NIHRDataInsights/HRCSData huggingface dataset:
Title: The environmental sustainability of data-driven health research: a case-study of genomics and digital phenotyping in the UK
Funder: Wellcome Trust

Abstract: Data-driven health research, and the technologies it produces (DHRTs), are increasingly driving the UK health sector. DHRTs, which rely on advanced computing sciences and ‘big data’, have the potential to make a profound impact on society, and the pace of development is staggering. Equally, the databases, infrastructures, and software supporting DHRTs have important environmental and health impacts: their heavy energy requirements lead to high carbon dioxide emissions, and the reliance on minerals to develop their technological components can lead to unsustainable and/or toxic mineral extraction and e-waste disposal. While the environmental footprint of DHRTs may be considered unproblematic because of improvements in energy efficiency and the move to renewable energy, the speed of innovation is set to outpace the world’s renewable energy sources, leading to increases in carbon emissions when other sectors are decreasing their energy use. Moreover, issues of unsustainable mineral extraction/e-waste disposal still remain. It is imperative that the environmental footprint of DHRTs is considered through responsible innovation that targets environmental sustainability. This project’s aim is to use a UK perspective, qualitative case-study approach, that builds an empirical knowledge base that identifies the ethical, social and regulatory issues associated with DHRT’s environmental impacts.

Lay abstract: UK data-driven health research, and the technologies it produces (DHRTs), which include the use of advanced computing and ‘big data’, have been promised to benefit current and future patient health. Alongside this, the databases supporting DHRTs have important environmental and health impacts because of the huge amounts of energy they use and carbon dioxide emissions they generate. While improvements in energy efficiency and the move to renewable energy may negate these issues, the pace of innovation could lead to a situation in which renewable energy sources are over-burdened, leading to increases in non-renewable energy consumption. With concerns about climate change at their highest, it is timely and urgent to consider DHRT’s environmental footprint through responsible innovation processes. This project’s aim is to build an empirical knowledge that identifies the ethical, social and regulatory issues associated with the environmental impacts of DHRTs through a qualitative, UK perspective, case-study approach.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE
Title: Envisioning Environmental Equity: Climate Justice is Racial Justice
Funder: Wellcome Trust

Abstract: The climate crisis affects us all, but not equally. Those who have contributed least to climate change, suffer the most from its health consequences. Racial injustice exists independent of the climate crisis, however climate change provides a new channel through which these discriminations can manifest. In this grant we will explore the intersection between climate, health and racial justice, engaging with the ‘most affected people and areas’ (MAPA). To realise climate and health justice, MAPA must be central to discussions on reimagining solutions. We will centre our conversations on health inequalities identified by MAPA, prioritising those who are already suffering the worst physical and mental health impacts. We will listen first, via stakeholder meetings in Brazil, the Philippines and Uganda, and then conduct art-based engagement with young people in these sites. The work will be underpinned by evidence collated for an academic review paper and we will develop an educational module that can be used longer term. We will also encourage co-learning across the three sites, where young people can help to empower each other. Our work will target the Conference of the Parties 27 (COP27) meeting, where we will hold an event and also run webinar and podcast series.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE
Title: Optimising health with gender equity: a missing piece in nutrition programme planning
Funder: Wellcome Trust

Abstract: The nutritional status of populations is a marker of societal development and realisation of human rights. Worldwide, pervasive gender inequity in nutritional outcomes reflects structural disparities in the rights, freedoms, and welfare of men and women. My doctoral research in Nepal found that women are strongly discriminated against in the intra-household allocation of foods, especially during pregnancy. Yet, the health and economic implications of this are unknown. This project aims to estimate the health, mortality, and economic costs of gender-based dietary inequity, and identify policy-amenable determinants of intra-household food allocation. I will collate 11 datasets from eight low- and middle-income countries (n=27,660 households). To estimate health impacts of inequity, I will re-allocate foods under different ‘equity’ scenarios and predict the health and mortality outcomes from these scenarios. I will then use microeconomic models to predict household-level economic costs of inequity, and the ‘PROFILES’ tool to estimate population-level economic costs of equity. A multi-level determinants analysis will identify factors that affect intra-household inequity. This will be the first analysis to address health, mortality, and economic effects of diet-based gender inequity, and will provide critical information to transform national and international policy and programmes so they can protect women and save lives.

Lay abstract: The nutritional status of populations is a marker of societal development and realisation of human rights. Worldwide, women have poorer diets than men, but the health and economic costs of this inequity are unknown. This project aims to estimate health, mortality, and economic consequences of this gender-based inequity in poor households, and inform how national and international nutrition policy can influence food allocation behaviours. I will use survey data from 27,660 households in eight low- and middle-income countries to predict the health consequences, numbers of lives lost, and economic costs of gender inequity. I will conduct a multi-country analysis to identify factors that affect intra-household food allocation and inform policy. This will be the first study on the health, mortality, and economic effects of gender inequity in diets, and will provide critical information to transform the design of national and international policy and programmes to protect women and save lives.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE
Title: Focal adhesions under force
Funder: Wellcome Trust

Abstract: Cellular development and function is influenced by the mechanical rigidity of the surrounding environment. A complex of proteins, known as focal adhesions (FAs), form a physical connection between the cytoskeleton and the extracellular matrix, transmitting and transducing mechanical stimuli. Focal adhesion kinase (FAK) is a unique player in this complex that functions as both a scaffolding and signalling protein. Furthermore, FAK can also detach from the FA and shuttle into the nucleus to modulate gene expression. Despite FAK’s physiological importance, the mechanisms that regulate its function remain poorly understood. Here I will investigate how mechanical force alters the function and localization of FAK using a combination of single-molecule and single-cell approaches. I will first test, at the single-molecule level, whether mechanical force perturbs the structure of FAK, switching it into an active conformation (Obj.1). I will then perform cellular experiments to determine whether cellular tension modulates the conformation of FAK, and if this is instrumental in converting forces into biochemical signals. I will then use a combination of single-molecule and single-cell approaches to study whether mechanical unfolding of FAK exposes key residues that can become chemically modified, leading to the translocation of FAK from the cytoplasm into the nucleus (Obj.2).

Lay abstract: The behaviour of a cell can be transformed by the rigidity of its local environment. This is mainly achieved through a specialised hub of molecules that form a highly orchestrated physical link between the cell and the surrounding matrix – the focal adhesion complex. The process of applying and sensing force is akin to a game of tug-of-war, where forces applied at one end can be easily detected at the other. An outstanding player in this molecular game, focal adhesion kinase (FAK), seems to be involved in multiple roles, including (i) sensing force, (ii) recruiting new proteins to the adhesion, (iii) triggering the disassembly of the adhesion complex, and (iv) changing gene expression. In this project, I aim to understand how FAK acts as a nanometre-sized mechanical sensor that can convert mechanical cues, such as substrate stiffness, into changes in the cell behaviour and gene expression.

Research activity codes: 1.1 NORMAL BIOLOGICAL DEVELOPMENT AND FUNCTIONING
Health categories: GENERIC HEALTH RELEVANCE
Title: Technologies of Health c. 1450-1750
Funder: Wellcome Trust

Abstract: This project investigates the production, use and impact of everyday health technologies in Britain and the global world c. 1450-1750. It explores a wide range of objects from Issac Newton's drawing of an ear trumpet to birthing chairs to patient records. Using a series of detailed case studies, it seeks to understand how technologies crucially influenced past sickness experiences, medical encounters and healthcare provisions and contemporary attitudes towards materials, skills and tools. The focus on the quotidian and, particularly, on how users adopted and modified technologies, will offer a view of medicine from the ground up, highlighting the dynamic relationship between patient and practitioner, user and maker and expert and lay. In doing so, it will revise existing narratives of early modern medical practice, answering calls to foster closer connections between histories of science, medicine and technology. Recognising the importance of colonial and commercial forces, it will also interrogate the relationship between expanding empires and ‘local’ ideas about health and the body. It will produce two main outputs - a monograph titled 'Technologies of Health in Early Modern Britain' and an edited volume of essays accompanied by a project website with a blog and a virtual exhibition of 'object studies'.

Lay abstract: 'Technologies of Health' investigates the production, use and impact of everyday health technologies in Britain and the global world c. 1450-1750. The project explores a wide range of objects from Issac Newton's drawing of an ear trumpet to birthing chairs to patient records. Using a series of richly detailed case studies, it seeks to understand how technologies crucially influenced past sickness experiences, medical encounters and healthcare provisions and contemporary attitudes towards materials, skills and tools. By focusing on everyday health-related activities and, particularly, on how users engaged with, adopted, modified technologies, this research will offer a view of medicine from the ground up, highlighting the dynamic relationship between patient and practitioner, user and maker and expert and lay. Finally, recognizing the importance of colonial and commercial forces, the project also interrogates the relationship between expanding empires and economies and ‘local’ ideas about health and the body.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE
Title: Assessing and testing health system resilience in practice: modelling routine immunisation delivery in the context of large-scale population displacement in Kenya and Lebanon using system dynamics methods
Funder: Wellcome Trust

Abstract: Maintaining a good standard of health for populations depends on having health systems that can cope as demands for healthcare change. The West African Ebola virus outbreak in 2014-16 showed that a crisis can become out of control when weak health systems are overwhelmed. Countries surrounding Syria are struggling to deliver essential health services in the face of growing refugee populations. Health systems that cope well with shocks including large inflows of refugees are said to be “resilient”, but little is known about what resilience means, how it can be assessed, and how it can be supported. The purpose of this project is to explore how health systems in two countries – Kenya and Lebanon – have responded to unprecedented strains in recent years resulting from large inflows of refugees from conflict in regional neighbours. The study will focus on childhood vaccination delivery because we know that this is one of the single most effective things health professionals can provide to protect the health of the public. The project will identify aspects of health systems that are resilient (or otherwise), and then build a mathematical model so that the effect of policy actions to improve resilience can be tested.


Research activity codes: 3.4 VACCINES
Health categories: GENERIC HEALTH RELEVANCE
Title: Mobilized, recruited, conscripted? Leveraging community health work, citizenship and public authority in northern Kenya
Funder: Wellcome Trust

Abstract: Who delivers health care, where and why? The COVID-19 pandemic has underscored stark global inequalities in answers to these questions. ‘Community participation’, an enduring pillar of interventions in the Global South, has been leveraged in response to COVID in Africa via Community Health Workers (CHWs). Key agencies who recruit Africa’s army of Community Health Workers (CHWs) have declared them to be COVID’s emerging ‘first line of defence’. This research will examine the structural factors that lead to the recruitment of CHWs and which contribute to the persistent undervaluing of CHWs’ work in Kenya. The research will innovate in its combination of discourse analysis, informed by critical/feminist/postcolonial thought, with detailed ethnographic fieldwork in Kenya's marginalized north. The research will firstly provide a critical reading of the ‘imperial remains’ within CHW recruitment practices on the part of health agencies and INGOs. The research will secondly provide a historicized reading of (gendered) narratives regarding citizenship, public service and voluntarism in postcolonial Kenya. This research will then be brought into dialogue with detailed interviews with and ethnography of/by CHWs in Isiolo, northern Kenya, with implications for CHW policy but also for rethinking the desirability and justness of one of global health’s core assumptions.

Lay abstract: Who delivers health care, where and why? The COVID-19 pandemic has underscored stark inequalities in answers to these questions. In many African contexts, voluntary work has been declared the 'first line of defence', before professional healthcare workers. Community Health Workers (CHWs), who are essentially volunteers recruited by northern-funded agencies, are undertaking expanding roles and are cited as central to achieving Universal Health Care. However, CHWs' challenging work remains undervalued due to socio-economic inequalities which have global, national and local determinants. I will scrutinize the assumptions underlying global drives to entrench CHWs in health; gendered structures of civic service and voluntarism at the national level in Kenya; and local determinants in Kenya's marginalized north. I will combine discourse analysis with ethnographic fieldwork. The research will have important implications for CHW recruitment and support but an additional profound implication as to the desirability and justness of one of global health's core assumptions.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE
Title: Fire starters - the rise of a community wellbeing movement: four decades of participatory arts, co-creation and embedded engagement in the archive of Welfare State International
Funder: Wellcome Trust

Abstract: The Welfare State International archive spans five decades and provides an unparalleled record of pioneering participatory arts practice for health and wellbeing a generation ahead of its time. This project will make available this uniquely detailed history of the evolution of community arts for wellbeing, and provide evidence and inspiration for future research and practice. We are responding to demand from a broad spectrum of social science, health and arts researchers, and practitioners, to enable exploration of WSI's innovative methodologies. Through community engagement and co-creation, WSI gave the marginalised a voice and empowered communities. They evolved from radical travelling performers, by way of intensely researched place-based and co-produced performances, to become embedded community practitioners and celebrants. Their internationally acclaimed work shifted the parameters of arts practice and policy in the UK and beyond, kindling the arts for wellbeing movement and emerging practices in social prescribing. A comprehensive archive catalogue will be produced and published online, alongside selected, co-curated digitised material responding to key research themes, increasing the resource’s usability in uncertain times. Repackaging will ensure long-term survival alongside remedial conservation for stabilisation where necessary. Audiovisual items will be preserved and digitised for access. Dissemination activities will create additional research impact.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE
Title: A good death? Interspecies entanglements and changing landscapes in end of life care.
Funder: Wellcome Trust

Abstract: Vets and doctors are both involved in managing death, but the changing ways in which the professions are involved in end of life care have not been studied together. nor has there been systematic examination of how the two professions might learn together in this field. Using cutting-edge post-human theories and inter-species empirical and ethical approaches, this project will drive forward such research. First, it builds on the small but growing literature which shows how companion animals are increasingly conceptualized as family members and can provide metaphors and models by which to discuss the care of human family members. Second, it responds to observable changes in practice by which the the end-of-life treatment of humans and non-humans animals are becoming much less distinct, for example, through the emergence of animal hospices and increasing discussion of medically assisted dying. The project examines how contemporary trends might contradict and complicate the legal and ethical basis of both overlapping and divergent clinical practices. At a time when approaches to end of life care are being redrawn, it will create opportunities for the veterinary and medical professions to learn together, through accessing shared ideals and valued differences within the negotiation of a ‘good death’.

Lay abstract: Vets and doctors are both involved in managing death, but the changing ways in which animals and humans are cared for at the end of life, and how the two professions might learn together has yet to be explored. The project will build on recent work which shows that pets are increasingly treated as family members, with veterinary care often being compared and contrasted with the medical care of humans. It also responds to changing practices across human and animal end of life care, such as the emergence of animal hospices and increasing discussion of medically assisted dying. The project examines how modern human-animal relationships might unsettle traditional differences in veterinary and human end of life care. At a time when what is expected of vets and doctors is changing, this project will create opportunities to learn together, through exploring shared goals and important differences in understanding a ‘good death’.

Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE
Title: Psychological wellbeing of health workers in low- and lower-middle income countries: A mixed-methods study of levels, determinants, and consequences for turnover and performance across twelve countries in Sub-Saharan Africa.
Funder: Wellcome Trust

Abstract: A healthy and productive health workforce is central to a well-functioning health system. However, health workers are at high risk of poor psychological wellbeing due to their particularly strenuous work demands. While a well-researched issue in high-income countries, tangible evidence from low- and lower-middle-income countries (LLMIC) is largely lacking. The few existing studies hint at poor psychological wellbeing of health workers being a substantial concern, compromising patient care in already heavily constrained health systems. Against this background, the study aims to assess psychological wellbeing of health workers and to explore determinants and consequences at the individual, organizational, and broader health system level, across twelve LLMIC in Sub-Saharan Africa. The study will employ a sequential explanatory mixed methods design. The quantitative component relies on comparable secondary data from large, quasi-representative samples, including data from structured health worker surveys, direct observations of clinical consultations and health facility management and resources, and patient interviews. Psychological wellbeing is measured with the WHO-5 Wellbeing Index. Data will be analyzed using multiple group multi-level structural equation modeling. Qualitative methods will then be employed to further explore and explain emerging quantitative results, likely using a case study approach. Key words: health workers, psychological wellbeing, Sub-Saharan Africa

Lay abstract: Health workers are at high risk of poor mental wellbeing due to their particularly strenuous work demands. This is a particular concern in heavily constrained health systems, such as in most low- and lower-middle-income countries. To date, however, little attention has been payed to this issue by research and practice. The study therefore aims to assess psychological wellbeing of health workers in twelve countries in Sub-Saharan Africa, using comparable quantitative secondary data. Using both quantitative and qualitative methods, the study further aims to understand potential reasons for poor (or good) psychological wellbeing as well as potential consequences for performance and turnover, at the individual, the organizational, and the broader health system level. The study is expected to make an important contribution to informing the development of context-appropriate strategies to ensure a healthy and productive workforce able to deliver high quality health care services to all in need.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE