I enjoy watching tennis, use words like 'loo' and 'supper', and open my Christmas presents after lunch. In the UK, this makes me firmly middle-class. But much as I might protest (usually by wittering about my 'deprived' schooling), I know it's the truth. Why else would I feel so at home in academic research, a profession dominated by the middle classes?
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| Strawberries and cream at Wimbledon |
On the plus side, this makes for some delicious bring-and-share lunches, what with all the Marks & Spencer nibbles, and home-made cakes (made, of course, with organic locally-sourced ingredients). But much as I enjoy free-range cupcakes, is it good for research, especially in a subject called 'public' health?
Former British Prime Minister Tony Blair might have once declared that 'we're all middle class now', but the gap between the UK's rich and poor is arguably wider than any time since the Second World War. And where there are income differences, there are also differences in health status and health-behaviour. Which has left me wondering, are a largely middle-class community best placed to understand and empathise with the UK's most deprived, so often the 'public' we are trying to target in 'public health'?
Don't get me wrong - I'm not saying that great work isn't being done by great people. And I'm not saying any researcher is actively biased. Anyone who's ever met a Scientist will agree; we are generally quite objective. After years of being drilled to act like a robot, some of us have even converted to running on petrol and oil, rather than continuing to rely on the inefficiency of food and water.* But even the most robotic researcher will find it harder to accept something, or even think to ask about something, that doesn't fit with their own experiences or world-view.
ERROR! ERROR! DOES NOT COMPUTE
Could this narrow demographic also (partly) explain why researchers find certain groups so hard to recruit? Or, to put it more bluntly, are UK public health researchers sometimes talking a different language? As an unhealthy person working in an Institute with the word ‘health’ in its name, I know how patronising it can feel:
“Post-exercise endorphins you say? I’m afraid all I get is wheezing, cramp, and a sensation of impending death”
Former British Prime Minister Tony Blair might have once declared that 'we're all middle class now', but the gap between the UK's rich and poor is arguably wider than any time since the Second World War. And where there are income differences, there are also differences in health status and health-behaviour. Which has left me wondering, are a largely middle-class community best placed to understand and empathise with the UK's most deprived, so often the 'public' we are trying to target in 'public health'?
Don't get me wrong - I'm not saying that great work isn't being done by great people. And I'm not saying any researcher is actively biased. Anyone who's ever met a Scientist will agree; we are generally quite objective. After years of being drilled to act like a robot, some of us have even converted to running on petrol and oil, rather than continuing to rely on the inefficiency of food and water.* But even the most robotic researcher will find it harder to accept something, or even think to ask about something, that doesn't fit with their own experiences or world-view.
ERROR! ERROR! DOES NOT COMPUTE
Could this narrow demographic also (partly) explain why researchers find certain groups so hard to recruit? Or, to put it more bluntly, are UK public health researchers sometimes talking a different language? As an unhealthy person working in an Institute with the word ‘health’ in its name, I know how patronising it can feel:
“Post-exercise endorphins you say? I’m afraid all I get is wheezing, cramp, and a sensation of impending death”
1) LOADING WEIGHT LOSS PROGRAMME LESSON 001
2) INSTRUCT AUDIENCE TO “DO 30 MINUTES OF MVPA**”.
3) LESSON END
OK. Slight over-exaggeration. In fact, the best public-health interventions draw on detailed qualitative research (i.e. where brave researchers have ventured outside the ivory tower to speak to real members of the public) to ensure it addresses the needs and barriers of the target population. But I still think a bit more demographic diversity wouldn’t do the profession any harm.
**MVPA, by the way, is public health research speak for 'Moderate or Vigorous Physical Activity'
I do think this is changing though and we're coming up through the ranks (slowly!). Some of us are middle class now but weren't as children. As everyone who knows me knows, I come from a very deprived background and am the only person (ever I think) to have got a PhD from the school I went too. There are others I know who come from similarly deprived backgrounds. I do think we can offer a different slant on work being done as we know how things really are. I'm happy to take a Chair to get things going quicker!
ReplyDeleteDot, you are definitely one of my heroes! And I agree that you offer a different slant on things, and I think that makes our research stronger overall. Just imagine the good that could be done if you were made Professor?! ;)
DeleteI suggest you listen to this 30minute podcast that talks about this sort of thing. It's Act 1: Harlem Renaissance - http://www.thisamericanlife.org/radio-archives/episode/364/going-big
ReplyDeleteI keep telling people in public health to listen to it, but I don't know if they are.
Very interesting. Thanks very much for sharing this.
DeleteThis is so narrow minded its unbelievable! ......;-)
ReplyDeleteOK...guess you could ask whether you need to empathise with people to understand the bits about them you are studying. I would guess that it would help but who knows...need more data (theres a grant proposal in there somewhere). Seems to me that this problem is manifest in many other human interactions (and cuts both ways). People have a hard time knowing what its really like to walk a mile in the other persons shoes. The question is, how influential is it in determining our actions or non-actions. That really is a research question.
Biggus Diggus
I definitely suspect my view has been over-narrowed by so many years in the ivory tower!
DeleteI agree with Dot, some of us are slowly coming into this field...I definitely did not come from a middle class background! Although I do have to admit that sometimes I think it would have made, and in fact still would make, my career and working life a bit easier. Very interesting post :)
ReplyDeleteThanks Rose!
DeleteAre you able to expand briefly on why having a middle class background would make your career and work life a bit easier even now? If you dont want to thats fine, just interested. :)
DeleteI think it is a lot to do with 'connections' and also language. As well as the usual things of attending a school with incredibly low aspirations (my careers advice was to become a hairdresser, despite saying that I wanted to go to university and study sociology to become a researcher). I feel lucky that my family have always been very supportive and that I grew up surrounded by books - this was very unusual amongst my peers. Sometimes I feel that I don't 'belong' in some of my work encounters but then again I have the same feelings sometimes when I 'return to my routes'. This is not a very coherent comment (and please excuse the many '', I have used this when I feel a word/concept doesn't quite fit with what I mean but is as close as I can get right now), I will think about it some more and try a better answer when my brain is properly engaged!
DeleteReally interesting piece Peter and I agree with above comments.
ReplyDeleteThere's a similar problem in medicine; classically doctors, along with all university attenders, have been from the higher socio-economic groups and whatever the papers/university admissions say, this is not changing. Most patients that these doctors go on to treat will be from lower socio-economic groups than themselves and this has obvious implications for the doctor-patient relationship and effectiveness of care. However well meaning, open-minded, unjudgemental etc etc we are trained to be, we can never truly empathise with most of our patients. How can we hope to deliver effective HOLISTIC care?
Is that why its easier to hide behind prescriptions than tackle the bigger problems, the real socio-economic and cultural causes for your patient coming to see you?
What do others think?
Completely agree. I thought about drawing parallels with the medical profession, where there definitely remains a lack of staff from lower socio-economic groups, which I equally suspect has implications for the doctor-patient relationship. Starting with the obvious: are they speaking the same language?!
DeleteMy favourite related anecdote concerns the Glossary of Yorkshire Medical Terms, launched by NHS Doncaster to aid European doctors understand their patients, but also 'useful for any healthcare staff needing a Yorkshire refresher' (in the words of Rebecca Wilkins from the BMJ).
There are two issues here.
ReplyDeleteThe first - lack of diversity in academia and the effect that has on choosing and shaping research questions - will not be easily solved. The undergraduate population under-represents some social groups, so the pool of people potentially entering academia is already biased. We're all aware of the multiple hurdles from PhD to tenured position, and the filtering at each stage means that groups under-represented at the bottom are even less likely to be represented at the top. Never mind 'class' - at a previous biomedical faculty I was based in, it was hard to find a Professor who didn't tick at least one box out of 'clinical', 'male' or 'Oxbridge'. As a non-clinical, non-Oxbridge female, I wasn't seeing 'people like me' in the most senior positions, even though social mobility meant I didn't share my grandparent's working class status.
The second issue - how the limits to diversity affects the ability to carry out effective and relevant research across society - could be addressed in other ways. Rather than wait for academics to be more socially representative, what about engaging the help of 'lay facilitators' who know the communities in which we might want to conduct research, and who understand what really matters? Charities working overseas increasingly work WITH communities rather than just IN them, so why not the same here?
Very very good points. I guess the first one can be tied into the age-old adage that while inequalities may be easy to identify, they are significantly harder to solve. Still, talking about them is an important first step...
DeleteI like the idea of working 'with' other communities to try and bring in a more diverse knowledge base (not quite as much as having them 'in' the system, but it's a reasonable stop gap). I suppose this is one of the foundations of the movement towards patient/public involvement in research. It is also why I am a strong advocate of qualitative research. I just don't believe the paternalistic model is appropriate for complex psychosocial issues.
Thanks Peter for this really interesting, thought-provoking post. It doesn't entirely resonate with my own experiences of academia, but I certainly don't think it's narrow-minded to write honestly from your own perspective (i.e. as someone who admits they are middle class). Maybe you should've also drawn attention to the fact that you're based at a Russell Group university and so your experience won't be the same as those working in other institutions, e.g. the former polys like Northumbria University where I'm based. There does seem to be a more diverse social mix here at Northumbria, both in terms of the staff and student populations. It's not that one way of doing things is right and the other is wrong, but you've asked an interesting question in terms of what impact this has on public health research (in terms of access to the profession and our ability to engage with working class participants). My PhD was on the subject of using lay health trainers to engage with fellow community members and support them to adopt healthier behaviours, so I'm a bit biased on that front! It would be great to see more lay/peer researchers in public health. I just think we need to remain aware of the power dynamics that exist and reflect on the fact that, by virtue of our role as academics and/or health professionals, many people will tend to see us as knowledgeable 'experts' (and also as middle class, whether we like it or not).
ReplyDelete