Giulia Ferrari

Interviewers: Angela Esi Micah and James Buchanan

The Early Career Researcher Interview Series is an initiative led by the IHEA Early Career Researcher Special Interest Group (ECR-SIG). The aim of this interview series is to showcase the diversity of people in the ECR subgroup in IHEA. By interviewing a variety of ECRs, we hope to describe the many interesting and emerging career paths available to ECRs in health economics, highlight the choices that individuals have made to help them to reach this point in their career, and reveal how ECRs are navigating the various challenges that they face.

The second interview of this series is with Giulia Ferrari. Giulia is a Research Fellow at the London School of Hygiene and Tropical Medicine. Prior to this appointment, Giulia completed her PhD in International Development at the London School of Economics and Political Science. Giulia has more than ten years of  experience in socio-economic research on violence in sub-Saharan Africa and the UK, and has worked as a consultant in the international and sustainable development fields. Angela Esi Micah and James Buchanan, two of the conveners of the ECR-SIG, spoke to Giulia in September 2018 to discuss the importance of the doctoral research environment, the advantages and disadvantages of part-time PhDs, and her research on gender-based violence in lower and middle income countries.

Hi Giulia, it’s great to talk to you today. You did your PhD at the London School of Economics and Political Science (LSE) – could you tell us how you ended up at this institution?

I did my undergraduate degree in Economics in Italy. It involved a lot of maths and statistics with a few theory-based macroeconomics and microeconomics courses, and I was a bit unsure as to whether I really wanted to go on down that track. Although I found it intellectually stimulating, I also thought it was highly technical and somewhat inward looking. There was a constant push to achieve internal validity by using a lot of maths to produce outputs that were solid from a formal perspective, but I found this to be very alienating – gaining proficiency in all of these things absorbs so much of your time and takes away energy from looking at what really happens on the ground. A friend of mine had done an MSc in Anthropology and Development at the London School of Economics and Political Science (LSE) and told me that I would really like the programme there, and encouraged me to apply. So I applied to do the MSc on Environment and Development, which sat across the Geography Department and the Development Studies Department. This seemed to better consider the substance of what was actually happening in the world – the actual events, the dynamics, the history – and took more of a political sciences approach to things, really looking into the issues on the ground, which is what I really missed in my undergraduate degree.

Did you enjoy doing your Masters at LSE?

I loved being at the LSE. This was partly because I finished my high school education at an international school in Swaziland. I come from a small provincial town in Sardinia where teenagers (including myself) mostly thought about doing well at school and what to wear to go out with friends. When I moved to Swaziland, I experienced a very different reality, with academically excellent people from different social backgrounds, from all over the African continent and the world. These people had a very high level of political awareness and engagement in social issues, and I was immersed in this very diverse society. After high school, I decided to go back to Italy to be an adult in my own country and to go to an Italian university. However, when I returned I found it very difficult fit in to the less multicultural system in Italy. Most if not all of my classmates had never been away from home, and I had a very different set of experiences. Going to the LSE after my undergraduate studies in Italy threw me back into those years at international school in Swaziland, and I really relished being in such a multicultural and highly motivated environment.

And then you decided to stay at LSE after your Masters?

I liked it so much that when I finally decided to do a PhD I decided to stay at LSE and to do this at the Department of International Development. By this time, I knew that I really wanted to stay in economics, because I do like the way that economics looks at things, but I also wanted to be free to draw from other disciplines without feeling constrained by my own discipline – in that respect I think economics can be quite focused. In addition, I had been working already, so I wanted to enrol in a programme that would allow me to work alongside doing a PhD, which was possible at LSE. So I decided that staying at LSE was the right thing for me.

Is it common for PhD students at LSE to work as they do their PhD? Is that how you funded the programme?

It is how I funded my programme. As far as I know it’s not terribly common for people to do the programme part-time, but I think this is perhaps a feature of the department that I was in. There were lots of people in the department who had been professionals before, for example working at the World Bank and other big institutions, and who had decided to go back to school. I had also done some consulting for these institutions, including the World Bank and the European Commission, and I saw the PhD as professional development; a lot of people had told me that if I wanted to progress in my career I would need a PhD. So my decision to do the programme part-time was driven by the thought that I didn’t really want to miss out on years of work experience while I was studying, and would rather take work and study forward in parallel. I also wanted to be ‘close to the ground’, looking at actual problems that people face, and thinking through those in a structured way. I’m motivated by being part of a process and finding issues that merit investigation.

Could you tell us a little bit about your PhD topic and your findings?

Sure, so the general policy topic was the prevention of gender-based violence in lower and middle income countries (LMICs) in sub-Saharan Africa specifically. I used applied econometrics to analyse the impact of two policy interventions that were designed to prevent intimate partner violence. One was a secondary data analysis on an intervention in South Africa for which I had already undertaken an economic evaluation. And the other was a primary data analysis of a similar intervention in Burundi. Both interventions provided people with access to financial resources and life skills sessions.

In addition to these two analyses, I also had an interest in wellbeing. I had been to Richard Layard’s lectures on wellbeing and happiness at the LSE and I was a bit critical of this approach and its relevance to countries and contexts outside of Europe, in terms of what it meant for people to be well. So as part of my PhD I also explored the concept of wellbeing in a population of programme recipients. I talked to a lot of women in focus groups about what their concept of wellbeing was, then I used specialist software for the statistical analysis of textual data to identify clusters of concepts. I found that these women’s concept of wellbeing had interesting characteristics. The most important finding was that they derive wellbeing, happiness and a sense of fulfilment from the role they play in their group. So their happiness is defined by their relationships. However, because networks are static, they can also be a source of unhappiness. The large-N studies in Europe and the USA suggest a positive association between networks and happiness. However, in a world where networks are predefined for you, rather than chosen on the basis of affinities and aspirations, they can also be a source of complications, so there is a more complex interaction at that level. I think we still do not understand these relationships fully, so there is a lot of exciting work ahead.

I used these insights to look at the impact of the two interventions on people’s outcomes, and I found that the interventions had a limited impact on these broad areas of wellbeing if you measure them using existing empowerment indicators. I also found that the interventions – particularly the intervention in South Africa – had an impact on women’s sense of autonomy, and this could be the way they experienced a reduction in violence. So the categorisations that I found in the qualitative data allowed me to interpret some of the patterns that I saw in the quantitative data.

When did you start and finish your PhD?

It took me about 10 years – from 2007 until 2016. A long time! Throughout that time I had lots of different jobs. At the beginning I was part of a group at the London School of Hygiene and Tropical Medicine (LSHTM) that was working on the economic evaluation of the IMAGE trial. After that I worked with an inspiring labour economist called Radha Iyengar who generated the Burundi dataset. With her I worked on a National Bureau of Economic Research (NBER) funded programme that then led to a chapter in an NBER collection. That was really interesting because I learned a lot about applied econometrics and I got a chance to interact with a lot of world leading thinkers and economists in the areas of development and health, which was exciting.

Towards the end of my PhD I took up a full-time job at the University of Bristol Medical School to do something that was slightly different. I was hired as the health economist and statistician on a three-year programme across five different projects, and we were looking at the role of healthcare services, especially primary care, in supporting survivors of domestic violence in the UK. So at the other end of the process, and in a high-income setting. This provided an opportunity for me to get more of a global experience, and also to look at care rather than prevention, which is very different.

At the end of my PhD, in 2015, I took up my current post at LSHTM. I’m part of a team that is devising methods for the economic evaluation of gender-based violence prevention programmes in LMICs. This is really exciting because there is very little work on economic evaluation in this specific area of global health and because of the increasing interest more broadly in cost-effectiveness analysis in development economics. Because there are many similarities between gender-based violence prevention interventions and empowerment interventions in education or the broader development sphere, there is the potential for this methodology to be useful for other programmes too. There are many interesting aspects of this work, but for me the most interesting part is thinking about the intervention outcomes, which ties into my research on wellbeing. These interventions are complex and multidimensional, and they have lots of outcomes that are usually measured with empowerment indicators, but we don’t know if they ultimately improve people’s welfare, and it isn’t clear how we should capture the full effectiveness of these interventions.

So since 2016 would you now consider yourself an Early Career Researcher?

Yes, in a way this is an important moment although I have gradually become more independent. The reason why this is an important moment is that I think I finally have the chance to really bring together all the different strands to my work – my PhD and related investigations – into my own research agenda, and to also pursue some lines of inquiry that I have wanted to for a while.

Would you say that this gradual transition has been facilitated by doing the PhD part-time?

Yes, I think so, because over time I have had to deal with different kind of responsibilities. For example, I have had to take the driving seat in a lot of the projects I worked on because my supervisors were either headhunted by other organizations or retired. An added benefit of this is that thanks to previous contacts with various funding agencies, I am now asked to review grant application for these agencies.

In addition, I learnt early on how to work with other researchers to co-author papers. This is common practice in health but very uncommon in other areas such as economics. Learning to navigate the coordination and negotiation issues related to such team activities has been very helpful at the early stages of my independent career. I also developed my writing style through this process. I remember clearly how I would go back to my PhD draft after 6 months of not being able to work on it because I had other deadlines at work and thinking to myself: “How could I have written that?”. This was usually because I had learnt so much from going through the process of writing a paper with others at work. So yes, there are lots of things I think I learnt through my job that made it easier to transition to become an independent researcher.

What are you working on now and how did you get to this particular position?

I got to this position through previous professional experience. I worked with this group at LSHTM in 2005 before starting my PhD and they funded the first couple of years of my PhD. When I was coming to the end of my contract at the University of Bristol they were recruiting a health economist to evaluate gender based violence prevention programs. The position seemed like such a great fit and the work was very relevant to the kind of work that I had been doing, so I could not refrain from applying. Gender-based violence prevention has been the policy focus of my graduate work all along: it is central to people’s health, and intertwined with a lot of economic choices in their lives, besides being a human rights violation. I never stopped working on it since my first LSHTM appointment.  Also, I had really enjoyed working with Charlotte Watts’ group at LSHTM back in 2005, and so I was really keen to join the team again.

I am currently working on a very large UKAID-funded programme on the prevention of gender-based violence across several sub-Saharan Africa countries and South Asia. I work on a small component that is an economic evaluation of five of the interventions, all of which are evaluated with randomized controlled trials. Part of my job includes providing advice to other grantees on how to integrate measures of economic and wellbeing impact in their interventions so that we can include some of these outcomes in the economic evaluation. In the long term, I hope that I can use some of these measures for secondary data analyses, specifically measuring impact along socioeconomic dimensions.

Can you tell us about one challenge that you have faced in your journey to this point?

Juggling the PhD and the work was interesting. Sometimes, I made mistakes in judging how much time I would need by overestimating and other times I underestimated. However, I think in a way people expect this – it has got to be challenging to mix work and PhD. I do not have a solution and I do not think I am necessarily a good example of how to do this – I sacrificed meeting up with friends for dinner and travelling long distances to weddings because the timing was not right!

Another challenge I would like to highlight is related to being a woman in the field of economics. This is an issue that has only gained some attention recently. At the last American Economic Association (AEA) meeting, some papers were presented about this problem. I think this has been a challenge for me for several reasons.  In my undergraduate career, a lot of my experiences were male dominated and oriented, in terms of the kind of issues people looked at and the sort of values proposed. This orientation really struck me about a year ago when I attended a professional meeting. After having interacted and engaged with a panel and audience that was almost composed of entirely men, the contrast with my experiences at LSHTM became apparent to me. Until then, I had not realized that it had been the norm until I moved into the health field. It was so shocking. Very few women make it to the top in economics. Some papers show a decline in female PhD graduates in economics. In the recent past there has been a lot of focus on STEM enrollments, but economics has lagged in this respect. These issues make a difference: it is important to have role models, and feel one’s perspective is valid, even if not mainstream. It is great that AEA has started to take steps more clearly at interventions targeting women and minorities and the intersection between these two.

A related issue is that the topics mainstream economics tends to focus on may not appeal to women and minorities. I like the tools of economics, but not the focus. The problems of international trade do not keep me up at night and the thought of how a production plant processes things and how efficiently it can churn out gadgets is not so exciting to me. I find the economics of the family, and health economics more engaging. I had come to the LSE with a mission to move from economics to anthropology to do something more interesting. I was reeled back in by people who were able to bring anthropological insights into economics, and that I found incredibly fascinating. It is really worth putting effort into creating more diversity and making economics more of a friendly environment for women and minorities, because it will broaden the profession and the areas that people work on, and strengthen the methods people use to work on topics that are not necessarily in the mainstream at the moment.

Looking back, is there anything that you would do differently as a PhD student or early career researcher? Would you take 10 years to do your PhD?!

I actually don’t think I would change anything. All of the different experiences were important to me. Sure, taking ~10 years comes with some challenges, and I would probably be at a different stage if I hadn’t done this, but I also think that everything I did was meaningful and important to me. I have learned from all of these things, so in many ways I think being true to myself and understanding what I need and what I want to do has been important, and I would not want to deviate from that. In the end, I do what matters to me even if it is not very easy.

And that’s certainly a very important message to get out to other PhD students!

Many thanks Giulia for talking to us today. Interested readers can learn more about Giulia’s work by visiting her profile page. The next interview in the Early Career Researcher Interview Series will be published in November 2018.