4 fully-funded PhD Studentships in Public Health Research

The Liverpool and Lancaster Universities Collaboration for Public Health Research (LiLaC) is offering 4 fully-funded PhD studentships focussed on various aspects of inequalities in health, that will be integrated into the major programmes of work of the NIHR School for Public Health Research (SPHR). Applications are invited from individuals with a strong academic record who wish to develop a career in public health research. More information hereApplications must be received by 12 noon on Wednesday, 23rd January 2019.

The Liverpool and Lancaster Universities Collaboration for Public Health Research (LiLaC) is offering 4 fully-funded PhD studentships focussed on various aspects of inequalities in health, that will be integrated into the major programmes of work of the NIHR School for Public Health Research (SPHR). LiLaC is one of eight members of SPHR, alongside the Universities of Sheffield, Bristol, Cambridge, Imperial and University College London; The London School for Hygiene and Tropical Medicine (LSHTM); and Fuse (The Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities).

Applicants must have a First or Upper Second UK Honours degree, or equivalent qualification gained outside the UK, in a discipline relevant to public health research and will be expected to complete a PhD during the award period.

Studentship awards include tuition fees (worldwide for Liverpool, UK/EU fees for Lancaster-based studentships), an annual tax-free stipend of £14,777 (index-linked) and a contribution towards research and training costs.

Application information and details of the projects on offer follow in this document.

Applications must be received by 12 noon on Wednesday, 23rd January 2019.

Research projects

Please note, we are advertising a total of 6 project outlines of which we intend to fund up to 4 studentships (2 in Lancaster and 2 in Liverpool). One of the Lancaster studentships will be funded by NIHR SPHR centrally, the other three are funded by the respective universities.

  1. Young people’s participation in health-related decision-making: exploring the role of digital technologies and inequalities in access (based at Lancaster University).
  2. The impact of economic shocks on health and health inequalities (based at Lancaster University).
  3. Understanding how GPs regard their role and capacity to use social prescribing to improve work outcomes for patients with long-term health conditions (based at Lancaster University).
  4. Transforming practice for health equity: Using the Health Inequalities Assessment Toolkit (HIAT) (based at Lancaster University).
  5. The equity impact of changing spatial distribution of resources for population health and inequalities (based at University of Liverpool).
  6. Reducing the burden of non-communicable diseases: which interventions are more effective and equitable? (based at University of Liverpool).

Supervision

Each studentship is supervised by two experts in their field from LiLaC and an informal advisory group drawn from across the SPHR. Applicants are encouraged to contact potential supervisors for more information on specific topics of interest.

Development and support opportunities

In addition to activities and training opportunities within NIHR SPHR and the host institution, students will also have access to development and support opportunities provided by the NIHR Trainees Coordinating Centre. Students will also be invited to become members of the new NIHR Academy following its launch in October this year which will include access to an expanded programme of development and support. The NIHR-funded studentship will offer the opportunity for the student to undertake a short placement in a public health practice or policy setting.

Publication & wider dissemination

It is expected that students will publish research from their PhD studies in good quality, peer-reviewed academic journals and communicate findings at conferences. In addition, we expect the research to generate outputs that are tailored to applied health research, public health practitioner, and policy making audiences.

Eligibility criteria

Applicants must have a good first degree in a discipline relevant to public health research and will be expected to complete a PhD during the award period. Candidates should also ensure they meet the eligibility criteria of the host institution.

Application shortlisting criteria

Your application will be assessed using the following criteria as part of the application shortlisting process:

  • A first or upper second class UK honours degree, or the equivalent qualifications gained outside the UK, in an appropriate subject (qualifications, or a combination of qualifications and experience, which demonstrate equivalent ability and attainment also considered)
  • Previous research experience or formal training (e.g. a Master’s degree) is desirable
  • Relevant previous research experience
  • Output from previous research experience
  • Evidence of commitment to a research career
  • Evidence of potential as a career researcher
  • Excellent written and verbal communication skills
  • Supportive academic references
  • Highly motivated
  • Able to work both independently and as part as part of a team
  • Able to plan and manage own work
  • How to make an application

For more information on specific projects, please contact the potential supervisors listed in each project information.

If you have decided on one of the 6 projects, note the project number and University and provide:

Your CV
A covering statement, explaining what your interest in a particular project is and what you bring to that project
Contact details for two academic referees.

Send these documents to:

Professor Margaret Whitehead for a University of Liverpool project at mmw@liverpool.ac.uk

(For projects 1 – 4) expressions of interest should be made to Professor Jennie Popay j.popay@lancaster.ac.uk including a covering letter, copy of your CV and contact details for two referees.

Applications must be received by 12 noon on Wednesday 23 January 2019.

Applications will be shortlisted and candidates selected for interview will be contacted and invited for interview. Unsuccessful applicants will be informed.

Successful candidates will be required to register for a PhD at the host institution. Detailed guidance will be provided to successful candidates.

Liverpool and Lancaster Universities Collaboration for Public Health LiLaC

LiLaC stands for Liverpool and Lancaster Universities Collaboration for Public Health Research. It combines the complementary strengths in public health research of these two Universities, creating the critical mass of internationally recognised multidisciplinary researchers needed to deliver the SPHR’s objectives. Established in 2011 when it became a member of SPHR, LiLaC consolidated a decade of cooperation directed at building public health research infrastructure in the North West (NW) region.

We now constitute the largest group in the North West (NW) region providing high quality evidence from applied public health research aimed at improving the social determinants of population health and reducing health inequalities. LiLaC’s membership is drawn from Lancaster’s Faculties of Health and Medicine (FHM), Arts and Social Sciences (FASS) and the Management School (LUMS) and from Liverpool’s Institute for Psychology, Health and Society (IPHS) and Department of Sociology, Social Policy and Criminology. Our expertise spans public health economics, modelling and statistics, social and clinical epidemiology, anthropology, sociology, social marketing, policy analysis, health protection and health promotion, primary care and the history of health and social policy.

LiLaC’s research is driven by policy questions focused on what can be done to reduce social inequalities in health and their social determinants. The two universities have world-leading reputations for policy-relevant health inequalities research. LiLaC’s methodological strategy is to combine qualitative with quantitative approaches creatively and to exploit the potential of cross-country comparative analysis and evidence-synthesis to address major policy-relevant research questions. Members of LiLaC have particular strengths in: intervention research; engagement with the policy and practice communities throughout the research and development process to ensure policy-relevance; and incorporation of the lived experiences of people suffering the brunt of social inequalities.

Project 1 – Lancaster University: Title: Young people’s participation in health-related decision-making: exploring the role of digital technologies and inequalities in access (based at Lancaster University).

Brief outline

Underpinning the Children and Young People’s theme is a commitment to address the question “What should cost-effective, equity-focused policies, practices and interventions for child and adolescent health look like?” Essential in achieving this will be a commitment to establish mechanisms and processes through which young people can actively participate in the decision making that effects their lives. Current mechanisms for involving young people are justifiably criticised on two counts. Firstly, that they are underdeveloped and tokenistic; and secondly, that they are conducted in ways that privilege certain groups of young people. The result of this is to create a façade of participation that excludes certain young people from decision making and consequently has the potential to reinforce inequalities.

Utilising the digital world to enhance young people’s participation has two particular benefits. The first is that it increases the diversity in the mediums and process for participation and therefore the range of young people who can be involved. The second is that it utilises a medium within which young people are the experts thus addressing some of the power differentials that underpin existing participation processes.

The PhD will use elements of system’s theory as a conceptual perspective. Aspects of systems theory are particularly useful in mapping patterns of engagement and in focusing on the quality and power relationships in connective processes. This approach will also provide an opportunity to reflect on how the digital world connects and intersects with other elements of the systems which inform and produce policy and practice relating to young people.

The precise nature of the methodology will be developed with the student and in partnership with young people who will be involved in an advisory capacity. It is likely that it will include a combination of system mapping and qualitative data collection in on-line spaces.

This PhD studentship has the potential for impact through the development of models for young people’s participation that draw on a more diverse range of views and concerns and which utilise methods that empower and enable young people to influence the direction of policy and practice.

The proposal builds on two current areas of work within LiLaC. The first is a PhD studentship (due to complete in 2018) that has used systems theory to explore young people’s participation in off-line spaces. The second is work exploring the health and well-being benefits of people’s participation in, and control over, the decisions that affect them.

Colleagues in Sheffield University will enhance the team from LiLaC particularly in relation to utilising digital technologies.

Supervisory team: Dr Mark Limmer, m.limmer@lancaster.ac.uk; Dr Maria Piacentini

Project 2 – Lancaster University: Title: The impact of economic shocks on health and health inequalities

Brief outline

The PhD is in the area of the impact on health of economic shocks. The causal pathways between economic circumstances and health status are affected by economic shocks, such as the recent economic recession, and the latest causal mediation analysis methods. According to the human capital model of health investment if individuals experience an economic shock, we expect their health to worsen, as they have less resources to invest in their health. Thus, sudden changes in income and wealth should directly affect the production of health. However, there might be indirect effects that may cause further health changes. For example, different levels of education might mediate the effect of an economic shock and we could also expect indirect effects from engaging in unhealthy behaviours (e.g. tobacco/alcohol consumption, poor diet/lack of physical activity). Furthermore, it is reasonable to assume that an individual could engage in unhealthy behaviours after an economic shock for three main reasons: because of reduced income, consumers might be forced into a poorer diet; individuals might adopt a more sedentary lifestyle due to increased costs of exercise; individuals might start more frequently consuming potentially addictive goods (e.g. tobacco) due to utility compensation (after an economic shock, they might shift resources towards the consumption of addictive goods, as this may increase short-term utility/pleasure). These indirect effects resulting in behavioural changes may affect physical health, with the potential of impacting on mental health as well.

Overall, the aim of this PhD project is to investigate and more precisely identify empirically the various causal pathways which link economic shocks to changes in health.

The research will focus on individuals aged 50 years or over because of the potential more severe health consequences of economic shocks among older adults. While the previous literature has identified that economic recessions may have larger effects on mental health and the incidence of depression amongst older individuals, the several mechanisms linking changes in economic circumstances with deteriorations in physical and mental health remain unexplored.

The PhD will use new and advanced quantitative techniques, building capacity in a key area (health economics) where there is a real world shortage of quantitatively skilled economists. In addition, there will be definite public health policy relevant papers showing for the first time how mediating effects impact upon health and financial changes in a population. This will allow policy makers to target scarce public health resources in areas where they can really make a difference, within particular populations.

Supervisory team: Professor Bruce Hollingsworth, b.hollingsworth@lancaster.ac.uk; Dr Eugenio Zucchelli.

Project 3 – Lancaster University: Title: Improving employment outcomes for people with long-term health conditions: the role of GPs and social prescribing.

Brief outline

Social prescribing is the referral of individuals from primary care to non-medical services provided by the voluntary and community sector, such as debt counselling, support groups and exercise classes, to improve their health and wellbeing.1 Most social prescribing referrals are made for people with mental health problems or long-term conditions. By addressing the social determinants of ill health, social prescribing seeks to improve health outcomes, address health inequalities and reduce demand on the NHS. Although most evaluations have been small scale, there is evidence that social prescribing can reduce social isolation, anxiety, depression and healthcare usage.2

There is significant inequity between the employment rates of people with and without disabilities/long-term conditions3. A recent report recommends clinicians should make greater use of social prescribing to help people with disabilities/long-term conditions stay in or return-to-work, and that social prescribing can improve work outcomes directly through referral to employment support services, or indirectly by improving health outcomes4. However, although the government has suggested social prescribing becomes “as normal a part of GPs’ job as medical prescribing”,5 GPs have voiced concerns social prescribing increases their workload6. Using social prescribing as a tool to support job retention or return-to-work for people with long-term conditions requires GPs to expand their existing remit beyond sickness certification and to engage more fully with employment issues.

The aims of this studentship are to explore:

1) GPs’ perspectives on social prescribing and the expectations it places on them to address the wider social determinants of health;

2) GPs’ willingness to uptake referrals to non-medical services and barriers in doing so;

3) Recipients’ perspectives and experiences of social prescribing, particularly in the context of worklessness, or where health conditions increase their risk of job loss.

References

Friedli L, Jackson C, Abernethy H, Stansfield J. (n.d.) Social prescribing for mental health – a guide to commissioning and delivery. Care Services Improvement Partnership NW Development Centre.
Thomson LJ, Camic PM, Chatterjee HJ. (2015) Social prescribing: a review of community referral schemes. University College London.
Work and Pensions Select Committee. (2016)
Steadman K, Thomas R, Donnaloja V. (2017). Social prescribing: a pathway to work? The Work Foundation.
NHS England. (2015) Building the Workforce – the New Deal for General Practice.
Roberts N. (2015) Analysis: What does social prescribing mean for GPs? Available at: http://www.gponline.com/analysis-does-social-prescribing-mean-gps/article/1354653
Jackson G. (2016) Social prescribing at a glance: North West England. Health Education England.
Supervisory team: Dr Paula Holland, p.j.holland@lancaster.ac.uk, and Dr Siobhan Reilly, Lancaster University.

Project 4 – Lancaster University. Title: Transforming practice for health equity: Using the Health Inequalities Assessment Toolkit (HIAT)

Brief outline

There is accumulating evidence that some interventions and/or policies can unintentionally increase health inequalities. This is in part because approaches to reducing health inequalities often focus on modifying people’s behaviours without consideration of the wider politico-legal, economic and socio-cultural forces that shape those behaviours – a process that has been described as Lifestyle Drift (Popay et al 2010). Despite this growing awareness, a health equity focus is not routinely embedded as a part of the development and evaluation of interventions/policies aimed at health improvements. In addition, there is a need for more imagination about effective ways in which front line health professionals can address the upstream social determinants of health inequalities. Unfortunately, many practitioners, members of the public and researchers perceive that health inequalities can only be overcome by addressing macro-level determinants of health that are outside their field of influence. The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North West Coast (CLAHRC NWC) has recognised this problem.

CLAHRC NWC has developed the Health Inequalities Assessment Tool (HIAT www.hiat.org.uk) to support all its partners to routinely incorporate an equity dimension into all their activities: applied research, evidence synthesis, capacity building, knowledge exchange, evaluation, dissemination and implementation. At the same time, the HIAT aims to infuse people with greater awareness of the structural determinants of health and stimulate more imaginative thinking about what action on inequalities is possible in their day-to-day practice as researchers, service providers, managers and/or commissioners.

The aim of this PhD project is to use qualitative methodologies to engage with individuals and teams that used the HIAT within CLAHRC NWC and to extend the enquiry to the NIHR School for Public Health Research, to discover what works to embed a narrative about the socio-economic causes of inequalities in health into research and knowledge transformation. The student will gain advanced expertise in qualitative enquiry and actions to tackle socio-economic inequalities in health, while developing a firm grounding in public involvement in research.

PhD supervisors: Professor Jennie Popay, j.popay@lancaster.ac.uk; Dr Ana Porroche-Escudero.

Project 5 – University of Liverpool: Title: The equity impact of changing spatial distribution of resources for population health and inequalities

Brief outline

Background

There are large difference in health between richer and poorer areas in the UK. People are 20% more likely to die under the age of 75 in the North, compared to the South of England. The way public resources (e.g. for housing, environment, education, leisure, welfare, public health services) are allocated to local places could influence this health divide. However, the way these resources are allocated has changed dramatically over recent years. Since 2010 local government budgets have been cut by 30% and the mechanisms used to distribute resources between local areas is changing. We do not know how this changing pattern of resources will influence health inequalities, a research gap that this PHD will address.

The project

This PhD will investigate how policies affecting the spatial distribution of local government funding have changed since 2000 to the present, how this has affected distribution of resources for public health between geographical areas and across different sectors, and the implications of this for health inequalities.

It is envisaged that the PhD will contribute to the development of innovative longitudinal spatial datasets mapping the changing pattern of expenditure across different sectors e.g. housing, environmental services, education, leisure services, transport, welfare, and other public health services. These will be aligned with health data using mortality records, Hospital Episode Statistics and national survey data. Analysis of policy changes will be used to identify ‘natural experiments’, applying advanced statistical methods to investigate the impact of these changes on health inequalities and the determinants of health inequalities. This will provide crucial new evidence to inform local government financing and investment policies that reduce health inequalities.

The studentship

Candidates should have a 2.1 or 1st class degree in a relevant discipline – e.g. geography, economics, social science, data science, population health. A Master’s degree in a relevant discipline would be an advantage, as would clear evidence of an interest in developing quantitative methods in the study of health inequalities. The student will benefit from research training in policy analysis and advanced econometric and statistical methods, data management and the use of statistical software. They will develop skills in policy-relevant research on health inequalities and establish a body of high impact research and publications.

PhD supervisors: Dr Ben Barr, benbarr@liverpool.ac.uk; Prof David Taylor-Robinson

Project 6 – University of Liverpool: Title: Reducing the burden of non-communicable diseases: which interventions are more effective and equitable?

Brief outline

Our research group researches the impact of a wide range of population level preventative policies (such as pricing and taxation policies for foods, tobacco and alcohol; regulation to restrict unhealthy products) on non-communicable diseases, such as cardiovascular disease, respiratory diseases and cancer. We need further evidence to take into account additional complexities created in a population as it ages, such as an increased risk of having more than one long-term illness at the same time (multi-morbidity) and functional decline. What are the impacts of these factors on health, equity and economic outcomes?

Building on our successful development of our previous work in LilaC on the equity of cardiovascular prevention, and on our more recent work on the IMPACT NCD modelling and city level microsimulation (BMJ 2016;353:i2793, NIHR funded project; WORKHORSE https://goo.gl/Q4kWuK), this PhD studentship will be involved in research to

A) Extend the model to explicitly model multi-morbidity and functional decline; and
B) Develop a methodology to co-produce scenario analysis with stakeholders and the public
C) Explore the best combination of interventions at structural and individual level that results in reduction in the health, economic and equity burden of NCDs.

The focus on multi-morbidity and functional decline will enable the explorations of impact on the provision of public services at the local level, such as social care budgets, impact on productivity at city level and on the NHS acute and hospital services.

The student will benefit from training on innovative simulation methodologies, advanced data analysis and datasets, access to high performance computer facilities and the group’s extensive experience in developing models suitable for policy decision making. Further, our extensive service links and local, national, and international policy stakeholder networks (PHE, Liverpool CVD prevention group, Liverpool City Council, British Heart Foundation, American Heart Association) will support the student to develop policy relevant research.

PhD supervisors: Prof. Martin O’Flaherty, moflaher@liverpool.ac.uk; Dr Chris Kypridemos

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