2026-27 Project (Hargreaves & Powell-Jackson)

Improving intervention design for health equity: inequality aversion parameters and infectious diseases in Africa

SUPERVISORY TEAM

Supervisor

Professor James Hargreaves at LSHTM
Faculty of Public Health & Policy, Department of Public Health, Environments and Society
Email: james.hargreaves@lshtm.ac.uk

Co-Supervisor

Professor Tim Powell-Jackson at LSHTM
Faculty of Public Health & Policy, Department of Global Health and Development
Email: Timothy.Powell-Jackson@lshtm.ac.uk

PROJECT SUMMARY

Project Summary

Addressing health inequities is a core goal for communities, governments, NGOs and global health institutions. Designing and resourcing interventions, policies and programmes that strengthen health equity is critical. There is often an inherent tension between achieving maximum health impact and achieving health equity, because, for example, more disadvantaged populations are harder to reach and require a greater investment in supporting and enabling interventions to ensure health access. Policymakers are often aware of this tension but lack the tools and data to address distributional (i.e. equity) concerns – even when they want to. Metrics have been developed but their application is limited almost exclusively to high income settings. This project will collect, analyse and interpret data on “inequality aversion parameters” and for the first time apply these to infectious disease control programmes in Africa.

Project Key Words

Health inequalities, infections, econometrics, social epidemiology

MRC LID Themes

Translational and Implementation Research
Infectious Disease
Global Health

Skills

MRC Core Skills

Interdisciplinary skills
Quantitative skills

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

The student will develop skills in the collection, analysis, interpretation and use of data on health inequalities, and specifically will advance understanding of how to formally collect and use data on “inequality aversion parameters” in a novel context – in relation to infectious disease control interventions in African country settings.

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:

LSHTM – MSc Control of Infectious Diseases
LSHTM – MSc Epidemiology
LSHTM – MSc Health Data Science
LSHTM – MSc Health Policy, Planning & Financing
LSHTM – MSc Medical Statistics
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. At a minimum, all students must meet the institutional research degree regulations and expectations about onsite working and under this scheme they may be expected to work onsite (in-person) more frequently. 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 and training. Other travel expectations and opportunities highlighted by the supervisory team are noted below.

Day-to-day work (primary location) for the duration of this research degree project will be at: LSHTM – Bloomsbury, London

Travel requirements for this project: The student will likely visit at least one of the institutions participating in the Wellcome Discovery Award proposal cited earlier, known as the Infectious Disease Equity, or InDiE Consortium. These are in Gambia, Zambia, South Africa and Zimbabwe. We anticipate the Gambia may be the most likely, but this will be confirmed during the first year.

Eligibility/Requirements

Particular prior educational requirements for a student undertaking this project

Minimum standard institutional eligibility criteria for doctoral study at LSHTM
A background in epidemiology and/or health economics at BSc or Msc level would be desirable, as well as evidence of mathematics and/or statistical skills to A-level standard (these skills will be further developed during the PhD)

Other useful information

Potential Industrial CASE (iCASE) conversion? = No

PROJECT IN MORE DETAIL

Scientific description of this research project

Health interventions are often least deployed where there is the greatest need for them (as predicted by the “inverse care law”) and new health technologies often benefit more advantaged groups quickest (as predicted by the “inverse equity hypothesis”). There is an inherent tension between achieving maximum health impact and achieving health equity, because, for example, more disadvantaged populations are harder to reach and require a greater investment in supporting and enabling interventions to ensure health access. Policymakers are often aware of this tension but lack the tools and data to address distributional (i.e. equity) concerns – even when they want to. Distributional cost effectiveness analysis is a good example of a method that incorporates health inequality concerns into evaluation of health interventions, but has rarely been used in the context of infectious diseases in Africa. Formally incorporating equity concerns into policy and programme design requires quantification of how much a society is willing to sacrifice total health to achieve a more equitable distribution. “Inequality aversion parameters” are the metrics that have been developed for this purpose, and methods have been developed for data collection in which respondents are asked to consider the trade-offs between efficiency and equity in different resource allocation decisions. However, their application is limited almost exclusively to high income settings. Further, infections have a number of specific properties that add complexity to considerations of equitable access, for example transmission dynamics mean that interventions with one group affect the risk of others, and the profile of who is most at risk may change over time. This project will collect, analyse and interpret data on “inequality aversion parameters” and for the first time apply these to infectious disease control programmes in African settings.

Aim 1:
To review the literature on how equity concerns have been incorporated in resource allocation decisions for infectious disease programmes in African settings.

Aim 2:
To develop and implement a web-based survey to collect and analyse data from stakeholders in infectious disease control programmes in up to three settings – HIV prevention in Zimbabwe, HPV vaccination in Zambia / South Africa, and measles vaccination in the Gambia – to inform the calculation of “inequality aversion parameters” to inform policy and programme design.

Aim 3:
To apply the inequality aversion parameter estimates to a healthcare resource allocation case study (e.g. distributional cost-effectiveness, concentration index or health achievement index)

The PhD will be nested within The Infectious Disease Equity (InDiE) Consortium funded by the Wellcome Trust, which from 2026-2030 will conduct research on maximising equitable access to new infectious disease interventions for HIV, HPV, measles and cholera in Zimbabwe, Zambia, South Africa, The Gambia and other African settings. The Consortium will facilitative access and engagement with stakeholder networks in selected countries, and can provide both human and financial resources to support the promotion, implementation and dissemination of the research.

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.

Hargreaves & Powell-Jackson Recording

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