Reading group conferences, workshops and networks
The Health Equity Network
We are an interdisciplinary network of early- and mid-career researchers and practitioners who are interested in promoting health equity across society through high quality research and advocacy. The network was born at the CRASSH workshop "How Can Primary Care Prevent Health Inequalities? 22nd May 2020. By design a balance of disciplines applied and were recruited through a competitive selection process to contribute to the workshop. A total of 14 then volunteered their interest to join the network with representation from Psychology, Sociology, History, Anthropology, Geography, Epidemiology, Public Health and General Practice.
The network’s approach is collaborative and our interests span local and global health and care inequalities. We comprise members from a range of disciplines and institutions and are supported by the St. John’s Reading Group on Health Inequalities and Cambridge Public Health.
The group aims to work together on reactive and proactive advocacy, developing relationships, support and is a forum for discussion and mutual learning. We planned to achieve this through discussion of emerging findings, research ideas, papers, presentations to develop commonalities and expertise, identifying gaps where we felt we could add value.
Areas/Themes of interest
- Primary & Community Health Care
- Development of Inequalities across the life course
- Addressing Social Determinants: Health Outside of Healthcare/Organizing, Activism, Civil Society, the Shadow State
- Government, Austerity, Lack of Investment in Health and Social Care Systems During COVID / Health Inequalities, Policy, & Politics
We meet about once a month with a different member of the group leading the discussion often based on a paper of interest relating to their own research. These topics have included the reorganization of Public Health England: leadership in public health and health inequalities, Liberation Medicine – health and social justice and perspectives of the Ethiopian Community Based Health Insurance scheme.
Collaborative work so far has included:
- Building our web presence - Health Equity Network | Cambridge Public Health and making connections with similar groups.
- Rapid Review of the Impact of Allied Health Professionals on Health Inequalities; involving five members of the group, commissioned by PHE to tight timelines. This work has been presented at PHE’s last Public Health Research and Science Conference 2021 and is undergoing peer review and publication.
- Health Equity Audit review to inform equity focused quality improvement has been published. This has been developed to inform quality improvement work in NHS QI leads and teams to explore QI distribution across the population.
- A practical framework to support action on levelling up health and an evidence review of effective policy, practice, and ways of working to ‘level up health’ through action on the socioeconomic conditions influencing geographic health inequalities. This was a second review commissioned by PHE this year, also in preparation for publication.
How Can Primary Care Prevent Health Inequalities?
How Can Primary Care Prevent Health Inequalities? New Connections and Research Priorities, May 2020
A workshop from the St John’s College Reading Group on Health Inequalities, in conjunction with CRASSH.
Blog post: How Can Primary Care Prevent Health Inequalities? New Connections and Research Priorities
The St John’s Reading Group on Health Inequalities has been holding regular interdisciplinary meetings since 2014 and has offered a series of public events including film shows and conferences to showcase its way of thinking (see the group’s website for more information). The group encourages its members to not only think beyond conventional descriptions of health inequalities but also to adopt new ways of taking into account the perspectives of disciplines beyond social epidemiology. These include sociology, biology, psychology, history, philosophy and economics.
The convenors of the group wanted to extend the reading group format to early career researchers, providing them with the opportunity to hear academic leaders taking a range of disciplinary perspectives on the role of primary care in addressing health inequalities. Originally, this was to be a face-to-face event held in Cambridge, however the circumstances led us to move the workshop to Zoom – thankfully the technology held out for the afternoon!
The workshop brought together 18 early career researchers from a range of disciplines (anthropology, history, sociology, psychology, public health, clinical medicine, and geography) interested in primary care and the role it could play in reducing health inequalities. The talks and discussion sessions were designed to challenge existing assumptions about primary care, and to start to think about potential new ways to involve a range of perspectives in framing future research.
Professor Ann Louise Kinmonth opened the online workshop by arguing for the contribution that interdisciplinary approaches could make in this area and in informing a breadth of methodologies to explore the complex nature of inequality in health
The first speaker session opened with Professor Kurt Stange, who began with an overview of the work of Barbara Starfield on primary care before questioning her approach to its typification. He noted that primary care is not homogenous, as primary care systems adapt to different socio-political contexts, and this creates challenges for how we should best study it. Rather than providing a set of properties that characterise primary care, Kurt proposed that the system of primary care instead does three things. First, it recognises and makes sense of problems and opportunities that it is presented with. Second, it works to priorities those problems and opportunities. And finally, it aims to generate solutions that lead to healing, improved health, and connections between individuals and between communities.
Professor Stewart Mercer followed by outlining his experiences of working with complex interventions in primary care on several projects in Scotland, which focused specifically on local contexts and communities. Indeed, this concept of ‘context’ proved important for the remainder of the event. He emphasised the importance of listening to a range of stakeholders involved in the delivery of primary care interventions, as this is how you will understand how resources are actually used in practice (instead of in theory), to what extent patients take part in programmes that are designed for them, and how they engage (successfully or not) with primary care. It is important, therefore, to use a range of methods from both quantitative and qualitative toolboxes in order to develop an in-depth view of the landscape in order to inform future research questions.
The first group discussion session encouraged attendees to consider how they could think differently about primary care and health inequalities. Indeed, the very idea of having a universal definition of primary care was viewed as problematic and potentially unhelpful, as primary care systems in different countries operate differently according to prevailing socio-economic conditions. Having an international perspective was therefore seen as vital to understanding how primary care could work to address health inequalities; an awareness of specific contexts. Participants were also concerned about possibly placing too much responsibility on primary care practitioners for reducing health inequalities. They drew attention to the range of other existing initiatives in communities that contribute to improving health, and to the wider duties of the state. Whatever work is done in primary care needs to be part of a wider strategy that includes addressing structural issues in society. Evaluating such a strategy necessitates the use of a range of methods from different perspectives.
The second main session saw three academics talk from their own disciplinary perspectives. Professor Mike Kelly spoke from his experience as a sociologist, emphasising the importance of social factors at the local level, and the interplay between working relationships and family structures in the home on health experiences. In order to maximise the contribution of primary care towards reducing health inequalities, he argued that we needed fine-grained accounts of local contexts, which used to be a feature of local public health reporting up until around the 1970s, but are now largely absent from such reports. Taking account of local contexts, communities and relationships is key to improving health outcomes and reducing health inequalities.
Professor Simon Szreter spoke from a historical perspective, placing the development of primary care in historical context. He spoke about health, welfare and security in the UK, and noted that the first universal welfare package was introduced in 1601 with the Elizabethan Poor Law. This provided a safety net for those in need, but was rescinded in 1834. Beveridge’s work in the 1940s was, essentially, a rediscovery of the need for support to be given to those who were suffering – this work eventually led to the introduction of the NHS. Simon demonstrated that, in order to understand the big drivers behind health (including health inequalities) and healthcare today, it is necessary to include a historical perspective.
Finally, Professor Mia Gray provided a geographical perspective, focusing particularly on economic changes and decisions in the UK since 2010 and how they impacted on different areas of the country. The introduction of austerity policies led to cuts to budgets in local authorities, but these cuts were not felt equally across all areas and indeed not across all services within those areas. Cuts to local government exacerbate and intensify problems with deprivation and poverty, which in turn affect the health of the population. As such, it is important to remember that politics, health, economics and geography are not separate but are intertwined.
The group discussions that followed were focused on exploring the potential contributions that other perspectives, including sociology, geography and history, could make to research questions on primary care and health inequalities. While a number of academic perspectives were deemed to be important in this area (including, amongst others, economics, politics, gender / queer studies, race studies), attendees also wanted to move beyond traditional academic knowledge and to include the knowledge held by patients, families, and communities. Inclusion of these forms of knowledge in discussions about primary care and health inequalities alongside academic understandings is essential to inform effective action. The discussions also touched on the need to ensure that influencers and decision-makers are involved in order to ensure that changes can be made. In fact, a range of disciplinary perspectives and kinds of knowledge could be helpful here – it might be possible to create different kinds of explanations that can be presented across the political spectrum to develop support for reducing health inequalities and the role that primary care should play in this.
The feedback we received from participants was broadly positive. There were a couple of areas that were flagged for further attention. First, a deeper exploration and comparison of primary care systems, and second greater specificity on the kinds of methods that could contribute to our understanding of the role of primary care in reducing health inequalities.
We intend to follow up these areas with interested participants, and to host a face-to-face event in the future so that attendees can get to know each other better and for the group to crystallise some areas of work into the future. We hope that the participants will go on to create an interdisciplinary network of early career researchers in Cambridge who are interested in thinking about public health and primary care and their role in addressing health inequalities. See Networks; Health Equality Network (HEN).
Comparative perspectives on social inequalities in life and death: An interdisciplinary conference
Comparative perspectives on social inequalities in life and death: An interdisciplinary conference
This conference took place on Friday 1st June 2018 – 10am-5pm in the Main Lecture Theatre, Old Divinity School, St John’s College, followed by a public lecture in honour of Robert Hinde from 5-6pm.
Since 2014, the St John’s College Reading Group on Health Inequalities has been bringing together scholars from a range of disciplines to consider the wider mechanisms by which disparities in human health arise and are sustained across time and generations. The focus is the interrelationships between social, biological, behavioural and historical processes and the patterning of mortality and morbidity in human populations.
The purpose of the conference is to widen our interdisciplinary approach to understanding inequalities in human health, through dialogue with ethologists. Ethology is the scientific and objective study of animal behaviour, usually with a focus on behaviour under natural conditions, and viewing behaviour as an evolutionarily adaptive trait.
There is strong evidence that position in the social hierarchy in humans is closely related to health and disease risk. The result is a social gradient in health—worse health the lower the social position. Yet social hierarchies, sustained across generations, are widespread among mammals and in evolutionary terms can be understood as offering advantage to the group as a whole, if not equally to all its members. Within the group, behaviour of individuals can vary between co-operative or competitive, and can affect reproductive success. A central form of cooperative behaviour is caregiving, the nature of which is a powerful predictor of later social and health outcomes in humans and other primates.
We present an interdisciplinary programme informing understandings of inequalities in health by drawing on new data from other social mammals, particularly non-human primates. The programme addresses the ways in which human and animal studies seem to proceed in parallel, with each side knowing little about the work of the other, and brings them together.
The programme moves from the consideration of the persistence of inequalities in human health, the relevance of social context, and mechanisms that sustain social position across both time and generations, to a consideration of fitness in other social mammals and aspects of resilience in unstable environments. In the afternoon, we take examples of free-living baboons in Botswana, and captive colonies of macaques in Bethesda, to consider social and epigenetic mechanisms maintaining social hierarchy and relationship across generations.
In a presentation in honour of Robert Hinde, we end with a Public Lecture drawing on the exceptional body of work of our keynote speakers in understanding a particular interest of Robert’s; the extent to which human differences in behaviour and relationship represent adaptations to the worlds in which children grow up.