Lester, Sarah;
(2025)
Becoming research-active in the social determinants of health:
a study of intelligent accountability in local government.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
The Health and Social Care Act (2012) returned responsibility for public health from the NHS back to local authorities. While the restructures increased potential for intersectoral, evidence-informed decision-making on the social determinants of health, studies from the last decade suggest academic research is neither being created nor used to optimal effect to bring about sustained policy action in this area. Since 2020 the National Institute for Health and Care Research (NIHR) has funded initiatives to address the disjuncture between academic research and local decision-makers’ needs by bringing the producers and users of public health research into closer proximity with each other. While collaborative initiatives to promote research-active cultures in local authorities are increasingly common, little is known about how their aims are conceptualised, or how they are realised in practice. To develop understanding of how local authorities are responding to attempts to build up research-active cultures to inform decisions on the social determinants of health I undertook two studies. First, I conducted 19 interviews with public health leaders and their close collaborators to evaluate how protected research time reshaped systems across geographically diverse local authorities in England. Second, I conducted an ethnographic study in one local authority to follow the interactions and work practices of key actors involved in the early stages of establishing a five-year funding award to embed research infrastructure to address health inequalities. Findings suggest that establishing research-active cultures requires knowledge practices and ‘soft’ skills - including humility and dynamic multilingualism - which are responsive to differing values across organisational borders. Leaders incentivised actors to confront shortcomings of current practice through continuous shared learning in safe-to-fail environments. Motivated by concern for dwindling organisational legitimacy, actors laid foundations for institutional wisdom which adhered to principles of ‘intelligent’ accountability, which is reflexive, compassionate and affords space for uncertainty and complexity.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Becoming research-active in the social determinants of health: a study of intelligent accountability in local government |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2025. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Education UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education > IOE - Social Research Institute |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10211631 |
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