
Professor Nicola Gale
Head of the School of Social Policy and Society
Nicola Gale is Head of the School of Social Policy and Society and Professor of Health Policy and Sociology, Health Services Management Centre at the University of Birmingham.


The unsustainability of a cure-focused health system and the need for a stronger approach to managing health risks has been emphasised internationally. In the UK, the government has been urged to develop prevention services ‘on an industrial scale’ (Darzi Report 2008) and the recent Five Year Forward View stated: “The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health” (NHS England 2014:9).
We know little of those at the ‘frontline’ of this work, i.e. the backgrounds, motivations, experiences, or goals of professionals, para-professionals and lay health workers. They are usually based in primary or community care, trained (although not always professionally qualified, and in which case paid far more modestly) to undertake activities to identify or manage health risks, such as screening for diseases or providing dietary advice.
In our work, we have developed a theory of ‘risk work’ – a concept bringing together the sociology of risk and sociology of work to explore the everyday practice of managing (health) risks and to understand its role in the implementation at ‘street-level’ of national policies. We continue to work with public and third sector collaborators to ensure that our research has impact in practice.
We have created a workforce development training programme for community health workers that addresses some of the challenges organisations face when working with risk. The programme is free and accessible to all.
It is a training programme was developed by a team of researchers, community health workers, service user representatives and a playwright, through the Health Services Management Centre (HSMC) at the University of Birmingham.
It has been developed in response to research into the experiences of Community Health Workers carried out by researchers at the University of Birmingham. The research uncovered lots of issues relating to conveying ‘risk’ to clients and the impact this had on relationships, and the nature of how CHWs delivered interventions.
The tool provides guidance for organisations to run five group-based sessions with community health workers, lasting around one hour each and delivered weekly. The course is structured around four short films that explore some of the issues around risk knowledge, interventions to reduce health risks and practitioner-client relationships by showing some different challenging situations faced by Community Health Workers.
It has been devised as an advanced development course, suitable for people who have been in the job for more than 6 months and, therefore, it is not a course on “how to” be a community health worker.
The project was funded by the Economic and Social Research Council as part of their “Impact Acceleration” programme.
Brown, P., & Gale, N. (2018). Theorising risk work: Analysing professionals’ lifeworlds and practices. Professions and Professionalism, 8(1), 1988.
Brown, P., & Gale, N. (2018). Developing a sociology of risk work in client-facing contexts: an editorial. Health, Risk and Society (Editors of the Special Edition)
Gale, N. K., Kenyon, S., MacArthur, C., Jolly, K., & Hope, L. (2018). Synthetic social support: Theorizing lay health worker interventions. Social Science & Medicine, 196, 96-105.
Gale NK*, Dowswell G, Greenfield S, Marshall T (2017) Street-level diplomacy? Communicative and adaptive work at the front line of implementing public health policies in primary care. Social Science & Medicine, 177:9-18.
Gale NK*, Thomas G, Thwaites R, Greenfield S, Brown, P (2016) ‘Towards a sociology of risk work: a narrative review and synthesis’, Sociology Compass, 10(11), 1046-1071.
Gale, NK (2017) Co-production in the epidemiological clinic: adecentred approach to understanding risk work; Working paper for: Inside coproduction: ruling, resistance, and practice; Organized by: Mark Bevir, Catherine Needham, and Justin Waring; Hosted by: Center for British Studies, University of California, Berkeley; Friday 28 April 2017.
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