Jonny Currie has been working with DECIPHer since August 2012, as part of an Academic Foundation Programme. He has worked on a project aiming to do quantitative analysis of trends in health-related risk behaviour in young people, and another looking at school health promotion and relationships between adolescent health and educational attainment.
The Academic Foundation Programme (AFP) was developed, Currie tells me, to develop the research skills of junior trainees and encourage them to take up roles straddling medicine and academia. Currie speaks highly both of the “tailor-built” training in research skills and “the more soft and subtle things” gained from the programme, such as “having the time both to do funding applications, go and interview people, all these things I’d never be able to do if I were full-time in a hospital. And having time to figure out what my agenda is, pull together the skills, find people to work with, and get the confidence to work towards that agenda, is incredibly valuable too”.
In working this out, Currie calls on another of these “soft and subtle things”, the knowledge and understanding picked up through research experience. This includes not only the job-application-friendly “transferable” and “leadership skills”, but also “the negotiation of this whole new world of academia – learning what it’s like to wait months and months to get hold of data, how you deal with that, how you can make stuff happen”.
An important part of working as a researcher is learning to navigate the daunting “new world” of academia.
Consumed with enthusiasm
Currie describes first looking at the DECIPHer website and being “consumed with enthusiasm – I know it’s cringe-making to say that, but it’s genuinely how I felt”. He remembers seeing it and thinking “That’s it, that’s where I want to work!” This enthusiasm has persisted; Currie is full of praise for the Centre’s focus on health inequalities, “the most important thing in public health, without a doubt”.
Currie traces this interest in health inequalities back to secondary school, which was “good at planting those sorts of views, without us really knowing it was happening”. He also describes an “abysmal, anarchic” post-secondary school gap year project in India, during which he started seeing things “not about luck and absence of luck, but about maintaining the status quo for people that have a motive for doing so”. Having failed to find a forum for this thinking at medical school, he became involved with the global health organisation Medsin, for whom he has since worked for a year and is now a trustee.
Currie is enthusiastic, too, about DECIPHer’s multidisciplinary, cross-sector, mixed-methods approach to research:
“It just all seems to make sense. You need a rich view from the general public to guide your research. And the whole quantitative – qualitative battle is ridiculous, you miss out on so much important research if you’re wedded to one or the other.”
I can see his point, especially when he relates it to health research:
“If you’re looking at health as a social phenomenon, looking at what it is, who defines it, should it be equally distributed, the only way of addressing those sorts of questions is by using social science. You couldn’t run an RCT to argue for the redistribution of wealth, it has to be a conversation.”
One thing I learn early on in the interview is that Currie is very much in favour of multi-everything. As well as his belief that the quant/qual divide is “hilarious and ridiculous”, Currie believes research has to be “all about synergy”, and that collaboration between medicine and academia is leading the way – but that the rest of medicine has some catching up to do:
“Medical training – any training – needs to recognise that there’s a wealth of different interests and skills that a body of people have, and that allowing some of those people the resources to use those skills to the betterment of their own practice shouldn’t be limited to academia and research. It could be sports medicine, music therapy – the medical profession needs to get better at acknowledging gaps in the system and using the skills of those in the system to address those gaps.”
Currie also believes the silos and divisions that define medical school should be abandoned in favour of “health schools, with the health and social care professionals and scientists and social scientists all together in one giant building”.
That’s another thing I learn pretty quickly – he thinks big. Giant “health schools”, utopian views of the future of public health where hospitals are no longer needed, and a radical shift of the medical profession away from the “antiquated, narrow” views still prevalent, towards an evidence-based and socio-ecological system. He talks of the frustration of having to pare down his initial idealistic research plans: “The person assessing the bid just kept saying, “You’ve got to constrain – it’s just – too big! Too big!” and I’m always going “Why too big?” Everyone’s too realistic!””
Currie’s next research plans certainly still seem pretty big. Although he will be heading to Liverpool to do two years of hospital medicine when the DECIPHer placement finishes, Currie recently won funding to carry out research into how doctors understand health inequalities, and what training needs to be given to “skill up” hospital doctors to address these more effectively.
Currie knows that achieving change will be no mean feat. He believes that an understanding of health as a social phenomenon – necessary in addressing health inequalities – doesn’t chime well with the ways of thinking common in medical professionals:
“I think a lot of doctors get stuck with a very individualistic view of the world. Medics are trained to think biologically, and sometimes in very black and white terms: it’s either genes or environment, and environment is choice. I think that makes them quite pessimistic, because if you look around, you see all these examples of what look like terrible health choices. But it’s just not that simple, it’s much messier and more complicated.”
Changing the way medical professionals think, then, seems central. But doing this – whether related to health inequalities or evidence-based medicine, another place Currie believes a major shift is needed – is no simple task. Currie is dismissive of the idea that changes to medical training alone can effect change. “Behaviour change as a method for improving whole systems does not work. We’ve seen it again and again in our attempts to teach people not to do lots of things that are really quite a bad idea – it’s a completely hapless approach.”
Currie is unequivocal about one thing, though – however we achieve, it, a shift is needed.
“A lot of health professionals are afraid of being political, and I think the changes we’re seeing in the NHS and in public health could be testament to the medical profession being too slow to respond. People say “the healthcare service isn’t political, we don’t like being political” but the health service, of all public sector bodies, is the most political organisation you could ever come across. We need healthcare professionals to realise that it’s OK to be political, it’s OK to be outspoken – and that doesn’t just include your hospital, the things that impact your life on a daily basis, but engaging with the wider issues.”
“We need healthcare professionals to realise that it’s OK to be political”
However, Currie admits that the responsibility doesn’t lie entirely with medical professionals. The “messiness” of health inequalities themselves presents another barrier to Currie’s vision:
“Even if every healthcare professional was 100% engaged and ready to follow some grand plan to address inequalities, at the moment no one’s quite got their head round the best way to do this in practice. Should doctors just quietly acknowledge that social problems lead people to end up in hospital, but concentrate on dealing with the end result and hope that someone else – social services, the government – will deal with the rest? Or should they point out that they’re seeing this all the time but can only do something about it at a late stage, and that it needs to be dealt with upstream?”
Some knotty questions, certainly, which should make for fascinating research. Currie, luckily, seems optimistic at the prospect of getting stuck into these big questions, rather than fazed by their enormity. A large part of this is his feeling that change is already happening. Although scathing of “imperialistic” gap-year tourism, Currie believes that campaigning organisations such as Medsin and a growth in global health programmes at university have contributed to a “huge groundswell of these people who think about health differently”, who can effect real change:
“I think they’re quite an influential body, and it’s them who are changing medicine for the better. When they’ve seen that they can influence not only their level but higher up, they seem to get much more confident in their ability to affect things, more strategic. And that’s how they should feel, that’s the question they should be asking: “I’ve got a vision of how I want the world to be, and the world’s currently like this, how can I connect the two?” And that’s not just about convincing these students they can be the health minister, or the president of the BMA. It’s about getting them to realise how they can engage and how they can change things from where they are.”