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In this series, guests from across UCL and beyond share their innovative solutions and ideas for addressing societal challenges, discussing topics from a cross-disciplinary perspective and inspiring and encouraging us to think differently about issues of local, national and global concern.
Transcript
Jade: Hello and welcome to Disruptive Voices from UCL Grand Challenges. I'm Jade Hunter, your host and the coordinator for UCL's Grand Challenge of Mental Health and Wellbeing.
In this episode we're exploring the grand challenge funded project Embodying the Social the Challenge of Urban Violence and Inequalities in the era of the Exposome. The project brings together researchers from anthropology, epidemiology, and psychiatryto examine how exposures across the life course shape the mental health of young women in urban environments.
Working within the borough of Islington in London and extending to comparative sites in Porto and Sao Paulo, the team partners with local communities and public bodies to map how lived experience of place, violence, inequality and embodiment influences wellbeing. By developing new participatory research methods that combine data with real world experience, the project aims to generate insights that can shape policies and interventions grounded in the realities of urban life.
So I'm m joined today by the project's co leads, Professor Sahra Gibbon and Rosie Mathers both from UCL Anthropology and Professor James Kirkbride from Epidemiology and Applied Clinical Research. So thank you all for joining me today.
Sahra so if we could start with you, could you give us a bit of background on the project please? So what's it all about and what do you hope to achieve?
Sahra Gibbon: Sure. Thank you Jade. yeah, so this really is a project that explores how mental health is shaped and impacted by urban living. In essence, I think it responds to a growing interest across a range of disciplines which are trying to better understand how different kinds of exposures and experiences in urban contexts interact with mental health and wellbeing. And we've been really fortunate to have been in fact first funded in our collaboration with a UCL Collaborative Social Science Award and then last year with a Grand Challenge as a mental health and Wellbeing pump priming award to explore these themes.
And I think in both cases we've had an opportunity to do something quite bold and innovative in aligning approaches from anthropology, my and Rosie's background and epidemiology, James's background to explore this question from diverse disciplinary perspectives and to try and better connect our methods and approaches in ways that might just help not only better understand urban mental health but really to combine these approaches in ways that might provide a better way to more effectively intervene and shape policy and practise.
So we've also been really fortunate that this project took place at a time when UCL developed a collaborative memorandum and understanding with Islington Council and in fact Islington Council have been our project partners in developing this work in London. so our collaboration has evolved over the last few years across these different disciplinary fields, anthropology and epidemiology, but also in dialogue with Islington Council, to focus on a particular aspect of urban mental health. So we have been focusing on women's experiences and perceptions of violence in a particular area of the borough of Islington, in fact in and around the Finsbury park area. And we know, we came to know in fact from census data, from police data, from council data that rates of violence and sexual crime against women were very high in this particular part of the borough and there are also significant rates, high rates of deprivation and inequalities.
So as you mentioned Jade, this particular focus on London is part of a wider project. and in fact the Grand Challenges funding has enabled us also to carry out comparative work in Porto and in Sao Paulo with different interdisciplinary teams. and so we're exploring these questions of urban violence and mental health in these very different urban areas in three different countries. But I'm going to primarily talk about the London work today. so focusing on our Islington work we have to date carried out 30 ethics ethnographic interviews with women who live and work in the Finsbury park area, engaging them in what we've described as walk along interviews, asking them to tell us really about the areas that they live and work in and the daily routes that they take, to go along with them on these routes, to talk to them on those routes and then to ask them to draw these routes, with mapping exercises which really reflect their kind of embodied sense of emotional, embodied sense of how it is to move in through these different areas, and their experiences of violence and safety in that area. and then we subsequently carried out photovoice work with a much smaller group of women and asked them over a period of four to six weeks to take pictures of the area that they lived in. And then these women came together to discuss these as a group and the pictures that they'd taken. So these are the ethnographic methods that we've been using. they really have produced very rich narratives, contextualised data and provided a really detailed win to how women manage risk, safety and the potential of violence in their day to day and embodied experiences. So this has been the ethnographic work, but also this has been combined with the epidemiological work undertaken by James and his team to explore from A different population level, the questions around urban mental health. So maybe it's appropriate to pass on to James to, talk a little bit more about that aspect.
James Kirkbride: Thanks, Sahra That's really, really nice introduction to the work we've been doing. And as Sahra says, I've been, chiefly looking at the epidemiological, work here by looking at bigger data sets that combine kind of routine statistics on the environment in Islington, with routine statistics on mental health need in the borough. And through that work we've been able to start trying to understand whether the themes and issues that are emerging from the ethnographic work correlate with what we're seeing when we look at this sort of bigger data, this broader data, across the region. And we found some really interesting, synergies there between the ethnographic work and the epidemiological work. We found points of departure from those two as well, where that's led us to think about what might be going on for different population groups within the borough. I'll just say a little bit more about the epidemiological work. What we tend to do is work with quite small area neighbourhoods.
So neighbourhoods are about 1,500 people, across the borough. And then we measure a range of environmental factors in those neighbourhoods, social factors, the factors around deprivation, inequality, crime, but also physical environmental factors, features of the built environment, features around noise pollution, light pollution, air pollution, crime statistics, as Sahra had mentioned as well. And we put all that data together and try and reduce the complexity of that data to, to bring out key themes, key underlying themes about the types of environments that the people in, the borough are exposed to. And then we look at whether or not those different types of environments are associated with mental health need using routine, data that's collected through different sources. But for example, routine data on the prescribing of antidepressants by GPs in the borough or, by the diagnoses of depression are made through primary care as well. So that's the kind of work we've been doing and I'm very happy to talk a little bit more about what we found, later in the podcast.
Jade: Thank you both. That's so fascinating because it sounds so rich in terms of the methods that are being used and the way they're working together across disciplines. So it'd be brilliant to sort of hear more about your findings as well as we move through. Could you explain the concept of the exposome as you use it in your project and why it matters for Understanding mental health in urban environments.
James Kirkbride: Sure. So the exposome is a concept that's sort of been around in social science, in medicine for a number of years, at least two or three decades now, if not longer, which tries to sort of draw down on the idea that the environments in which we live, the environments in which we work and socialise can be measured in some way that can provide insights into what's causing various health outcomes. And in this project we're particularly interested in mental health outcomes. the origins where the exposome came from really were an attempt to sort of give sort of scientific legitimacy to the sort of very social science construct of the role of the environment in health and to try and sort of equate how we might measure that in quite standardised and routine ways with how we might measure things like the genome, for example, in genetics and in medicine. And so it began to sort of try and bring sort of that scientific rigour and that scientific validity to routine measurement of our environment.
Of course, that is layered with complexity and it's a contested idea that we can perhaps reduce the experiential nature of living in different environments to simple numbers on a graph of for example, how urban your environment might be or how deprived it might be to equate it to something that's like a genetic measure of disease or health. So it's not universally accepted as a concept and I think that's something that we've grappled with as we've been going through the project as to whether or not through measuring the environment and reducing the environment to these kind of numbers is the right approach. And I think certainly what the kind of interplay between the ethnographic work and the epidemiological work is revealing is that it's probably not that simple and that the environments in which we spend, our lives and affect our mental health, are layered with complexity, layered with meaning, and layered with different challenges. And we can often be in an environment that has, for example, different constructs of meaning for different people or multiple meanings at the same time for the same individual. So trying to reduce that down to a simple number around deprivation or inequality is not always as straightforward as it might initially sound on paper. And Rosie, I don't know if you want to add anything from a kind of anthropological perspective on that.
Rosie Mathers: Sure, yeah. I mean, just to build on kind of what James has said, there definitely has been some pushback amongst the social sciences, on this concept of the exposome primarily with people sort of suggesting that it kind of reifies the power dynamic within the biosciences. So it suggests that biology and the kind of biological mechanisms are more important than some of the social measures which tend to act as kind of residual or confounding factors in these models. So they tend to be kind of viewed as more secondary or background factors rather than kind of name key features or interactions, kind of components.
So yeah, there is some pushback. and this idea that James was alluding to is this sort of ontologically flattening by suggesting that say, noise pollution can be measured and understood on equal par with something, say another facet of the environment which might be harmful to health. So in some ways it kind of reduces all these different and complex factors into one kind of singular measure. It does sort of remain to be seen however that, you know, the concept is being used by other researchers in innovative ways and researchers are aware of its limitations and kind of pushing against that. So we do know of other researchers and other institutions who are using the concept of the exposome to develop a more sort of life course perspective approach, or to kind of operationalise the idea of an ecological niche. So these concepts are kind of inherently more interactive, energetic and sort of intrinsically more embedded in the social world.
Jade: That's fascinating. Thank you both. So just to sort of think about the projects at the moment, Rosie, are there any kind of key impacts that you're seeing emerging from the project?
Rosie Mathers: Yeah, definitely. So as Sahra mentioned, we've been doing this project for about two years now. we've interviewed about 30 women, walking with them around the space that they live and work. And we've run these sort of different statistical models, and epidemiological analysis that James alluded to. And what we're sort of starting to see is, is that there are some associations between gendered experiences of urban violence and women's mental health outcomes. just to kind of give you a generalised summary of some of the findings that we've had is that this idea of the kind of urban atmosphere and how women feel in space has become very prevalent and come to the fore. So, the kind of constellation of different spatial dynamics, so things like sound, noise, the idea of the high intensity nature of the space that we walked around in Finsby park, so kind of some of the infrastructural challenges, the dark, busy roads, the narrow streets, noisy traffic jams, pollution, and how this creates a sort of lends itself a Kind of a feeling of uncertainty. So women felt that anything could happen in these spaces. they felt physically threatened, but also that some of these infrastructural factors kind of created opportunities for violence.
So if you think about the narrow streets, it pushes pedestrians closer together. It's more likely for things like pickpocketing or theft to occur. And also women describe these long traffic jams in these big A rows around Finsbury park that men would sit in the cars and catcall to them. So there's a kind of big interdynamic play between some of the infrastructural qualities of the environment and some of the physical, experiences and emotional experiences women are having.
Another key thing that I think has been really interesting from this work is the kind of mimetic nature of the social structural violence with women's sexual violence. So we've definitely started to see how kind of the impact of government cuts, austerity measures over the last 15 years, and kind of, political choices made by recent governments have in fact kind of mutated into a kind of everyday precariousness and violence that women experience on the streets. so some of the triggers that women mentioned were things like groups of men who were hanging around on the streets, hanging around outside Finsbury Park Station or along the Blackstock Road, rough sleepers or people engaging in antisocial behaviours. And a lot of these men, are victims of a precarious system and are victims of a kind of wider structural violence of a precarious lifestyle that has sort of become the norm over the past few years. And I think it's really interesting how the sort of precarity within, within their lives has been sort of translated into kind of gender violence that women experience on the street. And I think in realising that we've tried to kind of take away a sort of victim blame narrative and understand how all of these things kind of coalesce and interlink together.
Jade: It's really interesting to hear about how all these things kind of work together and the impact that you can kind of have at this immediate level. But then like, you're talking about kind of the political level and the impact of those broader contexts. I'd be really interested to sort of learn a little bit more about what it's been like working with your partners. So how has it been working with different disciplines and sort of working with the council too, if that's something you can comment on.
Rosie Mathers: Yeah. As Sahra mentioned, we have, we've been really lucky to work with the London Borough of Islington as part of this project which has been really generative and really exciting. We've worked in many different ways with them. So one of the initial things was we had, we ran sort of consultations with them to understand from their point of view where would be the best place in the borough to locate this research. And we all kind of collectively decided that Finsbury park was an area that had kind of high levels of need and specifically the Blackstock Road being an area that has been under kind of council, under their radar for about 20 years. So it's kind of a long standing issue in the area and we're really excited to kind of get our teeth into why that might be. we have run sort of knowledge share events with Islington Council and kind of feedback some of our findings. They also helped us in the first instance to recruit some of the participants. So we use some of their social networks. They put out call outs for us to get in touch with women and we had a quite shocking number of women reply who were really keen, really interested in being part of this project. Over 40 emails. So a really, really large volume of people who really wanted to speak to these issues. so it's been really great and I think some of the women who've been involved have really appreciated that they know that our findings will be directly fed back to the council.
We have run two knowledge exchange workshops with members of the VAWG, so the Violence Against Women and Girls team, some of the community safety teams at Islington. So we're working with them directly to relay what's been said. we're working also with Islington Faiths Forum which is a kind of affiliate organisation with LBI to run a quantitative survey for, available for all local women picking up on these themes and we've had over 500 responses so far. and some of this work is going to be used to support a bid to create an in person community safety hub for women outside Finsbury Park. So we're really excited about that. Ah, really hopeful that something really concrete and actionable can come from this work. and we've also ah, been speaking with teams from the Finsbury park nighttime economy drive. so they're kind of pushing nighttime economy within the area and they want to kind of engage with and reflect on some of our findings to see how businesses can expand in a way that is sort of socially equitable and supports women's experiences and realities in the space.
It's been really exciting, I think, for both Sahra and myself to work in an interdisciplinary team with representatives from psychiatric epidemiology. it's quite a novel approach, within our discipline to bring in kind of public health work and different methodologies. And we've had lots of conversations as teams about how we might do this. I think it takes careful work, it takes a lot of consideration and yeah, it's been really exciting part of the project.
James Kirkbride: What can I say? I mean, of course I've got my two anthropology colleagues here, it's been wonderful. could I say anything else at this point? I mean it has been great. I think, if I reflect on what this project has brought in kind of interdisciplinary terms, I think it's the broadening of my ideas and my understanding of evidence, if you like. So as an epidemiologist we're really interested in kind of quite precise measurement of hard kind of data, quantitative data to examine the differences in rates of different mental health conditions, in our case between different populations or within different parts of a population and then trying to work out what factors are different across those populations that might explain that variation in the health outcome.
So it's a very quantitative, very kind of fairly rigid scientific discipline in that respect that sort of draws down from clinical and medical kind of, research. but I'm a social epidemiologist. I'm fascinated by how the environment affect our risk of future mental health problems. And you know, we've talked earlier about how you can't reduce that down easily to a number, but yet epidemiology is still tasked with that challenge. And so it's really refreshing to work with Sahra and Rosie over the last couple years and with other others involved in the project as well from anthropology and from social science in just giving you a bit more licence to think more broadly that not everything has to be, a kind of statistical association between one thing and another thing that's proven at a certain level of statistical importance. rather we can think about the meaning behind things in a much more rich and much more detailed way that requires evidence from a much more qualitative perspective that is just as equally valid.
And so it's sort of pushing that boundary. So to give you an example, you the richness of the data that Rosie and Sahra have been able to extract from the women that they've done walk along interviews with in Finsbury park is data that we would never dream about getting as epidemiologists. It's really rich, it's really granular. But when we see that speaking to what the epidemiology signs tell us, then we really feel that that actually can strengthen our understanding of evidence. I think the violent stuff is a particularly good example for the epidemiology work we did on this project. We didn't limit ourselves to just thinking about urban violence or violent neighbourhoods. We were very broad in terms of our conceptualization of the environment, as we've talked about, from social through to environmental through to crime, whatever it might be.
But what popped out of the epidemiological data was one particular, construction, of the environment which is very, very clearly around violent neighbourhoods. And what you see in Islington is the data is quite a clear spine of higher violent neighbourhoods through the centre of Islington from south to north, which gets slightly larger towards the south. And that then was extremely highly correlated with two of our measures of depression, so antidepressant prescribing, and the prevalence of depression reported through gps. And so when you see that signal in the data that is ratified by the experiential findings and feedback from women on the walk long interviews, it kind of, I think that strengthens and accelerates our understanding of the kind of potential causal nature of how environments get under the skin, can affect our mood, can affect our need for mental health care and so on. So it's been a really valuable experience from that perspective, I would say.
And finally I'd add that interdisciplinary work just gets you out of your comfort zone. It forces you to meet in person. It forces you to meet in person for an afternoon to get together to discuss how we talk about evidence, how we think about things, how we work on the project together in a way that in our day to day academic jobs, as anthropologists or as epidemiologists, we rarely get time to because we're busy teaching or busy doing very focused research. But this breaks you out of that mould and gets you thinking in a different way. So for me that's been a real, real spark there for that.
Jade: That's brilliant. Thank you both. Really interesting to hear more about kind of how that working across disciplines kind of broaden knowledge but also how that kind of the practicality of doing that and the impact that that has as well in terms of how you're doing that in practise. And also Rosie, to hear more about the impact on communities too. And really amazing to hear more about kind of the centre that might be set up and yeah, the knowledge sharing with the council. It Sounds like there's some real real world impacts already happening from the project already. So Sahra and James, I wonder if you could say a little more about how this work relates to the UCL Grand Challenge of mental health and wellbeing and how does the collaboration between disciplines strengthen projects like this?
Sahra Gibbon: Maybe I can launch in. Yeah, I mean I think we've already heard, I think from James and Rosie that you know this kind of work is transformative in many, many senses. I think that is one of the key aims of the Grand Challenges really is to produce transformative cross disciplinary work and I think it certainly is proving to be that both across our disciplines and in the context that we're working with Islington. these are, you know the challenge of Mental health in urban spaces is not simple, it's complex. and so we need this multidisciplinary work but that's not easy. and so I think it's been really incredibly satisfying really to kind of allow this collaboration, this transformation of our thinking, the questions we ask, the way that we go about our research, to kind of you know to kind of challenge, gently challenge each other and to kind of really sort of Yeah, to kind of see that the ways that we think may be, may be changed by working together.
And I think there's been some examples already that have been discussed. But I think we should also mention this question of green spaces which from the ethnographic point of view this is. We focused on women's experiences of green spaces. and that data was really quite complex. There's a kind of an assumption in some public health and urban planning literature that access to green spaces is good for mental health. But for women this wasn't straightforward. Green space is not a straightforward space to move and live alongside and be part of it despite a desire to do so. So that's really kind of then that some shapes some of the epidemiological work that James has been undertaking as well. So that, and it was a great example of the way ethnographic work can kind of challenge some of the epidemiological framings of what green space and mental health might mean to different communities. So you know there are many, many other examples I think we could think of here about transformations in our thinking. But that's just one.
And then I think it's also been mentioned as well that you know one of the key commitments for Grand Challenges is to you know, think about transformations working with local communities and with Islington Council that has also been really, you know, incredible. Really the sort of process in which they've supported our research, the way that they have acted and been receptive to our findings and the way that they want to continue to work with us, as Rosie mentioned, you know, with Islington Face Forum inviting us to do a survey, a Triborough survey in fact, in London, and now the nighttime economy team also asking us to collaborate. So I think those elements of transformation are also incredibly satisfying.
And then finally, I just want to say about ECR involvement because I think we have as part of the funding the grand challenges funding we've had. We've run sandpit events and workshops, that have involved early career academics. And I think that's been also been incredibly valuable to kind of produce, to help sort of sustain this capacity to do this interdisciplinary work. and it's really wonderful to see how those who have been very closely involved in the project that includes Rosie, but now others as well in a wider team, how their careers are being shaped as part of this capacity building, around interdisciplinary work. so, yeah, that's my response, but maybe James has more to say.
James Kirkbride: It's a great response I think to that question and I think to the extent that the grand challenges in mental health tap into a number of important sustainable development goals the project we've got here is quite highly aligned to a lot of that. So certainly things like gender inequality, health and well being, promoting healthy urban environments and so forth are all really integral parts to the work that we're doing. particularly with respect to gender inequality here in this work we know that rates of depression are higher for women than they are for men. And as Rosie's already talked about earlier in the podcast, that women tend to, to be exposed to many, many more instances of these forms of urban violence that are clearly related to then subsequent mental health risks. So I think it speaks very well to trying to sort of chime in and help identify the problems, but then also think about where we might be able to intervene. What are the implications for Islington Borough Council for improving the quality of the urban environment for all people. but with a particular focus on reducing inequalities in mental health by gender or by other constructs.
Jade: Wonderful, thank you. So finally, how might people find out more about the work and how might they get involved?
Sahra Gibbon: so I would encourage anybody who's interested in this project to get in touch with either any of us here on the podcast, to directly make contact with us if they have questions or commentaries about the work we're doing. I also would point out that we've actually presented our work in wider UCL networks already. There are recordings of those presentations as well. We presented the work in the Urban Health Network that's led by David Osrin and Haim Yacobi. we presented on that work last year as part of another workshop. And just recently James and I presented the project at a SHS Health Mind Society interdisciplinary seminar as well which will also be available to view. so there are various kind of platforms in which some of this work is being disseminated already.
Also we have ah, follow on funding. Following the grand Challenges funding we managed to secure a Knowledge Exchange grant this year and we will through the Knowledge Exchange Grant be holding an exhibition in Islington next year in the spring or this year actually now in spring, showcasing the work we've been doing with the residents in Islington and that will be a public event. It will engage the community in Islington and also academic audiences. So we'll be disseminating that event very shortly.
And then finally we have publications that we're developing as a team that bring together some of the comparative work from the two other sites in Sao Paulo and Porto. And also reflecting on this interdisciplinary work that we've been doing that we really want to kind of use as a sort of as a tool really in which maybe other questions beyond the urban mental health paradigm might be able to be. We could be useful for those different approaches outside that field as well. yeah. And we very much hope this podcast is an entry point for others engaging and interested in this work.
Jade: Thank you. That's brilliant. Thank you all for joining me today. It's been so brilliant hearing more about this interdisciplinary project and how it can transform thinking and knowledge and the work across different disciplines and the value that that can bring. It's been especially interesting sort of hearing more about the impact that's had and the real world impact on communities too.
You've been listening to Disruptive Voices. This episode was presented by me, Jade Hunter, produced by Decibelle Creative and edited by Annabelle Buckland at Decibelle Creative. If you'd like to hear more of these fascinating discussions from Disruptive Voices, make sure you're subscribed to this podcast so you don't miss future episodes. Come and discover more online and keep up with the latest grand challenges News, events and research. Just Google UCL grand challenges.