There is substantial evidence linking non-communicable diseases (NCDs, e.g. respiratory illness, cardiovascular disease, diabetes, mental disorder, cancer) to: the quality of urban environments (e.g. air pollution, noise, lack of green space); socio-economic inequalities; and global environmental degradation. While there has been a great deal of effort looking into mid and down- stream causes of these unhealthy outcomes, interventions in these areas have not resulted in the levels of change to health outcomes as was hoped. As such, there is a push towards investigating upstream, where the broader, macro-level root causes, such as networks of relationships between powerful actors, can be better understood. This shift to upstream is described as part of a ‘fifth wave of public health’ where key problems and solutions are to be found in domains such as systems of governance, international finance, and legislative processes.
The aim of this PhD will be to develop a sufficiently deep understanding of power and interventions, so as design and test interventions that help to make power structures within the system explicit, and to influence these structures to shape decision-making in ways that improve downstream health outcomes. Our perspective on power comes from more recent attempts to recognize the many faces of power, such as a ‘family resemblance’ concept (Haugaard, 2010), where each conceptualisation is seen as a part of the puzzle in understanding how and why power is created, maintained, destroyed, utilized, withheld, and the outcomes this has for how people interact and structures work. Investigating the many ways in which power is understood (e.g. systemic/ episodic, dimensional (Lukes, 2005), power over/to), and taking a rather more critical view of mainstream power studies (Tong, 2014; Willmott, 2013), this work will be combined with a deeper understanding of interventions.
Interventions to promote behaviour change can be divided into two categories (Steg and Vlek 2009). Informational strategies are aimed at changing behaviour through knowledge, awareness, social norms, and attitudes (such as information campaigns to raise awareness about recycling). Structural strategies are aimed at changing the circumstances in which behavioural decisions are made (such as the provision of recycling facilities). Thus, power dynamics and how these are perceived by actors might differ depending on the specific informational and structural strategy that is in operation within their particular context.