Category Archives: Health Policy

Paper submitted to ECAL 17

Just submitted a new paper to ECAL 17, the European Conference on Artificial Life.  I wrote this together with Richard Shaw, Mark McCann and Laurence Moore in the MRC/CSO Social and Public Health Sciences Unit at the University of Glasgow.

The goal here is to get some of the Alife community interested in some key problems in population health to which we think Alife can make a strong contribution.  The paper describes the current state of computational modelling in population health, the reasons behind the growing popularity of ABMs/complex-systems-based approaches, and describes in detail some specific key problems where complex social and environmental determinants play important roles.

And before anyone asks, yes we’re already working on stuff like this, we just want more people joining the fun!

A little preview snapshot below:

ecal17cap

In other news:

Major projects: We’re still working on some significant attempts at gaining funding for longer-term projects in agent-based modelling for population health.  Watch this space.

Game development: Somewhat predictably, development on my game has been stalled since spring semester started and teaching took up all my energy and most of my research time.  I’m making an effort to read up on design principles, both for roguelikes specifically and in general, to improve the gameplay whenever I have the time to get back to it.

Music: I discovered recently that some old DJ mixes I had online for years now that I never promoted in any way actually attracted a decent number of listens and some very positive comments in my inbox, so I’ve dug my DJ kit out of the closet and am getting caught up on new DnB and hardcore releases.  I’ll put something new up on MixCloud or somewhere when I’m back in the groove.

On a side note, I’m so out of touch that I only just found out that Vestax, makers of my beloved DCI-300 DJ controller and my turntables before that, went out of business in 2015.  RIP Vestax, you made great gear that lasted forever and I loved you for that, although in retrospect maybe that’s why you had trouble keeping sales up!

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Paper submitted to Agent-Based Modelling of Urban Systems workshop

Just submitted a new paper with several colleagues from Teesside to the ABMUS 17 workshop at this year’s AAMAS conference in Brazil.  This is an overview of early-stage work on an agent-based modelling framework incorporating a 3D virtual environment.  The intention is to create an ABM that can be used as a research tool, simulating the actions and interactions of simulated agents in order to study some pressing problems in public health, and also as a learning tool that allows users to interact with the virtual world and see the health impact of changes to agent behaviour or their environment.

Here’s a little preview in the form of a screenshot of the paper itself — I’ll post the whole thing as usual if it’s accepted.

virtualenvpaper

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Looking for PhD students again

Teesside University will be recruiting another cohort of PhD students shortly, so a number of us will be looking for students interested in some ongoing research projects we’ve got going on here.  I’ll post the link to the appropriate page once it goes up, but for now here’s a sneak preview:

Agent-based computational modelling for public health

As the UK population ages and demand for health and social care services continues to rise, new solutions are needed to better manage resources and plan for a challenging and uncertain future.   This project will use agent-based computational models to unravel the complexities of health policy implementation and service delivery by modelling the multiple interacting processes underlying the health system. These models will investigate challenges in health and social care service delivery across a variety of spatial and temporal scales — from short-term studies of demands on accident and emergency services, to longer-term explorations of the pressures facing social care over the next several decades.

Contact: Dr Eric Silverman (E.Silverman@tees.ac.uk)

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Funded PhD opportunity at Teesside

Fully-funded PhD opportunity available! I’m looking for someone interested in working on agent-based modelling for healthcare applications. No fees and £20K stipend. These are four-year positions and you will be asked to contribute up to six hours per week of teaching (tutorials/demonstration only, no lectures), which is more work but also good for the CV. Click here and filter under ‘Computer Science’ to see my project.  For more about me, check out the various pages on this blog or my staff profile at Teesside.

Project description: This research will focus on the application of Agent-Based Modelling techniques to human social systems, with particular emphasis on digital health applications. In the context of public health, agent-based models can help us understand the complexities of health policy implementation and service delivery by modelling the multiple interacting processes underlying the health system. These models will investigate challenges in health and social care service delivery across a variety of spatial and temporal scales – from short-term studies of demands on accident and emergency services, to longer-term explorations of the pressures facing social care over the next several decades. Our multi-disciplinary team will work with members of the School of Health and Social Care here at Teesside, along with external collaborators and stakeholders. The project would be suitable for a graduate with a background in Computer Science, Artificial Intelligence, Statistics or Complexity Science with an interest in Public Health/Healthcare applications.

ACADEMIC FRIENDS: Please tweet/share this as widely as you can!

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York Inequality Workshop, Part II

In my last post I summarised the morning session of the York inequality workshop I attended last week.  Today I’ll cover the main event of the day, the plenary session by Kate Pickett and Danny Dorling.

Kate is well known as one of the co-authors of The Spirit Level, a book about the many and varied impacts of inequality in society that received major publicity a few years ago.  Danny Dorling has written several books on the topic, including Inequality and the 1% and Unequal Health: The Scandal of Our Times.  They delivered the talk jointly, framing it as somewhat of a contrast — with Danny offering a fairly sobering perspective on inequality, followed by Kate with a slightly more optimistic picture.

Inequality in the UK

Danny opened by showing us some graphs which showed a worrying trend.  The National Health Service here in the UK tracks a statistic on its success in reducing premature death from preventable causes — it’s referred to as statistic 1A, perhaps the single most important indicator of the health service’s performance.  The graph showed that in recent years, progress has stalled on this all-important indicator.  This has coincided with a general rise in health inequality in the UK and ever-increasing economic inequality.

In terms of the broader picture, the UK is at the bottom of the league tables in terms of equality in Europe.  Infant mortality is among the highest in Europe — our figures are closer to Europe than to Sweden.  Our income inequality is the highest in Europe, with the best-off 10% of the population taking home 28% of the country’s income.

Danny argued that research shows income inequality has a disastrous effect on everyday life and culture in highly unequal countries.  People in unequal countries tend to trust each other less, and tend to think of other people as less deserving of help.  Social classes become stratified, and culture begins to separate along economic lines.  Health inequality gets more severe as economic inequality grows — and that leads to disturbing outcomes.  For example, here in the UK two times more children die each year than in Sweden, a country with much greater equality.

Do we care enough?

By way of demonstration, Danny presented us with a number of comments from GPs on a story about the growing number of requests from patients for referrals to food banks.  In comment after comment, GPs offered comments that were shockingly unconcerned about the fact that their patients found themselves unable to put food on the table.  These patients were described as irresponsible, their problems seen as medically irrelevant or simply not the GP’s responsibility — despite the very clear and obvious link between poverty and poor health.

Danny presented these as evidence that even amongst members of our society trained specifically to look after others, the predominant view in recent years is that there are a substantial portion of people who do not deserve our help.  We are inclined to see people around us as irresponsible or lazy, rather than victims of circumstance, even despite the evidence that the vast majority of people in poverty spend enormous amounts of time and energy trying to escape it.

He argued that this predominant mindset leads to a culture in which we simply don’t care enough about the circumstances of others, and as a consequence we don’t act to prevent unnecessary death and misery in our society.  He pointed to figures showing the link between economic inequality and traffic deaths — two times more children die crossing the street than in more equal societies like France, the Netherlands or Norway.  Deaths due to suicide or drug poisoning are also far higher in the UK.  Overall we have a much higher incidence of mental illness in the UK than in Europe, second only to the US.

The political view

Danny closed by discussing how these damaging views on equality in our society are promoted and perpetuated by those in power.  Statistics show that the UK spends less on a per-capita basis for healthcare than any comparable country — in some cases drastically less (on the order of 28-40% lower than most countries in Europe, and half or less the spend of some countries like Denmark).  The fact that the NHS is able to demonstrate as many good health outcomes as it does is remarkable, given how little we spend compared to our neighbours.

When we zoom out and look at state spending in the UK as a whole, the trend continues.  The current Conservative government is presiding over a drastic shrinking of the state, to a level not seen since 1918.  Children in private education have 4.5 times more money spent on them than state schoolkids.  Once again when we compare state spending on health and welfare in the UK as a proportion of the overall budget, we are way down at the bottom of the league table.

Yet despite all this, the current government continues to paint a picture of the UK as a country where state spending is out of control.  George Osborne tells us that we’re a reckless tax-and-spend country, painting a dire picture of overspending leading to a precarious economy that could collapse at any moment (despite so many experts disagreeing with both his assessment and his predictions of the consequences of the sovereign debt).

So, Danny asks, does Osborne and the rest of the government actually believe this?  Are they so steeped in this economic view that they fail to see the myriad statistics that show the opposite?  How do they fail to see that these merciless budget cuts, so often levelled at the poor, the sick, and the disabled, push us further down the road toward deep inequality that will damage our health and further divide our society?

Kate’s response — Is it as bad as all that?

After Danny’s presentation the mood in the room was understandably severe.  He painted a picture of severe and growing inequality in the UK, and a government that appears totally uninterested in addressing it.  With our own views seeming fundamentally warped by inequality, is it even possible that we can get things back on track?

Kate started off by saying that she was going to try to offer a more optimistic picture than Danny — but that in fact everything he said was right and she didn’t disagree fundamentally with any of it.

She started off by highlighting the issue of wealth inequality, which has been a topic of much greater interest in recent years due to movements such as Occupy Wall Street.  She showed some graphs confirming the stratospheric rise in the share of wealth going to the top 1% of society in the US and UK since 1980 — a direct consequence of the policies of the Reagan/Thatcher era.  Post-1985 we’ve also seen a massive rise in pay for CEOs relative to their employees — we’re now at a point where CEOs tend to make 300-400 times what their average employee makes.  The UK historically was much less bad than the US on this measure, but in recent years has caught up.

Rising awareness of inequality

Kate said that one positive aspect of this is that most of these facts and figures are by now quite familiar to many of us — in no small part due to the efforts of Occupy Wall Street and similar movements.  She argued that wealth inequality has become part of the conversation now, after the economic crisis.  She gave several examples of how wealth inequality is now a target for major charities, including Oxfam.

She pointed to a particular campaign from Oxfam which offered the statistic that the world’s richest 85 people hold the same wealth as the poorest 3.5 billion people.  As it turns out, they got the figures wrong and had to present a correction — in fact, the richest 83 people hold the same wealth as the poorest 3.5 billion.

As it happens, Oxfam has updated those numbers just a few hours ago — and things have become even worse.  Now the top 62 wealthiest people hold the same wealth as the poorest 3.6 billion people on Earth — the bottom 50%.

As far as the UK is concerned, Kate discussed the case of the Sustainable Development Goals panel at the United Nations.  This panel, of which the Prime Minister David Cameron was a member, was tasked with producing a series of key goals for all countries leading up to the year 2030.  Kate in her capacity as equality campaigner and co-founder of The Equality Trust wrote to all the world leaders on this panel to urge them to include reducing inequality as one of the development goals.  She received a positive response from every leader on the panel (including President Barack Obama) — except for David Cameron.  He delegated his response to one of his cabinet ministers, who told her that inequality is not a policy priority in the UK.

Fortunately the other world leaders overruled Cameron’s objections, and the Sustainable Development Goals explicitly include reducing inequality (see #10).  This whole scenario very much backs up Danny Dorling’s assertions about the UK government’s views on inequality — they seem more than happy to ignore the evidence of the impact of inequality and continue their efforts to widen these gaps in society.

Can we reduce the impact of inequality and greed?

As a way of offering a more positive perspective, Kate discussed an interesting study about the behaviour of wealthy people.  She highlighted the work of Paul K Piff, a social psychologist who studies the behaviour of the wealthy.  He found that higher social class is a strong predictor of unethical behaviour — in laboratory studies wealthy people are more likely than poorer people to break the law while driving, steal valuable items from others, lie during negotiations, and so on (see the 2012 PNAS paper).  One of his studies actually, seriously involved taking candy from children — and yes, the wealthy subjects were far more likely to do it.

Follow-up studies have shown something interesting, however — when the wealthy subjects are asked to ponder some facts and statistics regarding inequality before engaging in these tests, their behaviour becomes markedly more moderated.  They become less likely to make unethical decisions once they’re asked to keep those ideas in mind.

So, in Kate’s view, this means that there’s a real, demonstrable impact from spreading the word about the problems caused by inequality, and from making these ideas part of the public debate.  The more people ponder these ideas, the more they may moderate their own behaviour — and perhaps become motivated to start their own efforts to address the problem.  She noted the recent spread of Fairness Commissions in local authorities throughout the UK, and suggested that these are a consequence of far greater numbers of people contemplating inequality and wanting to take direct action to address it locally.

Conclusions and thoughts

As is often the case with these kinds of presentations, I came away from the session feeling rather overwhelmed, exhausted and depressed — despite already knowing most of these figures.  There’s something about being shown the whole grim picture at once that makes it feel like a real gut-punch of hopelessness and despair.  All I could think was how powerless we all seem to be to stop the endless march toward inequality and division, how the entire power structure of the world seems oriented toward consolidating wealth and power at the very top of society while the rest of us are left with poverty and desperation.

In that respect I appreciated Kate’s perspective — she did offer some hope by presenting a possible future in which keeping inequality in the public conversation leads to changes in our behaviour, which eventually will be reflected in the structure of our societies.  She showed us that world leaders — well, except for David Cameron — do consider inequality a problem at least on some level, and are willing to commit to addressing it in the coming years.

However, I do feel that us academics need to do more here.  While I was comforted somewhat by what Kate had to say, I don’t think things are moving in the correct direction at all currently — as evidenced by the updated Oxfam report above.  On top of that, for every year these trends toward inequality continue, many many thousands more people across the world will die unnecessarily due to preventable causes, many of them attributable to inequality.  While it seems true that our community’s efforts to raise the profile of these issues are bearing fruit, we can’t hope to make a dent in these things by offering the occasional nugget of info every so often.  We should be taking sustained, concerted action.

That’s my view, anyway — and as anyone who knows me can testify, I’m always of the opinion that academics shouldn’t be afraid to step out of the ivory tower and cause a ruckus when we have something important to say.  In my mind, these studies of inequality are exactly that sort of thing — by pushing for action on these issues, which our community has studied a great deal, we can make a huge difference, even save many lives.  So we should follow up on this great work and keep up the pressure.

 

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NHS may charge migrants for GP services

There’s been coverage on the BBC today about a proposal to begin charging non-EU migrants for various NHS procedures.

Some of you who know me personally may remember when I ranted about the government’s decision to introduce charges for the NHS for migrants, and that this would be how the government introduces charges for NHS services across the board. That it would start with NHS fees with visa applications, then extend to GP and hospital charges for migrants, and then to the general citizenry. That the Tories couldn’t resist the opportunities presented by an NHS that suddenly and oh-so-conveniently has an infrastructure for charging for services.

Well, step 2 of that plan is already in evidence. If you didn’t believe me before, perhaps you should believe me now.

Oh, and Jeremy Hunt: I’ve been here for ten years, I’m not a ‘visitor’. I paid my own way as a PhD student and spent the years after that as a tax-payer, paying taxes for services I can’t even legally use as a migrant. I’ve even been doing research about health and social care provision in the UK.  So don’t you dare tell me I don’t ‘make a fair contribution to services’.

Do yourself a favour, people, and respond to the government consultation on Monday. Even if you don’t give a damn about people like me, us so-called non-EU ‘visitors’, and how this change would make my life in the UK unlivable and unaffordable, then at least look out for yourself by stopping this nonsense before the Tories extend it to everyone.

It’s time now to make a decision: is the NHS free at the point of delivery, or is it not?  If we want it to remain a free service, then we must stop this creeping commercialisation before there’s no turning back.

Let’s not forget too that the recent changes in April 2015 also included charges for 150% of the cost for non-emergency procedures for non-EEA visitors.  Perhaps a test run for introducing a profit motive within the NHS?

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Evidence, Policy and Regulation: The Importance of Context

I’ve just confirmed my attendance next week at an interesting seminar at Durham University:

The Importance of Context: evidence, values and assumptions in public health policy seminar:  In Stockton-on-Tees, the difference in male life expectancy at birth between the most and least deprived areas is 17 years – the highest in England.  This reflects a larger pattern in which health inequalities are increasing in parallel with the rise of economic inequality, and despite stated policy commitments to reducing them.  Review of current policies suggests that the application and interpretation of research evidence in public health policy relies on questionable assumptions about a high degree of choice and control over lifestyle, income, and quotidian living/working environment.  Rich and poor live in different ‘epidemiological worlds’, and some have far more control over those worlds than others.  Against this background, what forms of evidence, disciplinary perspectives and research methodologies are most relevant for the design of policies to reduce health inequalities?

I am writing on behalf of Linda McKie (Professor and Head of School, School of Applied Social Science, Durham University), Nancy Cartwright (Professor of Philosophy, Durham University) and myself  to invite you to an interactive workshop on 2 December, 2015 on Evidence, Values and Assumptions in Public Health Policy.  The seminar is part of the 2015-16 activity theme (‘Evidence’) of Durham’s Institute of Advance Study, and of the activities of an ESRC-supported seminar series on Revitalising the Health Equity Agenda.  Key contributors:

  • Dr. Katherine Smith (Reader, Global Public Health Unit, University of Edinburgh; author, Beyond Evidence Based Policy in Public Health: The Interplay of Ideas; winner of a 2014 Philip Leverhulme Prize for outstanding early career achievements in social policy), on the diverse journeys that characterise the movement of evidence and ideas about health inequalities into public health policy;
  • Prof. Ted Schrecker (Professor of Global Health Policy, Durham University; co-author, How Politics Makes Us Sick: Neoliberal Epidemics) on how the treatment of evidence, values and assumptions in environmental health policy sheds light on the question of how much evidence is enough to act on socioeconomic inequalities that drive health inequalities (the standard of proof question).

The seminar will be held at the Institute of Advanced Study seminar room, Palace Green, Durham on Wednesday, 2 December with coffee at 14:00; the seminar will run from 14:30 to 17:00. In order to maximise opportunities for interaction and developing an agenda for future activities, we will be distributing background materials and a discussion guide in advance of the seminar.

I’m hoping to do some work on how health inequalities emerge (using simulation, of course) so I’m excited for this seminar.  I want to make the case for simulation methodologies as a particularly useful approach for examining policies — given that they can provide insight into the individual-level impact of high-level policy decisions, and allow policy-makers to play around with possible changes in silico before actually inflicting them on the populace.

 

As usual I’ll report back with my impressions….

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