2025-26 Project (Harris-Fry & Powell-Jackson)

Cumulative effects of gender inequality on chronic disease and mortality risk across the life course

SUPERVISORY TEAM

Supervisor

Dr Helen Harris-Fry at LSHTM
Email: helen.harris-fry@lshtm.ac.uk

Co-Supervisor

Professor Tim Powell-Jackson at LSHTM
Email: Timothy.Powell-Jackson@lshtm.ac.uk

PROJECT SUMMARY

Project Summary

Why are South Asian women disproportionately affected by non-communicable diseases, compared to other regions? This project will answer this question by identifying gender inequalities in nutrition and healthcare over the life course, and unpacking how they interact and accumulate over the life course to cause inequalities in diabetes and cardiovascular disease in later life. The student will gain skills in advanced econometric techniques and apply these to analyse rich longitudinal data from the UK and India. This research aims to inform the development of gender-sensitive nutrition and healthcare policies to reduce inequalities and improve health outcomes in South Asia.

Project Key Words

Inequalities, chronic disease, econometrics, gender

MRC LID Themes

  1. Global Health
  2. Health Data Science

Skills

MRC Core Skills

  1. Quantitative skills
  2. Interdisciplinary skills

Skills we expect a student to develop/acquire whilst pursuing this project

The student will learn advanced econometric skills, including: 
1. The mathematical construction of dynamic, nonlinear health production functions.  
2. Knowledge of causal inference methods to identify effects of health inputs on health outcomes, using quasi-experimental techniques such as instrumental variables and control function approaches. 
3. Data management and analysis skills, with application to longitudinal datasets from the UK and India.

Routes

Which route/s are available with this project?

  • 1+4 = Yes
  • +4 = Yes

Possible Master’s programme options identified by supervisory team for 1+4 applicants:

  • City St George’s – MSc Global Health
  • LSHTM – MSc Demography & Health
  • LSHTM – MSc Epidemiology
  • LSHTM – MSc Medical Statistics
  • LSHTM – MSc Nutrition for Global Health
  • LSHTM – MSc Public Health
  • LSHTM – MSc Public Health for Global Practice

Full-time/Part-time Study

Is this project available for full-time study? Yes
Is this project available for part-time study? Yes

Location & Travel

Students funded through MRC LID are expected to work on site at their primary institution, meeting – at the minimum – the institutional research degree regulations and expectations. Students may also be required to travel for conferences (up to 3 over the duration of the studentship), and for any required training (for research degree study). Other travel expectations and opportunities highlighted by the supervisory team are noted below.

Primary location for duration of this research degree: LSHTM, London

Travel requirements for this project: None

Eligibility/Requirements

Particular prior educational requirements for a student undertaking this project

  • Minimum LSHTM institutional eligibility criteria for doctoral study.
  • MSc in epidemiology, economics, public health, nutrition, or related field, with a strong statistical background.

Other useful information

  • Potential Industrial CASE (iCASE) conversion? = No

PROJECT IN MORE DETAIL

Scientific description of this research project

There is far higher excess female mortality in India than in other parts of the world, leading to unequal sex ratios and an estimated 43 million so-called “missing women”. While part of this inequality arises in early life, around 45% of these excess deaths occur in women aged over 45 years, and are predominantly caused by nutrition-related chronic diseases like diabetes and cardiovascular disease.    

Why do so many more women die from chronic diseases in South Asia, than in other parts of the world? There could be a purely genetic explanation, with ethnicity and gender interacting to affect South Asian women more than any other demographic group. Another plausible explanation is that, unlike other contexts, older women in South Asia receive lower quality health inputs than men, meaning that they have poorer nutrition and access to healthcare. An alternative explanation, based on the “developmental origins” hypothesis, is that of gender inequality in early life. Girls may have received poorer nutrition and access to care in early childhood, which predisposes them to chronic disease in later life.    

Project objectives 
This project will: 
1. Identify gender inequality in nutrition, healthcare, and non-communicable disease across the life course, in a comparative analysis of South Asia and the rest of the world.  
2. Locate which types of inequality contribute most to gender inequalities in chronic disease, and when these inequalities emerge.  
3. Isolate what portion of inequality can be explained by genetic factors, as compared to sociocultural and economic factors.   

Techniques to be used 
The techniques will use a combination of descriptive statistics and advanced econometrics. 
1. Use descriptive statistics to conduct a global comparative analysis of gender inequalities in health inputs and outcomes. 
2. Use advanced econometric methods to develop gender-specific and dynamic health production functions for diabetes and cardiovascular disease, to identify how health inputs combine to affect health across the life course in India and South Asian populations in the UK.  
3. Use mathematical modelling to quantify the extent to which gender inequalities at different life stages could explain the number of “missing women” in India.   

Confirmed availability of required databases or specialist materials 
Databases and software to be used are all accessible to researchers: 
1. Demographic and Health Survey datasets, publicly available. 
2. APCAS (Andhra Pradesh Children and Parent Study) – an intergenerational cohort study in southern India that began in 2004 with long-term follow-up of children of the Hyderabad Nutrition Trial (1987-1990). Data can be requested by completing a collaborator form. 
3. UK Biobank data, containing extensive UK Biobank environmental, lifestyle, and genetic data on half a million participants. Data are available by completing an application form.  
4. R or Stata statistical software, the former is open source and free.   

Potential risks to the project and plans for mitigation 
– This is a low-risk study due to the availability of data and lack of primary research involved.  
– The analyses require advanced econometric and statistical skills, so the student will require training and skill development.

Further reading

Relevant preprints and/or open access articles:
(DOI = Digital Object Identifier)

Additional information from the supervisory team

The supervisory team has provided a recording for prospective applicants who are interested in their project. This recording should be watched before any discussions begin with the supervisory team.

Harris-Fry & Powell-Jackson recording

MRC LID LINKS

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