Relational Health Group
The Relational Health Research Group understands health as an emergent behaviour of the relations within systems and their environments.
We have developed a relational approach aimed at creating conditions for health, reducing health inequalities, and starting with an understanding of the local, dynamic context and its impact on health and wellbeing. This approach involves co-creating strategies to address issues and evaluating the resulting outcomes.
Healthcare & health services
Young people and families
Mental health and wellbeing
Skills and Expertise
Our skills and expertise: We have considerable expertise in transdisciplinary, engaged research approaches to understanding and addressing barriers to health and wellbeing and inequalities.
- Co-creating research with people experiencing the issues or caring for those experiencing the issues for example; Optimising Prescribing; Moralising narratives and mental distress in very low income communities ; Co-creating an evaluation of a peer-led dance group, theTR14ers
- Meaningful engagement with neighbourhoods, schools, workplaces to understand the nature of the issues – Connecting Communities - C2; Healthy Lifestyles Programme; the development and evaluation of a novel obesity prevention programme for children
- Developing health creating conditions which embrace the complex nature of the system - Healthy workplace programme for NHS secondary care organisations; Developing a health promoting school process for secondary schools
- Qualitative approaches including interviewing, conducting focus groups, ethnography, narrative analysis; The violence of narrative; The impact of the workplace capability on mental health; Understanding influences on young people’s diet and physical activity choices
- Evaluations of complex interventions including evaluability assessments, trials and process evaluations; Grad2020 project; Cluster randomised controlled trial and process evaluation of the Healthy Lifestyles Programme
- Realist, Systematic and Scoping reviews – Care under pressure; Implementing health promoting school programmes; The impact of the World Health Organization Health Promoting Schools framework approach on diet and physical activity behaviours of adolescents in secondary schools; systematic reviews of effectiveness of policy and programmes; scoping reviews looking at how sustainability and health are integrated in policy and practice
Who we are
Professor Katrina Wyatt
Professor of Relational Health
Katrina Wyatt is Professor of Relational Health; Relational health foregrounds the nature and qualities of relations to create the conditions for health and address health inequalities. She conducted the underpinning research for Connecting Communities, C2. C2 is a transformative engagement approach to enable communities to increase control over their lives and neighbourhoods and create health. She is committed to engaging publics in the design and delivery of her research and developed the strategy for engaged research for the Wellcome Trust funded Centre for Cultures and Environments of Health. She is also deputy theme lead for Public Health and Inequalities for PenARC. Read more
Dr Daniele Carrieri
Lecturer in Public Health
I have a background in philosophy and medical sociology – with expertise in ethics and qualitative methodologies – and professional experience in the management consulting industry and charity sector. I am a Lecturer in Public Health, a Research Fellow in the Relational Health Group and in the Wellcome Centre for Cultures and Enviroments of Health. I am also a member of the Centre for Research in Professional Learning. Read more.
I am a researcher based at the Wellcome Centre for Cultures and Environments of Health, and am also part of the Relational Health Group at the Medical School. I have a professional background in youth and community work, and take an engaged approach to research, working alongside communities and community organisations. My interest is in health inequalities, particularly in the areas of mental health, end-of-life care and the experiences of low-income communities. My current fellowship is exploring the impact of poverty on end-of-life and bereavement experiences. Read more
Dr Jennie Hayes
ESRC Postdoctoral Research Fellow
Jennie is an ESRC Postdoctoral Research Fellow with the Relational Health Group. Jennie is a qualitative social psychologist with a background in group interaction, creative facilitation, diagnosis, health and wellbeing. She has a particular interest in the social framing of diagnostic practices, narrative, creativity and wellbeing, mental health, bereavement and loss. Her current fellowship involves disseminating the results from her work on autism diagnosis and scoping ideas for a new research project within the context of exploring the barriers to health and wellbeing. Read more
Associate Research Fellow
My current role within the Relational Health Group is as the data manager. I am involved with any data related work, including supporting systematic reviews, producing tables and writing papers. Previously I have worked with several large Randomised Controlled Trials within the Child Health group including the Healthy Lifestyle Programme (HeLP) and the Helping Children Achieve (HCA) study. Read more
Dr Jenny Lloyd
Senior Lecturer in Public Health Research
I am a mixed methods researcher specialising in the development and evaluation of complex behavioural interventions using a wide range of methods; systematic reviews, stakeholder consultation, logic model development, intervention mapping and process evaluation. I have expertise in engaging stakeholders (patients, teachers, parents, children, public health practitioners and policy makers) and actively involving them in intervention design and optimisation. This expertise informs the grants I have been, and am currently, involved in.
I teach and lead modules on the BMBS and BMed Sci undergraduate programmes (Lifestyle Medicine, Clinical Trials) and the new MSc in Public Health (Behaviour Change). Read more
Professor Karen Mattick
Professor of Medical Education
Karen is professor of medical education and director of postgraduate education for the College of Medicine & Health. Her research focusses on the experiences of doctors-in-training, especially during the transition to clinical practice and when prescribing medications, and mental ill-health especially as it affects doctors-in-training. Karen is also deputy editor for the journal Medical Education, director of awards for the Association for the Study of Medical Education (ASME) and visiting professor at Queen’s University Belfast. Read more
Camilla Forbes (McHugh)
My role in the Relational Health Group has been the Saxton Fellowship, funded by the All Saints Education Trust, to explore how to create the conditions for the promotion of healthy lifestyle behaviours in secondary schools. Part of my role has also been to co-chair with young people the Young Person’s Advisory Group to give young people a voice in research. Read more
Dr Felicity Thomas
Senior Research Fellow
I am a social scientist with a cross-disciplinary background spanning anthropology, public health, education, and international development. Drawing on narrative, ethnographic and engaged approaches, my research examines how lived experiences of health inequalities can inform more ethical and effective health care practice and policy.
My work focuses around the mental health and wellbeing of low-income communities; early life trauma; migrant health; sexual health; and the promotion of young people’s health and wellbeing. I am a Deputy Director of the Wellcome Centre for Cultures and Environments of Health and Director of the WHO Collaborating Centre for Culture and Health. Read more
Dr Andrew Williams
Senior Lecturer and Co-Investigator for TR14ers
Trained as an epidemiologist, Andrew’s research interests lie in the social and cultural determinants of health (the fifth wave of public health), especially among children and young people. He is interested in the applications of theories such as complexity theory and salutogenesis to bring about improvements in the health of the public. Introduced to relational health during his PhD supervised by Professor Katrina Wyatt, Andrew has been on the fringes of C2: Connecting Communities ever since. Alongside Katrina, Andrew conducted research with the TR14ers in 2018/19 exploring their culture and ethos, and how this is sustained. Read more
PA to Professor Katrina Wyatt
Programme Co-ordinator and C2 Partnership Support
I’m part of C2 Connecting Communities team and coordinate the partnerships between C2 and research, including the DeStress Project & the public involvement and community engagement group for the national ARC Inequalities Programme.
I am currently conducting research in the WCCEH, with the Transforming Engagement Programme mapping social networks using Network Canvas software; this research is exploring new methodologies to evidence links between strong community networks and health in partnership with the TQ6 Community Partnership Hub project.
I provide mentorship and support for C2 partnerships and create spaces for C2 partners to engage with research for mutual benefit.
Dr Kerry Ann Brown
I have expertise in public health nutrition and work across the social and natural sciences using mixed-methods (qualitative, quantitative, and public engagement).
I research sustainable dietary guidelines and innovative methods to study food systems and evaluate food policies (e.g., food labelling and Healthy Start food vouchers). I have a particular interest in how sustainability can be integrated into the nutrition risk analysis process to effect policy change and make food systems healthier, fairer, and more environmentally sustainable. Read more
Prof Victoria Tischler BSW, MSocSc, PhD, CPsychol, AFBPsS
Associate Professor in Public Health, Sustainability and Environment, University of Exeter; Honorary Professor, University of West London
Professor Tischler is a Chartered Psychologist and Associate Fellow of the British Psychological Society. She has a PhD in psychology from the University of Nottingham where she worked for 12 years. She retains an honorary position at the University of Nottingham Medical School. Her research interests focus on creativity and mental health and multisensory approaches to dementia care. She is co-executive editor of the journal Arts and Health: an international journal for research, policy and practice. She has worked as a curator in the outsider art field, she serves on the scientific advisory board for Boots UK archive and is an advisory board member for the Hamwe Festival, University of Global Health Equity, Rwanda. Read more
Kath is a Research Fellow within the Relational Health Group. Kath’s interests are around early intervention and prevention activities to support parents and children, specifically relating to their mental health and wellbeing. Kath is also interested in how research knowledge is translated into practice and how programmes are implemented. She is currently undertaking an NIHR Fellowship and working with the charity Action for Children, looking into how community champions can support parent and child wellbeing and child development across Devon. Read more
‘If we wanted a unicorn we would have asked for a unicorn, what we wanted was a dentist’
This is a quote from a community partner on what it felt like to be told what the problems were for your community and then be given a solution to something that wasn’t a problem for them.
There is an increasing body of evidence demonstrating the association between positive relationships and health and wellbeing . Moreover, positive relationships can also mitigate some of the negative impacts of adverse conditions and experiences [2,3]. There is also an increased understanding of schools, communities, workplaces etc, as complex adaptive systems, and that health is an emergent property arising from the system’s complex nature [4,5]. Health, as an emergent behaviour of a complex system, is therefore a consequence of the nature of the relations that comprise such systems. These relations can be the relations that subsist within the system, as well as relations that exist between the system and its environment .
Hence, in order to understand how health is constituted in complex systems, we need to understand the relational nature of these systems and their distinctive “relationalities”.
Relational Health is therefore concerned with understanding the relationality of social systems to understand how the conditions are created for health/ ill health in and of the system. This focus on relationships within the system and its wider environment as determinants of health/ ill health takes the focus away from trying to affect individuals at risk of ill health or individual behaviours in isolation.
A Relational Health approach means the focus is on understanding the nature and the qualities of the relations which support the system to self-organise towards a more health creating ‘state’.
Taking a relational approach is a challenge to much of the dominant discourses of public health and public approaches. In particular, a relational health approach to understanding the nature of population health challenges is a radical departure from the way that health ‘problems’ are currently conceptualised and addressed. For the most part, population health problems are identified and determined externally, ie from outside of the system and then programmes or policies developed to address the problem, which is usually aimed at targeting unhealthy behaviours or populations deemed to be more at risk. Such programmes tend to be evaluated on individual outcomes (and with a ’logic of coherence’ which renders context as static). For example, research to prevent/ address childhood obesity has focussed on developing school based programmes as a means of affecting weight outcomes. The ‘problem’ ie preventing or addressing overweight and obesity is ‘imposed’ upon schools and subsequent programmes to address the problem target altering the behaviours of the children and sometimes their families. Whilst this approach might have some effect in the short term, there is evidence suggesting that programmes aimed at supporting health can actually widen rather than reduce inequalities . Moreover, schools are unlikely to be sustain the programmes unless having preventing or addressing obesity is deemed to be a ‘problem’ for that school . Rather, we suggest, that unless the relations within the system change sufficiently, the system will tend to revert back to prior ways of ‘being’ once the programme has ended.
By comparison, a relational health approach insists that a necessary condition for systems to self-organise into becoming health creating environments is for the school or neighbourhood or workplace to identify and recognise the nature of the issues.
Addressing poor health and health inequalities by creating the conditions to identify the barriers to health is a fundamentally different starting point to most stakeholder engagement processes; whereby stakeholders are brought into conversations about the externally determined problem to understand what it means to them and what would be feasible and acceptable ways of addressing it. What is significant here is that the problem is still externally determined.
A relational approach starts with the recognition that more of the same can not deliver change on the scale that is needed and that new ways of delivering services are needed in response to what people identify as the barriers to a health promoting environment.
These new ways of working /delivering services start by understanding the current behaviour of the system by actively listening to understand the nature of the lived realities for people living and working in particular neighbourhoods or organisations. This approach requires practitioners, researchers and commissioners to engage people living and working in these areas to hear what the ‘problems’ are for the service or school or neighbourhood and to develop new ways of working with the residents/ workforce to respond to these issues. The local partnerships which then form become a sustainable means for the identification of local problems and responding to them. The new relationality of the system becomes the process by which the system self-organises to a more health creating ‘state’ and becomes a sustainable way for the system to adapt and respond to changes in the environment.
- Holt-Lunstad J, Smith TB, Layton JB (2010) Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 7(7): e1000316. DOI
- ACE, W.A.C.E., 2018. Sources of resilience and their moderating relationships with harms from adverse childhood experiences. PDF [Accessed Jan 2021]
- Beckmann, K.A., 2017. Mitigating adverse childhood experiences through investments in early childhood programs. Academic Pediatrics, 17(7), pp.S28-S29.
- Davies SC, Winpenny E, Ball S, Fowler T, Rubin J, Nolte E. For debate: a new wave in public health improvement. Lancet. 2014 Nov 22;384(9957):1889-1895. DOI. Epub 2014 Apr 3. PMID: 24703631.
- Harry Rutter, Natalie Savona, Ketevan Glonti, Jo Bibby, Steven Cummins, Diane T Finegood, Felix Greaves, Laura Harper, Penelope Hawe, Laurence Moore, Mark Petticrew, Eva Rehfuess, Alan Shiell, James Thomas, Martin White. The need for a complex systems model of evidence for public health, The Lancet, Volume 390, Issue 10112, 2017,Pages 2602-2604, DOI.
- Goodwin, Brian. How the Leopard Changed Its Spots: The Evolution of Complexity. Princeton, New Jersey: Princeton University Press, 2001. DOI
- Lorenc T, Petticrew M, Welch V, Tugwell P. What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health. 2013;67(2):190-3.
- Pearson M, Chilton R, Wyatt KM, Abraham C, Ford T, Buckley Woods H and Anderson R. Implementing health promotion programmes in schools: A realist systematic review of research and experience in the United Kingdom. Implementation Science 2015 10:149 DOI