The socio-economic effects of geography on oral health

Principal Supervisor: Name: Dr Sarah Baker
Department: School of Clinical Dentistry
Tel: 0114 271 7837

Co-supervisor: Name: Dr Dimitris Ballas
Department: Department of Geography
Tel: 0114 222 7923

Description of proposed project

There has been a distinct lack of theoretically driven work surrounding the subject of “place” effects on health outcomes, much less in relation to oral health. Previous analyses of area based health outcomes have often failed to take into account the inter-related functions and feedback mechanisms that occur between individual level characteristics (‘composite’) and those of the local environment (‘contextual’). Often the outcomes are simply quantified and described, with little explanation as to why these patterns are occurring. The aim of this PhD will be to investigate how place determines patterns of spatial inequalities in oral health, and why such patterns exist. We propose using a theoretical framework similar to that outlined by Macintyre et al (2002), by conceptualising which resources are needed to meet the oral health needs of populations, and using this to test numerous pathways by which oral health is affected by place. To achieve this, agent-based models will be used as a means of bridging the gap between contextual and composite characteristics, and to allow measurement of these dynamic interactions. Such agent-based models, whilst increasingly adopted in the social and geographical sciences to investigate the spatial patterning of individual-level outcomes, have never been utilised within dental research in relation to oral health. Yet, Auchincloss and Diez Roux (2008) show how such models highlight the inter-dependent processes occurring between people, groups and their environment over time, as well as the effects of “agents” above the individual level (e.g. local government). All of these issues are discussed by Macintyre et al in outlining their framework, and are mostly beyond the scope of more traditional regression analysis tools. Through initial qualitative work we will gather data to conceptualise the way certain social resources are utilised and perceived in relation to oral health, which in turn will be used to give characteristics to the “agents” being used in the agent-based models. The use of existing secondary data sets (such as the Health Survey for England) will also provide an invaluable source of information for the basis of the development of these models. We believe this theoretically driven approach combined with the huge potential and extent of information available to us from the use of agent based models, will provide a clearer picture as to how area based effects influence spatial inequalities in oral health.


Auchincloss AH, Diez-Roux AV. (2008). A new tool for epidemiology: the usefulness of dynamic-agent models in understanding place effects on health. American Journal of Epidemiology; 168: 1-8.
Macintyre S, Ellaway A, Cummins S. (2002). Place effects on health: how can we conceptualise, operationalise and measure them? Social Science and Medicine; 55: 125-139.

The potential student will hold a good undergraduate degree in a relevant social science (e.g. geography) with strong research methods training. An MSc in Social and Spatial Analysis or Geospatial Analysis would be an additional advantage. Knowledge and experience of quantitative research methods, social and spatial inequalities and GIS software and statistics packages would be an advantage. A keen interest in interdisciplinary work, and excellent communication and organisational skills are essential.


Does geography matter when it comes to oral health? To what extent does where we live affect the chances of having poor health and poor oral health in particular? There have long been inter-disciplinary research efforts to explore the role of geography in health inequalities but there have been very few geographical studies of oral health. This PhD project will examine socio-economic and geographical factors that may be affecting oral health applying appropriate statistical methods as well as more experimental state of the art social simulation methods on secondary social survey data and small area geographical data. A key innovative feature of the research will be the development and use of state of the art agent-based social simulation modelling methods, which are conceptually very relevant to popular computer games such as SimCity and the Sims and involve the merging of census and survey data to simulate a population of individuals within households whose characteristics are as close to the real population as it is possible to estimate.

Additional Information

Dr Baker is a Reader in Psychology as applied to Dentistry and Research lead for the Person-centred and Population Oral Health Group in the School of Clinical Dentistry. She has successfully supervised 7 PhDs and 15 Masters in Dental Public Health dissertations to completion. She is currently supervising 5 PhD students (3 as primary supervisor, 2 as co-supervisor).

Dr Ballas is a Senior Lecturer in the Department of Geography. To date he has supervised to completion (all passed with minor amendments) four PhD students as primary supervisor and an additional five students as secondary supervisor (all passed with minor amendments). He is also currently the primary supervisor for three students and second supervisor of two students. He has extensive experience and expertise in the use of Geo-informatics in the Social Sciences and he is currently the Deputy Director of the University of Sheffield research Centre for Health and Well-being in Public Policy (CWiPP).