Acau&onarytale:Serendipityandacareerinresearch

“Weencounteralinguis0csage,walkdowntheillustrioushallsoftheHarvardMedicalSchool,a;endthe(serendipitous)birthofpenicillin,andmeetsomeonewho"managesserendipity"fortheU.S.Navy.”

“thebook.....representsMerton'slifelongprotestagainstthatrhetoricofsciencethatdefinesdiscoveryasanythingotherthanamessyblendofinspira0on,perspira0on,error,andhappychance–i.e.anythingotherthanserendipity”.

JenniePopayProfessorofSociologyandPublicHealth

1950’sSalford–eagertogetonwithlife

Late1960’s:LastcohortofunqualifiedVoluntaryServiceOverseasinEastAfrica

Mid1960’s:2yearsunskilledworkthenteachingassistantfor6months

WorkinginschoolsandadultliteracyinUganda,KenyaandTanzania

1970’s:atortuouspathbutspectacularviews!1950’sSalford–eagertogetonwithlife

Late1960’s:LastcohortofunqualifiedVoluntaryServiceOverseasinEastAfrica

Mid1960’s:2yearsunskilledworkthenteachingassistantfor6months

OfftoUniversityinNewZealandtogophysicalgeographyandgeomorphology!

1970’s:atortuouspathbutspectacularviews!1950’sSalford–eagertogetonwithlife

Late1960’s:LastcohortofunqualifiedVoluntaryServiceOverseasinEastAfrica

1980sLondonmovedintohealth18yearsfixedtermcontractsinUniversi&es&voluntarysector

Decadesofopportunis&cgrantcaptureVariouspublicappointmentsLotsofnetworksbuiltonwayMadefriendsandenemies

1994Salfordsetupresearchcentre–firstinNHSthenatenuredpostasprofessor2000-01ProfessorUniversityofLeeds2001–topresentProfessorLancaster

Mid1960’s:2yearsunskilledworkthenteachingassistantfor6months

Whythemovetohealth?

Published1979 A;endedlecturebyPeterTownsendonpovertyintheUnitedKingdomonvisithomeandwasconvertedtosocialpolicyandalife0mecommitmenttoresearchandac0ontoreducesocialandhealthinequali0es

Healthinequali&es–nothowmuchmoneyyouhavebutwhatyoudowithit?

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/

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

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

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

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

Prac&calwisdom&poli&calliteracy

2. Questioning dominant perspectives on health

(inequalities) and what is to be done about it/theme

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

•  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

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)

Evalua&ngExperimentsinCommunityEmpowerment

Local Trust & Big Local People’s Health Trust & Local Conversations

Earlylearning:incontextofcutsinpubicservicesandfinancialcrisisintheNHSCommunityandpa0ent

centerednessriskbecomingDIYhealthandwelfare.

The Political Paradox

1970’s:atortuouspathbutspectacularviews!1950’sSalford–eagertogetonwithlife

Late1960’s:LastcohortofunqualifiedVoluntaryServiceOverseasinEastAfrica

1980sLondonmovedintohealth18yearsfixedtermcontractsinUniversi&es&voluntarysector1990sonwardsbacknorth….

Mid1960’s:2yearsunskilledworkthenteachingassistantfor6months

?whatlessonsfromthis

career?

•  Manysurprisesalongtheway–butleastlikelyeventsmayofferopportuni0es

•  Missedopportuni0esaren’tadisasterbutformalqualifica0onsmoreimportantnow

•  Mostsectorsvaluepathwaystheyknow–butacademiamaybepar0cularlyconserva0ve

•  Buildingandmaintainingrela0onshipsover0meisreallyimportant

•  Learningtodealwithdifficultsitua0onsanddifficultpeopleveryvaluable

•  Workingacrosssectorshasvalue:acquiringdiverseknowledgeandunderstanding

•  Genderma;ers–combiningworkandfamilymakesacareermoredifficulttomaintain

Lessonsfrommycareer…….•  Leavingthingstoserendipityhassomedisadvantagesbut

canbemoreexci0ngandrewardinginlongrun

•  Imayhavefollowedapathmoretortuousthanmostbut‘HappyChance’createsacademicmongrels–wearetoughbutitcanbehardertodemonstrateworth