All posts by Rich Mitchell

Built Environment, Inequalities

What if neighbouring areas are very different?

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Waldo Tobler’s first law of geography is that “everything is related to everything else, but near things are more related than distant things.” This is an important idea for many aspects of spatial science, but it’s taken particularly seriously by people who draw maps and do statistics to investigate how and why disease rates vary from place to place.

If Tobler’s first law holds,  we should expect the characteristics of people and places who are close together (including their health) to be similar. So, in general, the folk who live in your neighbourhood should be more like you than the folk who live on the other side of town.

This matters when we are researching if and how environment affects health. We know that people’s health can be affected by a huge range of things. If we are to reveal the health impacts that environment has, we need to try and allow for as many of those other influences as possible. However, we know that it’s very hard to account for all of them. This means some of the relationship between environment and health we see in our analyses may actually be due to these ‘unmeasured’ influences, a problem we call ‘residual confounding’. Now, if Tobler’s law is right, it is also likely that these unmeasured influences are also more similar when they are closer together. When this happens, it’s called residual spatial confounding. If we don’t allow for it, we run the risk of making mistakes in assessing the strength of relationships between the characteristics of environments and the health of the people who live there.

The good news is that these problems have long been known about and there are a range of techniques to try and deal with them. They include ways to statistically ‘smooth’ maps showing how risk of a disease varies from area to area, and to adjust measurements of risk for how close together they are in geographic space.

The bad news is that Tobler’s first law is not always true! It’s not always the case that neighbouring areas do have similar characteristics or environments. Often areas that are right next to each other contain very different types of people and have a very different environment. You have probably experienced this when walking around a town or city. You cross a road, the housing changes dramatically, and the streets ‘feel’ different. Those statistical techniques assume that kind of sudden change doesn’t happen.

Dr Duncan Lee and Prof Rich Mitchell have just finished an ESRC funded research project (RES-000-22-4256) trying to improve the way we handle this situation in our research. We have successfully created, and published techniques that can spot when two neighbourhood areas are so different that we need to alter our statistical assessment of the relationships between health and environment. One technique, published in Biostatistics, can be used when we have data that tell us something about the characteristics of the people or the neighbourhoods, such as house prices or smoking rates. The other can be used when all we have is information about health in the areas (now in press with Journal of the Royal Statistical Society Series C) .

Here’s an example of our results. The map below (click it to view full size) shows 271 areas that make up the Greater Glasgow and Clyde Health Board (for the geeks, the areas are intermediate geography zones). We obtained data on the risk of admission to hospital with a primary diagnosis of respiratory disease, from the Scottish Neighbourhood Statistics database (http://www.sns.gov.uk/). The map is shaded so the colour of each area denotes its disease risk, with a value of 1.0 representing an average risk across the whole health board. Values above 1.0 represent high risk areas (for example a value of 1.10 indicates a 10% higher risk), while values below 1.0 represent low risk areas (for example a value of 0.85 indicates a 15% reduced risk). The red lines show boundaries between neighbouring areas that contain populations at very different risk of hospital admission for respiratory disease. These are the areas in which the conventional techniques would make mistakes. There are 173 of them… that’s 25% of all the boundaries in the map.

 

map of respiratory admissions

Data and boundaries © Crown Copyright. All rights reserved 2010.

We have created a free software package that will allow anyone to apply our techniques. It’s called CARBayes and is for the statistical software R. You can read about it and get it from here.

There has also been an interesting spin off from this research. Within Glasgow, we found a lot of neighbourhoods that were right next to each other but were very different in social and economic terms. We called these between-neighbourhood differences ‘social cliffs’. It prompted us to ask how such social cliffs occur. One idea is that they may be made more likely by physical barriers between the neighbourhoods, such as rivers, main roads or railways.The map below (click it to view full size) shows the kinds of physical features we’ve been looking at (note, our data are for the period before the new M74 motorway was opened).

 

figure2

Map based on data that are © Crown Copyright/database right 2012. An Ordnance Survey/EDINA supplied service.

Our research is now complete and we’re writing it up for publication. It seems that two kinds of physical feature are especially important. Where one or both of them lie along a neighbourhood boundary, it’s much more likely that the neighbourhoods will be very different socially, and economically. Which two do you think they are?

 

Built Environment

London 2012: inspiring a generation and regenerating East London?

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Immediately following the Olympics, Prime Minister David Cameron announced that government funding to support Team GB athletes would increase up to the Rio 2016 Games. “The motto of these Games has been ‘Inspire a generation’. Nothing has been more inspirational than seeing our elite athletes win Gold this summer. There’s a direct link between elite success and participation in sport” he said.

This link between the inspiration of elite athletes and wider public participation in physical activity was a key claim made for the London Olympics from the start. The London 2012 Candidate file, part of the initial bid for the Games, stated that the Olympics would: “…inspire a new generation to greater sporting activity and achievement, helping to foster a healthy and active nation.”

Furthermore, the Government’s Legacy Action Plan published in 2008 promised that the Olympics would “transform the heart of East London” the home of the Olympics Park by “turning one of London’s most deprived areas into a world-class district for living, leisure, business and sport, with safe and sustainable neighbourhoods, new parkland, new homes, jobs, and social and leisure facilities for generations to come.”

So, what is the evidence regarding the impacts of large scale sporting effects on public participation in sport and area regeneration?

A review of research into the impact of mass sporting events on physical activity among the wider population by Murphy and Bauman (2007) suggested a lack of evidence for a public health benefit. A systematic review of the health and socioeconomic impacts of major multi-sport events published in 2010 by McCartney and colleagues found that few studies looked at health outcomes and concluded similarly: “The available evidence is not sufficient to confirm or refute expectations about the health or socioeconomic benefits for the host population of previous major multi-sport events.”

Sport is not the only way that London 2012 might affect health and wellbeing. Huge amounts of construction and regeneration in East London have already taken place or are planned. Yet the impacts of that are also uncertain. A review by Davies (2010) of sport and economic regeneration also highlighted that “…no comprehensive longitudinal post-event study has ever been undertaken on the economic regeneration impacts of the Olympic Games”.

The impacts of regeneration for London 2012 are being closely watched. A longitudinal study of the health and social impacts of the London Olympics upon families in East London is already underway. The Olympic Regeneration in East London (ORiEL) Study, led by Professor Steven Cummins at Queen Mary, University of London, is a five-year study, following approximately 1,800 school children and their parents in Tower Hamlets, Hackney, Newham and Barking and Dagenham. It will assess their health and well-being over time. The results of this study should demonstrate whether claims that have been confidently made for the long term public benefits of the 2012 London Olympic games, and the regeneration accompanying them, prove to be true.

By Helena Tunstall

Inequalities

New review shows socio-economic position over the life course affects quality of life

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A new systematic review looking at the relationship between socio-economic position over the life course and quality of life has just been published in BMC Public Health by CRESH PhD student Claire Niedzwiedz, Rich Mitchell and colleagues at the University of Glasgow and MRC/CSO Social and Public Health Sciences Unit.

The review’s aim was to gather and examine evidence about how people’s quality of life as adults depends on the social and economic circumstances they have experienced throughout their life, from childhood onwards. Do childhood circumstances matter? Does it help if people move ‘up’ the socio-economic ladder? Does it harm if people move ‘down’?

In chronic disease epidemiology, several conceptual models have been developed to help explore these ideas and they provide a foundation for investigating life course effects. The accumulation model hypothesises that adverse socio-economic experiences have a cumulative, dose–response effect on health. The latent model (or critical period) suggests that circumstances during childhood have an effect on health, over and above adult circumstances. Pathway models emphasise the importance of trajectories across the life course. Social mobility models are usually divided into intra-generational and inter- generational where inter-generational mobility refers to a change in social class between generations and intra-generational mobility is the movement between different social classes in adulthood. The mobility models suggest that change in your socio-economic position will affect health, and in general lead us to expect that movement ‘up’ the social ladder is good for health, but movement down may be bad.

The review identified 12 relevant articles which used data from different five countries.

The evidence supported an overall relationship between socio-economic position over the life course and quality of life but results for each life course model were mixed.  There was some evidence to suggest a latent effect of childhood socio-economic position on later quality of life for women, but the effect was not found for men. Overall, results for social mobility models suggested little effect. We found very few studies that actually assessed inter-generational mobility or accumulation and pathway effects.

There was a very wide range socio-economic position measures, outcomes, analytic techniques, reference populations and quality across all the studies we looked at. This led to a key message from the review; the need to increase study comparability. A second key message was the need for comparable data and studies from different countries. This may help to uncover aspects of different societies that influence the relationship between socio-economic position over the life course and quality of life.

You can access the article here: http://dx.doi.org/10.1186/1471-2458-12-628.

 

 

Natural Environments

Key questions for researching natural environments and health

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There was a long session on natural environments and health at the Royal Geographical Society /IBG conference yesterday. It was put together by Dr Liz Richardson, from CRESH, and it featured an intriguing range of 9 papers. All were exploring the relationships between natural environments and health, but there was great variety in the perspectives, methodologies and opinions on display. The session felt like a nice summary of many current issues and questions in the field.

You can read the abstracts for the papers in the first part of the session here, and the second part of the session here. At the end, I led a discussion which tried to bring together the range of questions and perspectives in the session. Here’s what we talked about.

What can we expect natural environments to do for us? Nina Morris, from Edinburgh University, used the lovely expression ‘mission creep’ in her talk and it prompted us to note that green spaces suddenly seem to be responsible for doing an awful lot. If you believed everything you read, you might think that your local park or forest will cure all ills, make everyone thin, make everyone happy, be a boon to the local economy, prevent climate change and protect rare species. It’s likely that some natural environments can contribute to some of these things, some of the time, but they’re not miracle-workers. Keeping expectations realistic and evidence-based is important.

Several talks began with the assertion that green space is thought to be, (or even known to be) ‘good for health’. There were also anecdotes that, when hearing about plans for or results from research on natural environments and health, some policy makers, journalists (and even research funders) reply “we know that already”. So, we debated, is our job done? Do we now know enough about the relationships between natural environments and health? Can we stop researching it and turn our attention to something else? Perhaps not surprisingly, a room full of researchers disagreed… I do think they had good reason though. Some of the papers really challenged what we thought we knew about whether and how natural environments are related to health. The paper from Katherine Ord, a PhD student at CRESH, for example, strongly questioned the role of physical activity in the relationship between green space and health. Whilst we’re still discovering that we know relatively little about how, when and for whom natural environments matter for human health and wellbeing, there is more work to do. The fact that many people seem now to believe that ‘green space is always good for everyone’, makes the research even more important.

Assuming that there is more work to do, what kind of research is needed? There was much talk about the value of different approaches. Qualitative, quantitative and mixed methods studies were all on display and the range of insights and types of knowledge was a powerful argument for variety in study design and methodology. The epidemiological studies CRESH specialises in are important for learning if and how natural environments contribute to the health and wellbeing of populations, and how they relate to health inequalities. But the insights from qualitative work into how and why individuals use, move within and feel about natural spaces provide crucial depth in understanding. The need to study non-natural environments as part of our research (akin to a control group) was another thread running through the debate. This is vital to be sure that any apparent impacts on health and wellbeing are a function of the natural environment itself and not something else, like just being in a different environment, or a much loved place.

Finally, we discussed the need to understand how we should manage natural environments and our access to them, to maximise their potential benefits. A paper from Michelle Newman at Coventry University, for example, took a critical look at the issues surrounding children’s access to green space in schools. Its exploration of ideas about accessing ‘risky’ environments and who is paying for (and therefore controlling) access to these spaces, prompted wider thoughts about what kinds of spaces to preserve, make accessible or construct. There is a need to ask who has access and who uses their access. Governments and policy makers now explicitly acknowledge the values of green space for health and wellbeing, which is great. Would it be so great if they started to set targets for green space use, or even compel it?

It was a fascinating, useful (and long…) session.

Natural Environments, Physical Environment

Regular physical activity in natural environments halves risk of poor mental health

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Regular exercise in a natural environment may cut the risk of suffering from poor mental health by half, according to a new study published by CRESH today.

Rich Mitchell studied the use of natural and non-natural environments for physical activity, like walking, running and cycling. He found regular use of natural environments such as forests and parks seemed to protect against mental ill-health, whilst use of non-natural environments like a gym, did not.

Previous experimental studies have shown that exercise in natural environments has a positive effect on biomarkers and self-reports of stress, on mood and reported levels of fatigue. This new study was designed to look at whether such effects can be detected in the general population in every day settings.

Data from the Scottish Health Survey 2008, described the different environments in which 1890 respondents were physically active, including woodlands, parks, swimming pools, the gym, the streets and the home. The data also showed how often respondents used each environment and how physically active they were overall. Rich looked at the association between use of each environment and the risk of poor mental health as measured by the General Health Questionnaire. Only activity in natural environments was associated with a lower risk of poor mental health.

Rich said “I wasn’t surprised by the findings that exercise in natural environments is good for your mental health, but I was surprised by just how much better it is for your mental health to exercise in a green place like a forest, than in other places like the gym.”

 “Woodlands and parks seemed to have the greatest effect, so the message to doctors, planners and policy makers is that these places need protecting and promoting.

 “The results suggest that making the decision to exercise in a natural environment just once a week could be enough to gain a benefit. Any additional use may have a bigger effect.”

The study, published online by Social Science & Medicine, revealed that local pavements or streets was the environment most commonly used regularly for physical activity, followed by home/garden. Around 50 per cent of the sampled group reported using any natural environment at least once in the last month.

Rich did not know the type, duration or intensity of activity conducted in each environment and noted that this was a weakness in the study, but is also an area that could be looked at in more detail in future.

You can see Rich talking about the study here: http://itunes.gla.ac.uk/web/news/video/RichardMitchell.mp4 

You can read the full study here http://dx.doi.org/10.1016/j.socscimed.2012.04.012 (access required). If you don’t have access and want to read it, please email Rich at Richard.Mitchell@glasgow.ac.uk and ask for a copy.

The research was funded by the Scottish Government’s Rural and Environmental Science and Analytical Services division (RESAS).

Data

Are experimental studies always best?

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Work has begun on our NIHR funded evaluation of Forestry Commission Scotland’s Woodlands In and Around Town (WIAT) scheme. WIAT aims to improve quality of life in towns and cities by bringing neglected woodlands into management, creating new woods and supporting people to use and enjoy their local woods. Our study, led by Catharine Ward Thompson at OpenSpace, is focused on whether changes to the local woodland environment affect people’s health. The WIAT evaluation is exciting partly because it’s a rare opportunity to ask what impact environment has on health, at a population level, via an experimental study.

The vast majority of evidence about how health and behaviour are affected by environment comes from cross-sectional studies. In cross-sectional studies, we measure both the environmental characteristic of interest (for example, how much green space there is in a neighbourhood), and the outcome of interest (for example, how healthy or happy the residents of that neighbourhood are) at the same time. Cross-sectional studies are great for suggesting links or associations between environmental characteristics and health or related behaviour, but they have many problems. In particular, we can’t be certain that the aspect of environment we are interested in causes the health outcome in question. In the case of green space and health for example, we worry that the apparent relationship between access to green space in a neighbourhood and good health among residents is really because the residents of greener neighbourhoods tend to be wealthier, and wealthier people are more likely to be healthier anyway. So, it might be that access to green space in a neighbourhood doesn’t cause better health, it’s just that healthier people are more likely to live in greener neighbourhoods.

Experimental studies are very different. In an experiment, we deliberately alter some aspect of the environment for one group of people (the intervention group), but not for another very similar group of people (the control group). We then compare what happens to health or related behaviour in the intervention and control groups. If health improves in the intervention group, but not in the control group, we can be more certain that the change in environment has caused the change in health. So, in our WIAT study, we’ll be comparing what happens to the health of communities whose woodlands are improved and promoted, with those whose woodlands are not. (That sounds a bit unfair on the ‘control’ communities but, in fact, they’ll be eligible to get their woods improved later).

A lot has been written recently about how important experimental studies are*, how much better they are for telling us ‘what works’ to improve health and behaviour, and how we need far more of them. The idea has taken hold, helped by research funding and by the fact that some key journals in public health and epidemiology now refuse to even peer review studies that are cross-sectional. Jim Dunn and Martin Bobak’s editorial* on taking over the editorship of JECH is a good indication of increased interest in experimental designs from leading journals. Mark Petticrew has also written* about it.

I am excited about the prospect of experimental studies being used to examine the impacts of environment on health and health-related behaviour. I believe that the characteristics of the places we live and work in can be a strong influence on our health and behaviour and, in turn, I think that environment could be an effective lever for improving population health and narrowing health inequalities. Experimental studies are, in theory, the best way of finding out if my ideas are right or not.

However, I do have a few concerns about the assumption that experimental approaches are always best for researching ‘what works’ to improve public health. Their strengths have been highlighted in the literature, but there has been relatively little critical thinking about them.

The processes by which environment influence our health and behaviour are complex and life long. Environment doesn’t simply determine health and behaviour; people and environments influence each other. Think about the cycling infrastructure in Copenhagen for example. The environment there enables and encourages people to cycle, so the city’s high rates of active travel are partly because of the environment. However, the environment is so conducive to active travel because the residents use it, protect it, value it and continue to improve it.

Our relationships with different aspects of environment are also formed over the whole of our lives. Catharine Ward Thompson’s work*, for example, shows that one of the strongest predictors of whether we visit woodlands as adults was whether we did so as children. That means just changing access to woodlands in the neighbourhood may not affect immediately, or at all, residents who don’t have ‘visiting the woods’ as part of their culture.

Do we know how long it will take for an environmental change to affect health and behaviour? My guess is that the time will vary by environmental characteristic and/or the health or behavioural outcome being measured. I think, in many cases, effects will be slow to materialise. Yet the reality of research, and research funding, is that it’s difficult to sustain an experiment for a long time. In turn, this might lead us, or perhaps other less critical audiences, to prioritise interventions on aspects of environment that show a quick effect, at the expense of those which may have a greater but slower effect. Worse, if brief experimental studies find no effect of environmental intervention on health, and we think experimental evidence is the best there is, it may lead to the assumption that environment does not affect health.

I worry that in the rush to use experimental designs to see ‘what works’ for public health, we have forgotten some of what we know about relationships between health and environment specifically, and about relationships between place and identity more broadly.  I think experiments are very important, but I’d like to see a more critical perspective.

What do you think?

*NB links to journal articles may require institutional/personal subscription to the journal

Job

Research post available (the contribution of natural and cultural heritage to population health)

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CRESH has a new short term research post available , based in Glasgow

The purpose of the post is to undertake research and development for a project assessing and valuing the contribution of natural and cultural heritage to population health, wellbeing and happiness in Scotland. The project aims to explore whether an influence of Scotland’s cultural and natural heritage on health, wellbeing and happiness can be detected, measured and economically valued using secondary survey and routinely collected data. This post is to assess feasibility and, if possible, to develop a suitable approach. To that end, the job will involve reviewing relevant literature and existing practices, finding and appraising existing data sets which could contribute, beginning the design of appropriate methods (if feasible) and helping to build a coalition of interested parties and funders. The National Trust for Scotland (NTS) owns and manages some of Scotland’s greatest natural and cultural heritage and this project will be a collaboration between NTS and the University of Glasgow. This post might suit a range of numerate backgrounds including (but not limited to) economics, social or environmental science.

Main Duties and Responsibilities

1. To play a leading role in reviewing the relevant literature and in the search for key extant data sets that could be used in this project.

2. To play a leading role in assessing the feasibility of assessing and valuing the contribution of natural and cultural heritage to population health, wellbeing and happiness in Scotland, via secondary data sets and, if deemed feasible, in specifying the methods to be used.

3. To liaise with the NTS, including securing access to any useful data they have and can share, and communicating the progress of the project and its findings.

4. To document the progress of the research, administer team meetings and write progress blog posts as required.

5. To write up the findings/outcomes in a preliminary report.

6. To collaborate with other members of the group, and external interested parties as appropriate, in order to develop the work of the group as a whole.

7. To undertake or assist with the dissemination of the project progress and findings through presentations to a variety of audiences and, if appropriate, academic paper(s).

8. To assist, if required, in the preparation of further funding bids to continue the project.

9. To collaborate with colleagues and participate in team meetings/discussions and centre research group activities.

Salary will be on the University’s Research and Teaching Grade, level 7, £31,948 – £35,938 per annum.

This post is fixed term for 6 months. To find out more contact Richard.Mitchell@glasgow.ac.uk

Closing date: Friday 18th May 2012.

You can apply online here

Natural Environments, Physical Environment

More green space equals less stress (as measured by cortisol)

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A project team which includes Rich Mitchell has just published a study showing that cortisol circulation (a marker of stress) is more favourable in areas with greater amounts of green space. The team was led by Catharine Ward Thompson, at OpenSpace research centre. The study is the first to show effects of green space on biomarkers of stress in everyday (i.e. non-experimental) settings. It’s published in Landscape and Urban Planning and you may be able to read it here . The study is part of the wider GreenHealth project, in which CRESH plays a large part. It was funded by the by the Scottish Government’s Rural and Environment Science and Analytical Services (RESAS) Division. For those without access to the journal, here’s the abstract:

Green space has been associated with a wide range of health benefits, including stress reduction, but much pertinent evidence has relied on self-reported health indicators or experiments in artificially controlled environmental conditions. Little research has been reported using ecologically valid objective measures with participants in their everyday, residential settings. This paper describes the results of an exploratory study (n = 25) to establish whether salivary cortisol can act as a biomarker for variation in stress levels which may be associated with varying levels of exposure to green spaces, and whether recruitment and adherence to the required, unsupervised, salivary cortisol sampling protocol within the domestic setting could be achieved in a highly deprived urban population. Self-reported measures of stress and general wellbeing were also captured, allowing exploration of relationships between cortisol, wellbeing and exposure to green space close to home. Results indicate significant relationships between self-reported stress (P < 0.01), diurnal patterns of cortisol secretion (P < 0.05), and quantity of green space in the living environment. Regression analysis indicates percentage of green space in the living environment is a significant (P < 0.05) and independent predictor of the circadian cortisol cycle, in addition to self-reported physical activity (P < 0.02). Results also show that compliance with the study protocol was good. We conclude that salivary cortisol measurement offers considerable potential for exploring relationships between wellbeing and green space and discuss how this ecologically valid methodology can be developed to confirm and extend findings in deprived city areas to illuminate why provision of green space close to home might enhance health.

Built Environment, Grant news

CRESH gets new grant to look at risk to kids from alcohol and tobacco outlets

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The CRESH team, led by Niamh Shortt, has been awarded a grant from the MRC/CSO Scottish Collaboration for Public Health Research and Policy. The research will examine whether the density of tobacco and alcohol outlets around schools and homes affects smoking and drinking behaviours among 13 and 15 year olds, in Scotland. The grant begins in early 2011 and we’ll be looking to recruit staff soon. Watch our website for more details.

Natural Environments, Physical Environment

CRESH at the EUPHA conference on Public Health and Nature

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Rich Mitchell is giving a keynote address at a pre-meeting of the European Public Health Association in Copenhagen on the 9th November. Rich will be talking about Public Health’s new found interest in natural environments, the demand for high quality evidence and the relationships between experimental and observational studies. More details on the meeting can be found here.

PhD opportunity

PhD studentship available; health economics of green space

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Rich Mitchell and Andy Briggs (Glasgow Uni) have a PhD studentship available.

There is growing interest in whether contact with ‘green spaces’, including forests and parks, carries health benefits. Both Scottish and UK public health policy documents now explicitly recognise green spaces as ‘good for health’. The evidence for these effects stems from both experimental studies in lab and field, and from population level observational studies. Several experimental studies demonstrate direct effects of perceiving these environments on a variety of physiological and psychological measures. Several observational studies show independent associations between greener environments and better population health. However, this is an emerging field of research with much work still to do to confirm, quantify and qualify any positive impacts on health. If it is true that contact with nature brings health benefits, the cost of providing and accessing such environments, the subsequent health benefits and the relative merits of such ‘environmental health care’ need to be weighed carefully.

The Forestry Commission and other forest agencies are engaged in many programmes of woodland improvement and creation, with the explicit aim of increasing the use of woodlands and prompting health benefits. These programmes provide useful natural experiments through which health impacts of environmental interventions might be assessed. However, the specifics of how any health economic analysis might be applied to these situations are not clear. The prevailing methodology employed in health economic evaluation, is to use ‘Quality Adjusted Life Years (QALYs)’ to measure health benefits of interventions in favour of the more traditional monetary measures typically used for economic appraisal in areas such as environmental and transport economics. While the QALY framework may be appropriate for Health Related Quality of Life benefits of interventions relating to the woodland environment, the broader evaluative framework offered by cost-benefit analysis might be more appropriate for the broader wellbeing aspects of the environment.

The purpose of the PhD project will be to explore the potential use of economic appraisal techniques to value and evaluate woodland interventions. A broad perspective will be adopted to explore the potential to use and combine methods from environmental, health and transport economics.

Funding Notes:

Person specification:

Applicants should hold a first class or upper second class degree in economics and preferably have demonstrable interest in, and experience of health economics. A master’s qualification in a relevant discipline would be an advantage.

Award details:

This is a 3 year full time studentship and will provide an annual stipend and fees. The award is available to UK and other EU nationals only.

References:

How to Apply – Please send a full CV including the contact details of 2 referees and a covering letter explaining why you are particularly suitable for this post via email to Prof Richard Mitchell (Richard.Mitchell@glasgow.ac.uk) and Professor Andy Briggs (andrew.briggs@glasgow.ac.uk)

Further details: More details on the project, the supervisors and the departments involved is available from Professor Richard Mitchell (Richard.Mitchell@glasgow.ac.uk), Professor Andy Briggs (andrew.briggs@glasgow.ac.uk)

Built Environment, Physical Environment

Mental health and the environment symposium: some thoughts

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The CRESH symposium on mental health and the environment was one of those (quite rare) conference days that worked incredibly well. I’m not sure what it was that made the day so interesting and exciting. Perhaps it was the unusual mix of academics, practitioners, policy makers and GPs in the audience, all of whom seemed keen and willing to engage and debate. Perhaps it was the variety of interesting presentations. Whatever the magic ingredients, I came away from the day inspired and full of thoughts. I’d like to share two of them

1) There was much discussion during the day about the nature of ‘evidence’ for the influence of environment on health. There was a clear tension between the desire for evidence from ‘intervention / evaluation’ type studies, which hold the promise of identifying causal mechanisms and offer a higher standard of ‘proof’ about whether environment does or does not hold influence over health (especially if the studies are controlled in some way), and the bulk of existing evidence which stems from observational designs. It certainly feels like the balance of funding available for health research is shifting rapidly to favour study designs which are more experimental than observational. Colleagues of mine have recently had funding requests turned down because of their observational study design, and we have had papers rejected from leading medical journals specifically because of an observational design. This pressure is, rightly or wrongly, asking scientists to work further up the hierarchy of study designs. What concerns me is the extent to which we are ignoring the weakness of experimental / evaluation study designs, especially in a) the extent to which they have external validity (i.e. can we really learn anything about how the wider world works from the controlled and unusual situations that experimental studies either create or exploit) and b) the extent to which we are tempted to believe that what are often relatively short-term studies can really tell us much about how social and physical environments really influence population health and health inequalities. This is a topic to which we intend to return in the next CRESH event. What is the right balance between experimental and observational studies in a portfolio, or mixed economy, of evidence? Is it all over for observation?

2) Critical thinking is essential to the progress of science. If we don’t ask how, and for whom, our results or conclusions might not hold, our work is weaker. If we don’t question how and why we think and research in the way we do, our approaches will not develop. In one area CRESH researches, the health effects of contact with green spaces or natural environments, we frequently encounter land managers, policy makers and planners who adhere to a general orthodoxy that ‘green space is good for you’. The value of critical science is that it makes us aware that not everyone feels comfortable walking in the woods or the park, and that some people even feel threatened by open spaces in the their neighbourhoods. There is plenty of evidence from qualitative and quantitative studies that this is true.

One of the weaknesses of critical thinking in the field at the moment however is that the critique seems to stop at ‘not everyone benefits from green space’. My question is, what do we do with that knowledge? If we can understand how and for whom benefits are not realised, that could help adjust expectations about what green space can deliver, and also help us think through how benefits could be brought to a wider range of people. Perhaps the real value of critical approaches to thinking about environment and health is that they pose these questions.

News about the next CRESH symposium will appear on the site soon. In the meantime, if any attendees want to post their thoughts on the mental health and environment day, please use the form below.

This is a personal post, written by Rich Mitchell. It doesn’t represent the views of ‘CRESH’

Inequalities

How do you measure Big Society?

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The CRESH team and colleagues from Portsmouth and Liverpool are currently collaborating to produce a ‘blueprint’ for measuring Big Society.  You can read more about the work and funders on the project page.

To design a measure of Big Society begs a question… what is Big Society? Actually defining it is not easy. Although the general idea has been quite clearly articulated by David Cameron, a huge range of supporters, detractors and commentators have been writing and blogging about what it means since the coalition government took power. Opinions vary about what Big Society is and is not. There are also strong views about whether it’s a good thing or not. The government is also now encountering the realities of putting an idea developed in opposition into practice. Tony Blair has some interesting things to say about the difference between having an idea in opposition, and delivering change in government…

Although debates continue about what a Big Society should look like  and what policies the coalition need to build it, its key principle is clear; it represents a desire for a society in which citizens and communities take a vastly increased role in managing, shaping and delivering social and physical infrastructure. As Number 10 wrote in May 2010, their aim is “to create a climate that empowers local people and communities…[to] ‘take power away from politicians and give it to people’” .

We have a sense that some in government believe their job will be done once they change the law to empower people to run local services or to have a say on how their neighbourhood will be developed. The ‘offer’ to participate in a Big Society will have been made and it doesn’t matter who, or if anyone, takes up the offer. Others, however, want to see evidence of changes wrought. Will it alter how much people like you and I are aware of, care about, and get involved in, what’s happening in our local areas? Which communities will do well from it, and which will not?  The fact that Big Society has the potential to affect everyone makes it an important thing to monitor and measure.

At the start of the project, we focused on designing a framework for understanding ‘Big Society’ and identifying the set and sequence of changes which expect to see if it’s ‘successful’. Then, we looked for datasets and indicators to measure each of these things. It’s remarkable how many surveys which would have been useful to monitor and measure the progress of Big Society, have been cut. On Friday, we will visit the Department for Communities and Local Government to present our work so far and hear what they have to say about it. Sometime after that, we will post information about our ‘model’ of Big Society and how it might be measured.

Built Environment

Fast food outlets cluster around schools

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New CRESH research has found that fast food outlets tend to cluster around schools. The work published in the American Journal of Preventive Medicine demonstrated that fast food vendors are five times more likely to cluster around New Zealand schools than in other areas. Using data from four cities, the authors found that outlets are also more likely to be situated in poorer neighbourhoods. The results suggest that the geographical distribution of fast food outlets may be one factor in explaining the increase in obesity rates amongst youths, and its social distribution.

The work has been covered in the New Zealand media. See:

http://www.stuff.co.nz/dominion-post/news/4575897/Schools-out-and-the-junk-foods-in

 

The academic paper can be found here:

http://dx.doi.org/10.1016/j.amepre.2010.10.018