Scientists based in the US, Emily C. Dore and Michal Horný, delivered a lecture within the MUNI Seminar Series on 10 April. Its main topic was population health and health equity from the perspective of a sociologist and an economist. In this interview, they tell us what their respective fields have in common, compare Czech and US healthcare systems and open up about the work-life balance at US universities.
Was the lecture at Masaryk University your first together?
ED: Yes, it was! Michal had given a guest lecture in my class before, but this was the first time we had discussed our research within the same talk. We had only vaguely thought our research was related before, but this gave us a chance to think through the similarities and differences in a way we hadn’t before. Plus, it was just fun to have this experience of doing a public lecture in this type of setting for the first time together. We really enjoyed it!
How are your research interests related?
ED & MH: We frequently discuss our research with each other, mostly asking “does this make sense” either theoretically or methodologically. We also do a lot of copyediting for each other, so it’s been very helpful for our careers to be so well aligned. Our research interests overlap in the sense that they are both health related, but more narrowly, the overlaps are less obvious. In one way it’s nice, because we can get an “outsider” perspective for our work and step outside the echo chamber a bit. However, especially during COVID when we spent so much of the working day together, we had thrown around the idea of working on a project together. We have some ideas for papers that we could write together, and this public lecture really helped clarify how our research overlaps.
For example, we both are thinking about health equity, but we approach it from different angles. Michal studies the health care system and is dedicated to figuring out how to ensure better access to health care through decreasing financial barriers to care, which, of course, is important for everyone, but especially important for people with fewer financial resources. Emily studies social determinants of health and social and economic policy solutions that would decrease health disparities along the lines of class, gender, and race/ethnicity. So, there is overlap in terms of a goal, but we approach the solution to these problems differently. We’d like to think both approaches (as well as others) are needed to solve the problem of health equity.
What differences and similarities do you see between sociology and economics?
ED: Sociology and Economics are both pretty broad fields, and there can be a lot of overlap in interests between the two. For example, poverty is a very popular topic for both Sociologists and Economists. While both fields use theory to drive our hypotheses, sociological theory is driven by the consideration of social and historical context in understanding societal and individual outcomes. From what I understand, economic theories may be more focused on market forces or rationality, whereas sociological theories examine systemic forces unexplained by rationality like discrimination. However, nowadays I’m sure there are exceptions to this very broad generalization!
MH: There is a good amount of overlap between Sociology and Economics. Both are social sciences, and many social phenomena can be investigated by scientists in either field. As Emily mentioned, Sociology has a comparative advantage in incorporating theory and broader contexts, while Economics is strong in using rigorous study designs and quantitative methods for causal inference. In any case, both approaches are needed to fully understand various social problems and design effective policy responses with a minimum of unintended side-effects.
Is public health and healthcare stronger in Czechia or in the USA?
ED: I think most public health researchers would argue that public health and health care are stronger in Europe than in the US. One reason for this argument is that the US spends so much more money than European countries on health care but have worse health outcomes for many of the most important health indicators like life expectancy and infant mortality. As researchers who work on increasing access to health-promoting resources, Michal and I both agree that the US needs universal health care like European countries. For me, since I study the health impacts of safety-net programs, the weak social safety net in the US (especially in comparison to European countries) is also an important indicator of its weak public health infrastructure. Thankfully our older population in the US does have access to a relatively strong safety net with programs like Medicare and Social Security, providing more universal access to health insurance and financial support. However, as a life course researcher, I have to emphasize that providing these supports earlier in the life span would further improve outcomes for older adults.
MH: The US may offer better health care for someone with a severe illness that requires the latest and most advanced drugs, such as cancer, who also has substantial financial resources to afford high-quality medical care, but Czechia has an undoubtedly better and more equitable health care system overall. Although access to care has worsened in Czechia in recent years (e.g., hospital closures in rural areas, primary care physicians and dentists are often at full capacity and not accepting new patients), both geographic and financial access to care is still better than in the US.
What potential does healthcare have in the Czech Republic, especially in the context of population ageing?
MH: The aging population is going to be a major challenge for the Czech health care system in the coming decades. Not only will there be more elderly patients needing care and fewer working-age individuals supporting the system through taxes, but there will also be fewer physicians, as a disproportionate number of physicians in Czechia are nearing retirement age. The success of the Czech health care system against the aging population challenge depends on policymakers’ ability to design and implement a comprehensive reform to increase the health care system’s efficiency in the next few years. Postponing addressing this problem is only going to make things worse.
What is your experience with research funding in your respective fields?
ED: There are many forms research funding can take in the US. The biggest public funders in our fields are the National Institute of Health (NIH) and the National Science Foundation (NSF). However, the work of sociologists and economists is most often supported by private foundations such as the Commonwealth Fund or the Robert Wood Johnson Foundation. Then, there are other ways to be funded such as through contract work with research institutions. Funding can be difficult to navigate and can be a cumbersome task to take on but is necessary for many reasons, including for promotion purposes but also to protect your time for research (versus other responsibilities like teaching). I was able to secure funding for my dissertation work through an NIH funding stream meant specifically for PhD students. However, securing this funding took months of dedicated work and a lot of institutional support. Securing future funding is always uncertain, but I’m hoping that having gone through the process once so far will make the next time at least a little bit easier.
What recommendations would you give to Czech grant agencies?
MH: From my experiences so far, my main recommendation to Czech grant agencies would be to minimize the administrative burden for both investigators and themselves while maintaining the rigor of the award selection process. For example, most private foundations in the US solicit grant applications in a two-stage process. The first stage asks investigators to submit a brief “Letter of Intent” (typically 1-3 pages of text) that describes the big-picture idea and outlines the key aspects of the proposed research. The funding organization then reviews these short proposals and narrows down the pool of applications to the most promising ones (i.e., those that fit the funder’s strategic mission and appear to be of high quality). Only investigators who pass the initial screening round are then invited to submit a full proposal, in which they need to describe the proposed project in a lot more detail. Although this process has multiple rounds, it is more efficient overall for all parties than asking all investigators to submit a full, detailed proposal right away. Combing through applications is much easier when they have only a few pages in the first round, and then reviewers can dedicate their energy and full focus to only the most promising ones in the second round. At the same time, only investigators with a meaningful chance of receiving funding need to spend the substantial effort needed to write a full grant proposal.
Is work-life balance supported at US universities? What has your experience with work-life balance been so far?
ED: It varies based on the institution, as well as the department. The US doesn’t have the same type of family-friendly policies like they do in most European countries. For example, we don’t have guaranteed paid parental leave in the US, though some institutions and organizations pick up the slack by having their own policies that vary in generosity. We had our child while I was a PhD student, and at the time, I was able to take 8 weeks of paid maternity leave. I was happy to have that, but it doesn’t necessarily align with semesters that are 3-4 months long. So, it didn’t really make a lot of sense--for example, what happens if the 8 weeks end in the middle of a semester? Fortunately, the timing worked out with our daughter being born at the end of the spring semester, but it doesn’t always work out that way. Since then, I’ve been really happy to be a student while becoming a mother since the schedule was a lot more flexible than if I had a regular job. I was able to stay home with her when she was sick or take her to appointments in the middle of the day much more easily than if I was expected to be in an office 9-5. Yes, that means that we would both end up working at night and on the weekends, if necessary, but it was worth it to be more flexible in general.
MH: An academic career typically comes with a lot of flexibility, but that also means that people have to have really good time-management skills. On top of regular day-to-day activities such as teaching or providing service to the university, the pressure to obtain funding and publish research papers is immense. Finding the right balance between staying productive and having a life outside of work is definitely not easy. Universities typically provide faculty members with a variety of resources for work-life balance but, at the end of the day, everyone has to meet the strict criteria for productivity. I think both Emily and I are reasonably successful in keeping a work-life balance, but that does not mean that we haven’t had any challenges.
What are your future career plans?
ED: I’d really like to stay in academia for the foreseeable future. I start a 2-year post-doc at the Social Policies for Health Equity Research (SPHERE) Center at the Harvard T.H. Chan School of Public Health this June. After that, I hope to get a tenure-track faculty position in either a sociology department or at a school of public health so I can continue doing my research and also teaching classes. Ultimately, I want my work to make a difference, whether that means through positively impacting students’ lives and/or informing policies that promote health equity.
MH: I hope to build my career in academia balancing both research and teaching. I enjoy doing both, and I would not be happy if I had to do only research or only teaching. At this point of my career, I do not find much interest in administration. My plan is to build a research center with a mission to improve patients’ experiences with the cost of their care. This broad area includes research on health policy, health insurance benefit design, medical billing, etc.
