Dr Polly Mitchell
Polly is a post-doctoral research fellow on the Wellcome Trust-funded project “But why is that better?”, which investigates how applied philosophy and ethics can inform and support healthcare quality improvement. “But why is that better” explores the complex and contested concepts of healthcare quality and healthcare quality improvement. We seek to work within quality improvement, using the tools of applied philosophy, to address some of the ethical and conceptual challenges faced by researchers and quality improvement practitioners. Outside of the project, Polly's research broadly concerns the philosophy of health and well-being. In particular, she thinks and writes about the definition and measurement of health and well-being, and the role that measures of health and well-being play in healthcare decision-making and public policy.
Robert Yates is an internationally recognized expert on universal health coverage (UHC) and progressive health financing. At Chatham House he was previously project director of the UHC Policy Forum before becoming head of the Centre on Global Health Security. His principal area of expertise is in the political economy of UHC, with a focus on advising political leaders and government ministries on how to plan, finance and implement national UHC reforms.
Prof. Jonathan Bell
Professor of US History and Director of the Institute of the Americas at UCL since 2014. His current project, tentatively entitled Unhealthy Bodies: Health Care and the Rights Revolution since the Sixties, aims to unite the two phenomena of rights politics and health care delivery politics to help us understand how the sexual and gender dynamics of medical care in the US shed significant light on the political culture of the nation at a time of significant political change in the era of government and health care retrenchment that began in the seventies and grew considerably in the Reagan era. The project shows that both state and private conceptions of gender and sexuality impacted upon their ability to provide health care to a diverse population, and demonstrates how a private-public delivery system drastically impacted upon the ability of rights movements to translate basic legal rights into full-blown economic citizenship, a question of vital public importance today on both sides of the Atlantic.
Marta is the Executive Director of the UK Collaborative on Development Research. She leads UKCDR providing high-level engagement and strategic coordination of the SCOR Board. Marta previously led the development of the UK Department of Health’s first NIHR Global Health Research Programme, while on secondment from Wellcome, where she had been developing and implementing a wider range of Wellcome’s strategic research funding partnerships and capacity strengthening initiatives in developing countries.
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Session 1: Women's & Mental Health
Great Hall, 11.00
1. What evidence is there that engaging men to prevent violence against women works?
Team: Dani Bancroft, Rachel Merrick, Angeline Pesala, Shiron Rajendran, Anita Bolina
Commissioner: Professor David Osrin, UCL Institute of Global Health, SNEHA (Mumbai, India)
Every day in 2017, 82 women were murdered by a current or former intimate partner. Whilst numerous studies have validated the utility of programmes empowering women to stem the perpetration of intimate partner violence (IPV), few have evaluated interventions that instead target men to reduce IPV against women, either as individual “batterers” or at the community level. With limited resources, there is a growing feminist rhetoric that a male-oriented approach when women are the victims should not be allocated funding. Therefore, this review seeks to assess what evidence there is that working with men does reduce IPV against women, and consider how this might inform policies of those working with men instead of – or as well as – women.
A systematic literature review was conducted for critical appraisal of programmes engaging men to prevent IPV against women. Medline, Global Health, Embase, PsychEXTRA, PsychInfo and Social Policy & Practice databases were searched for terms and subject headings associated with IPV, men and interventions on June 17, 2019. After removing duplicates, 11,845 papers were screened, of which 222 were included for data extraction. Currently, 35 full papers have been read, 18 of which are relevant to this project’s aim and thus had pertinent data extracted. The quality of included papers will be assessed, with main findings amalgamated via a narrative synthesis.
The majority (59%) of the studies reviewed so far suggest positive impacts of engaging men to reduce IPV. These have been mostly court-mandated batterer intervention programmes (BIPs). However, effect size was often marginal, and frequently diminished 12-months post-intervention. Moreover, intervention effectiveness was commonly measured distally by batterer self-reported accounts of abuse, changes in attitudes and norms, or by programme completion.
Whilst early findings suggest meaningful benefits of programmes seeking to engage men to prevent IPV, substantial methodological variations (including absence of an appropriate control group), significant participant drop-out (~40-50%) and relatively short (≤12 months) follow-up periods undermine previous reports of programmatic success for such interventions. Subsequently, more rigorous studies, including those with proximal measures of IPV like partner-reported abuse and judicial recidivism, are needed before policy recommendations can be made regarding the evidence for working with men to reduce IPV.
2. The relationship between social media use and body image in young people
Team: Olivia Rowe, Isobel Ashby, Ananya Arora, Ines Grange, Rhiannon Osbourne
With over 3 billion active social media users in 2019, many academics are investigating possible negative impacts of social media usage. The following literature review investigates the relationship between social media and body image, including the potential moderators of this relationship. The purpose of this review is to highlight important areas for future research and provide guidelines for young people to encourage the healthier use of social media.
The data collection was conducted by searching standard databases for recent studies investigating this relationship in young people (below the age of 25 years old).
The review found strong support for a negative effect of social media usage on body image. This is likely mediated through the internalisation of a certain body ideal and comparison to peers and celebrities. Particular behaviours and personality styles influence the effect of any given social media site on body image, highlighting that it is the way the site is used, rather than the site itself, that influences body image.
We conclude with three guidelines to help individuals use social media more responsibly: restrict social media usage, censor social media content and educate yourself and others about digitally manipulated photos. Directions for future research are also suggested.
Session 2: Antimicrobial Resistance
Room 1, 11.00
Use of pull incentives to incentivise the pharmaceutical industry to develop antimicrobials: a systematic review and narrative synthesis
Team: Rebecca Leszczynski, Paul Kiet Tang, Vanessa Lok, Ali Khalid
Commissioner: Jeremy Lefroy
Antimicrobial resistance (AMR) is a global threat. Pharmaceutical companies are reluctant to invest in the development of new antimicrobials as they do not offer the same reward as other more profitable drug categories. New incentives are therefore required; these can be split into either push or pull mechanisms. Current incentives have focused on push mechanisms, but these have several limitations for antimicrobial drug development for which high sales volume is not the end goal. Less focus has been on pull mechanisms, which have greater potential for promoting drug development with low sales volume. In this study, we aimed to identify and propose a feasible incentive package focused on pull mechanisms alone or in combination with push mechanisms to encourage the pharmaceutical industry to invest in antimicrobials in a sustainable manner.
We performed a systematic review, searching Embase, MEDLINE, Web of Science, and Global Health from Jan 1, 2009, to Aug 10, 2019. We used both MeSH terms and keywords relevant to pull incentives and AMR. Only papers published in English were selected. De-duplication was done using RefWorks. All abstracts were screened by at least two independent reviewers in a blinded fashion using Rayyan. Conflicts and uncertainty were resolved by a third independent reviewer. Relevant abstracts were taken forward for full-paper screening. These papers were reviewed and data were extracted. The quality of included papers will be assessed and a narrative synthesis will be carried out to identify pull incentives evaluated in the literature.
We identified 779 papers of which 34 underwent full-paper screening with data extraction to determine the quality and relevance of these papers. Our preliminary results show that the literature has identified several viable pull mechanisms, including tradable exclusivity vouchers and de-linking sales volume to revenue. Data extraction is currently being finalised to complete synthesis of the final findings to facilitate the development of the policy recommendations.
We will report final details of the data extraction at the Polygeia Conference 2019. We hope this systematic review will provide the basis for policy makers and stakeholders to incentivise pharmaceutical companies to develop antimicrobials.
Session 3: Health Literacy & Technology
Great Hall, 12.30
1. A systematic review of the effectiveness of content and delivery of health literacy programs in native language curricula for non-native language speakers
Team: Yvonne Wasii Musa, Alba Le Cardinal, Laure Mourgue d'Algue
Commissioner: Dr. Ines Campos-Matos
As the number of international migrants continues to increase, the necessity to integrate
these populations becomes a challenge that must be answered promptly. In the health
sector, inability to do so compounds poor health outcomes to these non-native language
speaker groups. Investments and interventions to integrate health literacy into language
curricula have been developed as a solution to improving migrant health. This review aims to assess the most effective content and delivery methods of different health literacy programs embedded in language curricula for non-native language speakers.
Searches were conducted in September 2019 in nine databases including Cinnahl, Cochrane, Embase, ERIC, Medline, PsycINFO, Pubmed, Scorpus and web of science using the search terms, ‘health literacy’ and ‘curricul*’. All articles ever published on the subject were included if they were: peer reviewed, written in English, described a health literacy intervention embedded in a native language curriculum, described the intervention implementation and evaluation in non-native language speakers who are >18 years old.
16 articles were included, all originating from native English-speaking countries. Content delivered in the curricula varied from theme based, to disease specific, to comprehensive/non-specific content. Some studies highlighted different outcomes depending on the level of language fluency. Content was delivered using a combination of teaching methods in all the studies with resulting improvement in outcomes
Few studies assess the effectiveness of different health literacy content and their delivery
methods. Grounding the curriculum in a combination of adult learning methods rather than a
single one guarantees effectiveness of delivery. The use of disease specific content as
opposed to comprehensive content has not been shown to have superior outcomes. In
addition, self-standing lessons rather than prolonged courses are more effective. Simple
theme-based content that communicates practical information is more efficient than an
in-depth scientific approach to health literacy. Furthermore, curricula content that can flexibly
tailor to the needs and culture of its students is also more effective.
2. A Systematic Review Of The Effectiveness Of M-Health Interventions In The Prevention Of Cervical Countries In High- Income Countries
Team: Rahaf Abu Koura, Alay Rangel, Davina Nylander, Honey Ajisefini, Queena Luu
In 2018, an estimated 570,000 women were diagnosed with cervical cancer globally, ranking it fourth on the list of most frequent cancers in women. In 2015, 12-30 out of 100,000 women were affected by cervical cancer in Europe. The use of a comprehensive approach to cervical cancer prevention and control throughout the life course will help reduce the burden of the disease. Studies have shown that digital health and technology can play an important part in strengthening the prevention, control and management of cervical cancer. Through creating change in behaviour mediators such as knowledge, attitudes and beliefs, mHealth interventions can affect health-related behaviour and outcomes. The systematic review will identify and critically appraise studies to assess the effects of mHealth interventions in increasing awareness of cervical cancer and prevention of cervical cancer (including both vaccination and screening rates) in high income countries.
We searched for studies in PubMed/Medline, Embase, CINAHL Plus and Web of Science.
We excluded the following studies design: pilot studies, expert opinion, descriptive case studies, case series and technical reports and reviews. Studies carried out in low-to-middle income countries and those that included only males were also excluded. Randomised control trials, quasi-experimental studies and non-randomised control trials were used to assess how mHealth interventions can improve cervical cancer screening outcome.
Data collection and analysis: All five authors were involved in the screening then in the critical appraisal and data extraction of the identified eligible studies using a data extraction tool adapted from the Cochrane Intervention Review for Randomised Control Trials Data Extraction Form, EPOC Critical Appraisal Criteria and EPHPP Quality Assessment Tool. Data extracted included, study design, characteristics of study populations, interventions, controls and study results. In addition, the risk of bias of included studies was assessed independently by two reviewers.
We found 5850 studies in different electronic databases, 4165 studies were included after removing duplicated studies. All were screened and among them, 95 studies were fully assessed for eligibility criteria and then, 90 were excluded with reasons and 6 studies were included in meta- analysis. Currently, the meta-analysis and data interpretation is ongoing and will finalised by the end of this month.
Session 4: Environment & Development
Room 1, 12.30
1. A Guide to Microplastics: Risks and Alternatives
Team: Hampton Gray Gaddy, Anmol Arora, Eleanor Harris
Commissioner: Friends of the Earth UK
Microplastics are pieces of plastic less than 5 millimetres in diameter. They can be intentionally produced that small (e.g. as exfoliants for cosmetic products) or be produced from the fragmentation of larger plastics (e.g. the washing of synthetic clothes and the weathering of plastic litter). Microplastic pollution has become ubiquitous in both human and natural environments. It has been found in ecosystems quite remote from human activity, and human populations are subject to a daily dose of microplastics in their air and water. Understandable concern about the potential human health impacts of microplastics has arisen, fuelled by a flurry of popular interest in the last few months. Google Trends indicates that global interest in microplastics in October 2019 is roughly 2x greater than that in the first half of 2019 and 9x that in 2016. A WHO report released this August tentatively states that microplastics pose ‘a low concern for human health’ under the narrow conditions they studied. However, there remain significant gaps in both the scientific and the public understandings of microplastic pollution. This paper serves as a research-based but policy-oriented introduction to the issue of microplastics. The key questions addressed are how they enter the environment, how they may affect human health, how they may affect other parts of the environment, what economic effects their potential harms may have, what major research questions about them remain to be addressed, how their potential harms can be reduced, and what the current policies regarding them are. We hope that this guide will allay likely unwarranted fears regarding microplastics, spur more research into microplastics, and raise awareness about what could be a significant global health and environmental challenge.
2. How does a transition to low carbon development address poverty alleviation in Global South cities?
Team: Uzor KJ, Gowens E, Marková L, Tee S, Tan YJ, Ali S
Commissioner: C40 Cities Climate Leadership Group
Countries in the global south face many challenges. Apart from extreme poverty, there is evidence that climate change will exert most of its deleterious effects in developing countries due to their limited adaptation and mitigation capabilities. Rapid population growth, rural to urban migration, infrastructural deficits, poor urban planning and high rate of unemployment has increased the number of urban poor. As these challenges evolve, development experts are looking into innovative ways of solving the problems. One of such solutions is the role of low carbon development in the reduction of environmental pollution and wealth creation.
We found that the use of biogas in India presents a tool to provide sustainable energy for poor families while reducing the impact of environmental degradation by channelling biological wastes to energy generation. It also reduces the time spent by women to look for alternative energy sources like firewood, thereby encouraging more female education and workforce participation—activities that are directly linked to economic productivity. In Senegal, private investors are collaborating with the government and multilateral development institutions to scale-up investments in wind farms and solar panels. This will increase electrification in Senegal, especially in rural areas, where access to electricity is limited. In addition to increasing access to electricity, spurring economic growth and job creation, these projects will reduce Senegal’s reliance on fossil fuels. Bicycle schemes in Chennai, Bogota, and Lima were shown to reduce environmental pollution from car emissions and improve the health status of participants by encouraging exercise. Also, they encourage a more equal and inclusive society.
This research provided evidence that low carbon development not only reduces carbon emissions but also provides pathways to improve the lives of poor populations. Low carbon initiatives like biogas development, wind farms, solar panels, and bicycle schemes provide sustainable and green energy for communities; reduces environmental pollution; and improves the health and economic productivity of the citizens. These links between good health, economic productivity, and development have been widely recognised and form the basis for sustainable development goals.
Session 5: Sustainable Development
Room 2, 12.30
1. Exploring the synergies between climate and biodiversity action plans within cities
Team: Rebekah Hinton, Julia Wiener, Lisa Kong, Michelle Parker, Iona Pickett, Pei Lynn Tan
Commissioner: C40 Climate Cities
Cities across the world are preparing for and reacting to the effects of climate change on their ecosystems, including their human populations, by creating and implementing climate change action plans and, to a lesser extent, biodiversity action plans. In order to truly generate a sustainable cities with effective climate and biodiversity policies, potential synergies must be explored to generate action plans which have beneficial impacts on both climate and biodiversity.
This report investigates some of the key themes of city policies in which synergies between climate and biodiversity action plans can be identified and implemented. We investigate the role of urban planning, urban greening, urban agriculture, water management, waste management and air quality control on the biodiversity and climate policies of cities. We furthermore expand on some of the key cross-overs of these areas with social issues such as food security and nutrition, migration and relocation and public health. Using case studies from a range of cities around the world, alongside policy suggestions, we aim to highlight the importance of climate and biodiversity in generating sustainable, future cities.
2. Intersectoral collaboration and the Sustainable Development Goals
Team: Tim Lindsay, Isabella Weber, Lara Vecchi, Akhila Jayaram
Commissioner: Neil Squires (Public Health England)
The Sustainable Development Goals (SDGs) comprise an expansive and ambitious agenda across 17 themes and 169 targets. The SDGs explicitly emphasise that the individual themes and targets are fundamentally intertwined and cannot be achieved without a cohesiveness of planning and attention between them. We, therefore, propose that intersectional collaboration is essential to achieving the SDGs. However, what such collaboration looks like at this level is less clear.
Some policymakers have celebrated the interconnectedness of the SDGs as a leap towards creating coherence across themes that require mutual support and have shared goals. Others, however, have noted that some of the goals come into conflict with one another when specific regional and local issues collide. A requirement for intersectional collaboration is, therefore, simultaneously self-evidently necessary and a challenge.
We identify three examples of previous intersectoral collaboration to address a variety of issues – tobacco use in Austria, diabetes, and HIV. We evaluate the approaches taken to combat these health issues such as the FCTC and MPOWER framework and draw parallels with the SDGs. In doing so, we highlight methods of intersectoral collaboration that could be adopted to address the SDGs.
We identify past examples of successful intersectoral collaboration to provide a model for the utilisation of intersectoral collaboration in the future. Those working on the SDGs should not see intersectoral collaboration as applicable to only one type of goal or target, but rather as a framework that can be adapted and adjusted to suit the desired outcome. The complexity and interconnectedness of the SDGs demand an integrated and indivisible approach. In this respect, intersectoral collaboration could be the key to success.