Health Variations Newsletter
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Issue 4, July 1999, pp.6-7.

Making research work: reflections of a User Fellow
Helen Roberts

Becoming a User Fellow
Barnardo's no longer runs orphanages but it works with some of the most disadvantaged children in the UK, including children whose families struggle with poverty and children who are disabled, excluded from school, in trouble with the law or who live with violence and abuse.

I was lucky enough to be one of the first Health Variations Programme's User Fellows seconded from looking after R&D for Barnardo's, to work for 6 months on the relevance of health inequalities research to policy and practice in child welfare.

The User Fellowship was linked with Chris Power's project at the Institute of Child Health. The project is tracking the pathways through which childhood disadvantage exerts an influence on adult health and dovetailed with Barnardo's concern with improving the present and future lives of disadvantaged children. While risks for poor later outcomes accumulate over time, the benefits of early intervention cannot be underestimated. Our view in Barnardo's is that investing in the early years works. It makes a difference to both young lives and to later outcomes. But in order to do this most effectively, we need evidence-based public, fiscal, social and educational policies for the early years, as well as evidence-based practice.

The 6 month period of the fellowship beginning in July 1998 was one of unprecedented activity for both health inequalities and child welfare. The publication of the Acheson report, the completion of a BMA report on child health, a new policy initiative for 0-3 year olds (Sure Start) and the announcement of Health Action Zones were all issues relevant both to the User Fellowship and to the Health Variations Programme.

What was the 6 months used for?
I used the period of the fellowship to run a series of seminars and prepare presentations and publication for a range of audiences. The work involved:

1.

  • Meetings at the School of Public Policy, University College London (UCL) bringing together 30 influential figures in child welfare and health inequalities from government, the media, child welfare NGOs (non government organisations), medicine, public policy and the research community. These meetings addressed:
  • the role of the press in developing and disseminating ideas around inequalities (Health Variations Programme contributor - George Davey Smith);
  • lay understandings of policy and practice in health inequalities (Health Variations Programme contributor - Gareth Williams);
  • targeted and universal interventions (Health Variations Programme contributor - Waqar Ahmad).

2. Presentations to a range of people drawing on the Health Variations Programme including academic colleagues (Child Policy Group ), doctors (BMA; Manchester Medical Society), nurses (RCN congress) and health promoters (HEA conference).

3. Publications referring to the programme, or research emerging from it, in a range of outlets aimed at policy makers and practitioners including New Economy and the journal of the National Early Years Network

4. A European dimension, through presentations to the first European Parliament round table on child health and a meeting of the alliance of European cities working on health.

5. A report to be added to Barnardo's What Works series in late 1999 on What Works in Reducing Inequalities in Child Health, drawing in part on work completed during the fellowship.

And finally . . .
Current imperatives from the ESRC for researchers to 'involve users' can prove an irritant to both sides - a further hoop for academics to jump through, often involving a last minute call to a 'user' organisation asking for the use of their name rather than input to an application from the start, including defining the research question. So the structured user involvement provided for in the User Fellowship was welcome.

I was exceptionally fortunate in working with academics who were flexible, committed to bringing research into service provision and generous with their time. Chris Power and I were both aware, however, of the gap (perhaps yawning chasm might be more accurate) between the objectives of scientists and the needs of those who provide services. For over-stretched academics with their own deadlines and professional commitments, working with users - unless it is structured into career trajectories, recognised by the RAE and seen as worthwhile in terms of influence - will never be more than a charitable donation of academic time.

User Fellowships are a new departure for the ESRC. What else might work in bringing user and scientific communities together?

  • Intervention trials are still uncommon outside medicine. One consequence is that some welfare interventions are based on poor ( or no) evidence. There is scope in some research programmes for interventions, including RCTs, drawing on theoretical understandings from other projects in the Programme.
  • A greater emphasis on encouraging research proposals for funding under ESRC research programmes from researchers outside the university sector, or genuinely 'joint' applications between university-based and policy-based researchers.

Meanwhile, just as interventions in health and welfare can have unintended effects, that are both positive and negative, some of the best outcomes from the programme were not the ones foreseen when I applied. Barnardo's, which is developing new work on health, now has closer links, not only with the Health Variations Programme, but with the Institute of Child Health and our links with the new School of Public Policy at University College London (UCL) have been strengthened.