Thank you to the EASO Early Career Network for the opportunity to talk about my work! My name is Jack Birch and I am a Research Associate in the NIHR Policy Research Unit in Behavioural and Social Sciences at Newcastle University in the UK.
Health inequalities are “the systematic, avoidable, and unfair differences in health outcomes” that can be seen between different groups (such as ethnicity or gender) or across a gradient in the population (such as income). Obesity (defined as abnormal or excessive fat accumulation that may impair health), like many other diseases, is not equally distributed. Certain groups, such as those with low incomes (particularly women) or those from a minority ethnic group, are more likely to live with overweight or obesity. It is not just obesity itself where inequalities are present – illnesses associated with obesity are more likely to occur in those socioeconomically deprived areas. It is, therefore, important to consider how the interventions we use to treat or prevent obesity interact with these inequalities, so we can ensure that the interventions do not exacerbate these inequalities.
The first time I considered the impact of health inequalities in depth was during my PhD in the MRC Epidemiology Unit at the University of Cambridge. My PhD studied behavioural weight management interventions, primarily using data from randomised controlled trials in the UK. These interventions, commonly delivered via primary care and commercial organisations, are a commonly offered and accessed intervention for people living with obesity. They are generally multi-component interventions that aim to reduce an individual’s energy intake and increase physical activity by changing their behaviour. Often, they comprise of weekly sessions – in the UK, people with overweight or obesity may be given access to 12-weeks of a commercial programme (such as WW or Slimming World) through the National Health Service.
I considered whether there were inequalities in the adherence and effectiveness of these interventions by characteristics where we know health inequalities are present – such as someone’s gender or sex, ethnicity, income, or whether they are from a socioeconomically deprived area. Across four studies, I found that:
- Most trials of behavioural weight management interventions did not consider inequalities in study participation, intervention access, adherence, or effectiveness.
- Across UK-based trials, behavioural weight management interventions were less effective in minority ethnic groups – potentially exacerbating health inequalities.
- Interventions were similarly effective for men and women, despite the lesser uptake of behavioural weight management interventions by men.
- There did not appear to be evidence of inequalities in intervention effectiveness by other characteristics where inequalities occur such as occupation, income, or age.
Two of these studies have been published to date in Obesity Reviews and Obesity Facts and the remaining two studies are currently under review in public health journals.
Whilst it is important to ensure interventions for obesity are accessible and effective for all people living with obesity, my findings reinforced that more needs to be done to prevent these inequalities in the first place. This led me to adopt a broader focus beyond just considering obesity as a potentially preventable disease in my roles since completing the PhD in August 2023. Namely, I worked in a local government health determinants research collaboration, which sought to increase the use of research in local government policymaking to tackle the key determinants of health (such as housing, employment, education, and transport) to reduce health inequalities.
Recently, I began a new role as a Research Associate in the NIHR Policy Research Unit in Behavioural and Social Sciences at Newcastle University. We use behavioural and social science methods to inform government policy with high-quality evidence. I am leading a project that seeks to understand the relationship between local economic performance and health inequalities. Through detailed qualitative study, the project will explore the mechanisms that lead local economic performance – such as the availability of good quality employment and incomes – to affect someone’s health. The hope is that by considering health inequalities in this way, particularly within a relatively small local area, the evidence can influence wider national government policy around both health and economic growth.
My experiences to date have reinforced to me that there will never be a simple solution to health inequalities. Whilst in an ideal world we would prevent health inequalities from occurring, this is unlikely to be achieved. Therefore, it is important that we continue working on addressing both the causes of (health) inequality and minimising the effects of inequality once it has already occurred. This is crucial for diseases such as obesity, where people are living with a chronic disease that for some, if their life circumstances were different, could have been prevented, or its implications less severe.
If you are interested in connecting, collaborating, or finding out more, please find Jack’s contact details here: https://behscipru.nihr.ac.uk/staff/dr-jack-birch/ or @jackmbirch on X.