At the end of 2020, there were several good reasons to apply for the Marietta Blau Scholarship. I started my doctorate in Public Health at the Medical University of Vienna three months before the onset of the COVID-19 pandemic in March 2020. Before the pandemic, I had to explain what Public Health is and what it does (or tries to do). Now, the pandemic has dramatically changed people’s awareness about Public Health as a scientific discipline. A discipline that had, for many reasons, a difficult time getting Austrian research funding, was suddenly in the limelight. If there ever was a good time to apply for funding for public health research in Austria, this was it.
The funding for my position as a research assistant at the Center for Public Health came from diverse projects but for my dissertation I wanted to work on the socioeconomic gradient in health. The socioeconomic gradient in health is the ubiquitous observation that socioeconomic advantage (higher income, higher education, better working conditions) translates to better health in human populations.
Marietta Blau suits the reality of most students
Among the few available funding options for doctoral researchers in Austria, the Marietta Blau Scholarship suits the reality of most students very well. As their doctoral research often must be pursued in parallel to work on other research projects that fund their position, it can be challenging to find the time for the research that is at the heart of one’s dissertation and that will, ultimately, be the steppingstone of one’s academic career. With the Marietta Blau Scholarship, a doctoral student receives up to one year to work on what they are most enthusiastic about in world-leading research conditions. It sounded like a good deal and exceeded all my expectations.
In the discipline I would locate most of my work, Social Epidemiology, “world-leading conditions” means a high-quality data infrastructure. Cutting-edge health and social sciences are inevitably dependent on the funding of large longitudinal studies which collect data on health outcomes and social, biological, environmental, and behavioural exposures from a representative sample over a long period. Equally important for flourishing health and social sciences is a legally secured scientific access to routinely collected data like hospital data, birth registers, death registers, and other population registers. In the best case, all these data sources can be linked to each other to enable a more cost-efficient and effective use of collected data and ensure the quality.
Health inequalities research in Scotland
All of this and a longstanding tradition of health inequalities research exists in the United Kingdom and especially Scotland. For institutions, there were two natural choices. First, the renowned MRC/CSO Social and Public Health Sciences Unit (SPHSU) at the University of Glasgow generously funded by the Medical Research Council and the Scottish Chief Scientist Office. As my research also draws from health geography, the second natural choice was the Centre for Research on Environment, Society and Health at the University of Edinburgh. Fortunately, both were happy to host me.
I started my 10-months stay in Glasgow in September 2021. The researchers working at the MRC/CSO SPHSU are leading experts in the kind of research I wanted to do with my Marietta Blau Scholarship. Talking to them about the research planned for the scholarship, it became clear that, while interesting, my plans were far too ambitious and unrealistic for one person to achieve in 10 months. I was very lucky to have had an even better alternative. From 1987 to 2007, the MRC/ CSO SPHSU has conducted a longitudinal study – the Twenty07 Cohort Study – that was perfectly suited for my research interest: I wanted to find out how the extent of social inequalities in systemic chronic inflammation in human bodies varies between small areas with different levels of status inequalities and social cohesion. These data were unique because the Twenty07 study collected blood samples from participants and analysed, among other parameters, the concentration of c-reactive protein in their blood. The concentration of c-reactive protein is a well-established indicator of systemic chronic inflammation in the body and has been found to be higher among socially disadvantaged population groups. Higher systemic chronic inflammation in the body, in turn, is associated with a higher risk of cardiovascular disease, depression, and other leading causes of disability and mortality globally. Additionally, the study obtained extensive data on participants’ socioeconomic position and the social environment in their residential areas. To complete the required data for my study, Scotland makes full-population census data publicly available on small area levels. As an Austrian, I was quite surprised to hear that “you can simply download the data”. To summarise, I was able to use data from blood samples from a representative sample of about 2000 people, survey data on social environment they lived in, and census data on the socioeconomic characteristics of the population in the neighbourhood of participants in the Twenty07 study.
Socioeconomic inequalities in systemic chronic inflammation
Analysing these data, we found the expected socioeconomic inequalities in c-reactive protein concentration: more socioeconomically disadvantaged groups had, on average, higher concentrations. But we also found that these inequalities can vary quite strongly depending on the social environment people live in. Socioeconomic inequalities in systemic chronic inflammation were the largest in areas where the majority of the population had a high socioeconomic position. However, these inequalities in c-reactive protein concentrations were smaller when social cohesion among residents was high but even larger when social cohesion was low. In other configurations, we even observed reversed inequalities. Importantly, these results highlight that characteristics of the social environment people live in can increase, reduce, or potentially even reverse socioeconomic inequalities in health.
This study was not the only thing the Marietta Blau Scholarship allowed me to do. I volunteered to be involved in the MRC/CSO SPHSU’s research projects to get experience working with register-based individual-level health data. While these data have been available for researchers in Scotland and other countries for a long time, it was not possible to get such experience in Austria until the end of 2023. Of course, such experience is highly valuable, if not obligatory, for an academic career in population health sciences. The project I volunteered for has unexpectedly turned into a larger research project on the Lockdown Cohort -Effect hypothesis I am now leading (for a brief explanation, see links below).
Lasting collaborations
The scholarship’s impact, although completed in 2022, is still accompanying me and will most likely continue to do so. The research experience I collected and the supervision and mentoring of leading researchers in my field during the scholarship has shaped my career path ever since. Together with my colleagues in Vienna, they helped me to publish my doctoral research in well-regarded scientific journals in my discipline and put me in the best possible position for my next career steps. I was also able to establish lasting collaborations with my colleagues in Glasgow and Edinburgh and, importantly, made many new friends while doing so.
Beyond invaluably improving my academic career prospects, the scholarship also had a powerful impact on my perspective on research. To paraphrase an esteemed colleague in a Glaswegian pub on a Friday night: “There are scientific contributions worth more than every paper we will ever write”. It made me realise that focusing my career on trying to contribute to high-quality research infrastructure that lays the foundation for more useful and better research will most likely have a bigger positive influence on society than every study I will ever publish.
Short narrative CV
Moritz has defended his doctoral thesis on “Unequally Unequal? Context-dependencies of the socioeconomic gradient in health” at the Medical University of Vienna in 2023 and started as a postdoctoral researcher at the Helsinki Institute for Demography and Population Health (University of Helsinki) and the recently established Max Planck – University of Helsinki Center for Social Inequalities in Population Health. In 2024, he was awarded a Marie Skłodowska-Curie European Postdoctoral Fellowship to work on the Lockdown Cohort (LoCo)-Effect using individual-level register-based data from multiple countries.
Links:
Publications supported by the Marietta Blau Scholarship
Oberndorfer M, Leyland AH, Pearce J, Grabovac I, Hannah MK, Dorner TE. Unequally Unequal? Contextual-level status inequality and social cohesion moderating the association between individual-level socioeconomic position and systemic chronic inflammation. Social Science & Medicine. 2023;333:116185. doi:10.1016/j.socscimed.2023.116185
Oberndorfer M, Dorner TE, Leyland AH, Grabovac I, Schober T, Sramek L, Bilger M. The challenges of measuring social cohesion in public health research: A systematic review and ecometric meta-analysis. SSM - Population Health. 2022;17:101028. doi:10.1016/j.ssmph.2022.101028
Additional publications supported by the Mariette Blau Scholarship
Oberndorfer M, Henery PM, Dundas R, Leyland AH, Paranjothy S, Stock SJ, Wood R, Nelson SM, Kearns R, Pearce A. Study protocol: examining the impacts of COVID-19 mitigation measures on pregnancy and birth outcomes in Scotland—a linked administrative data study. BMJ Open. 2023;13(2):e066293. doi:10.1136/bmjopen-2022-066293
Oberndorfer M, Dundas R, Leyland AH, Pearce A. The LoCo (Lockdown Cohort)-effect: why the LoCo may have better life prospects than previous and subsequent birth cohorts. European Journal of Public Health. 2022;32(3):339-340. doi:10.1093/eurpub/ckac049
Oberndorfer M, Stolz E, Dorner TE. Evidence for changes in population-level subjective well-being during the COVID-19 pandemic from 30 waves of representative panel data collected in Austria between March 2020 and March 2022. Public Health. 2022;212:84-88. doi:10.1016/j.puhe.2022.09.004
Links related to the Lockdown Cohort- Effect:
Initial publication explaining the LoCo-effect hypothesis:
Oberndorfer M, Dundas R, Leyland AH, Pearce A. The LoCo (Lockdown Cohort)-effect: why the LoCo may have better life prospects than previous and subsequent birth cohorts. European Journal of Public Health. 2022;32(3):339-340. doi:10.1093/eurpub/ckac049
Article on the Improving Health Blog of the MRC/CSO Social and Public Health Sciences Unit
https://www.gla.ac.uk/schools/healthwellbeing/research/mrccsosocialandpublichealthsciencesunit/sharingourevidence/blog/headline_850818_en.html
Press release by the Medical University of Vienna (German & English)
https://www.meduniwien.ac.at/web/ueber-uns/news/news-im-juni-2022/geburtenrueckgang-bei-benachteiligten-bevoelkerungsgruppen-waehrend-der-corona-pandemie/
Helsinki Institute for Demography and Population Health
https://www.helsinki.fi/en/helsinki-institute-demography-and-population-health
Max Planck – University of Helsinki Center for Social Inequalities in Population Health
https://www.helsinki.fi/en/helsinki-institute-demography-and-population-health/maxhel-center