‘Knowing me, Knowing you’

 By Mark Green

I have just joined the department to take up a Lectureship in Health Geography here at the University of Liverpool.

Mark Green

Mark himself!

My research interests lie in two interconnected areas. Firstly, I am interested in how body weight and physical activity vary within the UK population, as well as their association to various health outcomes. Secondly, I am interested in examining how neighbourhoods influence health outcomes and behaviours. I also have a broad interest in social inequalities in health and in understanding the processes through which they persist.

I joined the department having previously been based at ScHARR (School of Health and Related Research, University of Sheffield), where I was a Research Associate in Public Health (2013-2015). I was attached to two large research projects during this post:

  • The Yorkshire Health Study: A survey of residents of Yorkshire collected every three years which began in 2010-2012. The aim of the survey is to better understand the health needs of the population of Yorkshire, as well as investigate the associations between a variety of personal, social and behavioural factors to long term health conditions. The study was funded by the NIHR CLAHRC for Yorkshire and the Humber.
  • An analysis of the associations between the density of different types of shops which sell alcohol and alcohol-related admissions to hospitals at a small geographical scale (2002/03 to 2013/14). The study was funded by Alcohol Research UK.

Mark is involved in the Global Burden of Disease study, which estimates worldwide trends in health. This figure is of the prevalence of overweight and obesity (source: Ng et al., 2014, Lancet, 384: 766–81).

Despite having a Public Health background, I am a Geographer by trade. I completed my PhD in Geography at the University of Sheffield (2010-2013), entitled ‘Death in England and Wales: Using a classificatory approach for researching mortality’ (supervised by Dr Daniel Vickers and Prof. Danny Dorling). My PhD explored the clustering of mortality patterns at a small scale for England and Wales through the creation of an area classification. I also have a MSc and BA(Hons) in geographical-related disciplines both from the University of Sheffield.


Mark’s PhD created an area classification of mortality patterns for England and Wales. Of course, as a geographer he loves maps! (Source: Green et al., 2014, Health & Place, 30, 196-204).

A list of my publications can be found here. If you have any questions or fancy a chat, feel free to pop by my office (Room 602c in the Roxby Building), or email me.

New Paper – Low immigrant mortality in England and Wales: a data artefact?

Guest Post by Matthew Wallace


Last week, I published a paper in Social Science & Medicine examining mortality among the major immigrant groups in England and Wales over a thirty year period from 1971 to 2001. While recent national media focus has fixated firmly on the fiscal cost of ‘health tourism’ – Migrants to face emergency NHS charges” (BBC), End of free NHS care for migrants under new bill” (Telegraph), Tough rules to stop health tourists” (Daily Mail) – there has been little focus on the health of immigrants who actually live in England and Wales. The health and mortality of these groups is of substantial interest to policy-makers. Evidence suggests inequalities in health by ethnicity and country of birth, but there has been insufficient consideration of the importance of country of origin and length of residence in the United Kingdom.

In short, results from the paper show low mortality (compared to non-migrants in England and Wales) for individuals from India, Pakistan, Bangladesh, Western Europe, China and group Other Asia. Analysis also shows that this low mortality begins converging to native levels over time – though low mortality persists for some groups at old ages. As to why we see these patterns, low mortality among first-generation immigrants provides evidence of a ‘healthy migrant effect’ whereby individuals initially ‘select’ for good health and the personality traits often associated with a successful migration (ambition, social adeptness and risk-resilience). This good health and low mortality then wears off over time as individuals ‘acculturate’ or adopt the unfavourable habits and behaviours of the host society.

There are of course many additional dimensions to the research which I do not cover here. If you would like to read the discussion in full, the paper is available online through journal Social Science & Medicine or alternatively, at: https://www.researchgate.net/profile/Matthew_Wallace3. If there is anything you would like to discuss, please feel free to email me at m.wallace@liverpool.ac.uk. The paper was co-authored with Dr Hill Kulu; the research was supported by the Economic and Social Research Council [ES/J500094/1] with permission from the Office for National Statistics. The next step of my research is to study the mortality of second generation migrants in England and Wales. Previous research suggests that this group do not share the low mortality of their parents and may actually have a higher mortality risk than natives.

A Northern Girl in the Deep South: Dissertation research in Mississippi

Welcome to Mississippi

Welcome to Mississippi

Post by Lydia Michie – 3rd year BA Geography student

After studying Population and Societies in my second year, alongside some sociology modules, I developed an interest in the changing trends in relationships and in particular the changes surrounding the sexual relationships of today’s younger generations. After watching a documentary on The Silver Ring Thing (a religiously based youth organisation that advocates abstinence amongst teens) in a sociology lecture, I began to wonder about the various ways in which society (and religion) are reacting to these changes in sexual attitudes. A simple google search about abstinence and teen sex brought up masses of media talking about the problems in Mississippi. As a travel addict, I decided that this would be an interesting way of combining my love of my degree with my love of travel and set about planning my final year dissertation research abroad and in June this year I headed out for a three month trip across the USA, stopping in Mississippi for a month mid-way.

Skeet shooting like a true American

Skeet shooting like a true American

Telling people on the East coast of the US that I was travelling down to Mississippi to do research into Abstinence and Sex Education was usually met with either one of three reactions; a wince of pity, a polite warning that I’ll “hate it down there” or simply a snort of laughter. Suffice to say, after a month of this I had become pretty wary of what to expect when I finally got there.

View on my journey through the South

View on my journey through the South

After a mammoth 34 hour hellish train journey from Washington D.C to Mississippi I was too tired to even think about what the following month was about to bring me. The following morning, when I woke up in my little closet that had been converted into a temporary bedroom (perhaps they thought all English people lived like Harry Potter), it soon became clear that this place was going to surprise me. Much in contrast to the ‘hillbilly’, ‘redneck’, ‘uneducated’ stereotype that had clouded my judgement of the South whilst on the East coast, I found myself surrounded by books on feminism and sociology, a sort of miniature Human Geographer’s library. Proudly hanging on the porch above the front door was the Gay Pride rainbow flag (a sight I had not imagined I would see in such a conservative and right wing state) and I was both relieved and admittedly a little shocked to find my new home to be filled with “a bunch of liberals”; a male feminist, a gay black man and an artist. Straight away I knew I had found myself somewhere unlike any other place I’ve experienced.

My Mississippi family: my housemates on the porch

My Mississippi family: my housemates on the porch

Despite being a big city, it didn’t take long for word to spread that there was an English girl in town and people were intrigued as to why a Brit would want to be there. The minute I mentioned my research project, I was bombarded with opinions and offers to be interviewed. The ball was in motion and I knew straight away that I wasn’t going to get the results I had anticipated.

Rural Mississippi

Rural Mississippi

Mississippi has the strictest abstinence policies in its high schools meaning that Mississippi teens are being taught next to nothing about sexual health and relationships other than to wait until they are “ready” or married. Sexual health services are sparse to say the least, or at least much more hidden than would be the case in other states and the stigma surrounding such services is often so negative that it may unfortunately put people off going. Despite the push for abstinence-based education and the flaws in the state’s offering of sexual health, Mississippi has some of the highest teen pregnancy and STI transmission rates in the USA, making it one of the worst in the Developed World. When looking at the economic and religious background of the state the trends would seem to show an obvious reasoning for the local Government’s sexual education choices but I wanted to explore this further and to see if there were any other factors aside from or running parallel to “The Bible Belt factor” that caused people to be in support of such policies.

A 'typical' Southern Home

A ‘typical’ Southern Home

Although finding interviewees proved quite easy, finding a means to interview them proved slightly more difficult. With no public transport, taxis or driving licence, I was reliant upon the generosity of the locals to ferry me about the city (an experience that certainly proved that Mississippi’s reputation as ‘The Hospitality State’ was nothing short of the truth). With each interview came new questions, new answers, new surprises and new perspectives. I found myself becoming more and more passionate about the subject and it was refreshing to find that, once they got going, my interviewees shared that passion. Although I think a lot of people are aware of the debate and have strong opinions, it doesn’t seem to be a regular topic of discussion and people jumped at the chance to vent some of their frustrations or to argue their point of view. One interviewee even said it was “like a therapy session”.

Leaving Mississippi

Leaving Mississippi

Although I’ll save the results for the actual dissertation, it’s safe to say my 7 hours’ worth of interviews, although having left me exhausted,  have also opened my mind to many factors that I could never have understood without actually travelling there and experiencing that Southern lifestyle. Although it can be expensive and stressful, I couldn’t be happier to have chosen to do my research abroad and I would recommend anyone who is debating giving it a go to just do it! If you take yourself out of your comfort zone you’ll be pleasantly surprised by how much it can teach you. But be prepared to never want to leave! I got some interesting results and along the way saw some beautiful places and made some beautiful friends. Mississippi and what I saw of the rest of the South is such a hard place to describe. It is one huge, humid, beautiful but messed-up contradiction of a state but that’s all part of its charm. It’s everything you might expect from the South but at the same time, it’s nothing like you’d imagine!

QWeCI Final Project Meeting – Barcelona

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Post by Andrew McCaldon

I am the Project Secretary for the EU–funded, QWeCI Project: Quantifying Weather and Quantifying Weather and Climate Impacts on Health in Developing Countries. The project is coordinated by Professor Andy Morse of the Department of Geography and Planning, School of Environmental Sciences, University of Liverpool.

QWeCI held its final annual project meeting in Barcelona, Spain, from 16th–18th May 2013 and over 40 academics and researchers were in attendance. Speakers from across the 13 participating European and African institutions presented papers covering, not only the progress of the individual work packages, but the cutting–edge science that QWeCI had produced.

In addition, the project was glad to welcome a distinguished team of external reviewers including: Jan Polcher from the Catalan Institute of Climate Sciences; Laragh Larsen from Trinity College, Dublin; the University of Burgundy’s Nadège Martiny; and Nick Ogden of the Public Health Agency of Canada.

Dr Larsen said, “I really enjoyed hearing more about QWeCI project” and Dr Ogden said, it is clear the “project has been well–managed” and the “highly qualified personnel will be a legacy of the QweCI Project”.

The meeting was a great success and an excellent opportunity to showcase the world leading science QWeCI has produced.

Science presentations can be found here and the conference programme can be downloaded here.

In the QWeCI Project, researchers across 13 European and African research institutions work together to integrate data from climate modelling and disease forecasting systems to predict the likelihood of an epidemic up to six months in advance.  The research, funded by the European Commission Seventh Framework programme, focuses on climate and disease in Senegal, Ghana and Malawi and aims to give decision–makers the necessary time to deploy intervention methods to help prevent large scale spread of diseases such as Rift Valley fever and malaria.

More information on the QWeCI Project can be found here and you can follow us on Twitter: @QWeCI_FP7

ESRC Funding Success- A Spatial Microsimulation Model of Co-Morbidity

Health care policy

Dr. Karyn Morrissey of The Department of Geography and Planning, in conjunction with the East Kent Hospital Trust, has just been awarded £200,000 from the Economic and Social Research Council (ESRC) Secondary Data Analysis Initiative, Award to to develop a spatial microsimulation of co-morbidity for the East Kent region.

Informed health care policy requires spatially detailed data on health outcomes and patterns of health service utilisation. Health differentials across space arise due to the clustering of individuals who share similar demographic profiles and lifestyle choices into areas where similar contextual characteristics come into play, for example, area-based effects related to low levels of health service provision. To establish the key determinants of health status at both the individual and small area level a large variety of spatially referenced demographic, socio-economic and health data is required at the individual level. Although there are a number of national datasets that contain detailed health and health usage data, these data tend to be aspatial or at too high a spatial resolution to permit health data analysis at the required local level. One solution to this problem that has emerged in the last two decades is the growing use of spatial microsimulation models to represent and simulate health processes at the individual and small area level. Drawing on the experience my experience developing health microsimulation models and with the help of Paul Williamson and Alex Singleton this project seeks to develop a spatial microsimulation for England to meet the information needs of health policymakers and practitioners. Collaboration with the Director of Information in East Kent Hospital Trust has identified the increased rates of patients presenting with two or more diseases (co-morbidity) as a pressing issue, of direct policy relevance, that requires detailed spatial analysis. Co-morbidity is associated with a significant decline in both life expectancy and quality of life and increased costs in the provisioning of health services for individuals. The World Health Organisation has identified increased rates of co-morbidity as a major challenge for health policy. Utilising data holdings made available to academics via the ESRC-supplied data services, this project will develop a spatial microsimulation model of co-morbidity for England. The project, In collaboration with EKHT, will specifically examine rates  of co-morbidity for the East Kent region.

Latest QWeCI Project Newsletter now available

Post by Andrew McCaldon

I am the project secretary and Dr. Andy Morse is the coordinator of the QWeCI Project – Quantifying Weather and Climate Impacts on Health in Developing Countries.

In this project, researchers across 13 European and African research institutions work together to integrate data from climate modelling and disease forecasting systems to predict the likelihood of an epidemic up to six months in advance.  The research, funded by the European Commission Seventh Framework programme, focuses on climate and disease in Senegal, Ghana and Malawi and aims to give decision–makers the necessary time to deploy intervention methods to help prevent large scale spread of diseases such as Rift Valley Fever and malaria.

Read about the recent activity in the latest QweCI Project newsletter, which can be downloaded here, and more information can be found here.

Depression in Ireland and a visit home – a tale of proximity


Quay Street, Galway

Post by Dr Karyn Morrissey

For the last three days (28th-30th of August ), I have been at the 41st British-Irish Regional Science Association Conference, hosted at the National University of Ireland, Galway. Hailing from Galway, I was doubly excited to present my findings at such an important conference and have my Mom and Dad pander to my every need for a few days!

The paper I presented reported on my research on admissions to acute psychiatric hospitals for depression in Ireland.  Ireland has traditionally reported high levels of mental illness and admissions to acute psychiatric hospitals. Indeed, at the turn of the 20th Century, 1% of 15 to 35 year old males were housed in a mental ‘asylum’ in Ireland. These high rates of reported psychiatric illness are what prompted my research.

My research sought to determine the factors which differentiate individuals with depression who seek acute psychiatric services from those who do not seek these services. Using spatial microsimulation techniques my research found that within my sample of individuals with depression, females, older individuals, those with higher education and interestingly those closer to a psychiatric hospital were more likely to be admitted to an acute psychiatric hospital. This would indicate that access to psychiatric services is a determinate in whether individuals seek acute help. Such a finding is interesting for two reasons – it may demonstrate that individuals without services are experiencing a service gap, but it may also indicate that living closer to an acute service leads to over utilisation and over-referral. So Geography matters in this relationship.

Thus, whilst happy that my research shows an interesting relationship between proximity to acute care and the uptake of these services – this research also shows that there is a lot more work to be done to understand these differences in access to psychiatric care and to address inequalities here.

So it’s back to the drawing board…and back to the internet to look for my next conference in Galway!