We are delighted to announce Naomi Miall as one of our Data Impact Fellows for 2023. In this post Naomi shares a bit about her background, her current work and research and what she hopes to get out of the Fellows scheme.
About me and my background
I am a research assistant in the MRC/CSO Social and Public Health Sciences Unit (SPHSU) in the University of Glasgow. This is an interdisciplinary research group that brings together researchers in public health, sociology, economics, among others, to work on the social determinants of health.
Before joining the SPHSU two years ago, I studied a MSc in Epidemiology at the London School of Hygiene and Tropical Medicine. Starting the course in 2020 made it quite an unusual year to be studying epidemiology, and a substantial part of my research so far has ended up focusing on how the pandemic impacted health inequalities. For example, my MSc thesis was exploring how working from home or losing employment during the pandemic was associated with intimate partner violence in a large global survey, and at Glasgow I have researched the impact of the pandemic on child mental health inequalities, and on relationship quality and sexual behaviour.
About my research
The research I work on primarily focuses on inequalities in child health. Inequalities in these early years of life are especially concerning because health at this age can determine the child’s future life chances, including their development and education.
The first project I worked on at Glasgow was looking at how inequalities in child mental health changed during the COVID-19 pandemic. There has been a concerning increase in child referrals to mental health services in recent years, which was exacerbated by the pandemic. We modelled the trend in child mental health inequalities among 5- and 8-year-olds prior to the pandemic, and then looked at how they changed in the pandemic. We were able to do this using data from the UK Household Longitudinal Study (Understanding Society).
Contrary to expectations, we found that traditionally more advantaged children generally experienced more rapid declines in mental health than their more disadvantaged peers. We have called this a ‘levelling down’ effect because inequalities narrowed, however the average level of child mental health declined. We saw this pattern for inequalities related to household income, parent education, employment, and lone parenting. We also found that white children had worse mental health than children from other ethnicities before the pandemic, and this inequality widened during the pandemic. If you are interested to read more about these results, this blog goes into greater detail, and the preprint is available here.
Since joining Glasgow, the largest project I have been part of has been a policy facing report, funded by the Health Foundation, describing trends in health inequalities in Scotland over the last 20 years. This was a very broad report, covering all parts of the life-course (not just childhood), and encompassing inequalities in the timing and cause of deaths, morbidity, health behaviours and health service uptake. We started with a large scoping exercise to see what data was available to monitor health inequalities in Scotland. We drew heavily on administrative data sources such as hospital records, and the Scottish Health Survey, but also more specific datasets like the Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) which focuses on adolescent health. At the start of the project we also contacted experts and stakeholders representing local and national policy making, the NHS, health advocacy groups and academics, who were incredibly helpful in shaping the content of the report and the way we decided to present the data.
One of our key findings were that inequalities in many outcomes were actually reducing in Scotland between 2000 and 2012, but since then we have seen stalling progress or even a reversal of improvements across a whole host of conditions. This trend has also been seen in England, and other research suggests that the austerity programme was an important contributor to the stalling progress. Another important finding was that, whilst health worsens along a gradient of increasing deprivation, those living in the most deprived fifth of areas are faring particularly poorly. For example, the rates of drug deaths in the most deprived fifth of areas are more than double the rates in the next most deprived fifth. The full report can be found here, alongside a link to a podcast recording about the results, and to posters which summarise some of our key findings.
More recently I have been researching inequalities in childhood obesity in Scotland, in collaboration with Obesity Action Scotland. I have been drawing on birth cohort data from the Growing Up in Scotland study to investigate how socio-economic circumstances experienced in the early years are associated with obesity in adolescence, and with longitudinal patterns of BMI between ages 4 and 14. One of the most striking findings of this work has been that children who experience food insecurity when they are toddlers are four times more likely to be living with obesity at both ages 4 and 14. In the face of the cost-of-living crisis, there is an urgent need for action to address child poverty to avoid storing up future health problems for a generation.
My future plans
I learnt a lot about data impact and engagement from collaborating with stakeholders and evidence users whilst writing the report about trends in health inequalities. I am excited to apply this to other research projects with the support of the Data Impact Fellowship. For example, I am currently working with a website developer to build an interactive website about health inequalities in Scotland, so am excited to explore this platform as a way to make research results more accessible to policy-makers. We have also started a project that integrates qualitative data on how the public perceive and experience health inequalities with quantitative data on the trends in health inequalities in Scotland, in order to deepen our understanding of the report’s results.
In the longer term, I hope to explore further how different experiences of disadvantage intersect and accumulate over time, what impact this has on health, and how policy design and implementation can account for this complexity.