Paul Bissell is currently professor of public health and director of the public health section and a member of the senior management team in the School of Health and Related Research (ScHARR) at the University of Sheffield, UK. Bissell has a degree in sociology and politics, a master’s degree in applied social research and a PhD in medical sociology. He is an active member of the British Sociological Association.
Besides his contributions for public health, Bissell manages a programme of research around weight management and obesity for the NIHR CLAHRC (the National Institute for Health Research — Collaboration for Leadership in Applied Health Research and Care) for South Yorkshire. His research interests focus on health inequalities, the social gradient in obesity and various aspects of food practices. He has published over 100 articles in peer-reviewed journals within the social science and public health.
Padam Simkhada is a senior lecturer in international health and director of ScHARR Internationalisation Committee at the University of Sheffield. Simkhada joined the university in June 2010. His researches revolve around public health problems in developing countries covering topics like reproductive and sexual health, maternal and child health, migration and sex trafficking, health promotion in middle and low income countries, and research methodology.
Before moving on to Sheffield, Simkhada was a programme coordinator and lecturer in international health at the University of Aberdeen, UK.
After delivering a number of successful projects in recent years, Simkhada is currently working on a project directing towards community based health promotion intervention in Nepal being funded by Green Tara Trust in London. He was recently awarded the CEA Award of Global Health Research for his contribution to the field of global research at a ceremony held at the Mahatma Gandhi University, Kottayam, Kerala.
Paul Bissell and Padam Simkhada recently visited leading health institutes of India to strengthen the bonds that their university has with Indian institutes. In an exclusive conversation with India Medical Times, they discussed about the ties that the University of Sheffield has with Indian institutes, their main research areas in varied fields of health and the current global scenario of health and research.
Tell us about the purpose of visit to India and the tie-ups with the Indian universities?
University of Sheffield is one of the oldest universities and running a number of undergraduate and postgraduate programmes since its beginning and it has a very old medical school. If you look at the overall university we offer over hundred postgraduate programmes and research degree programmes and over five hundred undergraduate programmes. We both are from the Faculty of Medicine, Dentistry and Health and under this faculty we have different schools. We both are from ScHARR (School of Health and Related Research).
The basic underlying philosophy of our higher education is to improve the people’s lives ultimately. And our teaching is not just teaching, its more research based teaching, that’s a key component. All the faculty that teaches our undergraduate or postgraduate programmes are research active faculties. They research and share their research experience in the teaching and not only the textbook teaching. Within the Health, we offer the Master of Public Health under the school and the students can specialize in a number of areas.
We came here to work mainly with the Public Health Foundation of India (PHFI) and the Tata Institute of Social Sciences (TISS) and other major quality medical institutions, in order to grow in this region to disseminate the research to high quality institutions. That’s the way we would like to make a difference. The purpose is both developing our research as well as developing our teaching by linking with Indian institutions.
We attended an international conference on ‘Inequity in Maternal and Child Health’ organized by the Indian Institute of Public Health (IIPH) in Gandhinagar. The meeting was one of its first kinds to bring together social scientists, NGOs, gynaecologists and experts working for maternal health. We discussed wide-ranging issues from child and women health to execution of policies in different countries.
Please highlight the course in Public Health at the University?
ScHARR brings together a wide range of health related skills including inter alia: health economics, operational research, management sciences, epidemiology, medical statistics, and information science. There are also clinical skills in general practice and primary care, psychiatry, rehabilitation and public health. Public Health is one of the main strengths of postgraduate teaching in School of Health and Research where we both work.
We also have postgraduate courses in Health Economics and Decision Modelling, which help our policy makers make decisions. So, we have real strength in Health Economics and we also offer clinical research degrees. So, one could specialize in Health Management, Health Research or one could opt for Masters in Public Health, which gives you different optional core modules. We used to have Masters in Public Heath in International Development to look into development issues. And alongside we also offer PhD programmes.
What is your approach for the programmes?
We have mainly different modes of teaching. We have students from 150 countries. They come to University of Sheffield to study and during their study period they could go back to the home country or some other country to get experience or research exposure. This is one type of course and we have another type of method for PhD programmes wherein students spend some time in the university and rest of the time at the place of their choice. We also have remote location or distance learning courses as well. For distance learning in postgraduate courses we provide all the support from the university using IT.
We also run Massive Open Online Courses (MOOC) on health inequalities, sustainable diets, nutrition and also on health technology assessment that School of Health and Related Research is running. The advantage of MOOC is that it is free and is a really good way to disseminate knowledge. We have a lot of responsibility as a university as some people cannot come to the university so we provide it for free. People from Asia, Africa and Europe etc can get same set of knowledge that students who go to the university get via MOOC.
How has been the response of Indian students for the courses?
There are challenges that we have to overcome but Sheffield is already a very popular place for students from this region. We have a number of students in Master of Public Health from India. The challenges like study visa can be overcome but then the number of students from India is still large like 300 students or so. One of the problems that I have observed with the students coming from this region to the university is that they have relied on textbook based learning. I would like to suggest the teaching approach should be changed and stress should be on effective learning. Lot of doctors that come for practice from this region face major communication skills problem. This is not the priority in this education system. Communication skills should be made a part of the curriculum.
How do you ensure exposure to the students?
We have placement spaces available for postgraduate students in Master of Public Health programme and we are seeking to develop plans to place the students all over in UK and also possibly overseas as well. We have memorandum of understanding (MoU) with over 15 institutions from America, Asia, Africa etc. We are closely working with Datta Meghe Institute of Medical Sciences (Deemed University), Nagpur. We have collaboration with Pune University and recently we developed good relations with Tata Institute of Social Sciences, Mumbai. We had a very useful conference with Indian Institute of Public Health in Gujarat. These are some of the institutions from India with which we are working together. Since the institutions with which we are working are independent universities so they are very welcoming. We are planning to increase our reach with the institutions in India. We were really impressed with the Public Health Foundation of India and got a grasp of public health problems that are in India and discussed how they can learn from us from what happens in UK. Similarly, how we can learn from them in setting up public health infrastructure and surveillance systems. So, we were really impressed with how they were thinking about public health.
What are your main areas of research?
Paul Bissell: My main interest is on health inequalities, why the health of the poor differs from the health of the rich and what we can do to address that. We also have a research programme running at the university on obesity. How you can manage that, what kind of interventions and strategies are needed particular in public health sphere to address that. Although obesity is at low levels here, but in the next 10-15 years it is likely to become a major health issue as income of the nation rises. Besides, I am also working on a project on human trafficking.
As social inequalities are likely to drive health inequalities, so an unequal society is likely to experience more health problems. In the Indian context, this reflection is useful to address the public health system.
Padam Simkhada: Most of my research is related to one way or another to migration and sex trafficking. Thousands of girls from Nepal and Bangladesh are trafficked to India for sex work in brothels. So, we are looking at how can we provide the evidence for the policymakers and what is the understanding about the health, how can we protect their health? So, most of it centres on topics like reproductive and sexual health.
My other research area is maternal health, HIV AIDS, new sexual culture that is developing among young people, how the globalization has affected the young people in this region.
Lot of our research is based on understanding of the problem and it has some good impact on changing the policy. For example, as an impact of our study the Nepal government is going to revise the curriculum for doctors’ and nurses’ education. I was also actively involved in both the advocacy and research to introduce sex education in textbooks of Nepal. With the help of UNICEF we managed to do it.
What are the major global challenges in Public Health?
Inequality, diabetes, cardiovascular diseases, accidents, infant mortality are major challenges. Non-communicable and chronic diseases are scaling up. If you look at the numbers chronic and non-communicable diseases is much higher in poor countries too. Somewhere problems are at the policy-making level and implementation. We need the welfare state system with a universal coverage of healthcare — the extent with which inequality is driving with the development.
In India, one is happy to buy and plant equipments which cost in lakhs or crores (of rupees) but they forget that lot of lives can be saved and diseases prevented at the initial level by distributing paracetamol and oral dehydration. Change in approach is what is required. Health and education is people’s right and it is a state responsibility. Privatization of healthcare can work better as long as State decides how it wants to privatize services and play an active role in that and does not just leave it for private players to decide. Private infrastructure should be used as public delivery system by the government to ensure health coverage by taking responsibility of the cost of healthcare. In India, government does have control over private system but does not have a grip and ultimately only those who can afford it go there.
Your message to the readers?
Our message is two-fold. Public health and health research is one area where the University of Sheffield would like to develop links with Indian institutions. Both the countries can share knowledge and expertise.
Another is, if we really want to improve the health standard of this country, we have to tackle the health problems of the bottom 20 per cent poorest of the poor people then the statistics will greatly improve, a lot of things will improve. Very simple interventions can change millions of lives in the country. There should not be any superiority or inferiority complex in terms of health intervention; we need to minimize the hierarchy and focus on the public health intervention. We need to solve the environmental problems, road traffic problems. Gender inequality needs to be addressed as well; violence against women is a public health issue not only in India but in developed countries as well. Women victims of domestic violence are 50 times more likely to get HIV/AIDS. So, the mental well-being of women should be treated as a public health issue.
by Vidhi Rathee