who gave evidence in October 2019 wrote that: “I’m really proud that the use of the term ‘problem gambling’ within the Lords set-up was translated to ‘disordered gambling’. I was told that to get this change would be a mountainous task. Thank you to the likes of @ProfRCassidy‬ for being a part of this change” [S10]‬.‬‬‬‬‬‬‬‬‬‬‬‬‬

In July 2020, Lord Grade, chair of the committee, presented 66 recommendations to Parliamentarians and the public. Cassidy’s contribution is acknowledged in paragraph 25 of the report [S5]. On 2 July Lord Grade wrote to Cassidy: “As our specialist adviser for the first half of our inquiry you pointed us in the right direction, helped set our agenda in the call for evidence, identified many of the essential witnesses, and helped us with written and oral briefing. We would not have got where we did without your guidance, and I hope you will feel that the report does you justice.” A review of gambling policy by the government is due to take place in 2020 [S6]. Since the launch of the government review of the Gambling Act in December 2020, Cassidy has been involved in advising Peers for Gambling Reform (the largest cross-party group in the Lords, dedicated to implementing the 66 recommendations made by the Select Committee).

4.3 Impacts on international policy and debates:

In 2019 in Istanbul, Cassidy participated in the inaugural meeting of the World Health Organisation panel on gambling. The purpose of the meeting was to develop recommendations for WHO’s further program activities in this area. Cassidy’s research featured in a documentary about gambling regulation for Japanese National Television (Somo Somo, 2015). In 2020, Vicious Games (R6) was translated into Japanese. In 2019 the New Zealand Problem Gambling Foundation reported that “delegates found your research inspiring in its courage and authenticity. Your presence and presentations have given impetus to the programme for change in Aotearoa” [S10]. In 2019 and 2020 Cassidy contributed to the Public Health England (PHE) Gambling-related harms evidence review, The National Institute of Health Research’s review of the effectiveness of national and international polices and interventions to reduce gambling-related harms. She also advised the Institute of Alcohol Studies and Scottish Health Action on Alcohol Problems (SHAAP) on future research initiatives.

4.4 Prompting changes to industry practices:

In 2018 the broadcaster Sky limited gambling adverts to one per commercial break, and introduced blocking technology. Before announcing the changes, Sky wrote to Cassidy saying, “When we met earlier this year we had a great conversation about action we could take as a broadcaster. I think this is a positive step, but interested to know how you see this and happy to catch up again.” In 2019 Cassidy shared her research with all English Premier League teams sponsored by gambling companies. Huddersfield and Swansea City football clubs made replica shirts without gambling logos available to under 18s. An industry consultant wrote to Cassidy describing this as a “small victory” [S10].

4.5 Promoting independent alternatives to industry funded research:

Policy makers internationally have described themselves as hampered by a lack of robust, high quality evidence on which to base gambling regulation. Cassidy’s research has improved the quality of the evidence base by creating new standards for funding, disclosure and ethical review.

Following the publication of Fair Game (R2), she was invited to write an editorial in International Gambling Studies, in which she called for a new, transparent framework for research. The journal responded by adopting a new disclosure policy [S7]. The Journal of Asian Gambling Studies followed suit. In 2017 Cassidy drafted, with Francis Markham, a new ethical code for professional gambling researchers. She presented this code at a meeting of the International Think Tank on Gambling Research and Policy in Auckland in February 2018 where it received strong opposition from industry funded researchers before being endorsed by a majority of delegates. The code has since been endorsed by funders and policy makers including colleagues at the Alberta Gaming Research Institute, Gambling Research Exchange Ontario, Problem Gambling Foundation of New Zealand, Gambling and Addictions Research Centre, AUT, and the Victorian Responsible Gambling Foundation [S8]. In 2019 the ethical code was one of the documents used as the basis of a discussion about the future of gambling research in the UK at a meeting of the Safer Gambling Board, a sub-committee of the Gambling Commission.

In 2020, Fair Game (R2) and Vicious Games (R6) were two of the key publications referred to in the launch edition of the new journal of Critical Gambling Studies which embraces the principles outlined in the ethical code. The journal provides a space for independent research which meets the standards of disclosure recommended by Fair Game (R2) and demanded in other fields of public health.

4.6 Challenging Public Debate:

Cassidy’s research has consistently informed public debate and underpinned calls for changes to government policies, appearing in publications ranging from The Daily Mail to The New Statesman, via the Guardian, The New York Times, The Lancet, and The New Scientist [S9]. Other examples of Cassidy’s influence on public debate include:

• In 2019, Nature, a journal with an impact factor of 42.778, reported that “science has a gambling problem” based on interviews with Cassidy about her research.

• Cassidy’s research has been used by campaigners for gambling reform including the Church of England, Gambling With Lives, Gambling Watch and Beat the Fix. In 2020 Vicious Games (R6) was used to argue for gambling reform in a report by the Social Market Foundation.

• Cassidy has spoken about her research at Falling Walls (2011), on Thinking Allowed (BBC Radio 4, 2014, 2020) and advised the producers of Panorama (BBC 1: 2018, 2020) and the Victoria Derbyshire Program (BBC 2, 2017).