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A	cau&onary	tale:		
Serendipity	and	a	career	in	research	
“We	encounter	a	
linguis0c	sage,	walk	
down	the	illustrious	
halls	of	the	Harvard	
Medical	School,	a;end	
the	(serendipitous)	
birth	of	penicillin,	and	
meet	someone	who	
"manages	serendipity"	
for	the	U.S.	Navy.”	
“the	book	.....	represents	
Merton's	lifelong	protest	
against	that	rhetoric	of	
science	that	defines	
discovery	as	anything	
other	than	a	messy	blend	
of	inspira0on,	
perspira0on,	error,	and	
happy	chance–	
i.e.	anything	other	than	
serendipity”.	
Jennie	Popay		
Professor	of	Sociology	and	Public	Health
1950’s	Salford	–	eager	
to	get	on	with	life	
Late	1960’s	:	Last	
cohort	of	unqualified	
Voluntary	Service	
Overseas	in	East		
Africa	
Mid	1960’s	:	2	years	
unskilled	work	then	
teaching	assistant	
for	6	months	
Working	in	schools	and	adult	literacy	in	
Uganda,	Kenya	and	Tanzania
1970’s:	a	tortuous	path	but	spectacular	views!	
1950’s	Salford	–	eager	
to	get	on	with	life	
Late	1960’s	:	Last	
cohort	of	unqualified	
Voluntary	Service	
Overseas	in	East		
Africa	
Mid	1960’s	:	2	years	
unskilled	work	then	
teaching	assistant	
for	6	months	
Off	to	University	in	
New	Zealand	to	go	
physical	geography	
and		geomorphology!
1970’s:	a	tortuous	path	but	spectacular	views!	
1950’s	Salford	–	eager	
to	get	on	with	life	
Late	1960’s	:	Last	
cohort	of	unqualified	
Voluntary	Service	
Overseas	in	East		
Africa	
1980s	London	moved	into	health	
18	years	fixed	term	contracts	in	
Universi&es	&	voluntary	sector	
Decades	of	opportunis&c	grant	capture		
Various	public	appointments	
Lots	of	networks	built	on	way	
Made	friends	and	enemies	
1994	Salford		set	up	research	centre	–	first	in	
NHS	then	a	tenured	post	as	professor		
2000-	01	Professor	University	of	Leeds	
2001	–	to	present	Professor	Lancaster	
Mid	1960’s	:	2	years	
unskilled	work	then	
teaching	assistant	
for	6	months
Why	the	move	to	health?		
Published	1979	 A;ended	lecture	by	Peter	Townsend	on	poverty	in	the	
United	Kingdom	on	visit	home	and	was	converted	to	
social	policy	and	a	life	0me	commitment	to	research	and	
ac0on	to	reduce	social	and	health	inequali0es
Health	inequali&es	–	not	how	much	money	you	have	
but	what	you	do	with	it?
Within countries: UK
Inequalities in life expectancy and
healthy life expectancy at birth
between more and less
disadvantaged areas of England
Women: 6 years difference in life
expectancy and 20.2 years difference in
healthy life expectancy between most and
least deprived areas
Poorest
areas
Richest
areas
Men-8 years difference in life expectancy
19 years difference in healthy life expectancy
h;p://visual.ons.gov.uk/how-long-will-
you-live-in-good-health/
Life expectancy by local authority areas in
England: 2009-13; greatest gap is 7 years for
women and 9 years for men
On average health of population
in the north is worse than that in
the south even when they are
living in the same socio-
economic circumstances
Within Country - The North South Divide
At the local level – health inequalities in Lancaster
Pattern of disadvantage
Lancaster	
Inequalities in life expectancy by area
disadvantage – 10 years shorter for
men and 9 years for women in most
disadvantaged areas
1. Practical wisdom & health inequalities	
•  individuals dominate
•  but as accumulations of risks,
vulnerabilities and resiliencies
or sets of freely chosen
behaviours
Absence of people as
‘knowing subjects’ using
practical wisdom to make decisions
that are logical
in context of their	lives
Many fault lines between lay and professional
understandings
•  Practical wisdom connects experience and behaviour with material and social
context and presents health damaging behaviour as coping strategies
•  Professionals/researchers fragment people’s experience into individual or
clusters of behaviours and/or lifestyle too often presented as ‘freely chosen’
•  Practical wisdom reflects realistic assessments of limited opportunities for
control - professionals see fatalism, low locus of control or health ‘illiteracy’
•  Lay people and professionals may share ‘values’ but interpret implications for
action differently e.g.
–  Both accept parental responsibility for child safety but professionals emphasise their
educational role, parents’ emphasise responsibility of many agencies & people
Prac&cal	wisdom	&	poli&cal	literacy
2. Questioning dominant
perspectives on health
(inequalities) and what is to be
done about it/theme
Public images of health
issues in UK
BreasTeeding	
mothers	offered	
£200	in	shop	
vouchers	
Paying	pregnant	
smokers	to	quit	in	
Glasgow	
	
Get	Paid	to	
Exercise	and	Live	a	
Healthier	Lifestyle	
–	BUPA	ini0a0ve	
Pay	children	to	
read	books	–	
Pay4Performance	
	
Obesity	crisis:	get	
paid	to	lose	
weight		
Pay	kids	to	eat		
fruits,	vegetables	
Incentives and
the rise of nudge
Better lifestyles = better health
•  Widening	socioeconomic	inequali0es	=	widening	health	inequali0es	
•  Evidence	suggests	life	expectancy	improvements	faltering	as	austerity	bites	
•  Response	–	more	about	that	in	a	moment…….		
An alternative
perspective
Enhanced	social	jus&ce	=	
be]er	health	(equity)	
An unjust and sickly Britain
Most unequal Least unequal
Income inequalities in 30 high income countries
Non-decent homes by tenure
3	Health	Inequali&es	&	Community	Control	
•  Study	of	Indigenous	suicide	in	Bri0sh	Columbia	
–  Significantly	elevated	suicide	rates	(overall	5	0mes	greater	between	1987-1992)	
–  But	not	uniformly	distributed	across	1st	Na0on	groups:		
–  So,	aboriginality	per	se	is	not	a	risk	factor.		
•  Tested	the	hypothesis	that	‘Cultural	con0nuity’	explained	differences	
	
	
• Measures	of	cultural	con0nuity	
reflected	degree	of	‘community	
control’		
•  history	and	success	of	land	claims;		
•  self	government;		
•  control	of	services;		
•  Dedicated	cultural	facili0es	
Personal	persistence,	iden0ty	development	and	suicide,	Chandler,	
Lalonde,	Sokol,	Halle;,	Monogr.Soc.Res.Child.Dev.	2003:68(2)
Evalua&ng	Experiments	in	Community	Empowerment		
	
	
	
	
		
Local Trust & Big LocalPeople’s Health Trust &
Local Conversations
Early	learning:		in	context	of	
cuts	in	pubic	services	and	
financial	crisis	in	the	NHS	
Community	and	pa0ent	
centeredness	risk	becoming	
DIY	health	and	welfare.		
The
Political
Paradox
1970’s:	a	tortuous	path	but	spectacular	views!	
1950’s	Salford	–	eager	
to	get	on	with	life	
Late	1960’s	:	Last	
cohort	of	unqualified	
Voluntary	Service	
Overseas	in	East		
Africa	
1980s	London	moved	into	health	
18	years	fixed	term	contracts	in	
Universi&es	&	voluntary	sector	
	
1990s	onwards	back	north….	
Mid	1960’s	:	2	years	
unskilled	work	then	
teaching	assistant	
for	6	months	
?	
what	
lessons	
from	
this	
career?
•  Many	surprises	along		the	way	–	but	least	likely	events	may	offer	opportuni0es	
•  Missed	opportuni0es	aren’t	a	disaster	but	formal	qualifica0ons	more	important	now	
•  Most	sectors	value	pathways	they	know	–	but	academia	may	be	par0cularly	conserva0ve	
•  Building	and	maintaining	rela0onships	over	0me	is	really	important	
•  Learning	to	deal	with	difficult	situa0ons	and	difficult	people	very	valuable		
•  Working	across	sectors	has	value:	acquiring	diverse	knowledge	and	understanding	
•  Gender	ma;ers	–combining	work	and	family	makes	a	career	more	difficult	to	maintain	
Lessons	from	my	career…….	
	
•  Leaving	things	to	serendipity	has	some	disadvantages	but	
can	be	more	exci0ng	and	rewarding	in	long	run	
•  I	may	have	followed	a	path	more	tortuous	than	most	but	
‘Happy	Chance’	creates	academic	mongrels	–	we	are	
tough	but	it	can	be	harder	to	demonstrate	worth

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