How do we develop health policies that help dismantle inequalities?
Matthew Purcell is a PhD candidate in LSE’s Department of Economic History and a recipient of the Alumni and Friends of Economic History scholarship. His research focuses on inequality in health outcomes for mothers and children in a variety of contexts.
Matthew talked to us about the history he studies and how it helps us to understand and tackle today’s inequalities.
What is your research about?
“I research maternal and infant health across the 20th century, focusing on the Southern United States. I look at different contexts, particularly racial inequalities in maternal and infant health outcomes and at policies and interventions designed, in theory, to improve equality of outcomes.
Overall, my work is really asking two big questions: what were the drivers of the inequality of outcomes in maternal and infant health between Black and white patients during that time, and how effective were various interventions – government policies, new hospital practices, and so on – at improving the equality of those outcomes?
What have you found in your research?
My dissertation is comprised of three papers that each focus on a different case. The first paper examines programmes in the 1930s that aimed to teach midwives in Black communities about basic hygiene concepts, like washing their hands before assisting with a labour. What my research suggests is that this programme wasn’t particularly effective because the scope of the support and information it provided to midwives was too limited. This is at the beginning of the era of the first antibiotics, and other patients are starting to get access to modern treatments which are contributing to massive improvements in maternal and infant health outcomes. So, while it’s true that these basic hygiene concepts are important, they were also well established at this point, and focusing on them did little to help the outcomes for Black families to catch up with others.
The second paper looks at the federal Hill-Burton Act, which subsidised hospital construction in rural areas. The outcome of this is interesting: on the one hand, building more hospitals in Black communities led to many more births taking place in hospitals rather than at home, which helped decrease the rate of stillbirths among Black mothers. But we don’t find the same level of success in reducing the infant mortality rate, which measures how many infants survive their first year of life, because infants are exposed to all kinds of other environmental factors and the effects of poverty that can impact their health in their first year. So, the effort was successful by some measures but unsuccessful by others.
The third paper analyses delivery ward records from Lincoln Hospital in Durham, North Carolina, to understand the interventions used during births – things like the use of forceps or Caesarean sections - and their impact on health outcomes. This research is motivated by a desire to get the history right about the experiences of doctors and patients in these hospitals. A lot of the existing literature on maternal and infant health outcomes in this era suggest that the quality of care was worse in facilities serving Black communities than it was in hospitals that catered to white patients, but often there is very little data to back up those claims. With this research, I want to analyse the care that was provided in one such hospital because, then we can tell these nuanced stories about care and inequality correctly.
Why did you choose to pursue a PhD in Economic History at LSE?
As a pre-med undergraduate student in the US, I volunteered in a paediatric intensive care unit and later worked in the Peace Corps on maternal and child health programmes in Belize. These experiences got me interested in these questions about health outcomes and equality. Initially, I planned to attend medical school in the U.S. after finishing my master’s here at LSE, but my advisor, Eric Schneider, encouraged me to pursue a PhD. I’m hoping to eventually be able to combine clinical care with research and teaching in an academic hospital setting.
The Alumni and Friends of Economic History scholarship I received has really made it possible for me to pursue this PhD. I’ve also been lucky enough to get support from the Phelan Centre to travel to the U.S. and access primary source data like hospital records, which has been invaluable in doing this research.
What impact do you hope your research will have?
Understanding the reality of how different policies and interventions have impacted health outcomes is essential if we’re hoping to make good decisions going forward. We need to look at the ways in which resources and capital have been invested in the past to try and address inequalities in health outcomes, and to evaluate how effective those investments have been, so we can learn from them as we try to address the inequalities we still find all around us today.
Image Credits
Lincoln Hospital, Durham, North Carolina, State Archives of North Carolina
St. Agnes Hospital Nursing School, St. Augustine's College, Raleigh, NC, 1949, State Archives of North Carolina
