Celebrating International Day of Women in Science
To celebrate the International Day of Women and Girls in Science we spoke with a couple of fierce female scientists SSM members about their role in driving forward population health research.
See our questions and their answers below:
Which aspects of social medicine and population health research do you enjoy the most?
Catherine Law
Problem-solving – the exercise in the logic of working out what needs to be done and the practical challenge of how to make it happen. I have been involved in commissioning, producing and using research, and they are all stimulating, creative and educational in so many different ways. And I also enjoy the social aspects of work – what a privilege to work in environments with so many clever and talented people.
In sum, my favourite thing is/was/and I hope will remain its cross-disciplinary magic.
Health inequality. There is no other branch of science where you consider both the social and the biological, and try to understand the ways in which these relate to each other. As Virchow said: Medicine is politics. And social epidemiology traces the ways in which this works.
The really exciting bit is finding out things that we can then try to do something about. Using epidemiology to identify modifiable risk factors and then developing interventions is something I find really exciting.
I have loved working amongst such a fantastic community of people from a breadth of disciplines. I love the fact that so many colleagues in social medicine remain fired up by wanting to improve health and well-being, and redress injustice. I’ve really enjoyed the challenges of understanding the perspectives of a wide range of stakeholders. I enjoy doing (some) fieldwork – being on the ground has helped to focus a lot of my ideas and forcefully brought home the challenges that some people face day-to-day in their lives. And I love the fact that the challenges keep changing!
Bringing different disciplines together to create new learning and perspectives, going beyond single topics and tackling major challenges – trying to make our research as relevant as possible not only to contemporary populations but also future ones.
For me, it is cross-disciplinary work and engaging with local communities to improve overall health. Their insights and observations are invaluable in terms of developing interventions that are likely to work and adapting accordingly. I also enjoy the policy relevance of the work I do. I enjoy introducing students to the world of social medicine research.
Working with colleagues from a range of disciplines. My background is in public health and epidemiology but I have colleagues who are nutritionists, psychologists, geographers, and statisticians. We all bring our different perspectives and expertise and this is an enormous strength for the kind of research we do.
I enjoy all of it, but the main aspects I enjoy are the multidisciplinary teams and using data. I like working within a team who all have different skills and expertise. I can learn from their approaches and improve what I do. I also really enjoy applying complicated statistical techniques to data to answer interesting research questions about people and their health.
Now that I am getting ‘longer in tooth’, I most enjoy seeing the next generation of social medicine leaders coming through — a good majority of them are women! There is nothing more gratifying than watching people develop their skills and confidence, and supporting that process where I can.
Identifying or quantifying issues where the action is needed, e.g. lengthening times available for pedestrians to cross the road because current settings were too short for actual walking speed in general population sample. My most fun job was in tobacco control advocacy. Not done as research but most projects also published in peer-reviewed journals.
I am passionate about public health and reducing health inequalities. One aspect that I enjoy most about my research is using visual participatory approaches to actively engage with community members, service providers, and decision-makers to tackle public health issues. I am committed to producing research that reflects community needs, informs policy and practice, and addresses current gaps in public health research. Since my PhD, I have been privileged to work in multidisciplinary teams that inspired me and complemented my research.
It is such a diverse, interdisciplinary field, what I find most exciting is exploring determinants of disease, at both the individual and environmental level, and try and translate this into recommendations/actions that can improve public health.
I love working with new data sets and feeling the excitement of discovering relationships between social factors and health outcomes. It’s always particularly satisfying when a research finding explains something that has appeared anomalous or mysterious up until then.
The variety in what we do, ranging from analytical data work, communication of our results, designing new studies and research questions, and working across disciplines, to name a few examples. We are constantly challenged to think about the individual, and broader, societal and economic factors that might affect health, and how these interrelate.
I enjoy searching for answers, exploring the biopsychosocial mechanisms and influencing factors involved in the aetiology of dementia. I love the challenge of scratching beyond the surface in order to uncover certain mechanistic pathways that seemed initially unclear. Working in social medicine can be quite magical as you get to discover how social, environmental and biological influences are interconnected and influence the overall health.
Which aspects of social medicine and population health do you find the most challenging?
Catherine Law
University bureaucracy and university politics – necessary in moderation but currently both waste public money for no discernible public good.
Methods. Recently there have been grievances in methods. Statistics have never been my strong point. But if we use the new. Methods properly done, allow us to approach important research questions better than we could before. Luckily, I’m good at collaborating with people a lot cleverer than I am. Epidemiology also now seem to be obsessed with genetics. This is something we need to be a lot more careful about. I suspect it will turn out not to add much to our understanding.
These days getting access to routinely collected data is a massive challenge.
The problem of confounding. It is a real challenge in observational research, and dealing with it is far from straightforward.
It’s sometimes difficult not to feel overwhelmed – e.g. by the undermining of the quality of people’s lives and the delivery health and social care by political decisions or intransigence, and by the sheer volume of output – some days it’s best to stay away from twitter!
Probably the model of funding and research careers that we have that hasn’t traditionally facilitated cross-institutional, cross-disciplinary and team working including the security of employment and a sense of being valued for long term skilled colleagues. I think we waste vast amounts of our time and skill on trying to sustain funding for research that really needs to be done but has been very hard to fund. So much energy and resource are spent on the competitive processes – a topic for a proper economic analysis of value and opportunity cost!
Knowing that people’s lives could be much healthier with just (fairly) small shifts in resources i.e. provision of NRT free of charge to everybody who is committed to giving up smoking. The bureaucratic challenges are increasing.
Interacting with policymakers can be a challenge. Policy change happens quickly so we need to ready with the evidence at the right moment.
Thinking upstream but delivering downstream. My research focuses on the social determinants of health and how they result in health inequalities. We know policies should be aimed at the population level and we should be “fixing the bridge” to stop people falling in the river, but much of the intervention delivery is about individual behaviour change and “pulling people out of the river”.
Juggling time spent staying abreast of the science, while taking on greater responsibilities is a challenge. Hopefully my early days of juggling babies with work and PhD studies has prepared me well.
Anything requiring data linkage! While Ministers exhort greater use of linked Big Data, I am still waiting, 6 years on, for mortality and HES data linked to Health Survey for England data DESPITE THE INDIVIDUALS HAVING GIVEN WRITTEN CONSENT!
I agree with Carol Brayne that one of the main challenges we are facing is represented by the insecurity of employment (especially for early and mid-career researchers). Moreover, the constant pressure to secure funding and the competitive processes do not often favour interdisciplinary work and cross-institutional collaboration – although there are some excellent examples of collaborative research out there :-).
Thanks to such an excellent research community, the methodology is often under scrutiny and novel methods are being proposed at a very fast pace, particularly regarding causal inference in observational studies. Keeping up to date with these methods, and incorporating them in my analyses are a big challenge.
Social medicine research is becoming increasingly inter-disciplinary so the breadth of theories and research findings that I need to keep on top of as a researcher is growing all the time. So it can feel overwhelming to stay up to date. But that’s also what makes the research so exciting as we’re discovering new things every day.
Barriers to getting linked data, getting research used in policy, attrition and non-response in data, which may affect research in marginal/minority groups.
The lack of standardisation across measures and the variation in the thresholds used for identifying the risk of disease.
How do you think `social medicine and population health’ research has changed over time?
That’s difficult because we probably all mean different things when we talk about “social medicine” research. The science presented at the ASM has got broader and more multi-disciplinary, as it has in other fields. What has not changed sufficiently is the scale and ambition -we have such entrenched and wicked problems to tackle, and we need to take some different approaches, with much more research on system change.
Social medicine research now takes a more uncompromising stance on eugenic and victim-blaming approaches which is great.
It seems to have become worrying concentrated in Russell Group universities and thus has not related so well to the socio-economic background to the work of other health service professions. This is unfortunate, as during the past years, they have become graduate professions and developed research agendas. A problem with the name Social Medicine is that it now sounds as if it relates to medicine, rather than also encompassing other areas, such as midwifery, where I have been working for the past fifteen years.
When I started out, the entire focus seemed to be on cancer and cardiovascular disease, with interest in infectious diseases in the tropics. It is so much broader now, and we recognise the multi-factorial nature of disease and exposures.
The need for a multi-disciplinary approach is now much more taken for granted which is great.
From the standpoint of the methods we routinely draw on, there have been many changes. There have been huge changes in technology and ways to collect, store and analyse data, leading to more robust and complex quantitative analysis and modelling (though we all still need to worry about what the data which we input into these analyses!). Alongside this has been a move to link routinely collected data and to ‘big data’, and an increasing assumption that data collected through public and charity funding. Having said this, we have to be careful that we don’t construct our view of the world solely based on what is easy/possible to measure, and from an inequalities perspective, it is still really important to be vigilant and critical about WHO is missing from these data sources and what that might mean?
The use of qualitative methods has moved beyond really valuable earlier work to further understandings of health and illness and is now essential understanding mechanisms and outcomes in policy and intervention analysis. Evidence synthesis – and the accessibility of research – has been another area which has seen a radical step change since I first worked in the field.
There’s so much more – such as moves towards developing and evaluating interventions, the current focus on systems, and the potential radical disruption to our thinking on social medicine that climate change is likely to bring is just beginning. Some things sadly haven’t changed – inequalities persist and we live in a society that is failing to invest sufficiently in improving the lives of the most disadvantaged.
And the expectations of ‘work’ have changed dramatically too. We need to find ways of redressing the continually escalating expectations of more hours, more output, more …, more …
I think we have many fashions that sweep over us and we have little time to reflect on true value of new investments. The role of reflection and social science narratives is not perhaps as strong as it has been at times. The societal movement has been away from the collective to the individual, and this is reflected in some areas of population science being highly focused on individualised risk, early detection that diverts major effort, new research training away from evidence generation for communities and populations. I think there’s a growing awareness of the need for a more balanced approach, which is welcome.
Greater interest. Moving from infectious diseases to chronic disease prevention in accordance with societal challenges. A greater focus on health systems, implementation science, the important role of qualitative data, the advancement of research methods, joining data sets and moving towards Artificial Intelligence. More funding is now directed to population health research and its translation into practice and policy.
Increasing emphasis on translational research and systems science approaches. These are positive developments and have brought with them a much greater emphasis on working across disciplines.
There has been a shift from descriptive and associative epidemiology to understanding causal effects. This has happened because there is a broader understanding from other disciplines on how to estimate causal effects and make use of natural experiments to evaluate policies.
My own impression is that it has moved further from the ‘social’ toward more concern about causal methods. This is progress as our claims to knowledge must be based on the most rigorous possible evidence, but hopefully not at the expense of understanding context and the wider social processes that give our findings meaning in the real world.
Far more genetics and epigenetics and omics etc. But social determinants of health are still the main underlying causes of health inequalities. And (socially patterned) smoking is still the main proximal cause of e.g. huge inequalities in premature mortality. Just because someone has a low genetic risk for CVD or one if the smoking-related cancers it doesn’t mean it’s safe to smoke. But recent suggestions that screening men for prostate cancer based on their polygenetic risk may show I am wrong….
Much progress has been made in the field of social medicine and population health research. For instance, there is now a realisation that public health is a holistic concept that requires a wide set of approaches to tackle the important challenges that we face. This implies a shift of thinking from a linear framework to one that recognises the complexity of the public health issues, and a recognition that for tackling health inequalities we need to implement strategies across all the social determinants of health, and the whole society.
I believe the most striking change in the last decade is the collection of omics data in large scale studies that can inform in much greater detail on biological mechanisms underlying observed associations. Epidemiologists are still at the dawn of using and interpreting these data and they represent both an immense opportunity and challenge for the future of social medicine.
Social medicine is definitely being taken more and more seriously as a research field. Politicians and clinicians are increasingly focusing on how social factors are related to health and disease and seeing this not as a fringe area of research but as something absolutely essential to population health.
We see more use of objective and sophisticated data, more cross-disciplinary work, larger and collaborative datasets, more sophisticated methods used to address the issues of causality. The field is constantly evolving.
I have seen substantial progress in data sharing, which is the primary source for our investigations. I think this has offered an increased opportunity for researchers to answer imperative questions related to health and quality of life of countless individuals. Topic-wise, I would like to see a more sustained funding stream for early detection and disease prevention.