By Holly D Mitchell, on 8 October 2019
Written by Lydia Franklinos, PhD Candidate, Institute for Global Health
As a veterinarian working across the fields of global health and ecology, I know from experience that cross-disciplinary work can be hard. You speak different languages, think in different ways, and it can be daunting providing an opinion on a subject you know relatively little about. Despite these challenges, the positives of collaborating with people across disciplines are endless; the discovery of DNA’s double helix structure was due to collaboration between biologists and chemists, the discovery of Uranus was due to collaborative work between an optician and an astronomer, and getting man to land on the moon involved collaboration between physicists, mathematicians, engineers physiologists and national governments.
With this in mind, I jumped at the opportunity proposed by UCL Grand Challenges to work with another PhD student from a different field. UCL Grand Challenges aims to cultivate cross-disciplinary collaborations to provide solutions to matters of pressing societal concern. A Grand Challenge award was advertised addressing the issue of migration and displacement in light of the recent UCL-Lancet Commission on Migration and Health co-authored by many colleagues from UCL’s Institute for Global Health (IGH), including my PhD supervisor, Prof Ibrahim Abubakar. Reading the report, I was struck by the gravity of the situation; one billion people were recorded as having migrated in 2018 alone, and there are currently more refugees globally than at any point since the Second World War. This level of migration will have great implications for global health, the global development agenda and political discourse at all levels of society. To meet the needs of migrants, the communities they leave behind, and their new, host communities, requires accurate data on who is moving, where they are going, and why. However, current information on migrant populations is relatively poor. The Commission provides a global mandate for better data on the drivers and impacts of migration on health, and it proposes that ‘big data’ could provide much needed information on how and why people are moving. The Commission also calls for increased cross-disciplinary work across the field of migration to address this great challenge.
I was intrigued by the report’s suggestion that big data could be used to address gaps in migrant data, since I use big data sources in my research. I use remote-sensing satellite data to understand environmental drivers of mosquito-borne disease risk (i.e., climate and land use factors). Big data refers to large, complex data from diverse sources, ranging from social media and mobile phone data, to large-scale long-term environmental datasets. Previous examples of big data use in migration and health research include the use of mobile phone data to predict patterns of human movement during natural disasters and examining the effect of human movement on disease transmission. Another potential application is the use of high-resolution satellite remote sensing data to map the relationship between environmental change and human movement. Overall, the ever-increasing availability of big data provides an immense opportunity to address gaps in knowledge on migrant populations and the drivers of migration patterns. I was excited at exploring the prospect of big data use for migration research but I had limited knowledge of human migration and so I needed to find a student studying migration to collaborate with. I knew the perfect person!
I met Bekki at the start of my PhD as we were both funded by the UK Natural Environment Research Council Doctoral Training Partnership scheme. Bekki’s background is even more cross-disciplinary than mine, having studied music and physics before starting a PhD at UCL on the effects of climate change on human migration. I contacted her about the UCL Grand Challenges grant, and after just one meeting we had developed our proposal; a cross-disciplinary workshop to explore the use of big data for migration research. We would address the call for cross-disciplinary collaborations by bringing together academics, humanitarian NGOs, policy-makers and big data researchers to facilitate knowledge exchange, and develop a better understanding of how big data can meet the needs of migration research and policy, as well as the needs of migrant populations.
After a few weeks of planning we submitted our proposal, and to our delight, we were awarded the grant to host the workshop. We wanted to maximise the opportunity for discussions across disciplines, so we decided to centre the event on three panel discussions; the use of big data for migrant healthcare, environmental drivers of migration, and data security and ethics. The afternoon session would then involve working group tasks to develop solutions to any key challenges highlighted in the panel discussions. We collated a list of suitable people to invite to the event and to our surprise there appeared to be a great willingness to network and collaborate across the different disciplines in the field. This meant that in a short period we amassed diverse panels of experts for the different themes.
I sought the help of a friend who facilitates innovation at a large national charity to ask her advice on how the workshop could be most impactful. This experience was a great insight into the corporate world! She helped me develop the event by deciding on measurable outcomes of the workshop and how to the structure the day to achieve them. Several action plans later, and we had developed an event plan which would address the main objectives of the workshop:
- Enable improved understanding of the current status of big data use in migration research across academia, policy and NGO sectors.
- Identify and prioritise the key challenges to using big data in migration research.
- Foster collaborations between different disciplines.
The planning paid off because the workshop was a great success, bringing together 50 attendees across academia, UK and international policy, and humanitarian NGOs. The panel sessions were insightful and key challenges were raised across the themes. These included questions such as; how do we gain access to big data, how can we act ethically when using it, how do we ensure data security, how do we measure the benefits of using big data for migration research, and who benefits from increased migration data collection?
In the working groups session, each group used a problem-solution canvas to develop solutions. This is a technique is often used in business to translate problems into effective solutions in a straightforward, structured way but, to my knowledge has rarely been used in academic settings. The working group session was intensive but was a great opportunity to test a new method of cross-disciplinary collaboration. Fortunately, some brilliant student volunteers from IGH chaired these groups and fed results back to us. The proposed solutions ranged from designing statistical methods to help analyse the data, to deconstructing what is meant by ‘big data’ and understanding the power biases within it. The workshop was successful in its main objective of fostering collaborations and we received positive feedback from attendees that felt they had a better understanding of the issue from varied perspectives. One attendee told us;
“The workshop was extremely interesting and very well-organised. Congratulations! You managed to bring together people from a diverse set of backgrounds and successfully blend each one’s perspective into the overall thematic of the event”.
To our surprise, a key issue that came up in discussions throughout the day was the question, “do migrants want big data used in migration research?”. The focus on using big data to understand how and why people are moving fails to consider the fact migrant populations do not always give their consent for its use. In an age when big data use is increasingly being thought of as an invasion of privacy, why should we presume migrants would be fine with their data being used in this way, even if we perceive it will be helping their situation? This important ethical issue, particularly in cases of vulnerable people such as irregular migrants (e.g., people who are trafficked or have otherwise undertaken illegal migration) and displaced persons and refugees. Addressing such assumptions may have been missed at a workshop consisting of largely big data researchers and users. The emergence of this pertinent question during the event provides a great illustration of why cross-disciplinary collaborations are needed to address solutions to complex challenges.
Lydia is a PhD student on the London NERC Doctoral Training Partnership investigating the impacts of global change processes such as climate change and land-use change, on mosquito-borne disease risk with the intention of informing intervention strategies.
By Rebecca C Parrish, on 8 August 2019
By Bekki Parrish, PhD Candidate, Institute for Global Health
For the last three months I have been interning with the Centre for Science and Policy, at Cambridge University. This internship is funded by the Natural Environment Research Council as part of the Research Council Policy Internships Scheme. The scheme offers roughly 130 PhD students the opportunity to undertake an internship with one of 28 policy-facing partner institutions. The idea behind the scheme is to support research excellence and build researcher capability through a variety of advanced skills trainings, including policy-internships. From a personal perspective, I wanted to be part of the internship to both broaden my work experience, and because my research interests have strong relevance to policy-making. As such I feel that understanding and fostering science-policy networks is an integral part of my research career.
The policy institute I decided to apply for was the Centre for Science and Policy, or CSaP, part of Cambridge University. CSaP offers an intriguing insight into science for policy because they are not themselves a policy-making body, but rather a broker of policy-academic relationships. Their mission statement is to improve the use of evidence and expertise in public policy. Their approach is based on addressing the questions which policymakers identify, and on building relationships characterised by mutual understanding, respect and trust. To achieve this, CSaP runs a variety of events such as professional development workshops, policy roundtables, lectures, and fellowships for all levels of policy makers, both from within the civil service and from other public and private sector organisations. At each event they invite attendees from their expansive network of policy professionals and academics to bring together experts to discuss contemporary topics that are of interest to policymakers. They also support academics who are interested in communicating their research by fostering one-to-one relationships with relevant policy professionals and by helping researchers understand their pathways to impact.
Despite knowing nothing about the ins and outs of policy making, I had a gut feeling that maybe a career directly in policy making was not for me, so I decided that working from within CSaP offered the perfect alternative. CSaP provides a balance between seeing how policymakers engage with and use science in their policy making, whilst still sitting within an academic institution thus maintaining independence from the rigmarole of actual policy making.
Indeed, the insight offered by CSaP was very illuminating. Within one week I was rubbing shoulders with ex-head of the British civil service, Lord Richard Wilson, and helping run and partake in a professional development workshop, connecting early career researchers with government Science and Technology Fast Streamers (the British civil service’s terminology for high-potential, early career civil servants). I also supported several roundtable discussions with senior members of the government and cabinet office. Recurring topics on the UK government’s policy-makers agenda seem to be emerging technologies – such as artificial intelligence, cybercrime, quantum- and bio- technologies. Health was of course also high on the agenda, and I helped organise and run two workshops on air pollution, health and the future of transport for the Department of Transport. I also partook in a policy roundtable discussion about the future of synthetic biology technologies with members of the cabinet office.
The key takeaways I have from the internship include a much deeper insight into how government makes policy and the inner workings of the civil service. Not only do I now know the difference between a permanent secretary and a Minister (explain!) but I also have at least some appreciation for the language that civil servants use, and the ways in which individuals and departments interact with each other and, critically, with academic institutions, materials and individuals. What struck me the most, was how, at the end of the day, it all boils down to relationships between individuals. CSaP is built upon a network of individual researchers and policy makers and almost 100% of its operations are based on the principle of putting these individuals in a room together to work towards a common goal. Indeed, from my limited experience it appears that perhaps policy and strategy formation also operate this way. To me, this is simultaneously reassuring and slightly off-putting. It is reassuring to be reminded that our highly complex and increasingly technical society is still built on people to people relationships and governed accordingly. However, I was initially slightly worried by the inherently fallible nature of relying on personal relationships to make policy. I’m not only talking about the classical risks of nepotism, bias and corruption, but also about the shortfalls this has based on the limits of your network. For example, researchers from developing nations or lesser known universities will have considerably less opportunity to communicate their research, regardless of how advantageous to policy it may be. Perhaps this is where institutions such as CSaP and other policy affiliates such as the UCL Public Policy department can help step in and support researchers get the soapbox platform they need in order for their research to have policy impact.
The impact of this internship on my research has been to reinforce my desire to not only deliver high quality research and publications in scientific journals (as all PhD students know we are pushed to do), but to dedicate more time to real-world impacts of my research via the individual relationships I forge. This is not merely an excuse to procrastination by going to more lectures, drinks receptions and conferences (basically anything to put off actually writing my thesis!) but is an essential part of a modern-day PhD. I believe that all PhD students should be encouraged to think sincerely and at length about what their pathways to impact may be, and how to work towards them. Universities should support this wherever possible, for example through offering policy internships, support for students from respective public policy departments, and by creating a culture where extra-curricular activities rather than only research and academic publications valued.
To that end, I am extremely grateful to UCL, Brunel university (my co-institution), NERC (my funders) and CSaP, for my internship opportunity. To any fellow PhD students and early-career researchers reading this blog: I thank you for your time and interest; I cheerlead you to keep up the great work – despite how difficult we all know it to be; and I implore you to keep going and to nurture your relationships, both professional and personal – to keep yourself sane and happy, and to push for real-world impact of your research outside of academia.
Bekki is a PhD student on the London NERC Doctoral Training Partnership, studying the impacts of climate change on human migration patterns with the Centre for Climate Change and Health at IGH and the College of Health and Life Sciences at Brunel University.
By Rebecca C Parrish, on 17 May 2019
Written by Tyrone Curtis, PhD candidate, Institute for Global Health
Since the start of the HIV/AIDS epidemic in the 1980s, much public health focus has been on the sexual health and sexual behaviour of men who have sex with men, or MSM, and in particular, men who identify as gay or bisexual. However, we know much less about MSM who identify as straight or heterosexual. These men, who I refer to as heterosexual-identifying men who have sex with men, or HI-MSM, are the focus of my research.
Who are heterosexual-identifying MSM?
Most people, when they think of this group, tend to think of men who have some same-sex attraction but are “in the closet”; that is, men who are “actually gay or bi” but just haven’t been able to admit it yet. This could be because they’re from a culture that stigmatises gay or bisexual identity, or because these identities conflict with other identities these men hold. However, some HI-MSM have little to no same-sex attraction (or not enough, in their view, to warrant calling themselves bisexual), but still enjoy sex with other men. The sex they have with men may be experimental, or something they do together with female partners (e.g. swingers). Sex with men may provide some HI-MSM with a sexual release they no longer get with their female partners, without the threat of emotional connection that would end that relationship. Others may just be much more relaxed about their sexuality (e.g. heteroflexibles or mostly straights), such that same-sex behaviour isn’t a threat to their heterosexual identity. In any case, their same-sex behaviour is not important enough to them to define their identity.
Data from NATSAL-3, a nationally representative survey of British adults aged 16-74 conducted in 2010-2012, suggest that around 22% of men with same-sex partners in the previous year identified as heterosexual, a little more than those identifying as bisexual (19%).
How do we study heterosexual-identifying MSM?
There is an obvious challenge in studying this population, and that is: where do we find them? Most studies of MSM recruit in-person at gay venues such as bars, clubs and saunas, or online via gay websites or social/sexual networking websites and apps. However, discretion is often important to HI-MSM, and so they are less likely to visit these places. As such, most samples of MSM recruit very few HI-MSM (typically around 1-2%), which makes analysis very difficult. This is a significant factor in our current poor understanding of this population.
Why are we interested in heterosexual-identifying MSM?
There is good reason to think that HI-MSM may be at risk of poor sexual health. HI-MSM are less likely to disclose the sex they have with men to healthcare providers, meaning they’re less likely to be given relevant sexual health information, offered regular testing for STIs and HIV, or offered preventative measures such as HIV pre-exposure prophylaxis (PrEP) or vaccinations for Hepatitis A & B. In addition, HI-MSM tend to be less involved with the LGBT community, either passively (because they have no connection to it) or through actively avoiding it. This means they are less exposed to sexual health campaigns which are promoted in the community, are less exposed to the norms of that community (e.g. frequent HIV testing, condom use), and may feel less comfortable accessing resources such as sexual health services within that community, especially if these are targeted towards gay men. As such, they may be poorly informed about the risks of their sexual behaviour.
In addition, these men are less likely to disclose their sex with men to female partners, potentially leaving those partners less informed when it comes to their own sexual decision making, particularly around condom use and other HIV/STI preventative measures. In this way, HI-MSM may also act as a bridge between the gay and heterosexual communities for HIV and other STIs.
What is my project about?
The aims of my project are to describe and characterise the sexual behaviour and sexual health of HI-MSM in Western Europe, North America, Australia and New Zealand; to compare their sexual behaviour and health to those of gay- and bisexual-identifying MSM; and to understand how HI-MSM perceive their risk during sexual encounters with both men and women, their experiences of and attitudes towards sexual healthcare, including HIV/STI testing guidelines; and also their feelings about HIV prevention measure like PrEP.
In recognition of the challenges of recruiting large samples of this population, I’m conducting my research using methods that avoid the need to recruit a large sample of HI-MSM. One component of my project involves carrying out individual participant data meta-analysis of behavioural surveys of MSM from Western Europe, Canada, Australia and New Zealand. Essentially, this involves pooling data from these surveys, each of which may only have a relatively small number of HI-MSM, in order to build a large enough sample of HI-MSM on which to carry out analysis. Special analysis techniques are used that take into account clustering within survey samples and countries (i.e. men within one country are more likely to act like other men within that country).
I will also be carrying out 15-20 semi-structured qualitative interviews with HI-MSM within the UK. This will allow me to ask more relevant questions than were asked in the various surveys included in the meta-analysis (which were written for MSM more general), and also allow me to probe more deeply into HI-MSM’s experiences, attitudes and feelings about the sex they have (with men and women) and with regards to sexual health and sexual healthcare.
By understanding more about the way HI-MSM engage in sex with their partners, and about their experiences with and feelings regarding sexual healthcare provision, we can better understand their sexual healthcare needs, and identify any gaps between these needs and current service provision. This will hopefully lead to more effective engagement with HI-MSM, resulting in better sexual health for both them and their partners.
keywords: sexual health, sexual behaviour, sexual orientation, hidden populations, men who have sex with men
Tyrone Curtis is a second year PhD student with an interest in the sexual behaviour and sexual health of MSM. Originally from Australia, he studied mathematics at the University of Queensland before moving to London in 2008. He completed an MSc in Applied Statistics with Medical Applications at Birkbeck College in 2014. When not at his desk, he can often be found in one of London’s parks hanging from a flying trapeze.
Follow Tyrone on Twitter: @spacepup84
By Holly D Mitchell, on 6 March 2019
Written by Georgine Leung, PhD candidate (part-time), Institute for Global Health
Whilst childbirth is a biological event, the experiences of the women throughout pregnancy to the postpartum period are heavily shaped by social and cultural factors. Pregnancy, birthing and postpartum customs are commonly observed in Asia and Africa (and the overseas diaspora) where many women avoid transgressions of these customs for their own health and to promote social harmony. In particular, mothers follow postpartum practices to protect the health of the mother and the newborn baby, and to prevent future ailments.
The postpartum period usually refers to the window of up to six weeks following childbirth. The various practices during this time are a way to demonstrate the women’s transition into motherhood, a process which is imbued with cultural meanings sustained by their immediate social sphere including family elders. Having sufficient empathy towards these considerations are of paramount importance to allow for the management of major health problems including postpartum depression, and facilitates better uptake of maternal health services.
Chinese postpartum rituals, collectively termed as Zuo yuezi (“doing” or “sitting” the month), refer to a set of instructions and proscriptions on women’s food intake, movement and daily hygiene practices for around 30 days following childbirth. These are dated back to ancient China, and were first recorded in medical texts from the Han dynasty (206BC to 220AD). Customs include consuming special tonic foods and drinks, refraining from going outdoors and limiting contact with water during this time. Zuo yuezi is considered to be a set of traditions congruent to the principles of traditional medicine and theory to protect women and prevent them from future ailments.
Accordingly, pregnancy depletes the mother’s internal ‘heat’ and energy through blood loss during childbirth and places the woman in a cold state. The opening of her joints and tendons following pregnancy renders her susceptible to external forces, such as wind and humidity, which may cause ill-health. As a result, dietary and behavioural rules are used to guide the restoration of her body’s harmony. Importantly, this means women are sanctioned to rest whilst childcare and domestic chores are assumed by other members of the family. However, commercialised postpartum care (such as the hiring of postpartum nannies or nurses and staying in postpartum centres) has become increasingly popular. Although this remain largely for the rich and privileged, their implications have not been well studied in the rapidly changing society of Mainland China.
The exact practices of postpartum rituals differ across the regions in China, and the nature of the dietary rules reflect the therapeutic aspects of Chinese food culture. For example in southern China, water infused with roasted rice replaces plain water are drunk for its warming properties, whilst dishes such as pork knuckles cooked in rice vinegar and ginger are consumed for replenishing the women’s energy levels, and fish soup is considered an aid for lactation. These intricate ideas between food and health have been firmly imprinted in Chinese foodways and play an important role to guide women on their recovery throughout the postpartum period.
In the past few years, Chinese postpartum practices have gained media attention around the globe. Often referred to as ‘confinement’, these practices are usually written in a prejudiced way and are depicted as superstitious and disempowering. What these reports fail to cover is the cultural significance of the practices, their place in birthing customs and the ways knowledge in health and nutrition are transmitted across generations. The limited available literature on Zuo yuezi tend to focus on the negative biomedical and health associations of the practice, but do not offer meaningful understandings on the complexities of inter-relational dynamics, especially within the family, and how the practice of Zuo yuezi may be negotiated between the domestic, public and commercial spheres.
My research study situates within the Institute for Global Health and the Thomas Coram Research Unit at UCL. Through qualitative approaches using interviews and ethnography, I will examine the practice of, and discourses in, Zuo yuezi, the construction of authority and knowledge in health and parenting practices, and the possible influences from social media outlets in Mainland China. This project aims to understand how postpartum practices are dynamically fashioned, in order to add value to the scholarship on women’s health in Chinese contemporary society and contribute to global health studies.
Georgine Leung is a UK-based nutritionist who writes about food and health and runs community workshops and food practicals, with a focus on women, families and children. She grew up in Hong Kong and has recently completed an MA in the Anthropology of Food at SOAS, University of London. Read more on her website: www.georgineleung.com or follow Georgine on twitter: @GEORGINECHIKCHI
By Holly D Mitchell, on 6 March 2019
Written by Lydia Franklinos on behalf of the IGH Student Blog Committee
In an increasingly connected and interdependent world, social inequalities, political unrest and environmental degradation occurring in one region can have a widespread impact across the globe. Indeed, the major global health issues we face today include dramatic health income gaps within and between countries, an increasing burden of chronic diseases, particularly in developing countries and, the detrimental effects of a rapidly changing environment. Furthermore, increasing global mobility and expanding transport networks enable infectious diseases to spread further and faster resulting in pandemics that become more difficult to control. Understanding and providing solutions to global health problems is complex and requires a cross-disciplinary approach. Furthermore, as major issues continue to evolve with our changing planet, the broad remit of ‘global health’ can make it prone to fragmentation and vagueness. As IGH research students, we want to document some of these changes, challenges and tensions in the field of modern global health and discuss what can be done to tackle some of these growing issues.
IGH prides itself in taking a cross-disciplinary approach to global health problems and this is reflected in the diverse expertise of the students, who have backgrounds in biomedical science, epidemiology, disease ecology, social sciences and humanities, policy and law. Each of us has a unique perspective and we have created this blog as an informal and engaging platform to talk about global health-related topics through our work as research students. Our blog will cover topical global health issues that our research addresses, conferences and symposia that we attend, experiences during our research degrees, student life and getting to grips with academia.
We understand that solutions to global health problems come from collaborating with communities at all levels, so we hope our blog engages not only global health practitioners, but also members of the public, researchers from other disciplines and prospective students alike.
IGH Students at the Annual PhD Student Conference