Why did you decide to get involved in social medicine?
I did a degree in Biology and then I went into medical research in London looking at ‘tissues and bits of people’. Then I got involved in some social movements when I was in Edinburgh and ‘human rights social campaigns’. I became more interested in ‘whole people’ than ‘bits of people’. Then I actually got a job at the Scottish Health Education Group in Edinburgh, which combined my biology and health with my growing interest in population health, and my interest in social medicine has grown ever since.
What was your first ever publication about, in 30 words or less?
One of my first publications was about the concepts and principles of equity and health (1991), and I did it for the World Health Organisation.
Which piece of research are you most proud of and why?
I am most proud of a piece of research that was published in Social Science & Medicine in 2000. It was entitled ‘Social policies and the pathways to inequalities in health: a comparative analysis of lone mothers in Britain and Sweden’. It was about evaluating the impact of welfare policies on health inequalities in relation to lone mothers. I am proud of that because it was theory-based on the Diderichsen’s model (with Finn Diderichsen as co-author) which was the first to bring together social context and policy entry points into the mechanisms generating health inequalities. The study itself was innovative, and it was about an important public health issue. It has been since been used as a framework by other investigators for carrying out health inequalities impacts assessments of social policies.
Where do you see social medicine heading in the next 20 years?
At the moment, there are quite depressing signs of a narrowing of the field, and this is what I call a ‘lifestyle drift’. Although everybody says that the social determinants of health are important and we should look at the ‘causes of the causes’, there is the tendency in practice to focus on individual behavioural factors. It seems to be, with this new Government, even more a tendency towards that lifestyle drift. I am hoping that in twenty years’ time, the trend would be reversed. The optimist in me says that we must carry on fighting to maintain our emphasis on the wider social determinates of health, and to resist this ‘lifestyle drift’.
What three pieces of advice would you give to an early career researcher looking to have a career in social medicine?
It is pointless having a career in social medicine if you are not absolutely passionate about the subject. The first piece of advice is that you should reflect on what you are passionate about and you feel you could dedicate your career to. If you then decide on social medicine, then your passion will carry you along. You should see it as a responsibility of your research to disseminate your findings to academic audiences but also to the other 14 audiences who can use your research. Too often, with PhDs for example, people complete their thesis and then it is left on the shelf, and it does not get anywhere else. I always emphasise to my PhD students that this would be failing their responsibility. If you have findings, you should get them out there where they can be used. Don’t be discouraged by the setbacks but keep on going. Particularly with publications: there will be rejections; research applications: there will be rejections. But you can learn from those and carry on, rather than just give up. There are going to be a lot of setbacks!
What do you perceive are the main challenges facing early career researchers in social medicine today and do you have any advice on how to overcome them?
One of the main challenges is that permanent posts have almost disappeared or are few and far between in academic research. Lectureships and senior lectureships are rare. Early career researchers can be expected to be on a series of fixed term contracts, and I think that is a great challenge. It leads to disruption and discontinuity in the research. There are going to be gaps in the contracts, and this affects the researcher’s personal life. There is no easy way to overcome it, but getting yourself in the position of being more ‘marketable’, definitively helps. That means that you really need to build up your publication record, and get experience of submitting grants, obviously, first of all as a co-applicant. Building your skills in a range of research methods also helps when it comes to justify applications.
If you had to recommend one book or research paper for an early career researcher in social medicine to read, what would it be?
‘The Spirit Level’ by Kate Pickett and Richard Wilkinson is a good place to start to be inspired to take up social medicine.
What is the best course you have been on and would recommend to ECRs?
One of the best courses I have been involved in was devised by Professor Mark Petticrew and his team at the London School of Hygiene and Tropical Medicine. It was about systematic reviewing of complex social interventions and policies.