jennie popay - a cautionary tale: serendipity and a career in research
TRANSCRIPT
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Acau&onarytale:Serendipityandacareerinresearch
“Weencounteralinguis0csage,walkdowntheillustrioushallsoftheHarvardMedicalSchool,a;endthe(serendipitous)birthofpenicillin,andmeetsomeonewho"managesserendipity"fortheU.S.Navy.”
“thebook.....representsMerton'slifelongprotestagainstthatrhetoricofsciencethatdefinesdiscoveryasanythingotherthanamessyblendofinspira0on,perspira0on,error,andhappychance–i.e.anythingotherthanserendipity”.
JenniePopayProfessorofSociologyandPublicHealth
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1950’sSalford–eagertogetonwithlife
Late1960’s:LastcohortofunqualifiedVoluntaryServiceOverseasinEastAfrica
Mid1960’s:2yearsunskilledworkthenteachingassistantfor6months
WorkinginschoolsandadultliteracyinUganda,KenyaandTanzania
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1970’s:atortuouspathbutspectacularviews!1950’sSalford–eagertogetonwithlife
Late1960’s:LastcohortofunqualifiedVoluntaryServiceOverseasinEastAfrica
Mid1960’s:2yearsunskilledworkthenteachingassistantfor6months
OfftoUniversityinNewZealandtogophysicalgeographyandgeomorphology!
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1970’s:atortuouspathbutspectacularviews!1950’sSalford–eagertogetonwithlife
Late1960’s:LastcohortofunqualifiedVoluntaryServiceOverseasinEastAfrica
1980sLondonmovedintohealth18yearsfixedtermcontractsinUniversi&es&voluntarysector
Decadesofopportunis&cgrantcaptureVariouspublicappointmentsLotsofnetworksbuiltonwayMadefriendsandenemies
1994Salfordsetupresearchcentre–firstinNHSthenatenuredpostasprofessor2000-01ProfessorUniversityofLeeds2001–topresentProfessorLancaster
Mid1960’s:2yearsunskilledworkthenteachingassistantfor6months
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Whythemovetohealth?
Published1979 A;endedlecturebyPeterTownsendonpovertyintheUnitedKingdomonvisithomeandwasconvertedtosocialpolicyandalife0mecommitmenttoresearchandac0ontoreducesocialandhealthinequali0es
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Healthinequali&es–nothowmuchmoneyyouhavebutwhatyoudowithit?
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Within countries: UK Inequalities in life expectancy and healthy life expectancy at birth between more and less disadvantaged areas of England
Women: 6 years difference in life expectancy and 20.2 years difference in healthy life expectancy between most and least deprived areas
Poorest areas
Richest areas
Men-8 years difference in life expectancy 19 years difference in healthy life expectancy
h;p://visual.ons.gov.uk/how-long-will-you-live-in-good-health/
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Life expectancy by local authority areas in England: 2009-13; greatest gap is 7 years for women and 9 years for men
On average health of population in the north is worse than that in the south even when they are l iv ing in the same socio-economic circumstances
Within Country - The North South Divide
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At the local level – health inequalities in Lancaster
Pattern of disadvantage
Lancaster
Inequalities in life expectancy by area disadvantage – 10 years shorter for men and 9 years for women in most
disadvantaged areas
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1. Practical wisdom & health inequalities
• individuals dominate • but as accumulations of risks,
vulnerabilities and resiliencies or sets of freely chosen
behaviours
Absence of people as ‘knowing subjects’ using
practical wisdom to make decisions that are logical
in context of theirlives
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Many fault lines between lay and professional understandings
• Practical wisdom connects experience and behaviour with material and social context and presents health damaging behaviour as coping strategies
• Professionals/researchers fragment people’s experience into individual or clusters of behaviours and/or lifestyle too often presented as ‘freely chosen’
• Practical wisdom reflects realistic assessments of limited opportunities for control - professionals see fatalism, low locus of control or health ‘illiteracy’
• Lay people and professionals may share ‘values’ but interpret implications for action differently e.g. – Both accept parental responsibility for child safety but professionals emphasise their
educational role, parents’ emphasise responsibility of many agencies & people
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Prac&calwisdom&poli&calliteracy
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2. Questioning dominant perspectives on health
(inequalities) and what is to be done about it/theme
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Public images of health issues in UK
BreasTeedingmothersoffered£200inshopvouchers
PayingpregnantsmokerstoquitinGlasgowGetPaidtoExerciseandLiveaHealthierLifestyle–BUPAini0a0ve
Paychildrentoreadbooks–Pay4PerformanceObesitycrisis:getpaidtoloseweight
Paykidstoeatfruits,vegetables
Incentives and the rise of nudge
Better lifestyles = better health
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• Wideningsocioeconomicinequali0es=wideninghealthinequali0es• Evidencesuggestslifeexpectancyimprovementsfalteringasausteritybites• Response–moreaboutthatinamoment…….
An alternative perspective
Enhancedsocialjus&ce=be]erhealth(equity)
An unjust and sickly Britain
Most unequal Least unequal
Income inequalities in 30 high income countries
Non-decent homes by tenure
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3HealthInequali&es&CommunityControl
• StudyofIndigenoussuicideinBri0shColumbia– Significantlyelevatedsuiciderates(overall50mesgreaterbetween1987-1992)– Butnotuniformlydistributedacross1stNa0ongroups:– So,aboriginalityperseisnotariskfactor.
• Testedthehypothesisthat‘Culturalcon0nuity’explaineddifferences• Measuresofculturalcon0nuityreflecteddegreeof‘communitycontrol’
• historyandsuccessoflandclaims;• selfgovernment;• controlofservices;• Dedicatedculturalfacili0es
Personalpersistence,iden0tydevelopmentandsuicide,Chandler,Lalonde,Sokol,Halle;,Monogr.Soc.Res.Child.Dev.2003:68(2)
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Evalua&ngExperimentsinCommunityEmpowerment
Local Trust & Big Local People’s Health Trust & Local Conversations
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Earlylearning:incontextofcutsinpubicservicesandfinancialcrisisintheNHSCommunityandpa0ent
centerednessriskbecomingDIYhealthandwelfare.
The Political Paradox
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1970’s:atortuouspathbutspectacularviews!1950’sSalford–eagertogetonwithlife
Late1960’s:LastcohortofunqualifiedVoluntaryServiceOverseasinEastAfrica
1980sLondonmovedintohealth18yearsfixedtermcontractsinUniversi&es&voluntarysector1990sonwardsbacknorth….
Mid1960’s:2yearsunskilledworkthenteachingassistantfor6months
?whatlessonsfromthis
career?
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• Manysurprisesalongtheway–butleastlikelyeventsmayofferopportuni0es
• Missedopportuni0esaren’tadisasterbutformalqualifica0onsmoreimportantnow
• Mostsectorsvaluepathwaystheyknow–butacademiamaybepar0cularlyconserva0ve
• Buildingandmaintainingrela0onshipsover0meisreallyimportant
• Learningtodealwithdifficultsitua0onsanddifficultpeopleveryvaluable
• Workingacrosssectorshasvalue:acquiringdiverseknowledgeandunderstanding
• Genderma;ers–combiningworkandfamilymakesacareermoredifficulttomaintain
Lessonsfrommycareer…….• Leavingthingstoserendipityhassomedisadvantagesbut
canbemoreexci0ngandrewardinginlongrun
• Imayhavefollowedapathmoretortuousthanmostbut‘HappyChance’createsacademicmongrels–wearetoughbutitcanbehardertodemonstrateworth