We were very sad to hear about the death of Dr Joseph Sonnabend on 24 January 2021 at the age of 88. In 2014, Joseph Sonnabend deposited a large collection of his archives with the LSHTM Archives Service. Sonnabend was not connected to the School but we received an urgent message from his friend Simon Watney that the collection needed a home or was going to be dumped in a skip. We made a quick decision that this collection was too important not to be saved and it also complimented our other collections relating to HIV and AIDS. In 2019, we received an additional set of material.
We have very fond memories of sitting at Joseph’s kitchen table in his London flat, drinking tea, stroking his beautiful cat and discussing his records. He could pick up a letter and tell you in great detail the story behind it. He also spoke about his childhood in Africa, it was fascinating to hear about his views on colonialism and his career in early AIDS research and care.
Joseph Sonnabend (b.1933) was a physician, clinical researcher, and community activist who played a significant role in the fight against AIDS from its earliest onset in the United States. His archives chiefly relate to his experience treating and researching AIDS in New York City and includes extensive research notes, laboratory notebooks, research data, scientific articles and medical records of patients he treated in his Greenwich village private practice along with material relating to his involvement in community based research such as papers relating to AIDS Medical Foundation (which he co-founded) and the Community Research Initiative/Community Research Initiative on AIDS, as well as the PWA Health Group.
Alongside the material relating to AIDS, the archives also holds research papers from his earlier career as a virologist studying interferon with Alik Isaacs, one of the discoverers of interferon. He spent more than a decade studying interferon largely for the Medical Research Council based in Mill Hill but later in the United States. Papers also include his work on infectious and venereal diseases in the States and include one of his earliest medical posts as a medical investigator onboard a ship returning Muslim pilgrims to Indonesia during an epidemic of meningitis.
The collection includes material on the publication ‘How to Have Safe Sex in an Epidemic: One Approach’, published in 1983. This publication was the first to advocate safe sex as a way to prevent the spread of AIDS. Joseph Sonnabend provided the scientific advice for the manual which was produced by two of his patients, Michael Callen and Richard Berkowitz. The book proved controversial with parts of the gay community as it opposed many aspects of sexual freedoms practiced at the time. The guide provides rational advice for safer sex for sexually active individuals, rather than condemning all physical contact or using medical language. There is further information on this publication in this blog post: Who was reading ‘How to Have Sex in an Epidemic’? – Library & Archives Service blog (lshtm.ac.uk).
In addition, to the papers deposited at the LSHTM archives and equally significant archive collection is held at the New York Public Library. The online catalogue provides a more comprehensive biography of Joseph’s pioneering work fighting AIDS in the United States.
The new research partners within the ACCESS SRHR (sexual and reproductive health and rights) consortium. We are looking forward to working with colleagues at LSHTM Uganda and HERD International, Nepal.
The number of citations of our piece in The Lancet, Community participation is crucial in a pandemic. In it, we lay out steps governments and health bodies must take to ensure citizen participation.
The number of words in our final NIHR report, This Sickle Cell Life. You can learn more about the findings from our project here.
The number of sickle cell patient and carer experts with whom we co-produced This Sickle Cell Life. We recently collaborated with them to present study findings to London NHS Trusts.
The number of new followers to our @DEPTH_LSHTM and our @ThisSCLife Twitter accounts. Check them out if you’re not signed up for daily updates, news articles and research findings.
The number of hits on our tweets in 2020 from our DEPTH Twitter feed. If you don’t follow us already, now’s your chance!
Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. The journal consists of four sections; Health Systems Research, Health Economics, Health Policy Processes and Implementation Research and Evaluation.
This year we have received a lot of enquiries from students and staff, including some of my library colleagues, about how to use e-books : how to read them, how to download, whether you need to use special software to download, and limits on how much you can copy or print being some of the most common questions.
Library e-books are mostly provided via commercial platforms, which offer a plethora a different licence and access models. Some titles permit a single user, others several simultaneous users, and some allow unlimited access. Very few titles offer a permanent download of the whole book. Copyright also comes into play regarding how may pages you can download or print. Some platform providers require their readers to create a personalized account for certain functions such as adding notes.
Last term I was tasked with putting together some instructional videos to demonstrate the main features of our most frequently used platforms; VLe Books and ProQuest Ebook Central.
Recording these videos was a new experience for me and at one point I was reminded of using audio recordings from my notes and exercise books when revising for exams when I was sixteen. Of course, this time I was recording not for my own benefit, but for that of staff and students, so in the delivery I used some techniques that I learned by observation of others, such as those of my colleagues, past and present, in the Information Services Team. My experience of reading out questions at quiz nights and speaking at trade union conferences also came in handy.
I’d like to thank all of my colleagues for providing feedback and advice on making the videos and I hope you find them useful. You can find them in the following places:
New year, new blog post! For our latest piece, DEPTH researcher Dr Sam Miles reflects on the journey from PhD to first academic job, and offers some advice to ECRs (early-career researchers) pursuing careers in academia. This blog has been adapted from The Royal Geographical Society ‘Postgraduate Life‘ Series, which you can find here.
I was recently invited to write a guest blog for the Royal Geographical Society about my journey to my first academic job. I don’t have all the answers – in the piece below I reflect on exactly why this might be, and my concerns probably resonate with many of you – but I do have some ideas. Many of these came about after discussions with former students, current colleagues and other early-career researchers (ECRs) in the field, and notes of my own taken over the years.
It’s not as simple as a tick-list, though I cannot tell you how much I wish it were. I just hope that these ideas can be helpful to social science students here at LSHTM and in the wider job market applying for postdoctoral or lecturer posts. I was asked to write the kind of blog post I wish I’d read when I was starting to job hunt; with that in mind, here goes.
It’s one of those truisms that finding an academic job is hard. And it really is – it feels somehow unlike finding any other kind of job, and the specific knowledge around academic job hiring processes is something you’re also somehow expected to know, maybe by osmosis. It’s no wonder Imposter Syndrome strikes so many of us. Take for example academic CVs, where longer is better. It goes against every fibre of my being to go over the 2 pages I was always told is the maximum you should fill. Even the listing of education/jobs/experience is differently ordered in an academic CV to CVs in every other job in the world. Job adverts themselves can be confusing in terms of terminology and contract type, or arcane or unclear working conditions, or freighted with acronyms without explanations. On top of this, salary, contract length and expectations of entry-level posts can be vague, missing or intimidating.
It all results in a task that feels unclear and applications that can feel rather uncertain. Usually, that’s through no fault of your own (as evidenced when you’re several applications in, facing radio silence from each institution. Are you even doing it right?) Obviously, the offer of an actual job would answer that question, but academic posts are so competitive that your empty inbox may be more of a testament to a stricken job market than your own application – and the COVID-19 pandemic has made a precarious market even worse. You will often be rejected without any feedback from the hiring institution. The standard response to requests for feedback is that feedback is only feasible at shortlist stage, but it is invariably difficulty to get to shortlist and interview if you don’t gain feedback on what you need to finesse! In the absence of clear direction from institutions, you may need to utilise a few different approaches. I’ll lay out some that I used.
Here’s what my own journey looked like: In the final year of my PhD, I applied to several lectureships. The applications I submitted were for posts that normally required a PhD, completed or near-completion. I took this to mean that they were open to nearly-there or newly-minted PhDs as much as anyone else, but have since recognised that the field of candidates is routinely so huge that many will have progressed a long way beyond this milestone. From asking more established colleagues at my institution, talking with early-career-researchers at a conference that spring, and looking out for the hiring announcements of successful candidates (people increasingly share job successes on Twitter), I realised the reality was that new PhD finishers rarely get these jobs. The market is crowded with brilliant and highly-qualified candidates. Vacancies are limited (and by some accounts, dwindling further).
It is now much more common for PhD finishers to work on one or several assistantships or postdoctoral posts before lectureships become a possibility. Even then, that post is often fixed term.
During my own job hunt, a Research Fellow post at the London School of Hygiene & Tropical Medicine (LSHTM) caught my eye. It required a PhD in public health or related discipline, including social sciences. Alongside my own research covering some (but certainty not all) elements of sexual health via a PhD researching the mapping of queer male relationships on location-based dating apps, I made sure I researched reproductive health, which was the other component of the post and an area where I was less experienced. The specification emphasised qualitative methods, which matched my experience, and co-produced research outcomes with communities. My doctoral research was participant-centred and I had been reflecting on making a safe space for sensitive topic discussions, but I wanted to develop this more in future work. The LSHTM post would specifically engage participatory research, so I took my knowledge of participatory action research (PAR) from my own work and brought myself up to speed on co-production and PPI (patient/public involvement) in health.
I revised (and revised, and revised) my academic CV, highlighting teaching experience as well as research outputs to date. I wrote a targeted cover letter which addressed each of the candidate specification requirements listed in their ‘essential’ list for the vacancy. I addressed each criterion only briefly, keeping the letter to the point, but then noted down longer answers to consider for a potential interview stage. The hiring panel requested academic and non-academic writing samples, so I included a published article but also a blog I had written about the Pulse nightclub shooting in Florida and its impact on LGBTQ space. I was shortlisted for interview(!) and prepared obsessively. I read articles, chapters and media pieces from the hiring team, and took them up on their invitation to produce a slideshow to present in the job interview. I tried to make sure I could highlight the ways in which my research experience matched their goals and I matched up every item in the person specification to a demonstrable activity, role or expertise. This is so key:
You need to show how you fulfil each and every ‘essential’ criteria to progress to shortlist. If you cannot show this, or don’t effectively communicate how you show this, your hiring panel will not be able to ‘get to’ other elements of your application that are lower ranking in priority.
And… I got the job! It was only a one-year contract, but with hopes of renewing this pending funding. That happened at the end of year one, and then again six months later, and again a few months later. Three years later, and I’m still hanging on. We are now embarking on a very exciting project, after which point I will again need to think about new grants, funding and tenure.
This brings me to precarity. One thing I was asked to reflect on in my blog post was worries I had when applying for academic posts. To be honest, it’s not a past tense concern: I’m funded for now, but then I’ll need to generate grant money for future posts. What started as a temporary position became less precarious, but I’ve yet to secure a permanent position, and know strikingly few ECRs who have managed it. Over half of all UK lecturers are now on fixed term contracts. I worked for several cash-strapped NGOs before my PhD and yet have never experienced precarity like I see in academia.
It’s not a personal failing of mine – nor of my colleagues, my line manager or even my Faculty. It’s the predictable result of the neoliberalisation of universities. ECRs are good value and high output, and the incredibly high requirements of REF and general institutional reputation require in turn workers who can relentlessly publish lots of high-quality, peer-reviewed research. In this context, the idea of ‘slow’ co-production in research sadly becomes a luxury, even as my colleagues and I have shown its value.
Some final tips:
Find academic jobs advertised on jobs.ac.uk and Times Higher. Jobs.ac.uk is better in my view because it allows tighter filtering by salary level, city and discipline. You can also ask it to direct new job alerts straight to your inbox.
Twitter is an incredibly useful tool, not just for academic networking, but for getting to know an institution and who works there (many staff now have Twitter profiles – DEPTH even has one). It’s also useful to catch job alerts from departments in case you’ve missed them on your job hunt.
Write a blog. It’s a tip I bet you’ve heard before and probably rolled your eyes at, but it’s true. Writing your own blog as a PhD student is invaluable. I may not keep up a regular blogging schedule, but writing a blog, especially at PhD level, has been useful for thinking ideas through, for connecting with other people online, for publicising my work. My hiring committee told me that they read writing samples closely to check that candidates can articulate ideas, and they judge generalist and academic writing equally. Writing a blog allows hirers to witness your skills already in action as a form of public engagement.
My PhD supervisor, who was relatively early into their academic career themselves, was a source of invaluable advice, and I would definitely recommend asking to speak with your supervisor in your final year about your job application plans. Ask to do this separately from your normal supervision slot if that’s what it takes to really get your head in the job hunting zone. Talking your plans over with a supervisor is doubly useful if you have sent them your CV in advance for them to review or comment on.
Your supervisor has been in your position themselves, and so their advice should be invaluable, but I also know that many supervisors haven’t been on the job market in years. Even if they have, the reality of today’s academic job market may be totally different from their understanding. They also may not have time to help you with cover letters or CVs. If this is your experience, ask around to see if another staff member – perhaps your head of department or research lead – would be willing to look over your application materials.
Find your university careers service and book a CV appointment. Be clear when booking that you are applying for academic jobs and need guidance on an academic CV and cover letter – the advisor is unlikely to be specialist in that area but at least you’re giving them the chance to check up on the conventions in order to offer you tailored help. In my case at QMUL they didn’t have anyone relevant in-house but hired a specialist for PhD students as and when required – the consultant was excellent, and free for students.
Take some precious days away from thesis write-up to rehearse how you can show your interview panel specifically how you are the best matched candidate for the role. I’m always surprised that most people I know don’t do this, which surprises me (they also tend not to rehearse conference presentations either – horses for courses, I guess). It seems obvious that the rhythms and flow of public speaking aren’t perfected on your first run through, and that goes doubly for a speech or presentation. Do I hate it? Yes. Do I force myself to set time aside for the activity anyway so that when it comes to the real thing ‘out there’ my flow mitigates my wobbly voice or mumbling? Absolutely!
When universities hire a candidate for a post, they need to fulfil these criteria to be shortlisted and need to demonstrate their fulfilment of these criteria again in interview, so taking time to really read and think about how you match to these criteria is crucial. Think about it: you need to minimise their labour in matching up what they are looking for when it comes to interviewing their candidates. You need to prepare some of this work for them, so they aren’t having to find ways to invite you to show how you match up – because you’ve already laid it out concisely and persuasively, on the page and in person. Good luck!
The London School of Hygiene and Tropical Medicine (LSHTM) is seeking to appoint a senior academic as Brass-Blacker Professor in Demography. This is an exciting opportunity to join a well-established and highly regarded group of demographers and population scientists embedded within a world-leading School for public and global health. This is an endowed Chair, funded through a bequest to the School by John Blacker. The role offers an opportunity to shape the future of demography at LSHTM, taking forward the research agenda and teaching programme of a discipline so vital to current global health concerns.
In this blog series we are giving a voice to practitioners, implementers and policy-makers involved in national COVID-19 responses in low- and middle-income countries. These posts seek to facilitate timely cross- learning by sharing opinions, insights and lessons on the challenges and actions taken by those on the COVID-19 front line.
Lost in the discourse and politics of containing the pandemic through strict implementation  of COVID-19 guidelines, producing vaccines, creating public awareness, and an endless push and pull on the drugs to treat COVID-19, we seemingly have neglected something- the everyday people. Health systems are made for people, yet this pandemic is worsening social inequality. People living through the pandemic are more likely to fall sick and without health cover they face severe financial hardship. In a low-resource setting – amidst limited income, no health protection, and caring for the family -availing health services is a conscious decision, and often a low priority.
Any discussion on universal health coverage is incomplete if private health payments are not accounted for, yet this is largely missed during the biggest pandemic of modern history. Many additional families are now more likely to face catastrophic health expenditures (CHE) due to COVID-19-related expenses. Seven months into the pandemic, we are yet to estimate the additional productivity costs of COVID-19 incurred by different population groups. Therefore, we remind the global health community to prioritise health financial-risk protection of families, failing to do so could potentially derail the economic-wellbeing and impact their future. In this blog we highlight the case of India which has recorded the second-highest reported cases of COVID-19 globally by November 2020.
The only way to access free or inexpensive health care in India is through the public health system, which can, unfortunately, cater to only about 30% of population needs at its current capacity. The COVID-19 burden was initially borne by the public hospitals; however, it negatively impacted the health service provision of non-COVID cases. Eventually, with incapacitated and overcrowded public hospitals, most of the large private hospitals also started providing COVID-19 treatment. The private hospitals and laboratories notoriously capitalized on the services provided and initially charged about USD60 for Sars-CoV-2 testing, USD1400 per day for ICU occupancy, and USD110 for ambulance services in some Indian states . Although the government later capped the price, these services remains a luxury for many. While the Out-patient department continue to be under-utilised, In-patient department (IPD) fees for all illnesses have increased due to the mandatory use of personal protective equipment (PPE). Moreover, some private hospitals have been accused of charging disproportionately inflated prices for PPE leading to remarkably high medical bills. The failure of many private insurers to cover the cost of PPE for IPD hospitalizations, means that families must bear this cost.
Has the government found a solution?
Clearly not. The national health protection scheme of India, still in its infancy, is attempting to cover COVID-19 testing and treatment for families registered below poverty-line. However, the number of beneficiaries availing these services are not publicly disclosed. These numbers are likely to be very low given the poor utilization of scheme in the empanelled large private hospitals where the hospitalization costs could often be greater than the national health cover provided. This clearly indicates that most patients availing treatment for COVID-19, especially the ones with ICU or longer hospital stays, would pay hefty OOPE, many of whom would . Consequently, the vulnerable may avoid utilising healthcare services, unless critical, due to the fear of CHE and abject deprivation.
In effect, the financial cover, especially for those visiting private hospitals for COVID-19 treatment, has not been thought well by the government. Like India, many Low- and Middle-Income Countries (LMICs) are facing a similar challenge and this is a significant issue to have been overlooked by the mainstream global health discourse.
The financial burden related to COVID-19 treatment can bar many families to seek care and can be an important reason for poor containment of the pandemic. This can lead to an excess wage loss, morbidity and mortality resulting in a vicious cycle of economic loss and a rising inequality. We hence argue that the governments should cover the COVID-19 treatment costs and offer financial protection to families at risk of CHE. Essentially, the governments should regulate and provide cover for OOPs incurred on direct and indirect costs of COVID-19 care such as transport, wage loss, OPD expenses, indoor expenses, tests, and medicines etc., while continuing the search for the highly contested vaccine and cure. The global health community must develop coherent strategies through necessary collaborations to mobilize resources and develop policies before many more of the everyday people are pushed towards or into poverty. The poor are already facing the brunt of the pandemic due to overcrowded public hospitals resulting in delayed availability and sub-optimal level of care that cost lives. More research is thus required to understand the social determinants of COVID-19 transmission, including financial barrier to COVID-19 care, especially in the in low-resourced settings.
Dr Rakesh Parashar is currently working as health systems and policy expert with Oxford Policy Management. He is a PhD in health systems studies and has a background in public health and medicine.
Ankita Mukherjee is presently working as a Research Assistant at Oxford Policy Management. She has an MScPH from London School of Hygiene and Tropical Medicine and has interests in maternal and newborn health.
 Includes enforcement measures to prevent transmission such as lockdown, curfews, fines for disobeying physical distancing or wearing masks, etc by the government.
 ‘Spending ≥40% of non-subsistence as out of pocket expenditure or ≥10% of household income; how-ever the cut-offs are variable per country
 Ambulance charged an average of up to USD 15 before COVID; respiratory illness such as TB tests cost about USD23; and ICU per day occupancy in private hospital were charged ~USD 410 and USD20 in public hospitals
Well, it’s 4 weeks to Christmas and that means that it’s 5 weeks until the first funders commit to Plan S! On 1st January 2021, Wellcome Trust and Bill and Melinda Gates Foundation will officially be Plan S-ers.
What follows is a quick reminder of what this will mean to researchers at LSHTM, what you need to know, and some handy tools to help you out.
So, tools.Probably the best one in anyone’s toolbag: The Journal Checker Tool
The big news is that yesterday, 18th November 2020, cOAlition S’s long-awaited Journal Checker Tool (JCT) has launched! I’ve had a quick play on it, testing out imaginary publishing scenarios, and so far it’s easy to use and to interpret the results.
It gives all the possible ways of complying with Plan S, taking into account both your funder and your affiliation, giving you a tailored response: transformative agreement, fully open access journal, or self-archiving using rights retention.
What is Rights Retention?
The Rights Retention Strategy is cOAlition S’s strategy to allow self-archiving (green open access) to form a compliant option for Plan S funders. They have written to publishers and notified them that, if you inform them on submission that “the AAM resulting from [your] submission carries a CC BY public copyright licence” then you can deposit the accepted manuscript in a repository (for example LSHTM’s Research Online) for immediate open access from the publication date.
If the journal objects, cOAlition S say they’ll argue the case so you won’t have to.
They’ve even made a handy PDF summarising this and giving an example of the statement you provide upon submission.
The Research Publications Team Plan S information and discussion session
We held a drop-in session for Open Access Week 2020 and recorded it. It goes into Plan S specifically at LSHTM, and answers some questions from viewers on that day. We’ll be holding more of these in the coming months and are also happy to answer questions via Service Desk, or come along to departmental meetings etc if you’d like an opportunity to pick our brains!
You can watch the recording here and we’ll also put it on Service Desk.
Other places to get information and guidance
cOAlition S are the driving force behind Plan S. Their website is the first port of call for all Plan S news and well worth a look. They’re on Twitter too.
UKRI have announced that they will be following Plan S from January 2022 so they state that “you should follow the RCUK policy on open access and REF 2021 open access policy until further notice. No changes will be made to the REF 2021 open access policy” You can keep up with them here.
What should you be doing now to prepare?
The Wellcome Trust have said that 1st January 2021 is the cut-off date for submissions so anything submitted before this date will still be subject to the current open access policies. This means that if you are hoping to publish in a hybrid journal which is not under an LSHTM transformative agreement (at time of writing we have signed up to agreements with Wiley and Sage, but use the journal checker tool for more up-to-date information) then it’s time to think about submitting!
Familiarise yourself with the Journal Checker Tool, and other tools like DOAJ (the Directory off Open Access Journals, which could come in handy for ideas of where to publish) and Sherpa/Fact, the Funders & Authors Compliance Tool.
Chat to us! Ask us anything on Service Desk, schedule a phone call, or get us along to a departmental meeting. We’ll also be in touch with any more drop-in sessions we run.
For our latest DEPTH blog we asked LSHTM researcher Kimberley Popple to share her thoughts on NGO-academic collaborations as someone who has recently moved from the former to the latter. Thank you for your insights Kimberley – lots of food for thought!
Evaluation, Evaluation, Evaluation
Back in January this year I made the move from practitioner in the NGO world to becoming a researcher in the academic sector. I wanted to combine the skills I had developed in Public Health research with my knowledge and experience of programme implementation in the field. It seemed to me that there were obvious synergies and opportunities for practitioners and academics to work together to improve global health. Certainly, from my own experience, the projects that I worked on could have benefited from drawing on people with specialist skillsets in data collection and analysis and with the time to conduct literature reviews, produce evidence maps, and test the change pathways that many of the programmes were built upon.
Before moving into academia, I worked on a large portfolio of grants in Sierra Leone as part of the Ebola response. Most of the data we collected was used solely for routine monitoring and evaluation of interventions at the project-level. Its purpose was to track progress against set indicators and to report on spending to funders. As a result, collecting data that could be easily quantified was prioritised, and quantitative data was assumed by funders to show a greater impact than qualitative data. Further, qualitative data tends to fall within the remit of the accountability teams – it is used and relied upon but not as an indicator of impact. In the Sierra Leone scenario, success of an intervention was often measured by a high number of medical consultations or a large number of attendees at a meeting, rather than focusing on data related to quality of services or patient satisfaction. I remember one example of a gender-based violence (GBV) project in Freetown which was categorised by the funder as “underperforming” as the target number of survivors had not been reached. The fact that that the women who had been reached had received high quality support across the GBV spectrum of services was seemingly less valued.
In Uganda, I worked on a maternal health project which introduced a client-exit survey for women to participate in at the hospital after receiving maternity care. However, the survey was administered by NGO staff who were working with the marginalised populations, and in close proximity to the medical staff who had provided their care. There was little recognition of the power imbalance between interviewer and interviewee or the desirability bias that might be present as a result of the women’s fear of negative repercussions from medical staff.
Evaluations were often seen as a tick-box exercise for donors and their design was fairly rudimentary. By the time the evaluation report was written, the programme had already moved onto the next phase to align with strict funding cycles. This left little room to reflect on lessons learned and engage in a process of iterative programme design. A recent systematic review has highlighted the lack of evaluations conducted on epidemic responses in humanitarian and low-income settings, with only one tenth of responses evaluated and with large gaps in quality, content and coverage of evaluations, limiting the ability to improve future responses.
Is the landscape changing?
Over recent years, the international development sector has intensified its focus on evidence-based programming and evaluation. Many NGOs have increased their research capacity with dedicated departments and research staff (for example Airbel Impact Lab at International Rescue Committee, and the Response Innovation Lab at Save the Children), giving them the expertise and space to test out new formats for implementation, and to ensure programming is based on the latest evidence of what works.
New funding streams have emerged for research in the humanitarian field, such as Elrha’sR2HC programme, and there is donor pressure to evidence learning and use data for decision-making. Donors like the UK government’s Foreign, Commonwealth & Development Office (FCDO, formerly DFID) have developed more in-depth guidance on how to develop and use evaluation frameworks to measure impact and ensure accountability, with requests to include qualitative indicators in logframes.
What can academia bring to the table?
So, is there still a role for academics to play in supporting the work of NGOs? I believe there can be, particularly in the evaluation of complex interventions. Universities train public health professionals who often go on to work in the NGO sector. Expert knowledge of process and outcome evaluations can be drawn upon to test change pathways in Theories of Change. Systematic reviews can be performed by academics with fewer time and funding constraints, reducing the need to reinvent the wheel every time to search for the latest evidence. As academics, we can add our voice to campaigns as advocates of change. And the humanitarian health sector can harness specific skill sets in conducting clinical trials and in disease modelling. My sense is that as both sectors continue to develop and evolve, it will be important to continue to reflect on the value of academic-NGO partnerships for global health.
In 2012, the world’s leading beer, wine and spirit producers collectively vowed to continue their efforts to combat harmful drinking, including the goal of reducing drinking and driving. Acknowledging the serious effects that the harmful use of alcohol can have, these producers committed themselves to supporting the World Health Organization’s Global Strategy to Reduce the Harmful Use of Alcohol as well as Target 3.6 of the United Nation’s Sustainable Development Goals to halve the number of global deaths and injuries from road-traffic crashes.
Good corporate citizenship? Or a wolf in sheep’s clothing?
Our study showed that while the alcohol industry acknowledges that drinking and driving is an issue of concern, it usually promotes solutions that are not aligned with public health evidence-based recommendations and would limit impact on sales, while allowing the industry to maintain its reputation as a good corporate citizen. It is important to note that the majority of the most effective and cost-effective interventions for reducing alcohol-related road traffic injuries are directed at reducing the availability and sale of alcohol, either overall or to particular vulnerable groups. Public health key informants from the study explained that drinking and driving is an issue that the alcohol industry cannot outright deny and as a result it has become a public health area where the industry has been investing in, particularly in terms of its corporate social responsibility activities, to make itself look like a good corporate citizen and divert attention away from the fact that alcohol serves as a major risk factor for over 200 different health conditions. This is similar to the message “drink – but don’t drive.”
The alcohol industry accomplishes this by developing arguments to frame the issue of drink-driving. One example is that alcohol misuse is an issue of personal responsibility – a rhetoric that has also been employed by other health harming industries such as the tobacco industry. Other arguments include: the majority of drinkers are moderate and responsible, and that the alcohol industry is a legitimate stakeholder. These messages are then conveyed through the following mechanisms described below to achieve the industry’s preferred outcome:
The alcohol industry presents itself as a legitimate stakeholder by partnering with public health and road safety stakeholders and participating in road safety coalitions. The industry also uses third parties such as Social Aspect Public Relations Organizations and other “astroturf” organizations (e.g. American Beverage Institute) to represent the industry during policy debates and in public and social discourse. Our study showed that partnership between the alcohol industry and public health/road safety stakeholders appeared to the enabler for all other types of involvement listed below.
Information production and management
The alcohol industry recruits scientists to carry out research, funds research directly or through a third party, and conducts research itself. It also manages its reputation as a good corporate citizen through engaging in corporate social responsibility activities: donating breathalyzers to police departments, putting money into the road safety sector, providing training and technical assistance to government, sponsoring campaigns, and promoting activities that have high public relations visibility.
Direct involvement inpolicymaking
The alcohol industry is also directly involved in the road safety policymaking process at both the global and national levels. At the global level, there is evidence to suggest that the alcohol industry is very active in its engagement with the United Nations. At the national level, industry representatives, lobbyists and other affiliates cultivate positive relationships with decision makers, setting up events to increase interactions and providing incentives, including donations to political campaigns.
Implementation of interventions
The alcohol industry supports and carries out drink-driving interventions, which often advocates for “responsible” drinking. A study conducted in 2016 found that of the 266 alcohol industry sponsored global initiatives to reduce drink-driving, only 2 (0.08%) were consistent with evidence-based public health recommendations.
Questions for the Future
Given this scenario, we would expect an outcry from the road safety and public health communities. Unfortunately, the responses thus far have been fragmented particularly with regards to the topics of receiving funding from and partnering with the alcohol industry. Groups affiliated with the industry argued that one of the key advantages of partnering with the alcohol industry is funding since there are few funders in the area of road safety. Several of them also highlighted that they were able to maintain independence from the industry, while retaining funding. On the other hand, non-industry-affiliated public health groups asserted that there is an inherent conflict of interest between public health and the alcohol industry and funding from the industry will necessarily make recipients more susceptible to industry influence, whether they are aware of such influence. Some groups within the road safety community also separate the issue of drink driving from other alcohol problems, arguing that it goes beyond the organization’s mandate.
This raises several important questions:
Should corporations that are promoting health harming products engage in corporate social responsibility activities, particularly when these activities help promote their products?
Should guidelines be developed to help road safety organizations gauge when it is ethical to partner with and/or receive funding from the alcohol industry?
In the field of tobacco control, Cohen et al identified 8 criteria that could be used by tobacco control organizations to evaluate tobacco industry funding: 1) transparency and independence, 2) competitive funding process, 3) ownership of data and freedom to publish, 4) independent research agenda, 5) governance, 6) protection against conflict of interest, 7) industry public relations gains that counteract public health and 8) feasibility
How do we convince road safety organizations that by separating the issue of drink driving from other alcohol problems we are actually doing public health a disservice?
The alcohol industry is involved in road safety despite the fact that drink driving is a key risk factor for road traffic injuries. Yet, responses from the public health and road safety communities remain fragmented. Political scientists have long argued that cohesiveness among the networks of actors concerned with a particular social issue is a key ingredient for meaningful macro-level change. Given this, there is an urgent need to raise awareness about the involvement of the alcohol industry in road safety and for the public health and road safety communities to generate consensus, rally in one voice, and build a cohesive transnational alcohol control advocacy alliance to curb injuries and deaths unnecessarily lost to drink driving.