Title: Inequalities in cumulative exposure to air pollution in the home and workplace, and their health impacts: exploring socio-economic and ethnic differences over the lifecourse.

Researchers: Gemma Catney and Fran Darlington-Pollock

Summary: This project adopts an environmental injustice perspective to explore exposure to air pollution and its health impacts. The research will consider why people (and in which areas) are most at risk from exposure to harmful air pollutants. In particular, the project aims to understand better the relationship between deprivation and ethnicity, and exposure. The project is innovative in taking a holistic approach to exposure, focusing not just on where people live, but on their commuting experience (workplace location, distance travelled, transport mode), and how these elements may add cumulatively to exposure (and ultimately health) risks. The role of selective sorting (geographic mobility) into and out of high risk areas across the lifecourse offers additional novelty. The result will be a comprehensive UK-wide understanding of the multiplication of risk of air pollution exposure across the lifecourse, and the inequalities in this accumulation.

Funding Awarded: £3,950

 

Title: Investigation of interplay of area deprivation, internal migration and mental health.

Researchers: Dawn Everington

Summary: There is an abundance of research showing a link between individual health and deprivation of the area. However, there is ongoing debate concerning cause and effect or a more complicated scenario where one effects the other eg poorer health could cause a movement of people to areas of higher deprivation (eg due to loss of income or to be near to treatment centres) which reduces the measured health rate of that area or there may be a direct effect of living in more deprived areas resulting in poorer health. Providing evidence of this pathway is of fundamental importance, as policy makers need evidence of whether to direct resources to people already experiencing ill health and/or to improve areas of high deprivation to reduce the burden of disease.

This project seeks to use longitudinal data from the Scottish Longitudinal Study (SLS) and Northern Ireland Longitudinal Study (NILS) to study the complex interplay of area deprivation, migration and mental health using detailed geographical location histories with associated area deprivation measures, Census variables that are associated with migration and health, and NHS data on hospital admissions and prescriptions.

Mental health conditions have been selected as poor mental health can severely impact lifestyle including physical health and employment with usually a long survival time for follow up.

Funding Awarded: £XX

 

Title: Chronic physical health conditions and mortality among people with severe mental illness in Northern Ireland and Scotland: a longitudinal administrative data study.

Researchers: Finola Ferry, Janine Cooper, Emma Curran, Gerry Leavey, Michael Rosato and Karen Cafferky

Summary: Evidence suggests that individuals with severe mental illness (SMI) die up to twenty years younger than the general population (Saha et al., 2017), with this excess mortality largely accounted for by causes due to life-limiting physical health conditions (Corell et al., 2017; Osborn et al., 2007). The elevated prevalence of life limiting conditions and associated mortality among people with SMI, such as respiratory disease, cardiovascular disease and cancer has received growing attention. There are numerous potential factors that contribute to adverse physical health outcomes among those with SMI, however there is increasing evidence suggesting disparities in healthcare provision (Lawrence and Kisely., 2010).

The National Institute of Clinical Excellence (NICE, 2014) emphasises the importance of a holistic approach to the management of severe mental illness to ensure that those living with these conditions have equitable access to diagnosis and treatment of physical comorbidities. The proposed study will inform the evidence base and development of policy in this area, providing an examination of SMI, multi-morbidity and mortality in Northern Ireland and Scotland. Using linked prescription, census and mortality data in both jurisdictions, this study will specifically:

• Examine patterns of physical comorbidity and multi-morbidity in people with severe mental illness.
• Examine the association between all-cause and cause-specific mortality in people with severe mental illness, accounting for physical comorbidity/multimorbidity and socio-demographic characteristics.
• Assess the comparability of administrative data in Northern Ireland and Scotland to inform the feasibility of a future comparative study and development of an ESRC grant application.

Funding Awarded: £5,000

 

Title: Looked-after children grown up: A scoping study of the Scottish and Northern Ireland Longitudinal Census data.

Researchers: Rebecca Lacey

Summary: The adverse life-long consequences of being looked after as a child are well recognised, although evidence on outcomes beyond the early adult years is currently very limited. An ongoing study is beginning to fill that gap using data from the Office of National Statistics Longitudinal Study (ONS-LS).

The aim of this scoping study is to examine whether we can extend the project to research the mental and physical health and well-being of looked-after children in more detail. Unlike the ONS-LS, the Scottish (SLS) and Northern Ireland (NILS) Longitudinal Studies’ data are linked to health, education and social data, potentially enabling a much more nuanced understanding of the experiences of young people who were in the care of their local authority as children. Using routine data such as these is complicated and necessitates large amounts of preparatory work before a larger research proposal can be fully developed.

This funding will make it possible to complete this work, establishing the feasibility and extent of the research as well as establishing good practice for analysing data in remote secure settings. Specifically, in this small grant we will:

• identify in each census year, children who were living in residential care, as a biological or adopted child in a parental household, as a child in a relative household, or as an unrelated member of an individual household;
• estimate statistical power for future analyses;
• assess data quality issues;
• investigate feasibility of linkage to other administrative data such as social care records.

Funding Awarded: £4400

 

Title: Trajectories to Poor Health: Exploring Socio-Spatial Sorting Across the Lifecourse in Scotland and Northern Ireland.

Researchers: Frances Darlington-Pollock, Mark Green and Paul Norman

Summary: Health, from a lifecourse perspective, is the cumulation and interaction of our exposure to healthy assets and hazards as we age. Our health, and ultimately our mortality, is therefore understood as the product of different experiences and exposures aggregated over time. At the micro-level, these assets and hazards manifest as social determinants of health through our place of birth, where we go to school, work, or play, and who constitute our social networks. Sustained advantage is associated with the best health while the accumulation of disadvantage over the lifecourse is detrimental, with compelling evidence pointing to critical periods during childhood. It is unclear whether particular lifecourse trajectories relating to differing socioeconomic circumstances culminate in particular health risks, nor whether these risks may be moderated by earlier sociodemographic states.

In the UK, key policy areas such as education, housing, labour market, and health and social care are at the discretion of devolved bodies. The context within which individual socio-spatial trajectories are shaped differs by the political and policy context, and may therefore lead to different health outcomes. For example, whilst successive generations in the UK have experienced increased longevity, the last few years have seen a falling and decline in life expectancy gains within a politically uncertain climate. Context, at the micro- and macro-level, is evidently important.

Social mobility features regularly in political and media debates and, whilst area deprivation is perennial in health inequalities debates, change relating to areas is invariably missing. It is likely that the myriad trajectories individuals experience through various socio-spatial sorting process, potentially moderated by contrasting socioeconomic and political contexts, are then pertinent to current health. This research will advance existing research into the complex relationship between migration/residential mobility, deprivation and health, extending debates to capture wider socio-spatial sorting processes. It will consider both general health and specific morbidities, particularly mental health, captured in the expanded health-related questions for the 2011 Census in Scotland and Northern Ireland.   Funding Awarded: £2,160

 

Title: A Regional Analysis of Religion and Labour Market Outcomes in the UK.

Researchers: Neil Rowland

Summary: This project seeks to analyse the relationship between religion and labour market outcomes in three UK regions – Northern Ireland, England/Wales, and Scotland. This will be achieved using data from each of the UK LSs.

In the UK, employment inequalities according to race, ethnicity and religion are an important feature of the labour market. In Northern Ireland, inequalities according to religious affiliation – specifically Catholic versus Protestant – have historically been more prominent. Yet while employment inequalities according to religion have been largely eroded in Northern Ireland, inequalities according to race, ethnicity and religion remain persistent in the rest of the UK (for instance, see Khattab et al., 2015) and thus remain a matter of policymaking concern.

One objective of this project is to use each UK LS to learn more about how Catholic/Protestant unemployment differentials were reduced in Northern Ireland. It will do so by investigating whether Catholic/Protestant differentials exist in each regional labour market and whether they have changed through time. This will help to shed light on whether Catholic unemployment was higher in Northern Ireland because of Catholic-specific behaviours (i.e., economic behaviour common to Catholics regardless of where they live) or because of Northern Ireland’s unique economic, social and political environment that has been argued to have been hostile to Catholics at various times (i.e., discrimination that was specific to Northern Ireland). Because the causes of the religious differential – and specifically the exact role of discrimination – are still not fully understood, this research has the potential to shed new light on this important economic question. Understanding how this inequality has changed, and in particular how discrimination has contributed, is relevant for understanding the dynamics of contemporary inequalities according to race, ethnicity and religion in the rest of the UK. This is because in Northern Ireland being Catholic or Protestant is not just a religious marker but an ethnic marker as well, albeit a less visible ethnic marker than in the wider UK context. In turn, this understanding may pave the way for a more effective framework for bringing about a reduction in these related inequalities.

The analysis will investigate whether Catholics and Protestants experience different rates of labour market success in each UK region, focusing on unemployment at this stage, using data for Census years 1991, 2001 and 2011. The rationale is that each context represents (or has represented) a distinctly different labour market environment for each religious group. Many have argued that Catholics faced various forms of discrimination in Northern Ireland, and that many of these had some degree of institutional support (e.g., support from the pre-1972 Stormont government). In Scotland, meanwhile, although allegations of anti-Catholic discrimination have been made, these were not backed up by a comparable system of `ethnocratic’ government, nor was there much reliable evidence that anti-Catholic attitudes translated into widespread labour market discrimination (Paterson and Iannelli, 2006). By stark contrast, England/Wales has not experienced any significant level of anti-Catholic discrimination in the labour market. One might therefore expect Catholics to face larger employment penalties in Northern Ireland compared with Scotland and in Scotland compared with England/Wales. The analysis proposed here will test whether this is the case.

It is anticipated that a future project would consider additional labour market outcomes such as occupational status, social class and educational attainment, thus contributing to wider debates about social mobility and whether the role of ascriptive characteristics – in this case, religion or religious background – has changed for different cohorts.

Funding Awarded: £4,800

 

Title: Internal Migration and Mortality in the United Kingdom.

Researchers: Michael J. Thomas

Summary: Geographical inequalities in mortality rates in the UK have been on the rise since the 1980s. While this pattern mirrors a broader rise in social and spatial inequalities in the UK, processes of selective migration are also thought to be associated with the uneven geography of morality risks. The proposed research utilise data from all three UK Longitudinal Studies (for the period 2001 to 2011) and link birth and death registers to provide the most geographically comprehensive and up-to-date analysis of the role of migration in regional inequalities in mortality. First, a descriptive picture of spatial variations in the role of migration across the UK will be drawn from an aggregate analysis comparing observed age-standardised mortality rates (period 2011-16) with hypothetical mortality rates based on zero inter-district migration during the period 2001-2011. A subsequent micro analysis will employ cross-classified multilevel models in order to simultaneously estimate the net effects of individual and place variations in mortality risks among the group of migrants. Estimates of residual place effects at both the origin and destination will be used to identify locations with unusually high/low mortality risks, having accounted for socio-demographic composition. The proposed research speaks to the RCUK/ESRC national priority area of ’Innovation in health and social care’, where work sensitive to issues of location are strongly desired.

Funding Awarded: £XX

 

Title: Developing the potential of the NILS and SLS for studying peer effects in health: A case study of fertility amongst neighbours and co-workers.

Researchers: Meng Le Zhang

Summary: Neighbours, work colleagues, and school classmates can all potentially have an influence on our behaviour. For instance, poor health behaviours amongst neighbours and colleagues may normalise and reinforce our own poor health behaviours. This is one example of a peer effect. Imitative behaviour can cause small initial changes in individual behaviour to spread amongst their social networks and result in a ’social multiplier’ effect. Understanding the size and mechanisms behind the ’social multiplier’ effect allows for more effective health interventions. It also helps us understand why persistent health inequalities exist across different neighbourhoods and social groups.

The NILS and SLS study are longitudinal studies with 28% and 5% census samples respectively. The high abnormally high sampling rate means that a proportion of both LS samples will be neighbours living in the same postcode, employees in the same workplace, or children in the same classroom. This presents an opportunity to test the existence of peer effects from neighbours, colleagues and classmates. Both LS have great potential for studying peer effects

Using instrumental variables and analysis of close neighbours, we will test the causal effect of women’s fertility on the fertility of their neighbours and work colleagues. The unique nature of Northern Ireland also allows us to test the degree to which peer interactions are mediated by religion in NILS compared to the SLS.

Funding Awarded: £4,810