Challenges in Global Health: The Complex Art of Leadership

Working in the field of global health can be challenging, as LSHTM alumni are well positioned to know. The complex nature of health ecosystems, cultural boundaries, socioeconomic context, changing landscapes and imbalanced power relationships are a few of the many daunting hurdles leaders within the global health community encounter as they strive to improve the well-being of vulnerable communities.

Experience within the context of the Ebola epidemic in West Africa in particular, emphasized the urgent demand for professionalism and integrity within the health sector. Lack of leadership – we learned during the outbreak – can have disastrous ramifications, especially in already challenging settings.

There is a call within the global sphere for strong, dynamic, competent leaders, who are skilled to navigate political and cross-institutional contexts. There is much work to do in leadership, across all levels of health systems. Global health leadership is not evenly distributed, nor is it sufficiently representative. As a recent WHO report outlines, while women comprise as much as 70% of the health workforce in many countries, they remain largely segregated into lower-status and lower-paid jobs.[1] Even more critical, the empowerment of local leadership needs to be at the top of the health agenda, ensuring context-specific effectiveness and long-term sustainable change to the health of affected populations.

Ensuring that effective and resilient leaders are recruited is the key priority. The London School of Hygiene & Tropical Medicine is committed to addressing this need through the Executive Programme for Global Health Leadership. Launched in 2017, this programme brings the ‘art’ of leadership to health. This programme helps build values and principles of leadership, while ensuring that leaders work across all sectors, through all levels of the health system, so that at the top, with their vision, leaders are able to empower and motivate individuals across the system right down to those who are delivering health at the front-line to affected populations.

The programme runs over 10-months, including three dynamic residential weeks with partner institutions, in London, Geneva and Cape Town, inter-residential activities, coaching and mentorship.  It is designed for emerging and established health leaders who can demonstrate leadership roles in their work.

We encourage you to nominate a Fellow to the Executive Programme for Global Health Leadership by sharing the news with your health leader colleagues and contacts who you think might be interested. We are committed at LSHTM to improving global health leadership. We are currently recruiting for September 2019 and would be delighted to answer any questions you might have regarding our programme – please do not hesitate to contact the Programme team at .

Here are some reflections from our former Fellows, now alumni and members of the Executive Programme Fellowship of health leaders from around the globe.

“I would not have been able to do my job, had it not been for this programme. I’ve done lots of great things; this is one of the best things I’ve ever done. I can quite honestly say it has changed my life.”
Mrs Penny Walker-Robertson, Head of the Fleming Fund for AMR, Department of Health

This experience has been an opportunity of a life-time.
Mrs Molly Guy, Head of Health Innovation and PolicyMedtronic Labs

What has been great about the course so far is the combination of the theoretical concept of leadership and how to apply them, real exposure to people with real leadership position in global health at the moment, together with an excellent group of classmates – we don’t have two people from the same country or background in our cohort. It has been a fantastic experience.
Dr Chikwe Ihekweazu, Chief Executive Officer, Nigeria Centre for Disease Control

This [residential week] has been the most important week of my life.
Dr Mya Maw, Health Adviser, DFID Burma

 

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[1] WHO, Delivered by Women, Led by Men: A Gender and Equity Analysis of the Global Health and Social Workforce, Human Resources for Health Observer – Issue No. 24.

 

Abstract submissions for the 8th African Population Conference (Kampala, 18-22 November) are now open

8th African Population Conference
Entebbe – Uganda, 18-22 November 2019

“Harnessing Africa’s Population for Sustainable Development: 25 Years after Cairo and Beyond.”

Deadline for submitting papers or abstracts: 30 June 2019

Every four years, The Union for African Population Studies (UAPS) organizes a general conference on the African population. The aim of this conference is to share and disseminate research evidence on population and development issues and explore ways for applying the research evidence to improve policies and programs aimed at uplifting the well-being of people in Africa. The conference provides an opportunity for networking and knowledge sharing among researchers, policy makers, program managers, international development partners, and other key stakeholders in the population field. The conference includes various capacity building activities targeted at young scholars.

All submission must be made online on the 8th African Population Conference Website, http://uaps2019.popconf.org/.

Posted in News | Comments Off on Abstract submissions for the 8th African Population Conference (Kampala, 18-22 November) are now open

Finding study spaces during the exam revision period

Finding Study Spaces

In the build-up to exams, the Library can become very busy. Students may wish to use alternative study spaces. There are a range of options at the School, and in the local area.

At LSHTM Keppel Street:

  • Library
  • LG24 Pop-Up Library Study Space (from 28th May to 11th June)
  • North Courtyard Library Study Space
  • eLibrary

Local Libraries:

  • Senate House Library
  • Birkbeck Library
  • SOAS Library
  • Wellcome Collection Library
  • British Library

Looking for 24/7 Library access? Birkbeck Library is open 24/7 until 16th June. You can use their Library IF you register during the day. You will need to take your student ID card and a passport sized photo.

You can find information on using and joining other libraries on our Service Desk pages: bit.ly/otherlibrary

Using the Library

If you are using the Library, please be aware of how your behaviour impacts other Library users during this busy time.

  1. The main floor of the Library (Reading Room and Barnard Room) is for quiet study only. Please use the upstairs Wellcome Gallery if you prefer conversation when studying, and to take phone calls. Ensure that you finish any conversations before entering the Reading Room.
  2. You are welcome to have drinks with lids anywhere in the Library, but if you want to eat food you need to use the upstairs Wellcome Gallery. We only allow cold snacks – hot food and meals should be eaten outside the Library.
  3. If you are taking a break of more than 30 minutes, please take your belongings with you so that other students can use the space. We have laptop and standard lockers available for borrowing. Ask for keys at the Library Enquiries Desk.

Best wishes for your exams from everyone in the Library & Archives Service Team!

 

Talk of trials, TB and surviving your PhD

Titus Divala from Malawi describes his research and shares his advice for a successful first year of PhD study

I am a medical doctor by training, having graduated from medical school in Malawi in 2009. For the past eight years, I have been in clinical practice, six of those working in clinical trials. I have a Master’s in Public Health from the University of Malawi and a Master’s in Epidemiology and Preventative Medicine from the University of Maryland.

The goal of my doctoral training at LSHTM is to strengthen my clinical trials expertise so I can become a fully independent investigator, conducting clinical trials and looking for new interventions for infectious diseases. We have a high burden of infectious diseases in Malawi, the key ones being tuberculosis (TB), malaria and HIV. I registered for my PhD in September 2017 in the Department of Infectious Disease Epidemiology. I am using systematic reviews and a randomised controlled trial (RCT) to establish whether the current practice of using antibiotic treatments as part of the diagnostic algorithms for TB has more benefits than harms. I consider my PhD as one of the global efforts towards averting the impact of TB and antimicrobial resistance (AMR), two major problems of this century.

Titus’s Top 5 Tips:

• Plan well – the goal for your first year should be to have a well-formed plan for your PhD
• Get to know your supervisors and their collaborations – they will be the people supporting you day in, day out
• Look beyond your PhD – see what other special lectures and events are happening at LSHTM, even if they are not directly related to your topic
• Get involved with the Centres – they will be a huge support system for your work
• Socialise with friends – you even get good ideas when you’re in the Pumphandle Bar!

During my first year, I have been working on my systematic reviews, which is what most students start with as a way of developing a broad understanding of the research area; and then the protocol for my RCT, which will be my main research activity. Next, I defended my planned PhD work in the upgrading process, and now I am in the process of obtaining ethical and regulatory clearance for my RCT. The RCT will take about twelve to fifteen months in Malawi, after which I will return to London to analyse the data, publish papers and write my thesis.

My first year has involved a lot of writing! But I think the key is to have a clear timeline. This can be difficult at first as you do not have a clear idea of what you need to achieve. You can have a plan, but your supervisors will keep bringing more ideas, so it’s good to put those in a proper timeline to get a clear picture of what is achievable within the time-frame of the PhD. I try to segment my time as much as possible, focusing on one particular activity at a time. It’s important to allow time for breaks to interact with other PhD students; and I also have many friends from MSc programmes as I have taken optional MSc modules in Clinical Trials and Statistical Methods in Epidemiology. These, along with the transferable skills courses, have been a very good way to build up the specific skills I need for my PhD.

LSHTM is rich in resources for students. Although you have a lot to do for your PhD, you have to get out of your shell and see what else is out there and grab those opportunities

I have had a very good relationship with my supervisors: Professors Liz Corbett and Katherine Fielding. While they give me a lot of independence in decision-making, they do pay attention to my questions, responding rapidly and giving me appropriate advice. I meet them every two weeks. Katherine is based here at LSHTM and Liz is based in Malawi. So when I am here, we sit in Katherine’s office and Liz joins meetings by phone; and when I go to Malawi for fieldwork it will be the other way round. I must say, if a relationship with supervisors is more ideal than this, I would be surprised! Learning from some of the best experts in the world on this subject has been wonderful, and I have been able to tap into their broader network of collaborations here in the UK and in Malawi. So getting to know your supervisors is very important, especially during the first few months.

Another support group you may need is your fellow PhD students. There are three other students under Liz and Katherine’s mentorship who have helped me every step of the way. As they had already been through the upgrading process, they were the first people to see drafts of my reports and presentations, and they helped me polish them.

Titus presents his prize-winning poster

Titus presents his prize-winning poster

 

LSHTM is rich in resources for students. Although you have a lot to do for your PhD, you have to get out of your shell and see what else is out there and grab those opportunities. There are so many special lectures here, by the likes of Professor Peter Piot or renowned experts from other institutions. They may not be directly related to your topic, but since you are here, you should take advantage of them.

In addition to my studies, I am a member of LSHTM’s TB and AMR Centres. I am a student representative for the TB Centre and recently organised a seminar designed to help MSc students working on TB topics for their summer projects prepare for fieldwork. Being a student representative also means I am part of the Centre’s steering committee, quite an honour for me, as the Centre is one of the top scientific bodies in the world looking at TB. My recent highlight was the opportunity to represent the Centre at a United Nations meeting in New York in preparation for the upcoming UN High Level Meeting on TB to be attended by heads of state.

In terms of other events, I attended the TB Centre retreat where my e-poster earned me a best poster award; and recently at LSHTM’s annual research degree poster day, I won the prize for the best poster by a pre-upgrade student. The abstract for one of my systematic reviews has been accepted for oral presentation at the 49th Union World Conference on Lung Health, which will take place in The Hague.

The biggest piece of advice I can give to a new PhD student is to be flexible

My long-term interest is to do as much as possible to identify solutions for the current high burden of infectious diseases we have in Malawi. So when I complete my PhD, I will remain in research to look at whatever solutions we can find using clinical trials. We are working towards establishing a centre for TB and HIV research within the University of Malawi, so I will be part of that centre for most of my career, while maintaining external collaborations.

The biggest piece of advice I can give to a new PhD student is to be flexible. In the first year, the research topic you have now will undergo metamorphosis to become the eventual project you will defend at upgrade and carry forward. So the best thing you can do in the first few months is to understand your topic and get to the point where you have well-formed research question, then go through a systematic review as early as possible as it will help you develop your main research protocol ready for defending in the upgrading seminar. To arrive at that point, plan your time well, set deadlines with your supervisors and don’t stress yourself too much! Give yourself time to socialise with the people around you and learn from them, and have other things to focus on beyond your PhD, so that when you come back to it, you are fresh. Once you are through the first year, everything should fall into place nicely, but hey, am not there yet!

 

Early London School of Tropical Medicine minutes

First meeting of the School Committee, July 1899

The Archives Service is pleased to announce that we have borrowed nine volumes of the London School of Tropical Medicine’s early minute books dating from 1899 when the School was established to 1924 when it became the London School of Hygiene & Tropical Medicine and received its Royal Charter. These have been borrowed from the Seafarer’s Hospital Society (formerly the Seamen’s Hospital Society) with which the original School was established and we are very grateful that they have kindly loaned these to us. Minutes from 1924 to the present day are held in the Archives.

London School of Tropical Medicine, Albert Dock

The Archives team will use the information in the minutes to discover more about the early history of the School and the issues that were being discussed by the School Committee. Researching the minutes will hopefully uncover new information about some of the historical events that occurred during this period including expeditions, staff recruitment, the First World War, the move from the Albert Dock hospital in the East End to Endsleigh Gardens and new School being formed in 1924. We will be writing blogs and tweeting about interesting facts that we find over the next few months.

We are hoping to put some of the minute books on display during the 120th anniversary celebrations and researchers are welcome to study them in the Archives. If you are interested, please contact us at archives@lshtm.ac.uk

16 – 22 May 2019

New LSHTM-led research finds that 1 in 7 babies worldwide are born with a low birthweight. The figures are the first estimates of their kind and indicate that national governments are doing too little to reduce low birthweight. Senior author Joy Lawn said: “These first ever national and global trends for low birthweight rates are a wake-up call to governments, UN and all partners to address three crucial gaps. Firstly, the gap in care to support those 20.5 million small babies. Secondly, the prevention gap, to meet the Global Goal and to reduce low birthweight rates. Thirdly, the data gap, to ensure that all babies are weighed at birth and that that data is entered into the system.”

The research was widely covered and coverage included The Times, Telegraph, Daily Mail, CNN, CBS, AFP, NPR, Irish Independent, Die Welt, El Pais, Der Spiegel, Die Zeit,  New Straits Times and Le Figaro.

LSHTM and Takeda Pharmaceutical announced the establishment of the “Takeda Chair in Global Child Health”, endowed by a £3 million donation by Takeda. It is LSHTM’s first fully endowed corporate chair and will support vital research to help reduce child deaths in low and middle-income countries.

LSHTM worked with Takeda to issue media releases, and the news was covered in nearly 500 outlets across the world, particularly in Asia.

Adam Kucharski speaks to Fortune about how new Disease Prevention Maps, produced by Facebook, which give information about population numbers and movement, could help in gathering information about outbreaks and responding to them. Adam said: “”This is an extra insight we have not had before. It saves us from making broad assumptions.”

Abigail Page is quoted in The Telegraph about a new study, conducted by LSHTM and Cambridge University, which looked at the move towards agriculture around 11,000 years ago. Researchers suggest that when communities in the Philippines moved from hunting to farming, life became 50% more difficult. Abigail said: “We have to be really cautious when extrapolating from contemporary hunter-gatherers to different societies in pre-history. But if the first farmers really did work harder than foragers then this begs an important question – why did humans adopt agriculture?”

Phil Edwards provides expert comment to the Washington Post about an experiment in New York where mobile light towers were placed across the city, with the purpose of reducing crime. Phil said: “The experiment adds to the considerable body of evidence that installing lights reduces crime.”

The Guardian cover news that the Royal College of Nurses (RCN) have voted in favour of decriminalising prostitution, in a move to protect sex workers’ health. In explaining their decision, the RCN cited LSHTM-led research which provided evidence that sex workers who had encountered arrest or imprisonment, were three times more likely to be victims of sexual or physical assaults.

Rachel Lowe speaks to Deutche Welle about how environmental change and increased temperatures can affect the movement of vectors that transmit diseases, such as mosquitoes that carry Dengue. Rachel said: “A warming climate can cause mosquitoes to expand to higher latitudes and altitudes.” (Rachel’s interview starts around 22minutes in)

Kessar Kalim features in an article in HR Magazine, about reporting extremism in the workplace.

Atlas Obscura publish an article about the LSHTM Keppel Street building and the gilded Art Deco vectors displayed on the building.

Social media highlight

This week’s social media highlight comes from the LSHTM Twitter page, and shares news that LSHTM was ranked the top UK University for open access and gender diversity in research 2019 CWTS Leiden Ranking. The ranking is also a media highlight as it was covered in The Guardian.

Beyond Birth Weight: How Dr Hannah Blencowe is Making Every Baby Count

Births at the Health Centre. Photo Credit IDEAS, Paolo Patruno

 

Dr Hannah Blencowe joined the London School of Hygiene and Tropical Medicine (LSHTM) fresh out of working in Malawi as a pediatrician at Queen Elizabeth Hospital, Blantyre where she helped to run the neonatal unit. Having trained in UK hospitals, Hannah was shocked to observe the number of small babies who were being brought to hospital and dying unnecessarily. Even worse, the deaths were in vain with no-one capturing or recording them, just a trail of bereaved mothers who would all too frequently be seen again in the coming years with the same problems.

Knowing that many of these deaths were preventable, and that action could make a difference, Hannah joined LSHTM. Initially as an M.Sc student and then stayed on as staff PhD with the Maternal and Newborn Health group within the MARCH centre at LSHTM. As someone who had always enjoyed counting, her PhD would focus on data collection and analysis.

10 years on, Hannah’s work has just been published in the Lancet Global Health – calling attention to, and demanding action for, the 20.5 million low birth weight babies born worldwide in 2015.

I managed to catch Hannah for an interview in the brief respite between submitting her PhD thesis, speaking to journalists, and preparing for her viva. Below is this extraordinary work in her own words…

Q: First, it’d be great to learn a bit more about you. What inspired you to work on maternal and newborn health at LSHTM?

I previously worked in Malawi as a pediatrician, part of my role was working with a team to run the neonatal unit there. There were so many small babies coming in and dying unnecessarily, and I’d come from the UK where those babies wouldn’t have died. Seeing the impact on the mothers, the healthcare staff – the demotivation.

And I realised that these babies counted to their mothers but not to anyone else – the hospitals weren’t interested in them, they weren’t being captured in any kind of data systems, and things weren’t changing. I’d see the same mothers coming back again and again with things that were preventable and we could have done things about. And that made me think: “Where can I start?”.

For me, I’ve always liked counting so data was a natural place to start. I long to see every baby count to their mothers, count to themselves, and also play a part in helping to improve outcomes for the next generation.

Q: And that’s led to the paper that has just been released! If you had to describe the paper in one sentence, what would you say?

That’s a tricky one! So, there were 20.5 million low birth weight babies were born in 2015.  And they are at higher risk of dying as babies and as infants, of being stunted, suffering malnutrition as children, and having chronic adult diseases.

Q: Okay – so for my understanding, what exactly do you mean by ‘low birth weight baby’?

It’s any baby born with a birth weight of less than 2.5 kilos. And there are two reasons for this. They’ve either not grown well enough in the womb, that’s called in-uterine growth restriction. Or they’ve not had long enough to grow in the womb and were born before 37 weeks, called preterm birth.

Some babies can actually be both – born early and born small. 

The term ‘low birth weight’ applies to any baby born less than 2.5kg. Image credit: IDEAS.

 

Q: You’ve covered this a bit previously, but why is low birth weight a problem? What are the short and long term consequences and why should we care about it?

The short term I’ve already alluded to, these babies need extra care at the time of birth. They’re more likely to get cold, they’re more likely to be unable to feed, they’re more likely to have breathing problems and get infections – particularly if they’re preterm as well. And all of these reasons mean they’re much more likely to die.

For those babies that survive, their small size and difficulty feeding means they’re often stunted and malnourished as a child.  This makes them more vulnerable to infections as children as well.

Long term as adults they’re at higher risk of chronic diseases such as hypertension and diabetes. We know the start of health begins in-utero, so if unhealthy at that point, it will lead to longer term problems.

And that’s why it matters for the babies, but it also matters to mums as well. These are mums whose babies may die, or go on to struggle through life. I think quite often we miss the parents out of the picture.

Q: Are there differences in the number of babies born in Low & Middle Income Countries (LMICs) versus High Income Countries (HICs)?

Yes, there are differences. These can be seen in the overall rates – the rates tend to be lower in HICs than LMICs.

The underlying reasons are actually similar in both settings, but each individual country has different risk and balances for how many are preterm, how many are growth restricted, and how many are both. For instance, in South-East Asia there tends to be more babies born on time but who are growth resticted and in Africa there are more preterm babies.

Q: Okay, so what are the underlying causes and are there any notable differences?

It varies across settings but the broad categories are generally the same wherever you are.

There’s maternal infection and that’s more common in areas where there are high levels of malaria, say, or HIV.  Areas like Africa, and this drives preterm births.

There are some specific causes related to environmental factors such as smoking and in  low income countries indoor air pollution remains an important preventable risk factor for low birthweight

Alternatively you have chronic conditions and that’s universal across the world – maternal hypertension and maternal diabetes.

What’s makes a huge difference in these cases is not the cause but the level of care. Most women in high-income countries can access ante-natal care and they get timely, high-quality care. Because of this the doctors pick up if the mum has an infection, if she has hypertension , if she has diabetes, and they manage her pregnancy accordingly. So the baby grows to the best of it’s ability and it’s born at the time for its optimal health and survival.

That’s not the case in LMICs, where even though women may access ante-natal care at least once in their pregnancy, the quality of care they get is too often really poor. The infections don’t get picked up, the women don’t get diagnosed with hypertension or any other issues – and that’s a big problem.

One of the unspoken, and “taboo” causes is maternal age, so mums who are either very young (under 17), and mums who are older (over 40) are at higher risk of low birthweight babies. And this can be the result of premature birth of growth restriction. In this instance, one of the biggest challenges is access to family planning and empowering women to be able to choose the time they have their babies for optimal health.

Q: When it comes to solving some of these challenges, what kind of changes would you bring about? And would that differ for LMICs vs. HICs?

In high income countries, I would look at the important factors we could do something about. For instance, in some HICs smoking is still a huge problem. And we’ve seen that in countries where we’ve reduced smoking – for instance Scotland – there have been really big reductions in pre-term babies and growth restriction. There are many countries in the east of Europe where smoking is still highly prevalent and acting on that could be an important change at the public health level.

Maternal age is also a big one – we’ve seen a shift up in maternal age across high-income settings, and I don’t think women are always aware of the risks of delaying pregnancies. Having workplace environments that are conducive to having pregnancies at a time that is optimal for maternal health, enabling career prgression, and clear routes back into work is really fundamental for HICs.

And a final change for HICs would be medically unecessary caesarean sections. It’s often the case that in these setting babies are born preterm by caesarean when they needn’t have been – and both mother and baby would have been better if the baby had have stayed inside a bit longer.

Women in LMICs need to be empowered through education, access to nutrition, and access to high quality healthcare. Image credit: IDEAS.

 

For LMICs it’s all about empowerment. I know it sounds really big, but actually, if women can be raised out of poverty, if they can actually have an education and be empowered to make choices about when they get pregnant, if they have knowledge around nutrition and adequate access to nutrition both before and during pregnancy, and finally if we can reduce their exposure to indoor air pollution – then that could improve maternal mental health and well being and make a real difference.

In addition they need access to high quality healthcare, including antenatal care. For women who access this service – they’re making that effort to go, but at the moment they’re all too often not receiving anything that would give them a benefit for themselves or their babies. We need to give them access to greater quality of care.

Q: They’re pretty big challenges and could appear intimidating to tackle. What would you advise anyone reading this to do if they wanted to make a difference?

We need people to advocate in all settings, but particularly for mothers and babies living in LMICs where we know 90% of these babies are born. Raising awareness that this is an important issue is really critical.

For those working in research, ask yourselves the question: “How could I include this if I’m working in the field of maternal and child health? How can I bring this in? How can I raise awareness through my work?”.

Q: If you could only tell people three key messages from this paper, what would they be?

For me, the three key messages are the three key gaps.

Firstly, the data gap. Low birth weights represent a really big global problem, we’re talking 20.5 million babies and their mothers affected in 2015 alone. But the data isn’t always available. Each baby should be weighed so that we can improve their care and improve things for the future as well.

Next is the prevention gap. We are reducing the number of low birth weight babies but slowly. There’s a target of 30% reduction in low birth weight by 2025, which is why we did this work to get some baseline tracking towards that target. But progress has been really slow over the last decade, and if we are to reach that target we need to more than double progress – meaning we need to take action to prevent low birth weight where we can.

Finally, is a care gap. Of these 20.5 million babies, 90% are in LMICs where they’re not getting the care after birth that they need. And I think many of these babies are dying because too often we’re not giving them the care that they need after birth – either on postnatal wards or in neonatal wards, and we’re not giving their mothers enough support to care for their babies once they go home.

Q: And if everything goes to plan with this type of research, where do you hope we’ll be in 10 years’ time?

I’d like to see investment at the critical places – and for me the critical places are antenatal clinics: improving quality of care, and picking up and diagnosing treatable conditions in mothers so that they can improve the outcomes for their babies. I would also like to see investment in newborn inpatient care, and postnatal care, coupled with improved support for mothers caring for these babies, enabling their babies to survive and thrive.

Q: Finally, as I’m writing for the MARCH blog I have to ask: has being a member of MARCH helped with this work?

Yes – being in an environment with loads of inspirational colleagues in the field of maternal and child health is really helpful and gives me drive to keep on going. Its not always easy, when you’ve spent 5 years collating all this data it can be easy to lose sight of the big picture. But being part of the MARCH reminds me that we’re working to ultimately improve the lives of women and children worldwide.

 References

  1. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30565-5/fulltext

Let’s talk about sex

How do researchers go about interviewing people about sex and sexualities? To what extent do we – or should we – share our own experiences? And what kind of ‘spaces’ do these highly personal conversations fit into?

DEPTH researcher Dr Sam Miles was invited by the academic journal Area to write a blog for their outreach website Geography Directions, based on his recent article ‘“I’ve never told anyone this before”: Co‐constructing intimacy in sex and sexualities research’. In the blog, Sam explores the ethics of fieldwork in sex and sexualities research. Have a read… 

The (in)famous male-male dating and hook-up app Grindr recently celebrated its 10th birthday. To mark the anniversary, a whole range of articles have cropped up variously celebrating and lamenting Grindr’s influence across the world (by which I mean literally across the world – it counts nearly 4 million active users across 234 different countries (Grindr, 2019)). What makes this generation of mobile phone matchmakers different from the online platforms that went before them, for example Gaydar, match.com, Yahoo chatrooms? Apps such as Grindr are GPS-enabled, which enables users to ‘rank’ other users of the app by proximity, ensuring that potential matches can be discovered and introduced in real-time across physical space.

Reflecting on Grindr’s first decade, The BBC identifies a ‘rocky relationship’, whilst VICE magazine explores Grindr’s relationship with identity fraud and drug-based ‘chemsex’; meanwhile, Gay Times reports that 56% of Grindr users believe they can find true love on the app. Whatever your opinion on it – and there are many – there is no doubt that this mobile phone matchmaker, along with its competitors Hornet, Scruff & Jack’d, has had a profound impact on gay and bisexual communities. These apps have also opened up new avenues for men seeking sex with men (MSM) who for whatever reason – familial, cultural, or religious – do not identify as gay or bisexual.

Grindr Stock image

The bigger question raised by these recent articles seems to be: how do dating and hook-up apps impact on same-sex and queer relationships today? This question cannot be answered by quantitative usage data alone. After all, we know that high usage does not necessarily mean high popularity. We need to explore peoples’ real life experiences in order to more fully understand the impact of dating and hook-up apps on same-sex and queer relationships.

I decided that the best way to get a detailed understanding of how these apps influence sexual and social behaviours would be to interview users about their experiences online, offline, and in the ‘hybrid’ space bridging the two, where virtual introductions result in real-life encounters. My doctoral research revealed some important findings: (1) that dating and hook-up apps play a significant role in how men now meet other men, especially within wider debates about the ‘death of the gay bar’, and (2) that the relationship between mobile phone dating app users and the people they meet can be awkward, with social cues yet to catch up to the sophistication of the technologies in use.

The sensitive nature of the research topic meant that there was an array of ethical and practical challenges for me to grapple with during my doctoral fieldwork. In my recent Area paper, I reflect on some of these challenges and explore how researchers and participants can work together to create a meaningful space that not only enables data collection, but facilitates honest and valuable conversation. I consider what the researcher’s responsibility should be for a participant’s safety in this discursive space. I also reflect on how ‘involved’ I should be as a researcher. I’m a person, not a robot, and several decades of feminist research has already explored the strengths and issues bound up in bringing ‘yourself’ into the research field (for example, see Bain & Nash (2006) and Smith (2016)). But the opposite extreme of the objective, positivist robot researcher is the inappropriately involved one, a role which would be both institutionally unethical and personally unacceptable. I therefore identified my own boundaries as well as the participants’s boundaries. The result was a co-constructed discursive space that we worked together to construct, perhaps surprisingly, in totally public venues and in one-off, hour-long interviews rather than more private or longer-term meetings. These were not ‘intimate’ spaces in a traditional sense, but nevertheless the space-within-a-space that we constructed invited app users to speak about highly personal experiences, some for the first time ever.

I also make the case for the using public places for staging sensitive conversations. The assumption that private matters cannot be discussed in public requires a rethink. Public spaces like libraries or cafes enfold within them more private spaces – not just actual booths or nooks, although these can contribute – but I’m thinking here about more conceptual spaces. These are built simply via one-to-one, in-person conversation in a space where a hubbub of background talking, or the hiss of coffee machines brewing, provides a backdrop to conversation that can be very productive.

Finally, when it comes to dating and hook-up apps in particular, I suggest that people are particularly keen to share their views because the social norms of dating app use are so complex and still so poorly understood. For lots of people online dating remains taboo. In this context, the chance to share their thoughts, feelings and experiences when it came to the digitally-introduced, physically-involved relationships these platforms offer may have been liberating.

Love dating apps or hate them (or both), what I hope the article communicates is that we need to talk more with users about the ways in which technologies impact on our personal lives, in order to think about the social codes developing from their use that will inform a whole range of wider contexts.

What do you think? Let us know by commenting below…

References:

Bain, A., & Nash, C. (2006) Undressing the researcher: Feminism, embodiment and sexuality at a queer bathhouse event. Area, 38, 99–106. https://rgs-ibg.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1475-4762.2006.00663.x

Damshenas, S. (2019) 56% of Grindr users believe they can find love on the app, study finds. Gay Times. Retrieved from: https://www.gaytimes.co.uk/community/119691/56-of-grindr-users-believe-they-can-find-love-on-the-app-study-finds/

Fox, L. (2019) 10 years of Grindr: A rocky relationship. BBC News. Retrieved from: https://www.bbc.co.uk/news/technology-47668951

Grindr. (2019) Grindr.com. Retrieved from: https://www.grindr.com/

Miles, S. (2017) Sex in the digital city: location-based dating apps and queer urban life. Gender, Place & Culture, 24, 1595-1610: https://www.tandfonline.com/doi/abs/10.1080/0966369X.2017.1340874?tab=permissions&scroll=top

Miles, S. (2018) Still getting it on online: Thirty years of queer male spaces brokered through digital technologies. Geography Compass. e12407. ISSN 1749-8198 DOI: https://doi.org/10.1111/gec3.12407

Miles, S. (2019) “I’ve never told anyone this before”: Co‐constructing intimacy in sex and sexualities research. AREA. https://rgs-ibg.onlinelibrary.wiley.com/doi/full/10.1111/area.12550

Smith, S. (2016) Intimacy and angst in the field. Gender, Place & Culture, 23, 134–146.

Staples, L. (2019) Grindr Users Talk Highs and Lows After Ten Years of the App. VICE Magazine. Retrieved from: https://www.vice.com/en_us/article/59x83d/grindr-users-talks-highs-and-lows-after-ten-years-of-the-app-1

09 – 15 May 2019

Heather Wardle co-authors a paper for the BMJ on public health harms caused by gambling. The paper calls for a compulsory levy on the gambling industry to address the harms caused. Heather said: “Gambling harms have been vastly underestimated. It is placing major burdens on resources, relationships and health. The time now is for action to reduce harms which is going to require a much more significant level of funding than is currently available. We believe that a compulsory levy on industry is the only way to achieve this.”

The research was covered in The Independent and ITV. Heather also recorded a podcast for the BMJ on the topic.

Jimmy Whitworth provides expert comment to The Telegraph on bubonic plague after two people in Mongolia died from the disease. Jimmy said: “It’s perhaps the biggest and most persistent hotspot. We think that the Black Death came out of Mongolia originally, and that it was the Mongolian armies expanding westwards that allowed it to spread and get to Europe.”

Heidi Larson features on BBC Radio 4’s The Briefing Room (starts from 08 m 20 s in), about whether vaccinations should be compulsory. Heidi said: “In some places there are some issues with service delivery or access – it’s a mix of issues. Some of the anti-vaccine sentiment has been amplified by the social media environment. People tend to look for things they are worried about and they find other people who are also worried and it has this amplification effect.”

Cicely Marston speaks to BBC Three about the declining use of condoms among young people for a piece that looks at the reasons why some young people are not practicing safe sex. Cicely said: “If you talk about having a condom, you have to talk in advance about whether you’re going to have penetrative sex or not. For some people, that can be a really awkward conversation and so it just doesn’t happen.”

Heidi Larson comments in Research Europe (subscription only) about the role of researchers in helping to counter scepticism about vaccine safety. Heidi said: “While outright bans are probably counterproductive, technology companies have a role to play. Public health researchers should talk to them about how their algorithms could be tweaked. This is a collective responsibility and we’ve created a collective mess.”

Martin McKee authors two opinion pieces for the BMJ on transparency around NHS charges for migrants and tackling the threat from disinformation around vaccines.

On social media

This week’s social media highlight comes from the LSHTM Twitter account. Sharing news of Peter Piot’s recent contribution to a panel at the Milken Institute Global Conference on tackling Antimicrobial resistance.

A pause for menopause

(Meno)Pause for thought

Embrace this time of life, ladies
Embrace it with fear, trepidation, elation
Embrace it anyway cos it ain’t going away.
Embrace it cos it’s coming your way.

Here are some stuff about it.
Enjoy.

Articles:
LSHTM username and password required:
Nelson, H (2008) “Menopause” pp. 760-770 Lancet 371 (9614)
http://www.sciencedirect.com/science/article/pii/S0140673608603463

Delanoe, D et al (2012)”Class, gender and culture in the experience of menopause. A comparative survey in Tunisia and France” pp. 401-409 Social Science & Medicine 75 (2)
http://www.sciencedirect.com/science/article/pii/S0277953612002730

Open access:
Rijanto, SJ (2018) “Factors affecting menopause” pp. 237-239 Health Notions 2(2)
http://heanoti.com/index.php/hn/article/view/hn20216/119

Erbil, N (2018) “Attitudes towards menopause and depression, body image of women during menopause” pp. 241-246 Alexandria Journal of Medicine 54(3)
https://www.sciencedirect.com/science/article/pii/S2090506817300726

E-books:
Open access:
Gailbraith, AM (2004) “The Four Epochs of Woman’s Life; A Study in Hygiene”
http://www.gutenberg.org/ebooks/4986#download

LSHTM username and password required:
Montemurro, B (2014) Deserving Desire : Women’s Stories of Sexual Evolution
https://ebookcentral.proquest.com/lib/lshtmuk/detail.action?docID=1843793