case study is better than historical analysis

The Ultimate Guide to Qualitative Research - Part 1: The Basics

• Introduction and overview
• What is qualitative research?
• What is qualitative data?
• Examples of qualitative data
• Qualitative vs. quantitative research
• Mixed methods
• Qualitative research preparation
• Theoretical perspective
• Theoretical framework
• Literature reviews

Research question

• Conceptual framework
• Conceptual vs. theoretical framework

Data collection

• Qualitative research methods
• Focus groups
• Observational research

What is a case study?

Applications for case study research, what is a good case study, process of case study design, benefits and limitations of case studies.

• Ethnographical research
• Ethical considerations
• Confidentiality and privacy
• Power dynamics
• Reflexivity

Case studies

Case studies are essential to qualitative research , offering a lens through which researchers can investigate complex phenomena within their real-life contexts. This chapter explores the concept, purpose, applications, examples, and types of case studies and provides guidance on how to conduct case study research effectively.

Whereas quantitative methods look at phenomena at scale, case study research looks at a concept or phenomenon in considerable detail. While analyzing a single case can help understand one perspective regarding the object of research inquiry, analyzing multiple cases can help obtain a more holistic sense of the topic or issue. Let's provide a basic definition of a case study, then explore its characteristics and role in the qualitative research process.

Definition of a case study

A case study in qualitative research is a strategy of inquiry that involves an in-depth investigation of a phenomenon within its real-world context. It provides researchers with the opportunity to acquire an in-depth understanding of intricate details that might not be as apparent or accessible through other methods of research. The specific case or cases being studied can be a single person, group, or organization – demarcating what constitutes a relevant case worth studying depends on the researcher and their research question .

Among qualitative research methods , a case study relies on multiple sources of evidence, such as documents, artifacts, interviews , or observations , to present a complete and nuanced understanding of the phenomenon under investigation. The objective is to illuminate the readers' understanding of the phenomenon beyond its abstract statistical or theoretical explanations.

Characteristics of case studies

Case studies typically possess a number of distinct characteristics that set them apart from other research methods. These characteristics include a focus on holistic description and explanation, flexibility in the design and data collection methods, reliance on multiple sources of evidence, and emphasis on the context in which the phenomenon occurs.

Furthermore, case studies can often involve a longitudinal examination of the case, meaning they study the case over a period of time. These characteristics allow case studies to yield comprehensive, in-depth, and richly contextualized insights about the phenomenon of interest.

The role of case studies in research

Case studies hold a unique position in the broader landscape of research methods aimed at theory development. They are instrumental when the primary research interest is to gain an intensive, detailed understanding of a phenomenon in its real-life context.

In addition, case studies can serve different purposes within research - they can be used for exploratory, descriptive, or explanatory purposes, depending on the research question and objectives. This flexibility and depth make case studies a valuable tool in the toolkit of qualitative researchers.

Remember, a well-conducted case study can offer a rich, insightful contribution to both academic and practical knowledge through theory development or theory verification, thus enhancing our understanding of complex phenomena in their real-world contexts.

What is the purpose of a case study?

Case study research aims for a more comprehensive understanding of phenomena, requiring various research methods to gather information for qualitative analysis . Ultimately, a case study can allow the researcher to gain insight into a particular object of inquiry and develop a theoretical framework relevant to the research inquiry.

Why use case studies in qualitative research?

Using case studies as a research strategy depends mainly on the nature of the research question and the researcher's access to the data.

Conducting case study research provides a level of detail and contextual richness that other research methods might not offer. They are beneficial when there's a need to understand complex social phenomena within their natural contexts.

The explanatory, exploratory, and descriptive roles of case studies

Case studies can take on various roles depending on the research objectives. They can be exploratory when the research aims to discover new phenomena or define new research questions; they are descriptive when the objective is to depict a phenomenon within its context in a detailed manner; and they can be explanatory if the goal is to understand specific relationships within the studied context. Thus, the versatility of case studies allows researchers to approach their topic from different angles, offering multiple ways to uncover and interpret the data .

The impact of case studies on knowledge development

Case studies play a significant role in knowledge development across various disciplines. Analysis of cases provides an avenue for researchers to explore phenomena within their context based on the collected data.

This can result in the production of rich, practical insights that can be instrumental in both theory-building and practice. Case studies allow researchers to delve into the intricacies and complexities of real-life situations, uncovering insights that might otherwise remain hidden.

Types of case studies

In qualitative research , a case study is not a one-size-fits-all approach. Depending on the nature of the research question and the specific objectives of the study, researchers might choose to use different types of case studies. These types differ in their focus, methodology, and the level of detail they provide about the phenomenon under investigation.

Understanding these types is crucial for selecting the most appropriate approach for your research project and effectively achieving your research goals. Let's briefly look at the main types of case studies.

Exploratory case studies

Exploratory case studies are typically conducted to develop a theory or framework around an understudied phenomenon. They can also serve as a precursor to a larger-scale research project. Exploratory case studies are useful when a researcher wants to identify the key issues or questions which can spur more extensive study or be used to develop propositions for further research. These case studies are characterized by flexibility, allowing researchers to explore various aspects of a phenomenon as they emerge, which can also form the foundation for subsequent studies.

Descriptive case studies

Descriptive case studies aim to provide a complete and accurate representation of a phenomenon or event within its context. These case studies are often based on an established theoretical framework, which guides how data is collected and analyzed. The researcher is concerned with describing the phenomenon in detail, as it occurs naturally, without trying to influence or manipulate it.

Explanatory case studies

Explanatory case studies are focused on explanation - they seek to clarify how or why certain phenomena occur. Often used in complex, real-life situations, they can be particularly valuable in clarifying causal relationships among concepts and understanding the interplay between different factors within a specific context.

Intrinsic, instrumental, and collective case studies

These three categories of case studies focus on the nature and purpose of the study. An intrinsic case study is conducted when a researcher has an inherent interest in the case itself. Instrumental case studies are employed when the case is used to provide insight into a particular issue or phenomenon. A collective case study, on the other hand, involves studying multiple cases simultaneously to investigate some general phenomena.

Each type of case study serves a different purpose and has its own strengths and challenges. The selection of the type should be guided by the research question and objectives, as well as the context and constraints of the research.

The flexibility, depth, and contextual richness offered by case studies make this approach an excellent research method for various fields of study. They enable researchers to investigate real-world phenomena within their specific contexts, capturing nuances that other research methods might miss. Across numerous fields, case studies provide valuable insights into complex issues.

Critical information systems research

Case studies provide a detailed understanding of the role and impact of information systems in different contexts. They offer a platform to explore how information systems are designed, implemented, and used and how they interact with various social, economic, and political factors. Case studies in this field often focus on examining the intricate relationship between technology, organizational processes, and user behavior, helping to uncover insights that can inform better system design and implementation.

Health research

Health research is another field where case studies are highly valuable. They offer a way to explore patient experiences, healthcare delivery processes, and the impact of various interventions in a real-world context.

Case studies can provide a deep understanding of a patient's journey, giving insights into the intricacies of disease progression, treatment effects, and the psychosocial aspects of health and illness.

Asthma research studies

Specifically within medical research, studies on asthma often employ case studies to explore the individual and environmental factors that influence asthma development, management, and outcomes. A case study can provide rich, detailed data about individual patients' experiences, from the triggers and symptoms they experience to the effectiveness of various management strategies. This can be crucial for developing patient-centered asthma care approaches.

Other fields

Apart from the fields mentioned, case studies are also extensively used in business and management research, education research, and political sciences, among many others. They provide an opportunity to delve into the intricacies of real-world situations, allowing for a comprehensive understanding of various phenomena.

Case studies, with their depth and contextual focus, offer unique insights across these varied fields. They allow researchers to illuminate the complexities of real-life situations, contributing to both theory and practice.

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Understanding the key elements of case study design is crucial for conducting rigorous and impactful case study research. A well-structured design guides the researcher through the process, ensuring that the study is methodologically sound and its findings are reliable and valid. The main elements of case study design include the research question , propositions, units of analysis, and the logic linking the data to the propositions.

The research question is the foundation of any research study. A good research question guides the direction of the study and informs the selection of the case, the methods of collecting data, and the analysis techniques. A well-formulated research question in case study research is typically clear, focused, and complex enough to merit further detailed examination of the relevant case(s).

Propositions

Propositions, though not necessary in every case study, provide a direction by stating what we might expect to find in the data collected. They guide how data is collected and analyzed by helping researchers focus on specific aspects of the case. They are particularly important in explanatory case studies, which seek to understand the relationships among concepts within the studied phenomenon.

Units of analysis

The unit of analysis refers to the case, or the main entity or entities that are being analyzed in the study. In case study research, the unit of analysis can be an individual, a group, an organization, a decision, an event, or even a time period. It's crucial to clearly define the unit of analysis, as it shapes the qualitative data analysis process by allowing the researcher to analyze a particular case and synthesize analysis across multiple case studies to draw conclusions.

Argumentation

This refers to the inferential model that allows researchers to draw conclusions from the data. The researcher needs to ensure that there is a clear link between the data, the propositions (if any), and the conclusions drawn. This argumentation is what enables the researcher to make valid and credible inferences about the phenomenon under study.

Understanding and carefully considering these elements in the design phase of a case study can significantly enhance the quality of the research. It can help ensure that the study is methodologically sound and its findings contribute meaningful insights about the case.

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Conducting a case study involves several steps, from defining the research question and selecting the case to collecting and analyzing data . This section outlines these key stages, providing a practical guide on how to conduct case study research.

Defining the research question

The first step in case study research is defining a clear, focused research question. This question should guide the entire research process, from case selection to analysis. It's crucial to ensure that the research question is suitable for a case study approach. Typically, such questions are exploratory or descriptive in nature and focus on understanding a phenomenon within its real-life context.

Selecting and defining the case

The selection of the case should be based on the research question and the objectives of the study. It involves choosing a unique example or a set of examples that provide rich, in-depth data about the phenomenon under investigation. After selecting the case, it's crucial to define it clearly, setting the boundaries of the case, including the time period and the specific context.

Previous research can help guide the case study design. When considering a case study, an example of a case could be taken from previous case study research and used to define cases in a new research inquiry. Considering recently published examples can help understand how to select and define cases effectively.

Developing a detailed case study protocol

A case study protocol outlines the procedures and general rules to be followed during the case study. This includes the data collection methods to be used, the sources of data, and the procedures for analysis. Having a detailed case study protocol ensures consistency and reliability in the study.

The protocol should also consider how to work with the people involved in the research context to grant the research team access to collecting data. As mentioned in previous sections of this guide, establishing rapport is an essential component of qualitative research as it shapes the overall potential for collecting and analyzing data.

Collecting data

Gathering data in case study research often involves multiple sources of evidence, including documents, archival records, interviews, observations, and physical artifacts. This allows for a comprehensive understanding of the case. The process for gathering data should be systematic and carefully documented to ensure the reliability and validity of the study.

Analyzing and interpreting data

The next step is analyzing the data. This involves organizing the data , categorizing it into themes or patterns , and interpreting these patterns to answer the research question. The analysis might also involve comparing the findings with prior research or theoretical propositions.

Writing the case study report

The final step is writing the case study report . This should provide a detailed description of the case, the data, the analysis process, and the findings. The report should be clear, organized, and carefully written to ensure that the reader can understand the case and the conclusions drawn from it.

Each of these steps is crucial in ensuring that the case study research is rigorous, reliable, and provides valuable insights about the case.

The type, depth, and quality of data in your study can significantly influence the validity and utility of the study. In case study research, data is usually collected from multiple sources to provide a comprehensive and nuanced understanding of the case. This section will outline the various methods of collecting data used in case study research and discuss considerations for ensuring the quality of the data.

Interviews are a common method of gathering data in case study research. They can provide rich, in-depth data about the perspectives, experiences, and interpretations of the individuals involved in the case. Interviews can be structured , semi-structured , or unstructured , depending on the research question and the degree of flexibility needed.

Observations

Observations involve the researcher observing the case in its natural setting, providing first-hand information about the case and its context. Observations can provide data that might not be revealed in interviews or documents, such as non-verbal cues or contextual information.

Documents and artifacts

Documents and archival records provide a valuable source of data in case study research. They can include reports, letters, memos, meeting minutes, email correspondence, and various public and private documents related to the case.

These records can provide historical context, corroborate evidence from other sources, and offer insights into the case that might not be apparent from interviews or observations.

Physical artifacts refer to any physical evidence related to the case, such as tools, products, or physical environments. These artifacts can provide tangible insights into the case, complementing the data gathered from other sources.

Ensuring the quality of data collection

Determining the quality of data in case study research requires careful planning and execution. It's crucial to ensure that the data is reliable, accurate, and relevant to the research question. This involves selecting appropriate methods of collecting data, properly training interviewers or observers, and systematically recording and storing the data. It also includes considering ethical issues related to collecting and handling data, such as obtaining informed consent and ensuring the privacy and confidentiality of the participants.

Data analysis

Analyzing case study research involves making sense of the rich, detailed data to answer the research question. This process can be challenging due to the volume and complexity of case study data. However, a systematic and rigorous approach to analysis can ensure that the findings are credible and meaningful. This section outlines the main steps and considerations in analyzing data in case study research.

Organizing the data

The first step in the analysis is organizing the data. This involves sorting the data into manageable sections, often according to the data source or the theme. This step can also involve transcribing interviews, digitizing physical artifacts, or organizing observational data.

Categorizing and coding the data

Once the data is organized, the next step is to categorize or code the data. This involves identifying common themes, patterns, or concepts in the data and assigning codes to relevant data segments. Coding can be done manually or with the help of software tools, and in either case, qualitative analysis software can greatly facilitate the entire coding process. Coding helps to reduce the data to a set of themes or categories that can be more easily analyzed.

Identifying patterns and themes

After coding the data, the researcher looks for patterns or themes in the coded data. This involves comparing and contrasting the codes and looking for relationships or patterns among them. The identified patterns and themes should help answer the research question.

Interpreting the data

Once patterns and themes have been identified, the next step is to interpret these findings. This involves explaining what the patterns or themes mean in the context of the research question and the case. This interpretation should be grounded in the data, but it can also involve drawing on theoretical concepts or prior research.

Verification of the data

The last step in the analysis is verification. This involves checking the accuracy and consistency of the analysis process and confirming that the findings are supported by the data. This can involve re-checking the original data, checking the consistency of codes, or seeking feedback from research participants or peers.

Like any research method , case study research has its strengths and limitations. Researchers must be aware of these, as they can influence the design, conduct, and interpretation of the study.

Understanding the strengths and limitations of case study research can also guide researchers in deciding whether this approach is suitable for their research question . This section outlines some of the key strengths and limitations of case study research.

Benefits include the following:

• Rich, detailed data: One of the main strengths of case study research is that it can generate rich, detailed data about the case. This can provide a deep understanding of the case and its context, which can be valuable in exploring complex phenomena.
• Flexibility: Case study research is flexible in terms of design , data collection , and analysis . A sufficient degree of flexibility allows the researcher to adapt the study according to the case and the emerging findings.
• Real-world context: Case study research involves studying the case in its real-world context, which can provide valuable insights into the interplay between the case and its context.
• Multiple sources of evidence: Case study research often involves collecting data from multiple sources , which can enhance the robustness and validity of the findings.

On the other hand, researchers should consider the following limitations:

• Generalizability: A common criticism of case study research is that its findings might not be generalizable to other cases due to the specificity and uniqueness of each case.
• Time and resource intensive: Case study research can be time and resource intensive due to the depth of the investigation and the amount of collected data.
• Complexity of analysis: The rich, detailed data generated in case study research can make analyzing the data challenging.
• Subjectivity: Given the nature of case study research, there may be a higher degree of subjectivity in interpreting the data , so researchers need to reflect on this and transparently convey to audiences how the research was conducted.

Being aware of these strengths and limitations can help researchers design and conduct case study research effectively and interpret and report the findings appropriately.

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What the Case Study Method Really Teaches

• Nitin Nohria

Seven meta-skills that stick even if the cases fade from memory.

It’s been 100 years since Harvard Business School began using the case study method. Beyond teaching specific subject matter, the case study method excels in instilling meta-skills in students. This article explains the importance of seven such skills: preparation, discernment, bias recognition, judgement, collaboration, curiosity, and self-confidence.

During my decade as dean of Harvard Business School, I spent hundreds of hours talking with our alumni. To enliven these conversations, I relied on a favorite question: “What was the most important thing you learned from your time in our MBA program?”

• Nitin Nohria is the George F. Baker Professor of Business Administration, Distinguished University Service Professor, and former dean of Harvard Business School.

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Organizing Your Social Sciences Research Assignments

• Annotated Bibliography
• Analyzing a Scholarly Journal Article
• Group Presentations
• Dealing with Nervousness
• Using Visual Aids
• Grading Someone Else's Paper
• Types of Structured Group Activities
• Group Project Survival Skills
• Leading a Class Discussion
• Multiple Book Review Essay
• Reviewing Collected Works
• Writing a Case Analysis Paper
• Writing a Case Study
• About Informed Consent
• Writing Field Notes
• Writing a Policy Memo
• Writing a Reflective Paper
• Writing a Research Proposal
• Generative AI and Writing
• Acknowledgments

Definition and Introduction

Case analysis is a problem-based teaching and learning method that involves critically analyzing complex scenarios within an organizational setting for the purpose of placing the student in a “real world” situation and applying reflection and critical thinking skills to contemplate appropriate solutions, decisions, or recommended courses of action. It is considered a more effective teaching technique than in-class role playing or simulation activities. The analytical process is often guided by questions provided by the instructor that ask students to contemplate relationships between the facts and critical incidents described in the case.

Cases generally include both descriptive and statistical elements and rely on students applying abductive reasoning to develop and argue for preferred or best outcomes [i.e., case scenarios rarely have a single correct or perfect answer based on the evidence provided]. Rather than emphasizing theories or concepts, case analysis assignments emphasize building a bridge of relevancy between abstract thinking and practical application and, by so doing, teaches the value of both within a specific area of professional practice.

Given this, the purpose of a case analysis paper is to present a structured and logically organized format for analyzing the case situation. It can be assigned to students individually or as a small group assignment and it may include an in-class presentation component. Case analysis is predominately taught in economics and business-related courses, but it is also a method of teaching and learning found in other applied social sciences disciplines, such as, social work, public relations, education, journalism, and public administration.

Ellet, William. The Case Study Handbook: A Student's Guide . Revised Edition. Boston, MA: Harvard Business School Publishing, 2018; Christoph Rasche and Achim Seisreiner. Guidelines for Business Case Analysis . University of Potsdam; Writing a Case Analysis . Writing Center, Baruch College; Volpe, Guglielmo. "Case Teaching in Economics: History, Practice and Evidence." Cogent Economics and Finance 3 (December 2015). doi:https://doi.org/10.1080/23322039.2015.1120977.

How to Approach Writing a Case Analysis Paper

The organization and structure of a case analysis paper can vary depending on the organizational setting, the situation, and how your professor wants you to approach the assignment. Nevertheless, preparing to write a case analysis paper involves several important steps. As Hawes notes, a case analysis assignment “...is useful in developing the ability to get to the heart of a problem, analyze it thoroughly, and to indicate the appropriate solution as well as how it should be implemented” [p.48]. This statement encapsulates how you should approach preparing to write a case analysis paper.

Before you begin to write your paper, consider the following analytical procedures:

• Review the case to get an overview of the situation . A case can be only a few pages in length, however, it is most often very lengthy and contains a significant amount of detailed background information and statistics, with multilayered descriptions of the scenario, the roles and behaviors of various stakeholder groups, and situational events. Therefore, a quick reading of the case will help you gain an overall sense of the situation and illuminate the types of issues and problems that you will need to address in your paper. If your professor has provided questions intended to help frame your analysis, use them to guide your initial reading of the case.
• Read the case thoroughly . After gaining a general overview of the case, carefully read the content again with the purpose of understanding key circumstances, events, and behaviors among stakeholder groups. Look for information or data that appears contradictory, extraneous, or misleading. At this point, you should be taking notes as you read because this will help you develop a general outline of your paper. The aim is to obtain a complete understanding of the situation so that you can begin contemplating tentative answers to any questions your professor has provided or, if they have not provided, developing answers to your own questions about the case scenario and its connection to the course readings,lectures, and class discussions.
• Determine key stakeholder groups, issues, and events and the relationships they all have to each other . As you analyze the content, pay particular attention to identifying individuals, groups, or organizations described in the case and identify evidence of any problems or issues of concern that impact the situation in a negative way. Other things to look for include identifying any assumptions being made by or about each stakeholder, potential biased explanations or actions, explicit demands or ultimatums , and the underlying concerns that motivate these behaviors among stakeholders. The goal at this stage is to develop a comprehensive understanding of the situational and behavioral dynamics of the case and the explicit and implicit consequences of each of these actions.
• Identify the core problems . The next step in most case analysis assignments is to discern what the core [i.e., most damaging, detrimental, injurious] problems are within the organizational setting and to determine their implications. The purpose at this stage of preparing to write your analysis paper is to distinguish between the symptoms of core problems and the core problems themselves and to decide which of these must be addressed immediately and which problems do not appear critical but may escalate over time. Identify evidence from the case to support your decisions by determining what information or data is essential to addressing the core problems and what information is not relevant or is misleading.
• Explore alternative solutions . As noted, case analysis scenarios rarely have only one correct answer. Therefore, it is important to keep in mind that the process of analyzing the case and diagnosing core problems, while based on evidence, is a subjective process open to various avenues of interpretation. This means that you must consider alternative solutions or courses of action by critically examining strengths and weaknesses, risk factors, and the differences between short and long-term solutions. For each possible solution or course of action, consider the consequences they may have related to their implementation and how these recommendations might lead to new problems. Also, consider thinking about your recommended solutions or courses of action in relation to issues of fairness, equity, and inclusion.
• Decide on a final set of recommendations . The last stage in preparing to write a case analysis paper is to assert an opinion or viewpoint about the recommendations needed to help resolve the core problems as you see them and to make a persuasive argument for supporting this point of view. Prepare a clear rationale for your recommendations based on examining each element of your analysis. Anticipate possible obstacles that could derail their implementation. Consider any counter-arguments that could be made concerning the validity of your recommended actions. Finally, describe a set of criteria and measurable indicators that could be applied to evaluating the effectiveness of your implementation plan.

Use these steps as the framework for writing your paper. Remember that the more detailed you are in taking notes as you critically examine each element of the case, the more information you will have to draw from when you begin to write. This will save you time.

NOTE : If the process of preparing to write a case analysis paper is assigned as a student group project, consider having each member of the group analyze a specific element of the case, including drafting answers to the corresponding questions used by your professor to frame the analysis. This will help make the analytical process more efficient and ensure that the distribution of work is equitable. This can also facilitate who is responsible for drafting each part of the final case analysis paper and, if applicable, the in-class presentation.

Framework for Case Analysis . College of Management. University of Massachusetts; Hawes, Jon M. "Teaching is Not Telling: The Case Method as a Form of Interactive Learning." Journal for Advancement of Marketing Education 5 (Winter 2004): 47-54; Rasche, Christoph and Achim Seisreiner. Guidelines for Business Case Analysis . University of Potsdam; Writing a Case Study Analysis . University of Arizona Global Campus Writing Center; Van Ness, Raymond K. A Guide to Case Analysis . School of Business. State University of New York, Albany; Writing a Case Analysis . Business School, University of New South Wales.

Structure and Writing Style

A case analysis paper should be detailed, concise, persuasive, clearly written, and professional in tone and in the use of language . As with other forms of college-level academic writing, declarative statements that convey information, provide a fact, or offer an explanation or any recommended courses of action should be based on evidence. If allowed by your professor, any external sources used to support your analysis, such as course readings, should be properly cited under a list of references. The organization and structure of case analysis papers can vary depending on your professor’s preferred format, but its structure generally follows the steps used for analyzing the case.

Introduction

The introduction should provide a succinct but thorough descriptive overview of the main facts, issues, and core problems of the case . The introduction should also include a brief summary of the most relevant details about the situation and organizational setting. This includes defining the theoretical framework or conceptual model on which any questions were used to frame your analysis.

Following the rules of most college-level research papers, the introduction should then inform the reader how the paper will be organized. This includes describing the major sections of the paper and the order in which they will be presented. Unless you are told to do so by your professor, you do not need to preview your final recommendations in the introduction. U nlike most college-level research papers , the introduction does not include a statement about the significance of your findings because a case analysis assignment does not involve contributing new knowledge about a research problem.

Background Analysis

Background analysis can vary depending on any guiding questions provided by your professor and the underlying concept or theory that the case is based upon. In general, however, this section of your paper should focus on:

• Providing an overarching analysis of problems identified from the case scenario, including identifying events that stakeholders find challenging or troublesome,
• Identifying assumptions made by each stakeholder and any apparent biases they may exhibit,
• Describing any demands or claims made by or forced upon key stakeholders, and
• Highlighting any issues of concern or complaints expressed by stakeholders in response to those demands or claims.

These aspects of the case are often in the form of behavioral responses expressed by individuals or groups within the organizational setting. However, note that problems in a case situation can also be reflected in data [or the lack thereof] and in the decision-making, operational, cultural, or institutional structure of the organization. Additionally, demands or claims can be either internal and external to the organization [e.g., a case analysis involving a president considering arms sales to Saudi Arabia could include managing internal demands from White House advisors as well as demands from members of Congress].

Throughout this section, present all relevant evidence from the case that supports your analysis. Do not simply claim there is a problem, an assumption, a demand, or a concern; tell the reader what part of the case informed how you identified these background elements.

Identification of Problems

In most case analysis assignments, there are problems, and then there are problems . Each problem can reflect a multitude of underlying symptoms that are detrimental to the interests of the organization. The purpose of identifying problems is to teach students how to differentiate between problems that vary in severity, impact, and relative importance. Given this, problems can be described in three general forms: those that must be addressed immediately, those that should be addressed but the impact is not severe, and those that do not require immediate attention and can be set aside for the time being.

All of the problems you identify from the case should be identified in this section of your paper, with a description based on evidence explaining the problem variances. If the assignment asks you to conduct research to further support your assessment of the problems, include this in your explanation. Remember to cite those sources in a list of references. Use specific evidence from the case and apply appropriate concepts, theories, and models discussed in class or in relevant course readings to highlight and explain the key problems [or problem] that you believe must be solved immediately and describe the underlying symptoms and why they are so critical.

Alternative Solutions

This section is where you provide specific, realistic, and evidence-based solutions to the problems you have identified and make recommendations about how to alleviate the underlying symptomatic conditions impacting the organizational setting. For each solution, you must explain why it was chosen and provide clear evidence to support your reasoning. This can include, for example, course readings and class discussions as well as research resources, such as, books, journal articles, research reports, or government documents. In some cases, your professor may encourage you to include personal, anecdotal experiences as evidence to support why you chose a particular solution or set of solutions. Using anecdotal evidence helps promote reflective thinking about the process of determining what qualifies as a core problem and relevant solution .

Throughout this part of the paper, keep in mind the entire array of problems that must be addressed and describe in detail the solutions that might be implemented to resolve these problems.

Recommended Courses of Action

In some case analysis assignments, your professor may ask you to combine the alternative solutions section with your recommended courses of action. However, it is important to know the difference between the two. A solution refers to the answer to a problem. A course of action refers to a procedure or deliberate sequence of activities adopted to proactively confront a situation, often in the context of accomplishing a goal. In this context, proposed courses of action are based on your analysis of alternative solutions. Your description and justification for pursuing each course of action should represent the overall plan for implementing your recommendations.

For each course of action, you need to explain the rationale for your recommendation in a way that confronts challenges, explains risks, and anticipates any counter-arguments from stakeholders. Do this by considering the strengths and weaknesses of each course of action framed in relation to how the action is expected to resolve the core problems presented, the possible ways the action may affect remaining problems, and how the recommended action will be perceived by each stakeholder.

In addition, you should describe the criteria needed to measure how well the implementation of these actions is working and explain which individuals or groups are responsible for ensuring your recommendations are successful. In addition, always consider the law of unintended consequences. Outline difficulties that may arise in implementing each course of action and describe how implementing the proposed courses of action [either individually or collectively] may lead to new problems [both large and small].

Throughout this section, you must consider the costs and benefits of recommending your courses of action in relation to uncertainties or missing information and the negative consequences of success.

The conclusion should be brief and introspective. Unlike a research paper, the conclusion in a case analysis paper does not include a summary of key findings and their significance, a statement about how the study contributed to existing knowledge, or indicate opportunities for future research.

Begin by synthesizing the core problems presented in the case and the relevance of your recommended solutions. This can include an explanation of what you have learned about the case in the context of your answers to the questions provided by your professor. The conclusion is also where you link what you learned from analyzing the case with the course readings or class discussions. This can further demonstrate your understanding of the relationships between the practical case situation and the theoretical and abstract content of assigned readings and other course content.

Problems to Avoid

The literature on case analysis assignments often includes examples of difficulties students have with applying methods of critical analysis and effectively reporting the results of their assessment of the situation. A common reason cited by scholars is that the application of this type of teaching and learning method is limited to applied fields of social and behavioral sciences and, as a result, writing a case analysis paper can be unfamiliar to most students entering college.

After you have drafted your paper, proofread the narrative flow and revise any of these common errors:

• Unnecessary detail in the background section . The background section should highlight the essential elements of the case based on your analysis. Focus on summarizing the facts and highlighting the key factors that become relevant in the other sections of the paper by eliminating any unnecessary information.
• Analysis relies too much on opinion . Your analysis is interpretive, but the narrative must be connected clearly to evidence from the case and any models and theories discussed in class or in course readings. Any positions or arguments you make should be supported by evidence.
• Analysis does not focus on the most important elements of the case . Your paper should provide a thorough overview of the case. However, the analysis should focus on providing evidence about what you identify are the key events, stakeholders, issues, and problems. Emphasize what you identify as the most critical aspects of the case to be developed throughout your analysis. Be thorough but succinct.
• Writing is too descriptive . A paper with too much descriptive information detracts from your analysis of the complexities of the case situation. Questions about what happened, where, when, and by whom should only be included as essential information leading to your examination of questions related to why, how, and for what purpose.
• Inadequate definition of a core problem and associated symptoms . A common error found in case analysis papers is recommending a solution or course of action without adequately defining or demonstrating that you understand the problem. Make sure you have clearly described the problem and its impact and scope within the organizational setting. Ensure that you have adequately described the root causes w hen describing the symptoms of the problem.
• Recommendations lack specificity . Identify any use of vague statements and indeterminate terminology, such as, “A particular experience” or “a large increase to the budget.” These statements cannot be measured and, as a result, there is no way to evaluate their successful implementation. Provide specific data and use direct language in describing recommended actions.
• Unrealistic, exaggerated, or unattainable recommendations . Review your recommendations to ensure that they are based on the situational facts of the case. Your recommended solutions and courses of action must be based on realistic assumptions and fit within the constraints of the situation. Also note that the case scenario has already happened, therefore, any speculation or arguments about what could have occurred if the circumstances were different should be revised or eliminated.

Bee, Lian Song et al. "Business Students' Perspectives on Case Method Coaching for Problem-Based Learning: Impacts on Student Engagement and Learning Performance in Higher Education." Education & Training 64 (2022): 416-432; The Case Analysis . Fred Meijer Center for Writing and Michigan Authors. Grand Valley State University; Georgallis, Panikos and Kayleigh Bruijn. "Sustainability Teaching using Case-Based Debates." Journal of International Education in Business 15 (2022): 147-163; Hawes, Jon M. "Teaching is Not Telling: The Case Method as a Form of Interactive Learning." Journal for Advancement of Marketing Education 5 (Winter 2004): 47-54; Georgallis, Panikos, and Kayleigh Bruijn. "Sustainability Teaching Using Case-based Debates." Journal of International Education in Business 15 (2022): 147-163; .Dean,  Kathy Lund and Charles J. Fornaciari. "How to Create and Use Experiential Case-Based Exercises in a Management Classroom." Journal of Management Education 26 (October 2002): 586-603; Klebba, Joanne M. and Janet G. Hamilton. "Structured Case Analysis: Developing Critical Thinking Skills in a Marketing Case Course." Journal of Marketing Education 29 (August 2007): 132-137, 139; Klein, Norman. "The Case Discussion Method Revisited: Some Questions about Student Skills." Exchange: The Organizational Behavior Teaching Journal 6 (November 1981): 30-32; Mukherjee, Arup. "Effective Use of In-Class Mini Case Analysis for Discovery Learning in an Undergraduate MIS Course." The Journal of Computer Information Systems 40 (Spring 2000): 15-23; Pessoa, Silviaet al. "Scaffolding the Case Analysis in an Organizational Behavior Course: Making Analytical Language Explicit." Journal of Management Education 46 (2022): 226-251: Ramsey, V. J. and L. D. Dodge. "Case Analysis: A Structured Approach." Exchange: The Organizational Behavior Teaching Journal 6 (November 1981): 27-29; Schweitzer, Karen. "How to Write and Format a Business Case Study." ThoughtCo. https://www.thoughtco.com/how-to-write-and-format-a-business-case-study-466324 (accessed December 5, 2022); Reddy, C. D. "Teaching Research Methodology: Everything's a Case." Electronic Journal of Business Research Methods 18 (December 2020): 178-188; Volpe, Guglielmo. "Case Teaching in Economics: History, Practice and Evidence." Cogent Economics and Finance 3 (December 2015). doi:https://doi.org/10.1080/23322039.2015.1120977.

Writing Tip

Ca se Study and Case Analysis Are Not the Same!

Confusion often exists between what it means to write a paper that uses a case study research design and writing a paper that analyzes a case; they are two different types of approaches to learning in the social and behavioral sciences. Professors as well as educational researchers contribute to this confusion because they often use the term "case study" when describing the subject of analysis for a case analysis paper. But you are not studying a case for the purpose of generating a comprehensive, multi-faceted understanding of a research problem. R ather, you are critically analyzing a specific scenario to argue logically for recommended solutions and courses of action that lead to optimal outcomes applicable to professional practice.

To avoid any confusion, here are twelve characteristics that delineate the differences between writing a paper using the case study research method and writing a case analysis paper:

• Case study is a method of in-depth research and rigorous inquiry ; case analysis is a reliable method of teaching and learning . A case study is a modality of research that investigates a phenomenon for the purpose of creating new knowledge, solving a problem, or testing a hypothesis using empirical evidence derived from the case being studied. Often, the results are used to generalize about a larger population or within a wider context. The writing adheres to the traditional standards of a scholarly research study. A case analysis is a pedagogical tool used to teach students how to reflect and think critically about a practical, real-life problem in an organizational setting.
• The researcher is responsible for identifying the case to study; a case analysis is assigned by your professor . As the researcher, you choose the case study to investigate in support of obtaining new knowledge and understanding about the research problem. The case in a case analysis assignment is almost always provided, and sometimes written, by your professor and either given to every student in class to analyze individually or to a small group of students, or students select a case to analyze from a predetermined list.
• A case study is indeterminate and boundless; a case analysis is predetermined and confined . A case study can be almost anything [see item 9 below] as long as it relates directly to examining the research problem. This relationship is the only limit to what a researcher can choose as the subject of their case study. The content of a case analysis is determined by your professor and its parameters are well-defined and limited to elucidating insights of practical value applied to practice.
• Case study is fact-based and describes actual events or situations; case analysis can be entirely fictional or adapted from an actual situation . The entire content of a case study must be grounded in reality to be a valid subject of investigation in an empirical research study. A case analysis only needs to set the stage for critically examining a situation in practice and, therefore, can be entirely fictional or adapted, all or in-part, from an actual situation.
• Research using a case study method must adhere to principles of intellectual honesty and academic integrity; a case analysis scenario can include misleading or false information . A case study paper must report research objectively and factually to ensure that any findings are understood to be logically correct and trustworthy. A case analysis scenario may include misleading or false information intended to deliberately distract from the central issues of the case. The purpose is to teach students how to sort through conflicting or useless information in order to come up with the preferred solution. Any use of misleading or false information in academic research is considered unethical.
• Case study is linked to a research problem; case analysis is linked to a practical situation or scenario . In the social sciences, the subject of an investigation is most often framed as a problem that must be researched in order to generate new knowledge leading to a solution. Case analysis narratives are grounded in real life scenarios for the purpose of examining the realities of decision-making behavior and processes within organizational settings. A case analysis assignments include a problem or set of problems to be analyzed. However, the goal is centered around the act of identifying and evaluating courses of action leading to best possible outcomes.
• The purpose of a case study is to create new knowledge through research; the purpose of a case analysis is to teach new understanding . Case studies are a choice of methodological design intended to create new knowledge about resolving a research problem. A case analysis is a mode of teaching and learning intended to create new understanding and an awareness of uncertainty applied to practice through acts of critical thinking and reflection.
• A case study seeks to identify the best possible solution to a research problem; case analysis can have an indeterminate set of solutions or outcomes . Your role in studying a case is to discover the most logical, evidence-based ways to address a research problem. A case analysis assignment rarely has a single correct answer because one of the goals is to force students to confront the real life dynamics of uncertainly, ambiguity, and missing or conflicting information within professional practice. Under these conditions, a perfect outcome or solution almost never exists.
• Case study is unbounded and relies on gathering external information; case analysis is a self-contained subject of analysis . The scope of a case study chosen as a method of research is bounded. However, the researcher is free to gather whatever information and data is necessary to investigate its relevance to understanding the research problem. For a case analysis assignment, your professor will often ask you to examine solutions or recommended courses of action based solely on facts and information from the case.
• Case study can be a person, place, object, issue, event, condition, or phenomenon; a case analysis is a carefully constructed synopsis of events, situations, and behaviors . The research problem dictates the type of case being studied and, therefore, the design can encompass almost anything tangible as long as it fulfills the objective of generating new knowledge and understanding. A case analysis is in the form of a narrative containing descriptions of facts, situations, processes, rules, and behaviors within a particular setting and under a specific set of circumstances.
• Case study can represent an open-ended subject of inquiry; a case analysis is a narrative about something that has happened in the past . A case study is not restricted by time and can encompass an event or issue with no temporal limit or end. For example, the current war in Ukraine can be used as a case study of how medical personnel help civilians during a large military conflict, even though circumstances around this event are still evolving. A case analysis can be used to elicit critical thinking about current or future situations in practice, but the case itself is a narrative about something finite and that has taken place in the past.
• Multiple case studies can be used in a research study; case analysis involves examining a single scenario . Case study research can use two or more cases to examine a problem, often for the purpose of conducting a comparative investigation intended to discover hidden relationships, document emerging trends, or determine variations among different examples. A case analysis assignment typically describes a stand-alone, self-contained situation and any comparisons among cases are conducted during in-class discussions and/or student presentations.

The Case Analysis . Fred Meijer Center for Writing and Michigan Authors. Grand Valley State University; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Ramsey, V. J. and L. D. Dodge. "Case Analysis: A Structured Approach." Exchange: The Organizational Behavior Teaching Journal 6 (November 1981): 27-29; Yin, Robert K. Case Study Research and Applications: Design and Methods . 6th edition. Thousand Oaks, CA: Sage, 2017; Crowe, Sarah et al. “The Case Study Approach.” BMC Medical Research Methodology 11 (2011):  doi: 10.1186/1471-2288-11-100; Yin, Robert K. Case Study Research: Design and Methods . 4th edition. Thousand Oaks, CA: Sage Publishing; 1994.

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History Matters: The Critical Contribution of Historical Analysis to Contemporary Health Policy and Health Care

Sally sheard.

University of Liverpool, Liverpool, UK

History is popular with health policymakers, if the regularity with which they invoke historical anecdotes to support policy change is used as an indicator. Yet the ways in which they ‘use’ history vary enormously, as does its impact. This paper explores, from the perspective of a UK academic historian, the development of ‘applied’ history in health policy. It draws on personal experience of different types and levels of engagement with policymakers, and highlights mechanisms through which this dialogue and partnership can be made more efficient, effective, and intellectually rewarding for all involved.

History is popular with health policymakers, if the regularity with which they invoke historical anecdotes to support policy change is used as an indicator. Yet the ways in which they ‘use’ history vary enormously, as does its impact. This paper explores, from the perspective of an academic historian, the development of ‘applied’ history in health policy. It demonstrates, through UK case studies, that historical analysis can improve policymaking and service delivery. By focusing on the actual process of policymaking and implementation, especially what happens when earlier policies have been forgotten or deliberately side-lined, historical analysis helps to open up wider opportunities. The paper highlights the similarities between history and improvement science: both disciplines are concerned with change over time, and have developed methodologies to cope with complexity. There is a case to be made for a greater use of historians in health policy and health care, but this requires policymakers and service providers to be aware of what they offer and where to find them, and to routinely engage with them at the start of new policy or service planning. It requires the development of shared objectives, language and planning schedules.

The paper first outlines how history has become a key component of popular culture, especially in the UK, and suggests that this has enabled UK some health policymakers to feel they can ‘do it themselves’ to the exclusion of professional historians. Second, it sets out some of the methodological issues and challenges around historical analysis, especially in the setting of periods of study, in comparison with improvement science. Third, it discusses how historians of healthcare in the UK have chosen their research topics, and crucially, the style of output, and how this has facilitated or hindered their engagement with policymakers and service providers. Fourth, it provides two case studies which demonstrate how history can be used at different scales: at the local level using an anniversary (of the first UK public health team in 1847) to provoke a city (Liverpool) to reflect on what has enabled population health to improve; at the national level (UK Department of Health) to demonstrate the impact of cuts in medical expertise in the civil service (1980s–1990s) on the ability of the government to respond to emerging infectious diseases (HIV/AIDS; BSE; MRSA).

Fifth, it outlines how UK historians are using new methodologies (witness seminars) and new modes of engagement and dissemination (the History and Policy organisation) to become more proactive in working with policymakers. Although history students are now often taught that their discipline is ‘useful’, or has practical significance, because ‘intelligent action’ invariably draws on past experience, some academic historians are unwilling to see historical ‘lessons’ applied to current ‘real-world’ situations. 1 They would suggest that the uniqueness of a historical event cannot translate perfectly to the present, and so has limited relevance. And, as the US historian Richard Hirsh puts it: ‘More practically, many historians realise that universities rarely provide rewards for work that has direct application outside the ivory tower’. 2 Yet in the UK historians have been developing external work for many years across policy, creative and other arenas, and indeed ‘impact’ is now a key indicator of success for research councils and for the Research Excellence Framework (REF) that helps determine state funding allocations for universities.

Challenges of Using History

There are multiple challenges for historians attempting to engage with non-academic audiences, perhaps the first (in terms of importance and sequence) is the issue of superfluity or irrelevance. I have already noted how historians themselves have been reluctant to let their work be used as crude analogy to contemporary circumstances, but equally, some policymakers do not naturally see history as ‘relevant’ to their work, unless provoked to do so. This is due to a number of factors. They will have an understanding of history based on their personal ‘history’—recollections of their school curricula (which in the UK invariably included the stock favourites of Tudors and Stuarts, and the Second World War)—and they will also draw on how they encounter history as entertainment. It has come to dominate TV scheduling in the UK, from mammoth series such as Kenneth Clarke’s Civilisation to the new generation of international ‘telly dons’ such as Mary Beard and Simon Schama. History as a genre regularly features in publication bestseller lists (often tied to TV series). This history as entertainment is passive: delivered to the audience, and requiring/allowing little interaction with the historians producing it. Even when historians are invited to deliver serious academic content, their raison d’etre can be misinterpreted. The well-known historian David Starkey gave a keynote speech at the 2006 NHS Confederation conference, but one of the organisers later commented that ‘to some extent, he was there as entertainment’. 3

The enthusiasm for mainstream history, as evidenced through its presence in the media and bestseller lists also occasionally surfaces within the policymaking community, where policymakers feel confident, perhaps because they have a history degree, that they can identify and apply historical analogies to current policy issues. Sometimes this is well-intentioned, but can also be seen as ‘history as pancea’. Aneurin Bevan, the Labour Minister of Health who oversaw the introduction of the NHS in 1948, has been regularly name-checked by his successors, usually to support politically contentious policy changes, such as hospital closures and service reorganisations. 4 The repetition of popular historical vignettes, such as the Black Death or the 1918 global influenza pandemic serves to retain and gain them cultural purchase. They also demonstrate preoccupations of their users that are ‘more gothic than historical’. 5

A second challenge—that of ‘time’—causes concerns for both historians and policymakers. Much of the history that is presented as ‘useful’ or ‘relevant’ by historians when consulted by policymakers (or history self-selected by policymakers themselves) can be labelled ‘contemporary history’. Every period has its own contemporary history, and historians differ on how to set our contemporary history’s parameters: whether it covers things within living memory, or as Francis Fukuyama suggests, can be dated from the nineteenth century advent of liberal democracy, in which technology and military competition acted as the twin engines of historical change, as opposed to Marxist theoretical mechanisms of class conflict, politics, and tensions between the individual and the state. 6 Geoffrey Barraclough provides yet another definition: ‘ Contemporary history begins when the problems which are actually in the world today first take visible shape’ (original italics). 7 Historians such as John Gaddis and Peter Catterall have championed contemporary history as a way to deepen the historian’s active engagement in the production of history—someone on the ‘inside’—in contrast to E H Carr’s view of the role of the historian as a general watching from the edge of the battlefield as ‘events’ march past him. 8

Irrespective of how historians conduct their intra-professional debates, for policymakers—especially those politically appointed—the main benefit of using contemporary history context is that it will be familiar to their intended audience: colleagues and/or the public. The supremacy of the recent recognises that ‘every age thinks itself to be the most important age that ever occurred’. 9

This is more than academic turf wars. It determines how history is ‘done’, both by historians and policymakers, as it delimits what is acceptable evidence, how the analytical frameworks handle it, and its potential for further application. Fernand Braudel (1902–1985), editor of Annales and one of the great French historians of the twentieth century, opened a significant debate with his 1958 essay History and the Social Sciences: the Longue Durée . 10 He highlighted the limitations of the historian’s conventional strategy of working with ‘unilinear’ time: in which historical development is presented as continuous on a single (and invariably short) time-scale. This approach, for Braudel, neglected the structures within which change occurred, and prioritised the very recent past. He proposed using an alternative ‘plurality of social time’ in which history operates on three simultaneous levels: the long term (la longue durée: fundamental conditions of life, including the environment); medium term (for social, economic and political systems); the short term (for analysing the individual and the l’histoire événementielle—the ‘event’).

In 1970 an academic symposium on ‘Time’ was convened by the Society for Values in Higher Education that brought together biologists, physicists, psychologists, philosophers and historians. As Dale Porter provocatively stated in his summary of the event, it was the historians who appeared to be least confident in working with the concept of time: ‘In short, historians are working without a viable theory of explanation. Their individual investigations cannot be related to each other in any systematic way, and they are largely irrelevant to studies in other disciplines’. However, their focus on narrative explanations, Dale suggested, were actually similar to the more analytical ‘explanatory models’ used by these other disciplines, and with a bit of effort could be re-purposed to effectively meet the challenges of complex temporal developments, working in a similar way to the ‘process’ philosophy that Alfred North Whitehead had developed earlier in the twentieth century in response to the breakdown in scientific positivism. 11

A third challenge for using history in policymaking centres on how historical explanation requires relative degrees of abstraction, generalisation and complexity. The main difficulty with narrative accounts is that they involve two kinds of understanding of events. The first is gained by following a sequence of incidents of a given duration, and any pattern abstracted from that narrative is therefore only meaningful by reference to what actually happened. The second kind of understanding—analytical—emerges from a natural tendency to use the pattern abstracted from the story as a heuristic device that prompts questions about the similarity or difference between one sequence of events and another. 12 These two modes of understanding—by following and by analysing—appeared to be antithetical, and Porter suggested that this duality within traditional historical narrative accounts was at the root of ‘a great deal of anxiety among historians and their critics in recent years’, whereas in other disciplines, especially in the social sciences, these two modes of understanding had been pursued separately. He proposed a conscious re-balancing in which the reciprocity between hypothesis and empirical evidence would validate the historians’ traditional prioritisation of the narrative form of understanding. 13

Thinking about history as change—of historical events as dynamic relationships between causes and effects that happen ‘over time’—raises a fourth challenge which relates more directly to the concept of ‘improvement’, which also has an inherent dynamism. Some weak history—generally that which is uncritical—is branded ‘Whiggish’: it assumes that the present is always better than the past; that there has been progressive, cumulative, ‘improvement’. 14 In health history/history of medicine, this is often an accurate (if superficial) observation, depending on what measurements are used: life expectancies have improved since the mid-nineteenth century (the upward trajectory only just flattening in the first decade of the twenty-first century). In the fifteenth century more than half the British population were aged under 20; in the early twenty-first century we are already seeing some countries where half the population are over 60. It is tempting to attribute these historical patterns to specific historical events: the introduction of anaesthesia, antisepsis, antibiotics, etc. But when crude national patterns are unpicked it is possible to see that improvement has been relative or unequal: lower mortality rates from the classic infectious diseases such as cholera and smallpox have been paralleled by rising mortality rates for chronic conditions such as diabetes and heart disease. Cancer is in essence a disease of modernity, becoming more visible to society as more human bodies now survive long enough into the new ‘middle ages of 50+’ to allow cell mutations. Underneath Whiggish national improvements in health is an enduring inequality that has been clearly linked to socio-economic factors for nearly two hundred years: Edwin Chadwick, Friedrich Engels and other early nineteenth century reformers were able to demonstrate a significant positive correlation between poverty and ill-health.

Yet ‘long’ health histories—those that begin with the early nineteenth century epidemic disease—are easier, perhaps lazier, and in some ways more politically acceptable, than more recent health history. Politicians are comfortable drawing on the triumph of scientific advances such as anaesthesia and the discovery of germ theory in their rhetoric as evidence of long-term ‘improvement’ in health. To shift to short term history, for the politician, and possibly their policymakers, is more risky. Even using the creation of the NHS in 1948 as a historical era marker raises the potential for political debate on its performance and sustainability. ‘Short’ historical analysis might also be more problematical for historians because it exposes their academic fiefdom to other academic disciplines, especially political scientists and sociologists. It returns us to the first challenge of relevance, and opens up the debate on how to make history useful to policymakers, which requires discussion of historians’ motive, language and agency.

The Emergence of History of Health and Medicine

The history of health and medicine did not emerge as a distinct sub-discipline before the twentieth century. Rankean historians consolidated their professional identity and status through studies of nation states, in which biographical information on the life (health) and death of key players was a by-product of the bigger narrative. 15 Studies of the health of populations by professional historians required source material. The introduction of the decadal census in the UK in 1801, and of vital civil registration (births, marriages and deaths) in England and Wales in 1837, enabled a more comprehensive analysis than was possible using the earlier religious archives. Histories of patients, as well as of the great men of medicine, were now possible. There is an irony to this: doctors have always ‘taken histories’ from their patients.

In the US there was an active community of health historians from the 1920s (united through the American Association for the History of Medicine which was formed in 1925, primarily by physicians with an amateur interest in the discipline). US pioneers in the early years, up to the 1960s, included Henry Sigerist, Erwin Ackerknecht and Owsei Temkin. A second generation responded to the concept of a ‘social construction’ of medical authority and the development of medicine as an industrial and commercial activity. Key scholars included Susan Reverby, Charles Rosenberg, Judith Levitt, David Rosner and Rosemary Stevens, to name some of the most prominent proponents. In European countries there were smaller communities of medical/health historians. In Germany it was primarily the province of medical professionals.

Yet a community of historians of health and medicine was not visible in the UK until the 1950s. 16 The watershed moment of creation of the full British welfare state in 1948 played a critical role in permitting more robust ‘before and after’ historical analysis. Indeed, many of the leading historians working in this area have focused on the achievements of 1948 within their work to support their personal political values. This is not the place in which to digress into a detailed history of the history of health and medicine, but it is useful to outline the leading UK scholars, and a broad split into sub-genres, as this impacts on the UK case studies provided in this paper.

Some, such as Roy Porter and W.F. [Bill] Bynum, focused on science and medicine in the period before the NHS. Others, such as Asa Briggs and Anthony Wohl would be more properly classified as social historians, but their classic books Victorian People and Endangered Lives: Public Health in Victorian Britain are defining works in the history of public health and early state medicine. 17 Some historians moved into this area having previously worked on related themes. Charles Webster’s early interests were in early modern science. He then widened his scope to consider medicine in the same period, but it was not until the 1980s that he shifted his focus to the twentieth century, and in particular the health of the working classes. 18 He was then invited to write the official history of the National Health Service, which appeared in two volumes in 1988 and 1996. 19

Webster is a ‘proper’ historian, in that he was trained and employed as an academic historian throughout his career. But it is interesting that some of the most influential UK health history books have been written by scholars for whom history was not their ‘day job’. Brian Abel-Smith, a health economist and professor of social administration, produced histories of the British nursing profession and hospitals which remain definitive texts. 20 These were important political and policy histories of aspects of health care: they were written in support of his socialist principles that a universal free health care system was an intrinsic component of social justice in a civilised society, and a basic human right. Abel-Smith actively used historical context and historical analysis in his work as one of the first special advisers to the British government. He worked closely with Richard Crossman, Barbara Castle and David Ennals, when they served as Secretaries of State for Health during the Labour governments of 1964–70 and 1974–79. 21 He routinely incorporated history into his briefing papers, and produced anniversary accounts of the NHS to help secure its position at times of increasing financial attacks from the Treasury. 22

Geoffrey Rivett also used his considerable insider knowledge of the NHS and the DHSS/DH as a former general practitioner and civil servant to write comprehensive histories of the British NHS. 23 Other health care (service) historians with different backgrounds who were writing in the first phase include Rudolf Klein who initially approached health care from a contemporary public policy perspective, and Nicholas Timmins, who was social policy editor for the Financial Times. 24 It has also attracted comparative historical analysis through the work of Dan Fox, a US health policy adviser. 25

‘Applied’ History and Historians in the UK

All of the British health care histories noted above, most of them produced in the 1980s and early 1990s, share common features: they are substantial books (most of them more than 300 pages) and their target audiences were primarily the academic community, although some sought wider policymaking and public audiences. Some, such as Abel-Smith, wished to use their work to consolidate and secure the history and future of the NHS; some of the anniversary histories have also been appropriated by politicians and used to legitimise their revisions to Health Minister Aneurin Bevan’s founding principles, while at the same time canonising him within political history (see for example Prime Minister Tony Blair’s foreword to Geoffrey Rivett’s history of the NHS on its 50th anniversary).

Yet it is labour-intensive to take these ‘gold standard’ comprehensive histories of British health care and to use them to support contemporary health policy making. Policymakers prefer short briefing papers and find synthesis of key analysis into bullet points helpful. It is difficult to take even standard academic papers, focusing on specific health care issues, to generate useful ‘policy-applicable’ history. Health care historians, responding to and building on the pioneers listed above, have increasingly chosen to focus on smaller, more manageable themes: hospitals, diseases, clinical innovations, staffing. There has been a trend since the 1990s to push back the period of study to before the creation of the NHS in 1948—to properly examine the ‘mixed economy’ of health care in the inter-war period, which had traditionally been written up as universally bleak. 26 Another trend has been to look specifically at the history of health care policy development, rather than its delivery and impact. 27

Alongside this trend for thematic health care histories, has been the emergence of overt ‘policy applied’ health historians. The case studies presented below draw on my personal experiences. Other historians who have increasingly adopted this mantle include Virginia Berridge, whose success is evidenced by her creation and leadership of the first Centre for History in Public Health, at the London School of Hygiene and Tropical Medicine in 2003. Berridge’s career has included significant advisory roles to policymakers working on AIDS, drugs and alcohol policy. 28 What policy-applied health historians have collectively experienced can be grouped as three key issues: the role of networking to gain access to policymakers; synchronicity with policymaking schedules; style of engagement. These are common issues in the expert/policymaking arena, as evidenced by policy theory literature. 29

Case Study 1: Public Health in 1847 and 1997

Liverpool experienced some of the worst epidemics of infectious diseases (cholera, typhus, typhoid) of the early nineteenth century. Its image as a dangerously unhealthy place finally persuaded the urban authority to take action. In 1846, a local Act of Parliament was passed which created the first British public health team, and three men were appointed to start work on 1 January 1847 to deliver a radical programme of sanitary reform (Dr William Henry Duncan as Medical Officer of Health, James Newlands as Borough Engineer, and Thomas Fresh as Inspector of Nuisances). Liverpool continued to develop and implement radical policy solutions through the nineteenth and twentieth centuries, including the first public housing schemes, clean air legislation and attempts at introducing a local ban on smoking in public places. In 1995, John Ashton, then Regional Director of Public Health for North West England, who had previously been a professor of public health at the University of Liverpool, and who had a keen amateur interest in history, commissioned a ‘year of public health’ for 1997 to mark the 150th anniversary of the start of professional public health in the UK.

Ashton supported the creation of a research post in the history of public health at the University of Liverpool, to which I was appointed (later converted into a lectureship). Together we discussed how Liverpool’s health history could be used to generate public debate on the changing determinants of health, especially income levels, unemployment, access to healthcare, and lifestyle factors such as smoking, exercise and diet. This deliberate public engagement policy was intended to be used as leverage with national policymakers on the negative impact of cutting benefits and health services, which had had a disproportionate effect in Liverpool since the election of a Conservative government (under Margaret Thatcher) in 1979. I used the history of local health and healthcare to develop an exhibition with the Museum of Liverpool Life and a programme of ‘celebratory events’, including artistic commissions and activities with local schools. The evaluation at the end of 1997 demonstrated that local awareness of the relative role of health determinants had improved. The city council and local NHS authorities were stimulated by understanding how major policy developments had been achieved by three pioneers in 1847, despite a lack of local funding, staffing or national support. They were encouraged to draw contemporary comparisons and to think more broadly and creatively about solutions to Liverpool’s chronic poor health.

The collaboration between myself and local health policymakers in Liverpool was reported to the UK Department of Public Health. As Liverpool’s pioneering 1846 Sanatory Act was also the foundation for the first national legislation: the 1848 Public Health Act, I was invited to brief the Chief Medical Officer (CMO), Sir Kenneth Calman, and to write a section for his annual report. Working with the US health historian Chris Hamlin, I also presented this history to a wider medical professional audience in an article in the British Medical Journal which drew comparisons between the 1848 Act and the plans to re-structure public health in 1998. 30

Case study 2: The Decline of the UK Medical Civil Service

Policymakers’ knowledge of where to go for health history is also highlighted through this second case study, which directly leads from the first. When I presented my analysis of the 1848 Public Health Act and its relevance to the 1998 Act at Calman’s final report launch I met the in-coming CMO, Sir Liam Donaldson. He wrote to me afterwards, expressing an interest in the history of the role of the CMO, and inviting me to write a joint research application, which was subsequently funded by the Nuffield Trust.

Between autumn 1998 and the publication of The Nation’s Doctor: the Role of the Chief Medical Officer 1855 – 1998 in 2006, Donaldson and I met regularly in his Department of Health office in Whitehall, London. We agreed a work plan in which I conducted the historical analysis and wrote the draft chapters, which he then commented on. As the research progressed we discussed emerging issues such as completeness of sources, strengths and weaknesses of oral history, balancing chronological progression with thematic analysis, and historiography: how previous historians had written about CMOs and their work. It emerged that most of the CMOs had faced similar recurrent problems, especially control of adequate staff; relations with the wider civil service and the medical profession; Whitehall culture; the right to speak independently of the government on health issues. These were also issues that Donaldson was then experiencing as the current CMO.

Over the course of 6 years I learnt a lot about how Whitehall works, from reading archive materials deposited by former CMOs, civil servants and politicians, and from discussions with Donaldson about how to achieve policy change, especially on contentious issues such as banning smoking in public places. This was one of his key objectives as CMO, but one which the UK government found tricky as it risked accusations of ‘nanny state-ism’. I researched how previous CMOs had handled the initial discovery of the association between smoking and lung cancer in the 1950s, and then worked towards effective policies to reduce smoking. I demonstrated, through analysis of the archives of the Ministry of Health and the Treasury, that the Conservative governments of Churchill, Eden and Macmillan were reluctant to run effective health education campaigns partly because the relatively new NHS was heavily reliant on revenue from tobacco tax. Sir John Charles, the CMO in post when the association was established, was persuaded not to be too pro-active on this issue. He was allowed to stay in post beyond the usual civil service retirement age because he was ‘amenable’ to pressure from the Treasury, who anticipated that his nominated successor, Sir George Godber, would not be so malleable. Godber did indeed take a much tougher line, and got around the issue of Whitehall policy intransigence by taking it outside government to his medical colleagues in the Royal College of Physicians. He persuaded them to run a hard-hitting, plain English campaign in 1962, which had significant impact in reducing the high levels of smoking in the UK. 31

The policy lessons from the 1950s history of smoking and lung cancer were indirect but helpful. They illuminated the importance of involving external expertise, and of ensuring senior medical civil servants were not intentionally side-lined by other government departments when financial concerns competed with scientific evidence. These were common ‘history lessons’ that emerged from other research for The Nation’s Doctor . One of the case studies that had significant ‘impact’ was on the history of the CMO’s access to medical expertise. From Sir John Simon in 1855 onwards, the CMO had direct line management of medical civil servants, and was able to direct them to conduct rapid investigations into emerging health crises, such as the outbreak of epidemics. This regularly caused friction with the rest of the civil service, especially the Permanent Secretaries in the Ministry/Department of Health, some of whom resented the CMO being able to directly access the Minister without their approval. Sir Arthur Newsholme (CMO between 1908 and 1919) later recorded his frustration that there was:

…an honest belief, common to many government departments, that technical advice is advice not to be given until called for by the secretariat [lay civil service] who, it is assumed, are entirely competent to decide whether such advice is needed. Second, when such advice is on record, it is assumed that it can be safely reapplied in what are regarded by the secretariat as analogous circumstances. 32

Many of the fourteen men who held the CMO role between 1855 and 1998 found ways to manage this issue, but the last two, Sir Donald Acheson (1984–91) and Sir Kenneth Calman (1991–98) came up against a more substantial obstacle: the successive Whitehall efficiency reviews that from 1979 onwards aimed at shrinking the civil service. These culminated in 1994 in the merger of the previously parallel medical and ‘lay’ civil service reporting hierarchies in the Department of Health, effectively reducing the CMO’s capacity to call upon the support of medical civil servants, at a time of several significant new health threats, including HIV/AIDS, BSE and MRSA. At the peak of the medical civil service in the early 1970s, the CMO had direct line management of over 170 medically qualified civil servants, who provided expertise on the development and implementation of new medical treatments as well as on broader health protection and promotion issues. By the time Calman gave evidence to the BSE enquiry in 1998, he was left with, in his own words, ‘a secretary and a mobile phone’. 33 I demonstrated, through analysis of archive papers (made available to the Phillips Enquiry on BSE, which would have been otherwise closed under the government’s 30 years rule), and through a series of oral history interviews with senior civil servants, medical professionals and politicians, that there had been a longer decline in medical manpower in Whitehall, and that this had restricted the effectiveness of responses to emerging health crises.

I used the historical evidence I collected on the issue of the shrinking of medical civil service in several ways. First, it formed sections of The Nation’s Doctor , co-written with Sir Liam Donaldson. Second, I was approached in 2008 by a medically qualified member of the House of Lords, who had read The Nation’s Doctor and wished to use the recent history of the decline of the medical civil service to push the government to invest in staffing and return some of the traditional mechanisms for soliciting external expertise, which had been damaged in the successive Whitehall culls. I re-drafted the analysis for a policy paper published on the website History and Policy . 34 This generated coverage in the Guardian newspaper, and a letter from Lord Ara Darzi, then Parliamentary Under-Secretary of State for Health (2007–09). I later learnt from senior civil servants in the Department of Health that the issues I had raised had generated internal debate and an investigation into how to improve institutional memory. Third, I published a longer version of the paper in the academic journal Social Policy and Administration , in a more conventional academic format. 35

Synchronicity and Styles of Engagement

These personal case studies illuminate the core issues of engagement: the role of networking to gain access to policymakers; synchronicity with policymaking schedules; style of engagement. I have discussed the need to be flexible (accommodating to policymakers’ schedules for meetings, deadlines and focus of outputs). It is worth saying more about the issues of synchronicity and styles of engagement. From my other experiences of working with policymakers I have come to appreciate the need to respond quickly: policymakers work on much shorter timescales, often looking for analysis results within weeks or months. Historians, especially those engaged on large projects, will be more comfortable with planning their research over years rather than months. The conventional format of outputs as monographs (prioritised by the periodic Research Excellence Framework [REF]), and academic journal articles take months or years to write and then work their way through rigorous peer review systems, which then need to be fitted into publishing schedules.

History and Policy, a UK web-based academic organisation, was founded in 2002 partly in response to this ‘constipated’ academic output culture. 36 It now has a membership of over 500 historians, who are encouraged to work up their research into short Policy Papers and Opinion Pieces. These go through quick peer review for rapid web-based publication. The papers are carefully targeted at policymakers and journalists by the organisation’s press officers. Where possible, publications are scheduled to coincide with anticipated government policy statements. The policy papers begin with executive summaries, in the style of policy briefing papers. They contain essential historical context, and provide suggested further sources. History and Policy has developed from its early focus on presenting academic history in a new format, to deliver bespoke services to government departments (seminar series and workshops). It engages directly with policymakers; responds quickly to invitations to collaborate, for example, providing historical content for the No. 10 Downing Street [Office of the Prime Minister] website; and supports historians in preparing written submissions to parliamentary enquiries. 37

Other new styles of engagement between historians and policymakers have been developed within the last couple of decades. Witness seminars provide opportunities for people who were involved in significant policy decisions to come together and reflect on the process and outcomes. The Wellcome Trust has been one of the most active pioneers of this format, convening more than 50 witness seminars on a wide range of health policy issues, from development of hip replacements to epigenetics. 38 Early career historians are offered training in public and policy engagement (History and Policy regularly run workshops, funded by the main research councils), and some are able to take up placements in government departments.

The issue of location of historians is also critical. While most historians are based within traditional university history departments, there is a strong case to be made for ‘embedding’ historians within other academic departments and in external policymaking environments. This provides more opportunities for serendipitous encounters, and encourages policymakers to seek advice. For historians, the benefit of having other homes is that they are there at the moments when policy shifts become apparent, and can respond efficiently. They can develop the necessary language of the policymaking organisation and knowledge of how policy ‘gets done’: the complexities of local and national government committees and reviews, the importance of knowing key staff. These issues are of course not specific to historians, but relevant to all expert policy advisers, and are analysed in Richard Freeman and Steve Sturdy’s excellent edited book, Knowledge in Policy: Embodied, inscribed, enacted . 39

Despite the considerable progress made by historians in engaging with health policymakers in the UK, it is important to be realistic on the authority of historical knowledge in the policy arena. It competes with analyses of the current situation, and predictions of possible future scenarios. The mode of engagement—usually crisis-driven if initiated from the policy community—de-limits a ‘context-only’ or ‘passive–reactive’ response from the historian. Yet history used to be the default policy science. 40 Although historians are still often asked for ‘facts’ rather than analysis, they are getting better at initiating a more useful mode of engagement. 41 Good examples come from the recent health and social care scandals of Mid-Staffordshire Hospital and those triggered by the exposure of Jimmy Savile’s abuse of vulnerable children and adults. Historians from the History and Policy organisation were invited to give evidence to the Savile public inquiry, and several opinion pieces were written that addressed the ‘never again’ issue behind these scandals. 42 However, we rarely reach a critical tipping point that permits policy change on the primary basis of historical evidence. 43 Historical analysis has not yet become an integral and initial part of policy planning process.

Robust and routine historical analysis of new policy issues can add real value. 44 It permits discussion of some of the bigger, or neglected questions in health and health care, such as choice of funding mechanisms, expectations and responsibilities (by both the public and the state). It can illuminate more fundamental issues, such as health as a human right, and demonstrate the implications of politicising access to health care, that may have evolved over centuries, rather than the years which usually delimit the frame of reference for policymakers. Historical analysis can explain the persistence of institutional structures (the NHS) and cultural attitudes (the British public’s love for the NHS) and expose how policymakers use history to reinforce or disrupt the status quo. Its preference for subjective, intuitive analysis (of texts, oral history) can cope with the finer nuances involved in policymaking: the ‘what if’ and ‘so what’ quandaries. It enables a better understanding of the policy development process, and through specific case studies show what happens when potential policies get forgotten or deliberately side-lined. 45 Historians are skilled at handling complexity: there are significant similarities between what historians, improvement scientists and policymakers do. What needs to be further developed are the shared objectives and language to enable a more rewarding collaboration.

1 J. Tosh and S. Lang, The Pursuit of History: Aims, Methods and New Directions in the Study of Modern History (New York 4th edition, Longman Pearson, 2006), p. 1–2.

2 R. Hirsh, ‘Historians of Technology in the Real World: Reflections on the Pursuit of Policy-Oriented History’, Technology and Culture 52; 1 (2011); 6–20.

3 V. Berridge, ‘History Matters? History’s role in health policymaking’, Medical History 52 (2008); 311–326.

4 See for example how the historian Charles Webster took the Labour government to task in 2002 for rewriting NHS history to suit its current reform plans: C. Webster, ‘The Parable of the Incompetent Steward’, British Journal of Health Care Management 8; 3 (2002); 113–14.

5 A. Bashford and C. Strange, ‘Thinking historically about public health’, Medical Humanities 33 (2007): 87–92. ‘Gothic’ is used here to mean a preoccupation with events that are portentously gloomy or horrifying.

6 F. Fukuyama, The End of History and the Last Man (Harmondsworth, Penguin, 1992); P. Catterall, ‘What (if anything) is Distinctive about Contemporary History?’, Journal of Contemporary History 32; 4 (1997); 451.

7 G. Barraclough, An Introduction to Contemporary History (Harmondsworth, Penguin, 1967), p. 20.

8 J.L. Gaddis , On contemporary history. An inaugural lecture delivered before the University of Oxford 18 May 1993 (Oxford, Clarendon Press, 1995); P. Catterall, ‘What (if anything) is Distinctive about Contemporary History?’, Journal of Contemporary History 32; 4 (1997); 444–52.

9 J.L. Gaddis , On contemporary history. An inaugural lecture delivered before the University of Oxford 18 May 1993 (Oxford, Clarendon Press, 1995), p. 21.

10 F. Braudel, ‘History and the Social Sciences: la longue durée’ , 1958, reprinted in F. Braudel, On History (trans. Sarah Matthews) (Chicago, University of Chicago Press, 1980). See also J. Tosh (with S Lang), The Pursuit of History (Harlow, Pearson Education Ltd, 1984).

11 D. Porter, The Emergence of the Past. A Theory of Historical Explanation (Chicago, University of Chicago Press, 1981), p. ix.

12 Porter, Emergence of the Past , pp. 29–31.

13 Porter, Emergence of the Past , p. 2.

14 The term comes from the Whigs—a British political party active from the seventeenth to the nineteenth century.

15 The German historian Leopold von Ranke (1795–1886) was influential in setting standards for historical methodologies, especially the use of primary sources and an emphasis on narrative history and international politics.

16 As one reviewer pointed out, this was also the period when medical ethics, bioethics and medical law emerged as distinct disciplines. See D. Wilson, ‘What can History Do for Bioethics?’, Bioethics 27;4 (2013); 215–223; J. Harrington, Towards a Rhetoric of Medical Law (London, Routledge, 2016).

17 A. Briggs, Victorian People (1983); A.S. Wohl, Endangered Lives: Public Health in Victorian Britain (London, Dent, 1983).

18 C. Webster, The Great Instauration: Science, Medicine and Reform 1626–1660 (New York, Holmes & Meier, 1975); C. Webster, Health, Medicine and Mortality in the Sixteenth Century (Cambridge, Cambridge University Press, 1979); C. Webster, Biology. Medicine and Society 1840-1940 (Cambridge, Cambridge University Press, 1981); C. Webster, ‘, ‘Healthy or Hungry Thirties?’, History Workshop Journal , 13, 1 (1982); 110–29.

19 C. Webster, Problems of Health Care: the National Health Service Before 1957 (London, HMSO, 1988); C. Webster, Government and Health Care: the National Health Service 1958–1979 (London, The Stationery Office, 1996).

20 B. Abel-Smith, A History of the Nursing Profession (London, Heinemann, 1960); B. Abel-Smith, The Hospitals 1800-1948 (London, Heinemann, 1964).

21 S. Sheard, The Passionate Economist. How Brian Abel-Smith shaped global health and social welfare (Bristol, Policy Press, 2013).

22 A. Abel-Smith, The National Health Service: the First Thirty Years (London, HMSO, 1978).

23 G. Rivett, The Development of London’s Hospital Systems (1986); G. Rivett, From Cradle to Grave: 50   Years of the NHS (London, King’s Fund, 1998).

24 R. Klein, The Politics of the National Health Service (London, Longmans, 1983); N. Timmins, The Five Giants: A Biography of the Welfare State (London, Fontana, 1996).

25 D. Fox, Health Policies, Health Politics: the British and American Experience, 1911–1965 (Princeton N.J., Princeton University Press, 1986).

26 S. Szreter, ‘Health, Class, Place and Politics; social capital and collective provision in Britain’, Contemporary British History 3(2002); 27–57; J. Stewart, ‘Ideology and Process in the Creation of the British National Health Service’, Journal of Policy History 14 No. 2 (2002); 114–134; M. Gorsky and S. Sheard (eds), Financing Medicine: The British Experience since 1750 (Routledge, 2006); A. Levene, M. Powell, J. Stewart and B. Taylor, Cradle to Grave: Municipal medicine in Inter-war England and Wales (Peter Lang, 2011); M. Gorsky, ‘Local Government Health Services in Interwar England: Problems of Quantification and Interpretation’, Bulletin of the History of Medicine 2011 (85), 384–412; M Gorsky, ‘The British NHS 1948–2008: A review of the historiography’, Social History of Medicine 21 (2008), 437–60.

27 V. Berridge (ed.), Making Health Policy: Networks in Research and Policy after 1945 (Amsterdam, Rodopi, 2005).

28 Berridge, ‘History Matters?’ (2008); V. Berridge and J. Stewart, History: a social science neglected by other social sciences (and why it should not be), Contemporary Social Science 7; 1 (2012); 39–54.

29 E. Perdiguero, J Bernabeu, R. Hertas and E. Rodriguez-Ocana, ‘History of health, a valuable tool in public health’, J. Epidemiology and Community Health 55 (2001); 667–673; S. Sheard, ‘History in health and health services: exploring the possibilities’, J. Epidemiology and Community Health 62 (2008); 740–744; R. Freeman and S. Sturdy (eds), Knowledge in Policy: Embodied, inscribed, enacted (Bristol, Policy Press, 2015).

30 C. Hamlin and S. Sheard, ‘Revolutions in public health: 1848, and 1998?’, British Medical Journal 317 (1998); 587–91.

31 Royal College of Physicians of London, Smoking and Health: report of the Royal College of Physicians of London on smoking in relation to cancer of the lung and other diseases (London, Pitman, 1962).

32 A. Newsholme, The Last 30   Years in Public Health (London, George Allen and Unwin, 1936), p. 62.

33 British Medical Journal editorial, ‘Staff cuts would leave the CMO stranded’ , British Medical Journal 317 (1998); 232.

34 S. Sheard, ‘Doctors in Whitehall: how the government manages medical advice at the 60 th anniversary of the NHS, www.historyandpolicy.org.uk (last accessed 27.12.16).

35 S. Sheard, ‘Quacks and Clerks: Historical and Contemporary Perspectives on the Structure and Function of the British Medical Civil Service’ , Social Policy and Administration 44;2 (2010), 193–207.

36 http://www.historyandpolicy.org/ . Last accessed 2.2.17.

37 M. Gorsky, Memorandum submitted to the Health Select Committee Inquiry into Public and Patient Involvement in the NHS. http://www.historyandpolicy.org/hp/docs/gorsky_memo.pdf/ . Last accessed 2.2.17.

38 https://blog.wellcome.ac.uk/2014/09/24/21-years-wellcome-witness/ . Last accessed 2.2.17.

39 Freeman and Sturdy, Knowledge in Policy .

40 V. Berridge and J. Stewart, ‘History: a social science neglected by other social sciences (and why it should not be)’, Contemporary Social Science 7; 1 (2012); 39–54; E. Fee and D. Fox, ‘Introduction: AIDS, public policy and historical enquiry’, in E. Fee and D. Fox (eds ), AIDS and the burdens of history (Berkeley, CA, University of California Press, 1988), 1–11.

41 V. Berridge, Public or Policy Understanding of History? Social History of Medicine 16; 3 (2003); 511–523.

42 See also the US historian Allan Brandt’s contributions as an expert witness in a landmark 2006 court case involving tobacco companies, in which he explained how they manipulated the scientific debate over the risks of smoking in the 1950s. A.M. Brandt, ‘From analysis to advocacy: crossing boundaries as a historian of health policy’, in F. Huisman and J.H. Warner (eds), Locating Medical History (Baltimore, Johns Hopkins University Press, 2004). A. Brandt, The Cigarette Century: The Rise, Fall and Deadly Persistence of the Product that Defined America (New York, Basic Books, 2009).

43 C. Hilton, ‘Whistle-blowing in the National Health Service since the 1960s’, History and Policy paper published 26.8.16. http://www.historyandpolicy.org/policy-papers/papers/whistle-blowing-in-the-national-health-service-since-the-1960s . Last accessed 2.2.17; S. Sheard, Can we never learn? Abuse, complaints and inquiries in the NHS’, History and Policy paper published 26.2.15. http://www.historyandpolicy.org/opinion-articles/articles/why-we-never-learn-abuse-complaints-and-inquiries-in-the-nhs . Last accessed 2.2.17; A. Bingham, L.Delap, L. Jackson and L. Settle, ‘” These outrages are going on more than people know”’, History and Policy paper published 26.2.15. http://www.historyandpolicy.org/opinion-articles/articles/these-outrages-are-going-on-more-than-people-know . Last accessed 2.2.17.

44 For a US perspective see J. Zelizer, Clio’s Lost Tribe: Public Policy History since 1978’, Journal of Policy History 12 (2000); 369–94.

45 R.E. Neustadt and E.R. May, Thinking in Time: the Uses of History for Decision Makers (New York, Free Press, 1986).

Exploring the significant problems confronting secondary schools history education: a baseline study

• Open access
• Published: 14 May 2024
• Volume 3 , article number  52 , ( 2024 )

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• Fekede Sileshi Fufa   ORCID: orcid.org/0000-0001-6035-8205 1 ,
• Abera Husen Tulu   ORCID: orcid.org/0000-0002-0408-9028 2 &
• Ketebo Abdiyo Ensene   ORCID: orcid.org/0000-0001-8492-9340 1  

The purpose of this baseline study is to determine the significant problems confronting history education in secondary school. The researchers employed qualitative research methods and case study design. The techniques that were employed to acquire credible data were document analysis, interviews, and classroom observation. Six experienced history education teachers and eight top-ten students from Sebeta town public secondary school were interviewed, and academic achievement statistics of 174 students in history education were analyzed. In addition eight lesson observations were carried out to validate the information gleaned from the interviews and document analysis. The study's findings show that the primary challenges influencing history education in Sebeta town public secondary schools were teaching strategy, a lack of awareness about implementing participatory teaching methods, a lack of comprehensiveness of the contents of history education teaching materials, and the issue of the bulkiness and scope of history education texts being covered on time. The findings also indicate the significance of training history education teachers to use participatory teaching tactics, as well as the need for curriculum experts to better coordinate the range of history education content and teaching strategies. The findings of this study will help teachers, practitioners, scholars, policymakers, and educational professionals find solutions to significant problems in secondary school history education, as well as develop effective techniques for teaching history education in secondary schools that involve twenty-first century skills and abilities.

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1 Introduction

History education as an academic discipline has a long history in the world. In the nineteenth century a German historian Leopold von Ranke an indispensable contribution to modernizing history writing [ 1 , p. 2, 2 , p. 171]. Ranke (1795–1886) not only established history as a major discipline, but he also established the idea that all accurate history must be based on primary sources and rigorous methodology [ 1 , p.13, 3 ]. As a result, he is regarded as the father of modern historiography [ 1 , p. 2]. Since the nineteenth century, history education has developed as an independent discipline across the world.

In terms of teaching strategies, evidence shows that teaching approaches play an important role in any subject of study in enhancing students' academic achievements [ 4 , p. 601, 5 ]. Many research findings demonstrate that the approach employed to develop any operation significantly determines the end product [ 6 , p. 7]. Several factors influence students' academic achievement; evidence suggests that teachers are the most essential ones in terms of students’ education and achievements [ 7 , pp. 2633–34]. According to the research findings conducted on student learning, the way teachers engage their pupils is crucial in the teaching and learning process [ 8 , p. 39]. The approaches used by the teacher should be matched to the demands of the students [ 6 , p.7]. Students’ motivation and achievement are mostly dependent on the teachers’ activities [ 9 , p. 15). Several researches have indicated that among the subjects offered in schools, students do have not much interest in history education [ 10 , p. 45]. According to a study conducted on secondary schools, history education has been taught through lectures rather than participatory and student- centred strategies [ 11 , p. 1). According to Kiio [ 11 , pp. 1–2], effective implementation of participatory teaching and learning methodologies can increase students' interest in history education. Issar [ 10 , p. 49] also emphasized the significance of learning history education, stating that learning history education should help students understand the complexities of human lives, the diversity and relationships between different groups, the changes and continuities and connect the past, present, and future events.

Scholars confirm that constructive learning approaches allow students to participate actively in the lessons [ 12 , p. 35]. Since 1980, the theory of social constructivism has been advocated as an effective way of learning and teaching [ 12 , pp. 35–36]. It is a theory developed by Russian psychologist Lev Vygotsky (1896–1934), which holds that individuals are active participants in the creation of their knowledge [ 13 , p.783]. Vygotsky’s social constructivism focuses on pedagogies that encourage active learning, effective and meaningful learning, constructive learning, and learning by doing [ 13 , p.783]. Current research in the field of history education supports the notion that participatory approaches to teaching the subject at the secondary school level are the preferred method for developing the skills required to handle the world's future historiographical needs [ 14 , p. 81]. In several works of literature, interactive teaching approaches are vital in increasing student academic achievement. The purpose of this baseline study is to investigate the significant problems confronting history education in Sebeta government secondary schools.

2 Statement of the problem

History education is frequently a source of public debate, a source of unrest, and a site of struggle over what and how should be taught in schools in Ethiopia [ 15 , p. 2]. National history is taught as a compulsory subject in different countries. Several countries believe that knowing the country’s history is a requirement for all citizens [ 16 , pp. 1–2]. In the case of history education teaching in Ethiopia, for the first time, a history syllabus was included in the education curriculum after 1943 [ 17 , p.87]. However, no specific research on significant problems confronting history education in Ethiopian secondary schools has been conducted. Researchers who have studied the problem of education in Ethiopia have directly and indirectly addressed the issue of history education [ 18 , pp.18–19].

According to research conducted by Resource and Guide [ 19 , p. 8], teaching is important by incorporating 21st-century skills such as critical thinking skills, problem-solving, language proficiency, communication and collaborative skills, cognitive skills, adaptability skills and the ability to make decisions. Furthermore, student-centred teaching method fosters students' comprehension, deep learning, problem-solving, critical thinking, and communication [ 20 , p. 4]. Research conducted on history education has discovered a link between teaching approaches and students' attitudes towards history education [ 21 , p. 3]. A scant study has been conducted on significant problems confronting history education in Ethiopian secondary schools and on approaches more appropriate for teaching history.

This motivated the researchers to conduct research on major problems confronting history education in Ethiopian secondary schools in Sebeta town. To fill this gap, the researchers used a variety of tools to analyze significant problems confront history education in Ethiopian secondary schools in general, and Sebeta town public Secondary School in particular.

Thus, this study attempts to answer the following questions:

What are the most significant problems facing history education at Sebeta town public secondary school?

What are the most common teaching strategies employed at Sebeta town government secondary school?

How is the student’s academic achievement in history at Sebeta public secondary school?

3 Objectives of the study

To find out the most significant problems facing history education at Sebeta Town Government Secondary School.

To identify the most common teaching strategies employed at Sebeta town government secondary school.

To determine a student’s academic achievement in history at Sebeta government secondary school.

4 Literature review

Any research project needs theory to provide direction and help on how things are implemented. Theoretical foundation aids in deciphering the way phenomena happen and the basis of specific actions [ 22 , p. 75]. This research is founded on Vygotsky’s social constructivist learning theory, which supports historical thinking. According to a social learning theory developed by Russian psychologist Lev Vygotsky (1896–1934), individuals are active participants in the development of their knowledge [ 23 , p. 395]. This social constructivism approach places a strong emphasis on pairs and small groups [ 24 , pp.13–15]. According to this theory, students learn primarily through interactions with their classmates, instructors, and parents, whereas teachers are expected to facilitate dialogue in the classroom [ 25 , p. 243]. According to Richard [ 26 , p. 380], good teaching and learning are strongly reliant on interpersonal interaction and conversation, with the primary focus on the student’s understanding of the topic.

Scholarly works reveal that there is very little study on the significant problems confronting history education. The existing scholarly works on teaching approach and students’ learning, on the other hand, demonstrate that there are strong relationships between the effects of teaching strategies and students’ achievement. Sugano and Mamolo [ 27 , p. 827] conducted a study on the “Effects of Teaching Methodologies on Students’ Attitude and Motivation,’’ found that teaching methods had an enormous positive impact (Cohen’s d = 0.379) on student attitude. The study also found that cooperative learning had a greater power than traditional teaching methods in improving students’ positive attitudes, motivation and interest.

History teaching should not only be mastery of the basic content (substantive knowledge) but also enhance the acquisition of subject skills and competencies that will make students learn on their own and manage their own lives and carry it through the adversities of life in society [ 26 , 28 ]. Luka [ 14 , p. VII] discovered in his study, “The Impact of Teaching Methods on Attitudes of Secondary School Students Towards Learning of History in Malawi,” that students in secondary schools have negative attitudes towards learning history. One of the reasons he highlighted is that student-centred techniques of teaching are not regularly used in the subject of history education ( Ibid , [ 29 ]).

Moreover, Mazibuko [ 30 , p. 142] revealed that teaching methods in history education greatly contributed to students' negative perceptions of the subject. He discovered that traditional methods of teaching history utilized by teachers contributed to students decreasing interest in the subject ( Ibid ). Besides, Zhu and Kaiser [ 31 , p. 191] discovered that teaching methods influence students’ motivation, attitudes towards school, willingness to do homework, and confidence in their learning.

In his study on effective teaching in history, Boadu [ 8 , p. 39] discovered that effective teaching of history should bring the subject closer to students’ lives, hearts, and minds. He argued that effective teaching cannot emerge from traditional history teaching, because the teacher lectures on the subject intensely, and students are forced to take and memorize notes.

Silver and Perini [ 32 , p. 16) argued that teachers who use a variety of teaching techniques have well-behaved and motivated students, resulting in high student academic achievement.

Adding to this, according to [ 33 , p. 74], the quality of teaching strategies influences student learning and contributes to a 15 to 20 times improvement in student achievement. These researches highlighted that effective teaching strategies played a crucial influence on student motivation, developing students’ positive attitudes, and improving students’ academic achievement more than traditional teacher-centred approaches. There has been no research undertaken in Ethiopian secondary schools to determine which methodologies could be better appropriate for teaching history. Using the designed study instruments, the researchers examine and determine the significant problems confronting history education in Sebeta government secondary schools.

5 Research methodology

The study was conducted using the constructivist paradigm view with the qualitative research approach. In this study, the researchers utilized a qualitative research approach. The qualitative research approach allows the researchers to conduct an in-depth investigation of the problem under study [ 34 , pp. 177–179, 35 , p. 12]. The qualitative research approach has different specific designs. These are Phenomenology, Ethnography, Narrative inquiry, Case study, Grounded theory and Historical research [ 36 , p. 49]. In this study, the qualitative case study design was used. Case studies are ways to explain, describe, or explore phenomena. According to Hatch [ 37 , p. 37], case studies are the type of qualitative work that investigates a contextualized contemporary phenomenon within specific boundaries. This study was carried out using document analysis, interviews, and classroom observation techniques.

The researchers received the accreditation letter from their institution and submitted it to the relevant authorities to confirm the legality of the research. The letter was then submitted to the Sebeta town’s education office and Sebeta secondary schools to acquire authorization to collect primary data from sampled respondents. The data collection process was started after getting all relevant permits from the authorities. Before interviews with respondents, the researchers described the goal of the study to the participants to acquire their permission. The researchers told participants that the study's primary aim was to collect data for the research titled "The significant problems confronting history education in history education in Sebeta town public secondary schools, Ethiopia." After extensive verbal discussions with the respondents, interviews were conducted with those who expressed full interest in participating in the study.

5.1 Sampling procedure

This study employed a purposive sampling technique. In the first stage, the study site was chosen purposively, which is Sebeta town. In the following step, this baseline study was confined to two out of four government secondary schools in Sebeta town with similar standards, a higher number of students and staff than the others. The schools that were purposely selected for the study are those that have been in existence for a long time, have more experienced staff than others, and are expected to provide firsthand information. Purposive sampling was used to select knowledgeable research participants [ 38 , pp. 512–513]. Because it allows the researcher to select the research participants who were believed informed sources of information, thoughtful, informative, articulate, and experienced with the problem under the study [ 35 , p.142, 39 , pp. 100–114]. The researchers selected individuals who have a good source of information about the issue under study (history education teachers and students [ 39 , p. 100]. In the selected two secondary schools, there are six history education teachers, five males and one female. These teachers were purposefully included in the study. The researchers believed that the experienced teachers who were chosen were useful as a primary source of data because they were familiar with the subject's contents, as well as its problems. Eight top-ten grade ten students from the two schools also took part in the study directly. The researchers believed the top-ten students were able to explain the area of study more accurately than the others. Grade ten students were purposefully chosen for the study. The following are the grounds for choosing grade ten students: First history education in Ethiopia begins in grade nine. Students began studying history education grade nine onwards. Because it is assumed that grade ten students know more about history education contents than grade nine students. Second, it is assumed that grade ten comprises all types of students (higher achievers, moderate, and slow learners), as well as grade 10 students who will choose a major (social sciences and natural sciences) in their future grade eleven. As a result, the researchers opted to gather the finest information from grade ten students to establish their perspectives toward history.

6 Results and discussions

6.1 what are the significant problems facing history education in sebeta town government secondary school, 6.1.1 interviews analysis.

For explanation, the abbreviation SSST stands for “Sebeta Secondary School Teacher”, similarly, BSSST stands for “Burka Sebeta Secondary School Teacher” and the numbers denote the order. As shown in Table  1 , six history education teachers were interviewed for this study. Of the six teachers interviewed, five had more than 15 years of teaching experience. Five of these teachers hold a bachelor's degree and one has an MA in history. Five of the teachers interviewed were male and one was female. During the interviews, the teachers revealed to the researchers that three of the six teachers had an MA in another academic discipline (Table 2 ).

For clarification, the abbreviation SSSS stands for, “Sebeta Secondary School Student”, BSSS, “Burka Sebeta Secondary School Student” and the numbers represent the order. Eight students’ four males and four females from both schools were chosen for the interview of this study.

An interview is one of the data collection instruments that were used to explore the significant problems confronting history education in government secondary schools. An interview allows the researchers to gather information that is directly related to the research objectives [ 40 , p. 411]. It is typically conducted one-on-one with informants who have firsthand experience with the research topic [ 25 , p. 144]. An interview was conducted with six experienced history education teachers, and eight secondary school students to gather adequate data about the topic under investigation.

The researchers began their interview with teachers by asking, “What are the significant problems facing history education in Sebeta town government secondary school?” The researchers interviewed teachers concerning the organization of the history education curriculum. Teacher SSST1’s response to this question is as follows: “I have been teaching history education for 18 years but I have never seen or read the curriculum of history education until today.’’ Furthermore, BSSST1 shared the same point of view saying: “So far, I have not read any history education syllabus or seen what it contains except students’ textbook. There is no available history education syllabus in secondary school for teachers. ” Teacher SSST2 also made a similar note: “We do not have a history syllabus, and the teaching materials that we use to teach students are only students’ textbooks.”

All of the teachers interviewed stated that they did not have a history curriculum and had never utilized it. The researchers found that teachers do not see contents, structures, recommended teaching aids, and methodologies in the history education syllabus and teachers’ guide.

Teachers explained that the history education textbook is divided into three parts: world history, African history, and Ethiopian history. According to the teachers interviewed, the history of the Ethiopian peoples are not written inclusively in students’ textbooks, and Ethiopian history education does not adequately addressed the political, social, and economic history of the Ethiopian people (BSSST1, BSSST2, SSST1, SSSS2, SSST3). However, research work suggests that in multi-ethnic countries, all students should be able to learn about themselves and their culture from the books they learn from Hodkinson et al. [ 41 , p. 3] stated that “all learners must be able to find themselves and their world represented in the books from which they learn.”.

In addition, teachers were asked as history education teaching materials in the same way as other Subjects. To this question, all of the teachers interviewed consistently said no. Teachers claim that “since our country’s political changes, textbooks for all disciplines have been updated three to four times, but history education has not been updated in the same way” (BSSST1, BSSST2, SSST1, SSSS2, SSST3, SSSST4). They demonstrated this to the researchers by referring to the textbook they were using. In this instance, a history grade 10 students’ textbook was published in 2002 GC/1994, reprinted in 2005/1997 and renewed in 2023 after 18 years. According to the teachers interviewed, there has been no detailed reform of history education in terms of adding or removing content, implementing new teaching strategies, or keeping up with the 21st-century world. One interviewed teacher said, ‘’I have been teaching history for 18 years and have not observed any changes in history education contents since I started teaching history education.’’ (SSST1).

The researchers continued their interview with teachers by asking, is the content of the history education curriculum appropriate for the student's abilities? This question is to gather evidence to understand that the content of the history curriculum is appropriate for the student's abilities. Teachers and students were asked this question. When asked about the content of history education in grade ten, teachers made two comments:

Students who did not study history as a subject in elementary school (1st grade to grade eight) may find it more difficult when they begin studying history education as a subject in grade nine (SSST1 and SSST2).

They have been studying in their mother tongue in primary school (grades 1 to 8) and studying in English from grade 9 onwards will make it difficult for students to understand the contents (SSST1 and SSST2). The students interviewed strongly agree with the latter. According to the students, “the content of history is very difficult to understand, history is not like other subjects, it requires proper knowledge of English” SSSS1, SSSS2, BSSSS1 and BSSS2).

Follow-up questions were also raised for teachers, to determine the teaching methods included in the history education curriculum. However, teachers were unable to respond to this question because they were not implementing the teaching practices outlined in the history education curriculum due to a lack of a history syllabus. A well-designed teaching strategy has a crucial role in improving students' academic achievement [ 42 , p. 51–64]. Therefore, teachers teach history using their own teaching and learning methods. When asked what teaching method they used, the teachers stated that they used the lecture teaching method (SSSS1, SSSS2, BSSSS1 and BSSS2). The reason they use lecture methods more than other teaching and learning methods is that the content of history lessons is extensive and the time allocated for history lessons is 80 min per week (SSSS1, SSSS2, BSSSS1 and BSSS2).

6.1.2 Classroom observation analysis

The researchers used lesson observations to obtain firsthand and ‘real' facts and data about the significant problems confronting history education in Sebeta government secondary schools. This is because many people do not want to discuss all topics during an interview [ 43 , p. 117]. The researchers employed the lesson observation checklist, which included activities such as the teacher's teaching strategies, teacher and student activities throughout the session, teacher-student interaction during the lesson, student seating arrangements, and teaching aids used. Using this checklist, the researchers observed the teacher’s teaching practice during the lesson. The researchers observed four different classrooms. The primary aim of this observation was to strengthen the data obtained from teachers and students during an interview. The teachers in all of the classrooms first ask students what they learned in their last class. Aside from that, they only used to give notes and lectures to the students in every class.

Another point that the researchers visited in the classroom was the teachers’ and students’ activities during the lesson. The teachers gave notes, and lectures and many students were busy writing notes. When the teachers lecture the content some students do not pay attention and instead take notes. Some students do not take notes, do not listen and look elsewhere. As observed by the researchers, teacher-student interaction during the lesson is very weak. Based on the observation students' seating arrangements were traditional in that three students' seats occur on a wave which is not convenient for group discussion, group work and collaborative learning.

During classroom observation, there are no teaching aids used in all classrooms visited by the teachers to make the lessons practical.

Finally, based on the findings of the study through classroom observation, traditional methods of teaching and learning in history classrooms are still the dominant teaching strategies in the twenty-first century. Researchers who research teaching strategies confirm that participatory teaching is an effective way to improve students’ academic achievement. Madar and Baban [ 42 , pp. 51–64] also discovered that participatory teaching is a good strategy to develop students’ skills and increase their academic achievements. They added that participatory teaching strategies put students at the centre of the teaching and learning process (p. 51). However, through interviews with teachers, students, and lesson observation, the researchers discovered that teachers are not employing student-centred approaches that are fitting for students' learning and achievement.

The responses of teachers and students are consistent with the literature on strategies for teaching. Researchers who conducted studies on teaching strategies found that the teacher- centred method is a traditional strategy that is not very effective in enhancing student achievement. The findings of this study also agree with Mohammed [ 44 , p. 11] who conducted a study on, “strategies in the teaching of geography …” , and stated that the lecture method of teaching has a negative effect on students’ creativity, critical thinking, ability to produce new ideas, and academic achievement of students. Similarly, this study’s findings also concur with Ezurike [ 45 , pp. 1120–124] conducted a study on, “The Influence of Teacher-Centered and Student-Centered Teaching Methods on Academic Achievement of Students,” which discovered that poor methods, mostly teacher-centred and conventional teaching methods used by teachers, are one of the major factors contributing to students’ poor achievement.

Finally, it is better to conclude that teaching strategies can positively and negatively influence students' academic achievement. If teachers only employ the lecture approach without involving students in the lesson, it may result in low student academic achievement in contrast if teachers employ student-centred strategies students can understand the main point of the lesson and enhance the academic achievement of students.

6.2 How do teaching strategies influence students' academic achievement in Sebeta secondary schools?

To answer this question, the researchers conducted interviews with teachers and students, as well as document reviews and classroom observations. This issue was addressed by both teachers and students. Methods of teaching have a wide range of effects on the academic success of learners. When asked this question, they all had similar answers. According to teachers, good teaching strategies play a significant role in improving students’ academic achievement. They state this as follows:

Using collaborative teaching practices can significantly improve students' academic achievement. Because collaborative instruction is a teaching technique in which students learn together by assisting one another. Higher achiever students support the low achiever learner in this instructional learning process. However, if teachers utilize traditional teaching methods without involving students in the teaching-learning process, students' academic achievement may suffer (BSSST1, SSST2, and SSST3).

However, for a variety of reasons, teachers do not use collaborative teaching strategies to improve the academic achievement of their students. Rather than focusing on improving the academic achievements of students’ teachers are only concerned with completing their content. Furthermore, the student stated that teaching strategy can positively and negatively influence students' academic achievement. According to students:

…if teachers employ interactive teaching strategies during teaching lessons, students can understand the main point of the lesson and profit much from it. In contrast, if teachers exclusively employ the lecture approach without involving students in the lesson, it may result in low student achievement in the subject. Furthermore, students responded with two statements: excellent teaching strategies encourage students’ interest in the subject and are also, critical for improving students' academic achievement (BSSSS1, BSSSS2, SSSS1, SSSS3, and SSSS6).

The teachers were interviewed about teaching methods they implement when teaching a history education lesson. The teachers were asked to mention teaching methods that they always use in teaching history. The majority of the teachers claimed to use lecture approaches when teaching history education lessons. Teachers noted: “huge class sizes and low time allotted to history subjects, making it difficult to apply participator/student-centred methods (BSSST3, SSST, and SSST2). Furthermore, when asked about their teachers’ teaching methods in history class, students stated that “teachers only use teacher-centred strategies (lecture, dictation, note-giving and reading notes on the blackboard)” (BSSSS3, SSSS1, SSSS2).

During the interview all interviewed teachers acknowledged the use of the lecture method in their teaching. The justifications provided for the use of the lecture method include saving time, the convenience of covering content on time and the nature of students. Teachers said, “A lecture method helps the teacher to cover a lot of content in a short period” (SSST1, SSST2, SSST3, SSST4, BSST1, and BSST2). The findings of this study are consistent with the findings of a study conducted by Luka [ 14 , p. 30] on the topic of “the impact of teaching methods on attitudes of secondary school students towards learning of history in Malawi,” which discovered that teachers use boring lecture methods to complete their courses rather than focusing on students' results.

History teachers' perceptions of the use of the participatory approach were very low. Based on the interview conducted with history education teachers they were not interested in using student-center teaching strategies (BSSST1, BSSST2, SSST1, SSST2, SSST3, and SSSST4). Teachers claimed that participatory teaching strategies were time-consuming and unsuitable for large-class settings ( Ibid ). Instead of using participatory teaching strategies teachers choose teacher-centred methods to cover a large portion within a given time.

The researchers interviewed history teachers at Sebeta secondary schools about the challenges that they confront when implementing the participatory approach. The interviewed teachers stated that the time allotted for history education did not correspond to the content (BSSST1, BSSST2, SSST1, SSST2, SSST3, and SSST4). They were unwilling to utilize student-centred teaching methodologies because they believed it would be time-consuming and difficult to cover the contents of the student’s textbooks within the academic year. According to the teachers, the time allotted to history education every week was only two periods (80 min), although history education included more than 246 pages ( Ibid ). Students also stated that teachers frequently employ lecture methods when teaching history lessons. Both teachers and students agree that collaborative learning methods are more beneficial than traditional teaching methods in improving students’ academic achievement (SSST1, SSST2, SSST3, SSST4, BSST1, and BSST2). Teachers claim that "due to the wide range of topics covered in history education, we use lecture methods of teaching rather than participatory approaches" (SSST1, SSST3, BSST1, and BSST2).

6.3 How is the student's academic achievement in history at Sebeta government secondary school? To answer this question, the researchers used document review

6.3.1 document analysis.

Document analysis is part of the qualitative data collection strategy that every researcher engages in throughout the research period. In this research researchers reviewed, history education students’ textbooks, published articles and roasters of students (students’ mark list). The history education achievement of 174 Sebeta government secondary school students scored in grade 9 in 2020/2021 was compared to look at their achievement in grade 10 in 2021/2022. As a result, one student achieved less than 50% out of 100%, 39 students’ scores ranged from 50 to 60 out of 100%, 98 students scored from 61 to 70 out of 100%, 27 students scored between 71 and 80 out of 100%, 8 students scored between 81 and 90 out of 100%, and 1 student scored between 91 and 100, in grade nine. In grade 10, 11 students scored below 50, 103 students scored between 50 and 60, 45 students scored between 61 and 70, 9 students scored between 71 and 80, 4 students scored between 81 and 90, and 2 students scored between 91 and 100 out of 100%.

Based on this analysis, we can witness students’ achievement in two ways. The first is that in grade 9, 138 out of 174 students scored less than 70% out of 100% and the results of students scoring from 70 to 100% declined significantly. The second point to mention is that student achievement in history education has been highly declining at the subsequent grade level. In Grade 10, the number of students scoring less than 50% grew, and 159 out of 174 students scored less than 70% in history education. This indicates students' achievement in history in grade 9 decreased in grade 10. This suggests that students' achievement in history education was inadequate. Following the analysis of student achievement, interviews were conducted with students and teachers to identify why students' achievement in history education was so low.

7 Conclusion and recommendations

Research shows that teaching strategies are a crucial aspect in successful learning because they enable learners to learn, create, and take a proactive attitude towards learning. The significant issues confronting history education have been identified were teaching strategy, a lack of awareness about implementing participatory teaching methods, a lack of comprehensiveness of the contents of history education teaching materials, and the issue of the bulkiness and scope of history education texts being covered on time and Lack of teachers’ understanding of employing creative teaching strategies to improve students’ academic progress. Despite this, the study found that teachers in Sebeta government secondary schools use the teacher-centered lecture approach rather than interactive or student-centered strategies, which are recommended for students' learning. Teachers were cognizant of student-center teaching and learning improved student achievement. Conversely, teachers are hesitant to adopt participatory teaching methodologies due to the vastness of history textbooks and the lack of time provided to history education to cover bulky texts. As a result, they employ teaching approaches that they believe will allow them to complete the history education contents in the allocated time rather than focusing on enhancing students' academic achievement.

Furthermore, the study also found out that teachers are reluctant to use participatory student-centred learning methods because the two periods per week allocated (80 min) to teaching history education are not enough to cover a wide range of history education content. They believe participatory student-center teaching is ineffective in large classrooms and takes more time than the lecture method. Such thinking stems from a lack of understanding (imparting knowledge) on the use of innovative teaching strategies. The researchers examined the lecture teaching approach that students had learned as well as their results. Several students' achievement in history education shows below 70% out of 100% at Sebeta government secondary schools. The main reason for this low achievement is the teachers’ teaching strategies (the use of teacher-centred approach) to teaching history education to complete a wide content within the allotted time. Teachers do not consider which strategies could improve students’ achievement rather than focus on completing their content. This has also resulted in students’ negative attitudes towards the subject.

The outcomes of this study can serve as the foundation for future research in academic and professional studies. This discovery is notable for the fact that teaching and learning approaches influence students' academic achievement in both directions. Accordingly, if teachers only employ the lecture approach without involving students in the lesson, it may result in low student academic achievement in contrast if teachers employ student-centred strategies students can understand the main point of the lesson and enhance the academic achievement of students.

Thus, for future studies intervention exprimental research in history education is required to measure the extent to which participatory methods of instruction increase the academic achievement of students over teacher-centred strategies. More research, according to the researchers, should be conducted using participatory teaching methods in one classroom and lecture methods in others to determine to what extent participatory teaching methods improve the academic achievement of students when compared to teacher-centred strategies. Following the findings, researchers provided the following recommendations: national and regional education experts should collaborate closely in making history education content inclusive, as well as training history education teachers in the use of participatory teaching approaches. Curriculum experts should effectively organize the breadth of history education contents. To ensure that students learn successfully, the relevant authorities should rigorously monitor the state of the teaching and learning processes in general and history education in particular.

Data availability

The data of this study is the primary source, which is the roster of students' results and education policies. The student results/ marks analyzed for this study are from two Sebeta town public secondary schools: Sebeta secondary school and Burka Sebeta secondary school and Ethiopian education policies. So, the data are available from the corresponding author upon reasonable request from anyone.

Andreas D. Leopold von Ranke on Irish history and the Irish nation. Cogent Arts Hum. 2017;4:1. https://doi.org/10.1080/23311983.2017.1314629 .

Article   Google Scholar  

Stern F. History as an academic discipline. Engl Hist Rev. 1970. https://doi.org/10.1007/978-1-349-15406-7_11 .

Vierhaus R. Leopold von Ranke. Encyclopedia Britannica; 2022. https://www.britannica.com/biography/Leopold-von-Ranke .

Hobbs L, Porsch R. Teaching out-of-field: challenges for teacher education. Eur J Teach Educ. 2021;44(5):601–10. https://doi.org/10.1080/02619768.2021.1985280 .

Schneider M, Preckel F. Variables associated with achievement in higher education: a systematic review of meta-analyses. Psychol Bull. 2017;143(6):565–600. https://doi.org/10.1037/bul0000098 .

Hirsh A, Nilholm C, Roman H, Forsberg E, Sundberg D. Reviews of teaching methods which fundamental issues are identified? Educ Inquiry. 2022;13:1. https://doi.org/10.1080/20004508.2020.1839232 .

Chetty R, Friedman JN, Rockoff JE. Measuring the impacts of teachers II: teacher value-added and student outcomes in adulthood. Am Econ Rev. 2014;104:9.

Google Scholar  

Boadu G. Effective teaching in history: the perspectives of history student—teachers. Int J Hum Soc Sci. 2015;3:1.

Han J, Yin H. Teacher motivation: definition, research development and implications for teachers. Cogent Educ. 2016;3(1):1–18. https://doi.org/10.1080/2331186X.2016.1217819 .

Issar K. Students’ attitude towards studying history and teaching practices. Educ Quart Rev. 2021;4(3):45–50. https://doi.org/10.31014/aior.1993.04.03.316 .

Kiio MN. A critical study of methods and materials used to teach History and Government in secondary schools in Kenya (Doctoral dissertation, Doctoral dissertation); 2012.

Zajda J. Constructivist learning theory and creating effective learning environments. Glob Comp Educ Policy Res. 2021. https://doi.org/10.1007/978-3-030-71575-5_3 .

Gogus A. Constructivist learning. Encyclopedia of the Sciences of Learning. 2012. https://doi.org/10.1007/978-1-4419-1428-6_142 .

Luka MJB. Impact of teaching methods on the attitude of secondary school students toward the learning of history in Malawi: a case study of some schools in Shire Highland Education Division (SHED) (Doctoral dissertation, Mzuzu University); 2018.

Awgichew S, Ademe E. History education for nation-building in Ethiopia, Germany, Rwanda, South Africa, Switzerland, and the USA: a comparative analysis. Cogent Educ. 2022;9:1. https://doi.org/10.1080/2331186X.2022.2113210 .

Jemal M. The challenge of teaching Ethiopian history in Ethiopian high schools: the case of the Ethiopian Somali Region. Jigjiga University; 2014.

Fisseha A. An investigation of history teaching in Ethiopian senior secondary schools. Ethiop J Educ. 1992;13(1):89–93.

Negash T. The crisis of Ethiopian education: some implications for the nation- building, vol. 29. Nordic Africa Institute; 1990.

Resource A, Guide P. 21st Century skills, education & competitiveness. Partnership for 21st Century Skills; 2008.

Walters K et al. An up-close look at student-centered math teaching: a study of highly regarded high school teachers and their students . American Institutes for Research; 2014. https://eric.ed.gov .

Agiro T. Factors affecting teaching history in senior secondary schools, in Addis Ababa. M.Ed Thesis: Kenyatta University; 1990. http://ir-library.ku.ac.ke/handle/123456789/13926 .

Schull E. Theoretical foundations. Standards Futures Res. 2022. https://doi.org/10.1007/978-3-658-35806-8_9 .

Schreiber LM, Valle BE. Social constructivist teaching strategies in the small group classroom. Small Group Res. 2013;44(4):395–411. https://doi.org/10.1177/1046496413488422 .

Johnson M, Bradbury T. Contributions of social learning theory to the promotion of healthy relationships: asset or liability? J Fam Theory Rev. 2015;7(1):13–27. https://doi.org/10.1111/jftr.12057 .

Punch KF. Introduction to research method in education. Gosport: Ashford Colour Press Ltd; 2009.

Prawat R. Teachers’ beliefs about teaching and learning: a constructivist perspective. Am J Educ. 1992;100:3. https://doi.org/10.1086/444021 .

Sugano SGC, Mamolo LA. The effects of teaching methodologies on Students’ attitude and motivation: a meta-analysis. Int J Instr. 2021;14(3):827–46. https://doi.org/10.29333/iji.2021.14348a .

Phillips I. Teaching history: developing as a reflective secondary teacher. Los Angeles: Sage; 2008.

Book   Google Scholar  

Nyamwembe EO, et al. Attitudes of students towards studying history and government in some selected secondary schools in Mosocho Division. Kisii. J Educ Pract. 2003;4:11.

Mazibuko EZ. Developments in history teaching at the secondary school level in Swaziland: lessons from classroom research. Yesterday and today; 2008

Zhu Y, Kaiser G. Impacts of classroom teaching practices on Students’ mathematics learning interest, mathematics self-efficacy and mathematics test achievements: a secondary analysis of Shanghai data from the international video study Global Teaching Insights. ZDM Math Educ. 2022;54:581–93. https://doi.org/10.1007/s11858-022-01343-9 .

Silver HF, Perini MJ. The eights Cs of engagement: how learning styles and instructional design increase students’ commitment to learning. On excellence teaching; 2010. p. 1–18.

Hussar KM, Horvath JC. Do children play fair with mother nature? understanding children’s judgments of environmentally harmful actions. J Environ Psychol. 2011;31:309–13. https://doi.org/10.1016/j.jenvp.2011.05.001 .

Creswell J. Qualitative inquiry & research design: choosing among five approaches. 3rd ed. Thousand Oaks: Sage Publications; 2013.

Mills GE, Gay LR. Education research: Competencies for analysis and applications. London: Pearson Education; 2016. https://doi.org/10.37074/jalt.2018.1.2.14 .

Johnson RB, Christensen L. Educational research, qualitative, quantitative and mixed approaches. 5th ed. Los Angeles: Sage Publication Inc.; 2014.

Hatch A. Doing qualitative research in an educational setting. New York: State University of New York Press; 2002.

Kirkbride R. A guide to practitioner research in education. Educ Res Eval. 2012;18(5):512–3. https://doi.org/10.1080/13803611.2011.643361 .

Patten ML. Understanding research methods: an overview of the essentials. 10th ed. Routledge; 2017. https://doi.org/10.4324/9781315213033 .

Cohen L, Manion L, Morrison K. Research methods in education. Seventh education. Routledge; 2011.

Hodkinson A, Ghajarieh A, Salami A. An analysis of the cultural representation of disability in school textbooks in Iran and England’. Education 3–13: international journal of primary, elementary and early years education; 2016.: https://www.researchgate.net/publication/301271604_An_analysis_of_the_cultural_representation_of_disability_in_school_textbooks_in_Iran_and_England

Muresan-Madar A, Băban A. The development and piloting of a CBT group program for postpartum depression. J Evid Based Psychother. 2015;15(1):51–64.

Merriam. 30 Things you can do to promote creativity. Open Colleges; 2012.

Ayalew M. Strategies in the teaching of Geography in higher education preparatory secondary schools of Ethiopia. PhD Dissertation, University of South Africa; 2015.

Precious EC, Feyisetan AVA. Influence of teacher- centred and student-centered teaching methods on the academic achievement of post—basic students in biology in Delta State, Nigeria. Teach Educ Curr Stud. 2020;5(3):120–4. https://doi.org/10.11648/j.tecs.20200503.21 .

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Fufa, F.S., Tulu, A.H. & Ensene, K.A. Exploring the significant problems confronting secondary schools history education: a baseline study. Discov Educ 3 , 52 (2024). https://doi.org/10.1007/s44217-024-00132-8

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Women’s work and GDP

Women’s work is posited to be related to development through the process of economic transformation.

Levels of female labor force participation are high for the poorest economies generally, where agriculture is the dominant sector and women often participate in small-holder agricultural work. Women’s participation in the workforce is lower in middle-income economies which have much smaller shares of agricultural activities. Finally, among high-income economies, female labor force participation is again higher, accompanied by a shift towards a service sector-based economy and higher education levels among women.

This describes the posited  U-shaped relationship  between development (proxied by GDP per capita) and female labor force participation where women’s work participation is high for the poorest economies, lower for middle income economies, and then rises again among high income economies.

This theory of the U-shape is observed globally across economies of different income levels. But this global picture may be misleading. As more recent studies have found, this pattern does not hold within regions or when looking within a specific economy over time as their income levels rise.

In no region do we observe a U-shape pattern in female participation and GDP per capita over the past three decades.

Structural transformation, declining fertility, and increasing female education in many parts of the world have not resulted in significant increases in women’s participation as was theorized. Rather, rigid historic, economic, and social structures and norms factor into stagnant female labor force participation.

Historical view of women’s participation and GDP

Taking a historical view of female participation and GDP, we ask another question: Do lower income economies today have levels of participation that mirror levels that high-income economies had decades earlier?

The answer is no.

This suggests that the relationship of female labor force participation to GDP for lower-income economies today is different than was the case decades past. This could be driven by numerous factors -- changing social norms, demographics, technology, urbanization, to name a few possible drivers.

Gendered patterns in type of employment

Gender equality is not just about equal access to jobs but also equal access for men and women to good jobs. The type of work that women do can be very different from the type of work that men do. Here we divide work into two broad categories: vulnerable work and wage work.

The Gender gap in vulnerable and wage work by GDP per capita

Vulnerable employment is closely related to GDP per capita. Economies with high rates of vulnerable employment are low-income contexts with a large agricultural sector. In these economies, women tend to make up the higher share of the vulnerably employed. As economy income levels rise, the gender gap also flips, with men being more likely to be in vulnerable work when they have a job than women.

From COVID-19 crisis to recovery

The COVID-19 crisis has exacerbated these gender gaps in employment. Although comprehensive official statistics from labor force surveys are not yet available for all economies,  emerging studies  have consistently documented that working women are taking a harder hit from the crisis. Different patterns by sector and vulnerable work do not explain this. That is, this result is not driven by the sectors in which women work or their higher rates of vulnerable work—within specific work categories, women fared worse than men in terms of COVID-19 impacts on jobs.

Among other explanations is that women have borne the brunt of the increase in the demand for care work (especially for children). A strong and inclusive recovery will require efforts which address this and other underlying drivers of gender gaps in employment opportunities.

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Hot history: Tree rings show that last northern summer was the warmest since year 1

A new study finds that the broiling summer of 2023 was the hottest in the Northern Hemisphere in more than 2,000 years

The broiling summer of 2023 was the hottest in the Northern Hemisphere in more than 2,000 years, a new study found.

When the temperatures spiked last year, numerous weather agencies said it was the hottest month, summer and year on record. But those records only go back to 1850 at best because it's based on thermometers. Now scientists can go back to the modern western calendar's year 1, when the Bible says Jesus of Nazareth walked the Earth, but have found no hotter northern summer than last year's.

A study Tuesday in the journal Nature uses a well-established method and record of more than 10,000 tree rings to calculate summertime temperatures for each year since the year 1. No year came even close to last summer's high heat, said lead author Jan Esper, a climate geographer at the Gutenberg Research College in Germany.

Before humans started pumping heat-trapping gases into the atmosphere by burning coal, oil and natural gas, the hottest year was the year 246, Esper said. That was the beginning of the medieval period of history, when Roman Emperor Philip the Arab fought Germans along the Danube River.

Esper's paper showed that in the Northern Hemisphere, the summer of 2023 was as much as 2.1 degrees Fahrenheit (1.2 degrees Celsius) warmer than the summer of 246. In fact 25 of the last 28 years have been hotter than that early medieval summer, said study co-author Max Torbenson.

“That gives us a good idea of how extreme 2023 is," Esper told The Associated Press.

The team used thousands of trees in 15 different sites in the Northern Hemisphere, north of the tropics, where there was enough data to get a good figure going back to year 1, Esper said. There was not quite enough tree data in the Southern Hemisphere to publish, but the sparse data showed something similar, he said.

Scientists look at the rings of annual tree growth and “we can match them almost like a puzzle back in time so we can assign annual dates to every ring,” Torbenson said.

Why stop the look back at year 1, when other temperature reconstructions go back more than 20,000 years, asked University of Pennsylvannia climate scientist Michael Mann, who wasn't part of the study but more than a quarter century ago published the famous hockey stick graph showing rising temperatures since the Industrial Age. He said just relying on tree rings is “considerably less reliable” than looking at all sorts of proxy data, including ice cores, corals and more.

Esper said his new study only uses tree data because it is precise enough to give summer-by-summer temperature estimates, which can't be done with corals, ice cores and other proxies. Tree rings are higher resolution, he said.

“The global temperature records set last summer were so gobsmacking — shattering the prior record by 0.5C in September and 0.4C in October — that it’s not surprising they would be clearly be the warmest in the past 2,000 years,” said Berkeley Earth climate scientist Zeke Hausfather, who wasn't part of the study. “It's likely the warmest summer in 120,000 years, though we cannot be absolutely sure,” he said, because data precise to a year doesn't go back that far.

Because high-resolution annual data doesn't go back that far, Esper said it's wrong for scientists and the media to call it the hottest in 120,000 years. Two thousand years is enough, he said.

Esper also said the pre-industrial period of 1850 to 1900 that scientists — especially the Intergovernmental Panel on Climate Change — use for the base period before warming may be a bit cooler than the instrumental records show. The instruments back then were more often in the hot sun instead of shielded like they are now, and tree rings continue to show that it was about 0.4 degrees (0.2 degrees Celsius) cooler than thermometers show.

That means there's been a bit more warming from human-caused climate change than most scientists calculate, an issue being hashed out by researchers over the last few years.

Looking at the temperature records, especially the last 150 years, Esper noticed that while they are generally increasing, they tend to do so with slow rises and then giant steps, like what happened last year. He said those steps are often associated with a natural El Nino, a warming of the central Pacific that changes weather worldwide and adds even more heat to a changing climate.

“I don't know when the next step will be taken, but I will not be surprised by another huge step in the next 10 to 15 years, that's for sure,” Esper said in a news briefing. “And it's very worrying.”

This story has been corrected to refer to Jesus of Nazareth, rather than Jesus Christ.

Read more of AP’s climate coverage at http://www.apnews.com/climate-and-environment

Follow Seth Borenstein on X at @borenbears

The Associated Press’ climate and environmental coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

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Open Access

Peer-reviewed

Research Article

Are young and older children with diarrhea presenting in the same way?

Roles Conceptualization, Formal analysis, Methodology, Writing – original draft

Affiliation Clinical and Laboratory Services, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh

Roles Writing – review & editing

Roles Formal analysis, Writing – review & editing

Affiliation Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh

Roles Conceptualization, Writing – review & editing

Roles Conceptualization, Formal analysis, Supervision, Writing – review & editing

* E-mail: [email protected] , [email protected]

¶ ‡ RD and TA are contributed equally as senior author on this work.

Affiliations Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh, Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, GA, United States of America

Roles Conceptualization, Supervision, Writing – review & editing

Affiliations Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh, James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh, United States of America, Department of Global Health, University of Washington, Seattle, WA, United States of America, Office of the Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh

• Sharika Nuzhat, 
• Baharul Alam, 
• S. M. Tafsir Hasan, 
• Shamsun Nahar Shaima, 
• Mohammod Jobayer Chisti, 
• A. S. G. Faruque, 
• Rina Das, 
• Tahmeed Ahmed

• Published: May 13, 2024
• https://doi.org/10.1371/journal.pone.0300882
• Peer Review
• Reader Comments

Diarrhoea is a global health problem. More than a quarter of diarrhoeal deaths occur among children less than five years. Different literatures analyzed presentation and outcomes of less than five diarrhoeal children. The world has made remarkable progress in reducing child mortality. So, older children are growing in number. Our aim was to identify clinical differentials and variations of pathogens among younger (less than five) and older (five to nine years) diarrhoeal children.

Data were extracted from the diarrhoeal disease surveillance system (DDSS) of Dhaka Hospital (urban site) and Matlab Hospital (rural site) of the International Centre for Diarrhoeal Disease Research, Bangladesh for the period of January 2012 to December 2021. Out of 28,781 and 12,499 surveillance patients in Dhaka and Matlab Hospital, 614 (2.13%) and 278 (2.22%) children were five to nine—years of age, respectively. Among under five children, 2456 from Dhaka hospital and 1112 from Matlab hospital were selected randomly for analysis (four times of five to nine years age children, 1:4).

Vomiting, abdominal pain, and dehydrating diarrhoea were significantly higher in older children in comparison to children of less than five years age (p-value <0.05) after adjusting study site, gender, antibiotic use before hospitalization, diarrhoeal duration < 24 hours, intake of oral rehydration fluid at home, parental education, WASH practice and history of cough. Vibrio . cholerae , Salmonella , and Shigella were the common fecal pathogen observed among older children compared to under five after adjusting for age, gender and study site.

Although percentage of admitted diarrhoeal children with five to nine years is less than under five years children but they presented with critical illness with different diarrhoeal pathogens. These observations may help clinicians to formulate better case management strategies for children of five to nine years that may reduce morbidity.

Citation: Nuzhat S, Alam B, Hasan SMT, Shaima SN, Chisti MJ, Faruque ASG, et al. (2024) Are young and older children with diarrhea presenting in the same way? PLoS ONE 19(5): e0300882. https://doi.org/10.1371/journal.pone.0300882

Editor: Sanjoy Kumer Dey, Bangabandhu Sheikh Mujib Medical University (BSMMU), BANGLADESH

Received: August 29, 2023; Accepted: March 6, 2024; Published: May 13, 2024

Copyright: © 2024 Nuzhat et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: It is the policy of our centre (icddr,b) that the data, which contain identifying patient information, are not to be made available. However, data related to this paper are available upon request. Researchers who meet the criteria for access to confidential data may contact with Armana Ahmed ( [email protected] ) at the Research Administration of icddr,b ( http://www.icddrb.org/ ).

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Diarrhoea is a global health problem. In 2016, diarrhea was the eighth leading cause of mortality among the total population, responsible for more than 1·6 million deaths [ 1 ]. More than a quarter (26·93%) of diarrhoeal deaths occurred among children younger than five years, and about 90% (89·37%) of diarrhoeal deaths occurred in South Asia and sub-Saharan Africa [ 1 ]. A systematic review of diarrhoea morbidity and mortality [ 2 ], suggested that diarrhoea morbidity rates have remained constant in all ages since the 1980s in both developed and developing countries, also estimated more than 2.8 billion episodes of diarrhoea per year in children aged more than five years, adolescents, and adults [ 2 ]. Older children and adolescents are responsible for large burden of communicable disease [ 3 ].

Globally, diarrhoea is the second leading cause death among under five children [ 4 ]. In Asia, this risk remains high from ages 5–14 and reaches a low and constant plateau throughout adolescence and adulthood. At the same time, it declines less dramatically in Africa among more than five years old children and remains relatively stable throughout the lifespan [ 2 ]. In Bangladesh Demographic and Health Survey (BDHS) 2017–18, information was obtained from under five children about their experience of having an episode of diarrhoea in the two weeks before the survey. Overall, 5% of children under age of five years had diarrhoea during last two weeks period [ 5 ]. Prevalance remained the same in BDHS 2022 survey. But limited data were found on older children suffering from diarrhoea. Children in the age group of 5–14 years are regarded as school-age. This period lays the foundation for good health and sound mind in children, which persists throughout their lifetime [ 6 ]. The first growth spurt, the preadolescent or mid-growth spurt, is seen at around six to eight years of age. This is followed by the adolescent growth spurt between 10–17 years of age. There are many factors present in children’s day-to-day household settings which make them vulnerable to undernutrition.

Infectious disease morbidity was associated with lower weight gains in Bangladeshi children aged 5 to 11 years [ 7 ]. Global diarrhoea mortality among individuals older than five years was dominated by Shigella [ 8 ] and nearly 70% occurred in children more than five years [ 8 ]. Vibrio cholerae (cholera) was the third leading cause of diarrhoea mortality among all ages, responsible for 0.11 million deaths [ 8 ]. In Bangladesh, diarrhoea mortality rates decreased among children under five from 15.1 to 6.0 per 1000 live births between 1980 and 2015 [ 9 , 10 ].

In recent decades, little is known about the burden of diarrhoeal disease in children under five and in older children aged five to nine years. Hence, to address the existing knowledge gap and share research findings with policymakers and clinicians to formulate better case management strategies, we undertook this comparative assessment of the clinical features and etiology of diarrhoea among older children of five to nine years with that among under five years old children.

Materials and methods

Ethical statements.

For this study, data were extracted from the electronic database of the hospital-based diarrhoeal disease surveillance system (DDSS) of Dhaka hospital and Matlab hospital of the International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b). The DDSS has the approval from the institutional review board of icddr,b (Research Review Committee and Ethical Review Committee) for data analysis. Ethical Review Committee was also pleased with the voluntary participation, maintenance of rights of the participants, and confidential handling of personal information by the hospital doctors and accepted this consenting procedure. At the time of enrolment into DDSS, verbal consent was obtained from the parents or the attending caregivers of each child, following hospital policy. The verbal consent was recorded by keeping a checkmark in the questionnaire that was again assured by showing the mark to parents or caregivers.

Study population and study site

Diarrhoeal Disease Surveillance System (DDSS) is routine ongoing surveillance in hospitals of icddr,b located in Dhaka and Matlab, Bangladesh. In the Surveillance system of Dhaka Hospital, systematically (from every 50 th patient according to their hospital ID number) collects information including age, sex, socio-demographic characteristics, clinical features, and identifies common bacterial and viral isolates from fecal samples. In Matlab Hospital, patients from the Matlab HDSS (Health and Demographic Surveillance System) area are included in the hospital surveillance system.

For the present study, we used 10 years data limited to 0–9 years of children enrolled in the DDSS from January 2012 to December 2021. In this study period, 28,781 and 12,499 diarrhoeal patients were enrolled in Dhaka and Matlab Hospital surveillance systems, respectively. Of them, 614 and 278 children aged five to nine years from Dhaka and Matlab, separately, were included in the analyses ( Fig 1 ). We considered randomly selected children aged less than 5 years as the comparison group (controls) in a 1:4 ratio to increase the statistical power for analyses using SPSS [ 11 ], Dhaka Hospital was considered an urban study site, and Matlab Hospital was a rural study site.

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https://doi.org/10.1371/journal.pone.0300882.g001

Study design

In this retrospective study, five to nine years of diarrhoeal children were considered as cases and compared with under five diarrhoeal children. The study period was from 2012 to 2021. Fig 1 shows the flow chart for selecting the cases and comparison groups.

614, five to nine years old children and 2456 under-five children were selected from Dhaka hospital. 278, five to nine years children and 1112 under-five children were selected from Matlab hospital.

Stool microbiology

After collection, fresh stool specimens from DDSS-enrolled patients were sent to icddr,b central laboratories for routine screening of the aforementioned enteric pathogens. The details of the laboratory procedures for detecting entero-pathogens in stool samples have been described elsewhere [ 12 – 14 ]. In brief, Vibrio cholera was isolated by growth on tellurite taurocholate gelatin agar (TTGA) media with enrichment in bile peptone broth. Salmonella spp. and Shigella spp. were isolated by growth on MacConkey agar and Salmonella-Shigella (SS) agar with enrichment in selenite broth followed by antisera panel testing (Denka Seiken Co., Ltd.). Campylobacter spp. was isolated by growth on Brucella agar. Aeromonas spp. were isolated by growth on TTGA and gelatin agar followed by phenotypic characterization of long-sugar metabolism. For the detection of ETEC, fresh stool specimens were plated onto MacConkey agar. The plates were incubated at 37˚C for 18 hours. Six lactose fermenting individual colonies morphologically resembling E. coli were isolated and tested for the presence of heat-stable and heat-labile toxins using ganglioside GM1 ELISA and multiplex PCR [ 15 , 16 ]. Antimicrobial susceptibility was checked for each of the isolated bacteria. The presence of Group, A rotavirus-specific VP6 antigen in stool samples, was detected using the ProSpect Rotavirus kit (Oxoid Ltd, Basingstoke, UK), which utilizes a polyclonal antibody in a solid phase sandwich-type enzyme immunoassay according to the manufacturer’s instructions [ 17 ].

Statistical analysis

We summarized the characteristics of children using percentages and mean with standard deviation (SD) as appropriate. Bivariable and multivariable binary logistic regression models were used to assess the association of outcome variables (dehydration status, presented with fever, presence of watery stool, abdominal pain, convulsion, death, and infection with rotavirus, Vibrio . Cholerae , Salmonella , and Shigella ) with age groups (five to nine years compared to less than five years). The number of observations in one cell was less than five for the convulsion and death variable, so we could not include these two variables in the final model. Each of the clinical outcome variables was analyzed as a separate model adjusting for potential available covariates, such as study site, age, sex, use of antibiotics prior hospitalization, diarrhoeal duration, use of oral rehydration fluid at home, parent’s education, WASH practice, and history of cough. Isolated pathogens were adjusted for study site, age, and sex. We expressed the strength of association as odds ratio (OR) and adjusted odds ratio (aOR) with a 95% confidence interval (95% CI) with a <0.05 p value. All statistical tests were two-sided. Data analysis were done in Stata v15.1 (Stata Corp, College Station, TX, USA).

In Dhaka hospital, there were 28,781 surveillance patients during the period 2012 to 2021. Out of them 614, five to nine years old children and 2456, under five children were included in analysis. ( Fig 1 ). From 2012 to 2021in Matlab Hospital total surveillance patients were 12,499. Among them, we included 278, five to nine years old children and 1112 under five children for analysis ( Fig 1 ). Yearly admission of the children of both groups in both study sites was comparable though it showed the rise of younger children during the COVID pandemic 2020–2021. In the COVID period, older children presenting with diarrhea were lower in percentage than younger children ( Fig 2 ).

https://doi.org/10.1371/journal.pone.0300882.g002

Tables 1 and 2 show the comparison of demographic and clinical characteristics of five to nine years children and less than five years children. Parents of older children were illiterate compared to younger children in both study areas. Five to nine years children of urban and rural sites more commonly presented with short duration of diarrhoea (<24 hours), some/severe dehydration, vomiting, and abdominal pain. On the other hand, these children were less likely to present with a history of fever and cough. No death was observed among the older children in both hospitals.

https://doi.org/10.1371/journal.pone.0300882.t001

https://doi.org/10.1371/journal.pone.0300882.t002

Table 3 shows that in logistic regression analysis after adjusting for study site, sex, use of antibiotics before hospitalization, diarrhoeal duration, use of fluid at home, parent’s education, source of drinking water, use of water treatment, use of improved latrine, h/o cough, five to nine years old diarrhoeal children were significantly associated with some /severe dehydration, vomiting, and abdominal pain.

https://doi.org/10.1371/journal.pone.0300882.t003

Table 4 shows isolated organisms among the study group in both the study sites. All microorganisms were not tested in the rural study site. Isolation of V . Cholerae , Shigella , and Salmonella was significantly higher in the study areas among five to nine years children than under five children. On the other hand, Rotavirus predominance was observed among the young children group. After adjusting the study site, age, and sex, V . Cholerae , Shigella , and Salmonella were significantly associated with five to nine years children than under-five children. At the same time, rotavirus was substantially lower in older children.

https://doi.org/10.1371/journal.pone.0300882.t004

To our knowledge, this is the first study that investigated the clinical presentation and etiology of diarrhoea among five to nine years old children of Bangladesh and compared it with younger children. Though the percentage of five to nine years diarrhoeal children has been limited in number in the last 10 years in both urban and rural sites, these older children presented with critical illnesses.

The world has made remarkable progress in reducing child mortality. The global U5MR decreased by 59% (90% uncertainty interval [UI] 56–61) from 93·0 (91·7–94·5) deaths per 1000 live births in 1990 to 37·7 (36·1–40·8) in 2019 [ 18 ]. If all countries met the SDG target on under five mortality, 11 million under five deaths could be averted between 2020 and 2030 [ 18 ]. With more young children now surviving, improving the survival of older children is an increasing area of focus nowadays. Globally, mortality rates among older children declined by 40% during this period [ 19 ]. Every region of the world has made progress in reducing more older child mortality rates, with the most significant percentage reductions occurring in Southeast Asia (65%), Africa (60%), and European (40%) LMICs (lower and middle income countries) [ 19 ]. In 2016, about 1 million children died, mainly from preventable causes like pneumonia, diarrhoea and malaria [ 20 ]. Globally, the top five causes of death among older children were diarrhoeal diseases (10%), lower respiratory infections (10%), road traffic injuries (8%), malaria (7%), and meningitis (6%) in 2016 [ 19 ]. Despite absolute reductions in mortality rates, African LMICs had substantially higher older child mortality rates than all other regions due to the continued burden of infectious diseases, including diarrhoeal diseases, lower respiratory infections, and malaria [ 19 ]. Southeast Asian LMICs, in contrast, had the fastest progress of any region. This success was mainly achieved by reducing mortality rates from the exact infectious causes that continue to burden the African continent [ 19 ].

The focus on the diarrhoeal disease was on under-five children. In our study, we have found that older children are more likely to be associated with dehydrating diarrhoea, vomiting, and abdominal pain in the adjusted model compared to younger children. Several studies have assessed the accuracy of the WHO, CDS, and DHAKA methods of dehydration assessment in different contexts, none have been validated for assessing dehydration in patients over five years with acute diarrhoea [ 21 – 24 ]. Differences in both adult physiology and diarrhoea etiology may compromise the accuracy of clinical diagnostic models initially developed for use in young children [ 25 , 26 ]. NIRUDAK is the first study to empirically derive clinical diagnostic models for assessing dehydration severity in patients over five years of age [ 27 ]. A systematic review reported the estimates of duration and severity outcomes [ 28 ]. Due to the lack of studies reporting results for children 5–15 years of age, they could not directly estimate the burden of diarrhoea on this age group [ 28 ]. Dehydration in younger children is associated with poor intake, and amount of purging in comparison to low body weight [ 29 ], but for older children lack of knowledge regarding ORS intake, negligence probably the factor associated with their presentation. A study conducted on determinants of dehydrating diarrhoea reported that risk of severe dehydration in diarrhoea increases abruptly from zero to ten years of age and Vibrio cholerae is identified as contributing organism for dehydration [ 12 ]. But this study did not differentiate other clinical features between young and older children.

Childhood morbidity status, especially diarrhoea, has been reported in other studies to impair the growth of children, specifically in weight gain [ 30 ] which in the long run halts the development of the children. A study conducted in a neighboring country found a significant association between being underweight and episodes of diarrhoea in the last year among school-aged children [ 31 ]. This follows the findings of Torres et al. [ 7 ], who reported that diarrhoea correlates significantly with retarded weight gain among children above preschool age. So, diarrhoeal illness among these older children needs to be appropriately treated, and proper nutrition counseling is also required for post-diarrhoeal days.

Another study conducted for older children, adolescents, and adults revealed that the most frequently isolated pathogens among patients hospitalized for diarrhoea are ETEC and Vibrio cholerae O1/O139 [ 25 ]. Rotavirus, which is known to be a leading cause of death among young children, was not found to be as important among older persons providing additional evidence suggesting immunity with increasing age [ 25 ]. In outpatient settings, Salmonella spp., Shigella spp., and E . histolytica were the most frequently isolated pathogens in the older age group [ 25 ]. In our study, we analyzed our hospitalized diarrhoeal children where rotaviral diarrhoea is less likely associated with more than five years of children. This is similar to other studies suggesting better protection with older age [ 32 ]. But Salmonella spp. and Shigella spp. were significantly higher in percentage among older age group compared to younger children.

Irrespective of the scientific pertinence of the abovementioned findings on five to nine years children, our study has some limitations. We included only the diarrhoeal children who visited the hospital. Lack of data related to caregivers’ s knowledge regarding the management of diarrhoeal along with data regarding follow-up of such children was not available. We could not evaluate the effect of the Rota viral vaccine as this is yet to incorporate into the EPI schedule of Bangladesh. Although this study had been conducted in the largest diarrhoeal disease facility in the world and also focused on both urban and rural communities, such data as mentioned above along with nationwide data on the disease severity and fatality among older children would have enhanced the reliability of our observation. In addition to that the areas where the burden of Cholera is insignificant might show different presentation.

Our study suggested that children over five might get benefit from greater attention to controlling diarrhoeal diseases, thereby reducing their morbidity. International initiatives targeting child mortality have focused on children under five years of age [ 7 ]. Including older children in the program, management would help to reduce morbidity and mortality in this age group who are neglected. High-quality prospective community- and facility-based studies on the etiology of diarrhoeal illness among children aged five to nine years old are needed, ideally, ones that cover an entire 12-month period to account for diarrhoea seasonality.

Acknowledgments

This research was supported by core donors who provide unrestricted support to icddr,b for its operations and research. Current donors providing unrestricted support include the Governments of Bangladesh and Canada. We gratefully acknowledge our core donors for their support and commitment to icddr,b’s research efforts.

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• 5. NIPORT I.Bangladesh Demographic and Health Survey 2017–18: Key Indicators. Dhaka, Bangladesh, and Rockville, Maryland, USA. 2019.

McKinsey Global Private Markets Review 2024: Private markets in a slower era

At a glance, macroeconomic challenges continued.

McKinsey Global Private Markets Review 2024: Private markets: A slower era

If 2022 was a tale of two halves, with robust fundraising and deal activity in the first six months followed by a slowdown in the second half, then 2023 might be considered a tale of one whole. Macroeconomic headwinds persisted throughout the year, with rising financing costs, and an uncertain growth outlook taking a toll on private markets. Full-year fundraising continued to decline from 2021’s lofty peak, weighed down by the “denominator effect” that persisted in part due to a less active deal market. Managers largely held onto assets to avoid selling in a lower-multiple environment, fueling an activity-dampening cycle in which distribution-starved limited partners (LPs) reined in new commitments.

About the authors

This article is a summary of a larger report, available as a PDF, that is a collaborative effort by Fredrik Dahlqvist , Alastair Green , Paul Maia, Alexandra Nee , David Quigley , Aditya Sanghvi , Connor Mangan, John Spivey, Rahel Schneider, and Brian Vickery , representing views from McKinsey’s Private Equity & Principal Investors Practice.

Performance in most private asset classes remained below historical averages for a second consecutive year. Decade-long tailwinds from low and falling interest rates and consistently expanding multiples seem to be things of the past. As private market managers look to boost performance in this new era of investing, a deeper focus on revenue growth and margin expansion will be needed now more than ever.

Perspectives on a slower era in private markets

Global fundraising contracted.

Fundraising fell 22 percent across private market asset classes globally to just over $1 trillion, as of year-end reported data—the lowest total since 2017. Fundraising in North America, a rare bright spot in 2022, declined in line with global totals, while in Europe, fundraising proved most resilient, falling just 3 percent. In Asia, fundraising fell precipitously and now sits 72 percent below the region’s 2018 peak.

Despite difficult fundraising conditions, headwinds did not affect all strategies or managers equally. Private equity (PE) buyout strategies posted their best fundraising year ever, and larger managers and vehicles also fared well, continuing the prior year’s trend toward greater fundraising concentration.

The numerator effect persisted

Despite a marked recovery in the denominator—the 1,000 largest US retirement funds grew 7 percent in the year ending September 2023, after falling 14 percent the prior year, for example 1 “U.S. retirement plans recover half of 2022 losses amid no-show recession,” Pensions and Investments , February 12, 2024. —many LPs remain overexposed to private markets relative to their target allocations. LPs started 2023 overweight: according to analysis from CEM Benchmarking, average allocations across PE, infrastructure, and real estate were at or above target allocations as of the beginning of the year. And the numerator grew throughout the year, as a lack of exits and rebounding valuations drove net asset values (NAVs) higher. While not all LPs strictly follow asset allocation targets, our analysis in partnership with global private markets firm StepStone Group suggests that an overallocation of just one percentage point can reduce planned commitments by as much as 10 to 12 percent per year for five years or more.

Despite these headwinds, recent surveys indicate that LPs remain broadly committed to private markets. In fact, the majority plan to maintain or increase allocations over the medium to long term.

Investors fled to known names and larger funds

Fundraising concentration reached its highest level in over a decade, as investors continued to shift new commitments in favor of the largest fund managers. The 25 most successful fundraisers collected 41 percent of aggregate commitments to closed-end funds (with the top five managers accounting for nearly half that total). Closed-end fundraising totals may understate the extent of concentration in the industry overall, as the largest managers also tend to be more successful in raising non-institutional capital.

While the largest funds grew even larger—the largest vehicles on record were raised in buyout, real estate, infrastructure, and private debt in 2023—smaller and newer funds struggled. Fewer than 1,700 funds of less than $1 billion were closed during the year, half as many as closed in 2022 and the fewest of any year since 2012. New manager formation also fell to the lowest level since 2012, with just 651 new firms launched in 2023.

Whether recent fundraising concentration and a spate of M&A activity signals the beginning of oft-rumored consolidation in the private markets remains uncertain, as a similar pattern developed in each of the last two fundraising downturns before giving way to renewed entrepreneurialism among general partners (GPs) and commitment diversification among LPs. Compared with how things played out in the last two downturns, perhaps this movie really is different, or perhaps we’re watching a trilogy reusing a familiar plotline.

Dry powder inventory spiked (again)

Private markets assets under management totaled $13.1 trillion as of June 30, 2023, and have grown nearly 20 percent per annum since 2018. Dry powder reserves—the amount of capital committed but not yet deployed—increased to $3.7 trillion, marking the ninth consecutive year of growth. Dry powder inventory—the amount of capital available to GPs expressed as a multiple of annual deployment—increased for the second consecutive year in PE, as new commitments continued to outpace deal activity. Inventory sat at 1.6 years in 2023, up markedly from the 0.9 years recorded at the end of 2021 but still within the historical range. NAV grew as well, largely driven by the reluctance of managers to exit positions and crystallize returns in a depressed multiple environment.

Private equity strategies diverged

Buyout and venture capital, the two largest PE sub-asset classes, charted wildly different courses over the past 18 months. Buyout notched its highest fundraising year ever in 2023, and its performance improved, with funds posting a (still paltry) 5 percent net internal rate of return through September 30. And although buyout deal volumes declined by 19 percent, 2023 was still the third-most-active year on record. In contrast, venture capital (VC) fundraising declined by nearly 60 percent, equaling its lowest total since 2015, and deal volume fell by 36 percent to the lowest level since 2019. VC funds returned –3 percent through September, posting negative returns for seven consecutive quarters. VC was the fastest-growing—as well as the highest-performing—PE strategy by a significant margin from 2010 to 2022, but investors appear to be reevaluating their approach in the current environment.

Private equity entry multiples contracted

PE buyout entry multiples declined by roughly one turn from 11.9 to 11.0 times EBITDA, slightly outpacing the decline in public market multiples (down from 12.1 to 11.3 times EBITDA), through the first nine months of 2023. For nearly a decade leading up to 2022, managers consistently sold assets into a higher-multiple environment than that in which they had bought those assets, providing a substantial performance tailwind for the industry. Nowhere has this been truer than in technology. After experiencing more than eight turns of multiple expansion from 2009 to 2021 (the most of any sector), technology multiples have declined by nearly three turns in the past two years, 50 percent more than in any other sector. Overall, roughly two-thirds of the total return for buyout deals that were entered in 2010 or later and exited in 2021 or before can be attributed to market multiple expansion and leverage. Now, with falling multiples and higher financing costs, revenue growth and margin expansion are taking center stage for GPs.

Real estate receded

Demand uncertainty, slowing rent growth, and elevated financing costs drove cap rates higher and made price discovery challenging, all of which weighed on deal volume, fundraising, and investment performance. Global closed-end fundraising declined 34 percent year over year, and funds returned −4 percent in the first nine months of the year, losing money for the first time since the 2007–08 global financial crisis. Capital shifted away from core and core-plus strategies as investors sought liquidity via redemptions in open-end vehicles, from which net outflows reached their highest level in at least two decades. Opportunistic strategies benefited from this shift, with investors focusing on capital appreciation over income generation in a market where alternative sources of yield have grown more attractive. Rising interest rates widened bid–ask spreads and impaired deal volume across food groups, including in what were formerly hot sectors: multifamily and industrial.

Private debt pays dividends

Debt again proved to be the most resilient private asset class against a turbulent market backdrop. Fundraising declined just 13 percent, largely driven by lower commitments to direct lending strategies, for which a slower PE deal environment has made capital deployment challenging. The asset class also posted the highest returns among all private asset classes through September 30. Many private debt securities are tied to floating rates, which enhance returns in a rising-rate environment. Thus far, managers appear to have successfully navigated the rising incidence of default and distress exhibited across the broader leveraged-lending market. Although direct lending deal volume declined from 2022, private lenders financed an all-time high 59 percent of leveraged buyout transactions last year and are now expanding into additional strategies to drive the next era of growth.

Infrastructure took a detour

After several years of robust growth and strong performance, infrastructure and natural resources fundraising declined by 53 percent to the lowest total since 2013. Supply-side timing is partially to blame: five of the seven largest infrastructure managers closed a flagship vehicle in 2021 or 2022, and none of those five held a final close last year. As in real estate, investors shied away from core and core-plus investments in a higher-yield environment. Yet there are reasons to believe infrastructure’s growth will bounce back. Limited partners (LPs) surveyed by McKinsey remain bullish on their deployment to the asset class, and at least a dozen vehicles targeting more than $10 billion were actively fundraising as of the end of 2023. Multiple recent acquisitions of large infrastructure GPs by global multi-asset-class managers also indicate marketwide conviction in the asset class’s potential.

Private markets still have work to do on diversity

Private markets firms are slowly improving their representation of females (up two percentage points over the prior year) and ethnic and racial minorities (up one percentage point). On some diversity metrics, including entry-level representation of women, private markets now compare favorably with corporate America. Yet broad-based parity remains elusive and too slow in the making. Ethnic, racial, and gender imbalances are particularly stark across more influential investing roles and senior positions. In fact, McKinsey’s research  reveals that at the current pace, it would take several decades for private markets firms to reach gender parity at senior levels. Increasing representation across all levels will require managers to take fresh approaches to hiring, retention, and promotion.

Artificial intelligence generating excitement

The transformative potential of generative AI was perhaps 2023’s hottest topic (beyond Taylor Swift). Private markets players are excited about the potential for the technology to optimize their approach to thesis generation, deal sourcing, investment due diligence, and portfolio performance, among other areas. While the technology is still nascent and few GPs can boast scaled implementations, pilot programs are already in flight across the industry, particularly within portfolio companies. Adoption seems nearly certain to accelerate throughout 2024.

Private markets in a slower era

If private markets investors entered 2023 hoping for a return to the heady days of 2021, they likely left the year disappointed. Many of the headwinds that emerged in the latter half of 2022 persisted throughout the year, pressuring fundraising, dealmaking, and performance. Inflation moderated somewhat over the course of the year but remained stubbornly elevated by recent historical standards. Interest rates started high and rose higher, increasing the cost of financing. A reinvigorated public equity market recovered most of 2022’s losses but did little to resolve the valuation uncertainty private market investors have faced for the past 18 months.

Within private markets, the denominator effect remained in play, despite the public market recovery, as the numerator continued to expand. An activity-dampening cycle emerged: higher cost of capital and lower multiples limited the ability or willingness of general partners (GPs) to exit positions; fewer exits, coupled with continuing capital calls, pushed LP allocations higher, thereby limiting their ability or willingness to make new commitments. These conditions weighed on managers’ ability to fundraise. Based on data reported as of year-end 2023, private markets fundraising fell 22 percent from the prior year to just over $1 trillion, the largest such drop since 2009 (Exhibit 1).

The impact of the fundraising environment was not felt equally among GPs. Continuing a trend that emerged in 2022, and consistent with prior downturns in fundraising, LPs favored larger vehicles and the scaled GPs that typically manage them. Smaller and newer managers struggled, and the number of sub–$1 billion vehicles and new firm launches each declined to its lowest level in more than a decade.

Despite the decline in fundraising, private markets assets under management (AUM) continued to grow, increasing 12 percent to $13.1 trillion as of June 30, 2023. 2023 fundraising was still the sixth-highest annual haul on record, pushing dry powder higher, while the slowdown in deal making limited distributions.

Investment performance across private market asset classes fell short of historical averages. Private equity (PE) got back in the black but generated the lowest annual performance in the past 15 years, excluding 2022. Closed-end real estate produced negative returns for the first time since 2009, as capitalization (cap) rates expanded across sectors and rent growth dissipated in formerly hot sectors, including multifamily and industrial. The performance of infrastructure funds was less than half of its long-term average and even further below the double-digit returns generated in 2021 and 2022. Private debt was the standout performer (if there was one), outperforming all other private asset classes and illustrating the asset class’s countercyclical appeal.

Private equity down but not out

Higher financing costs, lower multiples, and an uncertain macroeconomic environment created a challenging backdrop for private equity managers in 2023. Fundraising declined for the second year in a row, falling 15 percent to $649 billion, as LPs grappled with the denominator effect and a slowdown in distributions. Managers were on the fundraising trail longer to raise this capital: funds that closed in 2023 were open for a record-high average of 20.1 months, notably longer than 18.7 months in 2022 and 14.1 months in 2018. VC and growth equity strategies led the decline, dropping to their lowest level of cumulative capital raised since 2015. Fundraising in Asia fell for the fourth year of the last five, with the greatest decline in China.

Despite the difficult fundraising context, a subset of strategies and managers prevailed. Buyout managers collectively had their best fundraising year on record, raising more than $400 billion. Fundraising in Europe surged by more than 50 percent, resulting in the region’s biggest haul ever. The largest managers raised an outsized share of the total for a second consecutive year, making 2023 the most concentrated fundraising year of the last decade (Exhibit 2).

Despite the drop in aggregate fundraising, PE assets under management increased 8 percent to $8.2 trillion. Only a small part of this growth was performance driven: PE funds produced a net IRR of just 2.5 percent through September 30, 2023. Buyouts and growth equity generated positive returns, while VC lost money. PE performance, dating back to the beginning of 2022, remains negative, highlighting the difficulty of generating attractive investment returns in a higher interest rate and lower multiple environment. As PE managers devise value creation strategies to improve performance, their focus includes ensuring operating efficiency and profitability of their portfolio companies.

Deal activity volume and count fell sharply, by 21 percent and 24 percent, respectively, which continued the slower pace set in the second half of 2022. Sponsors largely opted to hold assets longer rather than lock in underwhelming returns. While higher financing costs and valuation mismatches weighed on overall deal activity, certain types of M&A gained share. Add-on deals, for example, accounted for a record 46 percent of total buyout deal volume last year.

Real estate recedes

For real estate, 2023 was a year of transition, characterized by a litany of new and familiar challenges. Pandemic-driven demand issues continued, while elevated financing costs, expanding cap rates, and valuation uncertainty weighed on commercial real estate deal volumes, fundraising, and investment performance.

Managers faced one of the toughest fundraising environments in many years. Global closed-end fundraising declined 34 percent to $125 billion. While fundraising challenges were widespread, they were not ubiquitous across strategies. Dollars continued to shift to large, multi-asset class platforms, with the top five managers accounting for 37 percent of aggregate closed-end real estate fundraising. In April, the largest real estate fund ever raised closed on a record $30 billion.

Capital shifted away from core and core-plus strategies as investors sought liquidity through redemptions in open-end vehicles and reduced gross contributions to the lowest level since 2009. Opportunistic strategies benefited from this shift, as investors turned their attention toward capital appreciation over income generation in a market where alternative sources of yield have grown more attractive.

In the United States, for instance, open-end funds, as represented by the National Council of Real Estate Investment Fiduciaries Fund Index—Open-End Equity (NFI-OE), recorded $13 billion in net outflows in 2023, reversing the trend of positive net inflows throughout the 2010s. The negative flows mainly reflected $9 billion in core outflows, with core-plus funds accounting for the remaining outflows, which reversed a 20-year run of net inflows.

As a result, the NAV in US open-end funds fell roughly 16 percent year over year. Meanwhile, global assets under management in closed-end funds reached a new peak of $1.7 trillion as of June 2023, growing 14 percent between June 2022 and June 2023.

Real estate underperformed historical averages in 2023, as previously high-performing multifamily and industrial sectors joined office in producing negative returns caused by slowing demand growth and cap rate expansion. Closed-end funds generated a pooled net IRR of −3.5 percent in the first nine months of 2023, losing money for the first time since the global financial crisis. The lone bright spot among major sectors was hospitality, which—thanks to a rush of postpandemic travel—returned 10.3 percent in 2023. 2 Based on NCREIFs NPI index. Hotels represent 1 percent of total properties in the index. As a whole, the average pooled lifetime net IRRs for closed-end real estate funds from 2011–20 vintages remained around historical levels (9.8 percent).

Global deal volume declined 47 percent in 2023 to reach a ten-year low of $650 billion, driven by widening bid–ask spreads amid valuation uncertainty and higher costs of financing (Exhibit 3). 3 CBRE, Real Capital Analytics Deal flow in the office sector remained depressed, partly as a result of continued uncertainty in the demand for space in a hybrid working world.

During a turbulent year for private markets, private debt was a relative bright spot, topping private markets asset classes in terms of fundraising growth, AUM growth, and performance.

Fundraising for private debt declined just 13 percent year over year, nearly ten percentage points less than the private markets overall. Despite the decline in fundraising, AUM surged 27 percent to $1.7 trillion. And private debt posted the highest investment returns of any private asset class through the first three quarters of 2023.

Private debt’s risk/return characteristics are well suited to the current environment. With interest rates at their highest in more than a decade, current yields in the asset class have grown more attractive on both an absolute and relative basis, particularly if higher rates sustain and put downward pressure on equity returns (Exhibit 4). The built-in security derived from debt’s privileged position in the capital structure, moreover, appeals to investors that are wary of market volatility and valuation uncertainty.

Direct lending continued to be the largest strategy in 2023, with fundraising for the mostly-senior-debt strategy accounting for almost half of the asset class’s total haul (despite declining from the previous year). Separately, mezzanine debt fundraising hit a new high, thanks to the closings of three of the largest funds ever raised in the strategy.

Over the longer term, growth in private debt has largely been driven by institutional investors rotating out of traditional fixed income in favor of private alternatives. Despite this growth in commitments, LPs remain underweight in this asset class relative to their targets. In fact, the allocation gap has only grown wider in recent years, a sharp contrast to other private asset classes, for which LPs’ current allocations exceed their targets on average. According to data from CEM Benchmarking, the private debt allocation gap now stands at 1.4 percent, which means that, in aggregate, investors must commit hundreds of billions in net new capital to the asset class just to reach current targets.

Private debt was not completely immune to the macroeconomic conditions last year, however. Fundraising declined for the second consecutive year and now sits 23 percent below 2021’s peak. Furthermore, though private lenders took share in 2023 from other capital sources, overall deal volumes also declined for the second year in a row. The drop was largely driven by a less active PE deal environment: private debt is predominantly used to finance PE-backed companies, though managers are increasingly diversifying their origination capabilities to include a broad new range of companies and asset types.

Infrastructure and natural resources take a detour

For infrastructure and natural resources fundraising, 2023 was an exceptionally challenging year. Aggregate capital raised declined 53 percent year over year to $82 billion, the lowest annual total since 2013. The size of the drop is particularly surprising in light of infrastructure’s recent momentum. The asset class had set fundraising records in four of the previous five years, and infrastructure is often considered an attractive investment in uncertain markets.

While there is little doubt that the broader fundraising headwinds discussed elsewhere in this report affected infrastructure and natural resources fundraising last year, dynamics specific to the asset class were at play as well. One issue was supply-side timing: nine of the ten largest infrastructure GPs did not close a flagship fund in 2023. Second was the migration of investor dollars away from core and core-plus investments, which have historically accounted for the bulk of infrastructure fundraising, in a higher rate environment.

The asset class had some notable bright spots last year. Fundraising for higher-returning opportunistic strategies more than doubled the prior year’s total (Exhibit 5). AUM grew 18 percent, reaching a new high of $1.5 trillion. Infrastructure funds returned a net IRR of 3.4 percent in 2023; this was below historical averages but still the second-best return among private asset classes. And as was the case in other asset classes, investors concentrated commitments in larger funds and managers in 2023, including in the largest infrastructure fund ever raised.

The outlook for the asset class, moreover, remains positive. Funds targeting a record amount of capital were in the market at year-end, providing a robust foundation for fundraising in 2024 and 2025. A recent spate of infrastructure GP acquisitions signal multi-asset managers’ long-term conviction in the asset class, despite short-term headwinds. Global megatrends like decarbonization and digitization, as well as revolutions in energy and mobility, have spurred new infrastructure investment opportunities around the world, particularly for value-oriented investors that are willing to take on more risk.

Private markets make measured progress in DEI

Diversity, equity, and inclusion (DEI) has become an important part of the fundraising, talent, and investing landscape for private market participants. Encouragingly, incremental progress has been made in recent years, including more diverse talent being brought to entry-level positions, investing roles, and investment committees. The scope of DEI metrics provided to institutional investors during fundraising has also increased in recent years: more than half of PE firms now provide data across investing teams, portfolio company boards, and portfolio company management (versus investment team data only). 4 “ The state of diversity in global private markets: 2023 ,” McKinsey, August 22, 2023.

In 2023, McKinsey surveyed 66 global private markets firms that collectively employ more than 60,000 people for the second annual State of diversity in global private markets report. 5 “ The state of diversity in global private markets: 2023 ,” McKinsey, August 22, 2023. The research offers insight into the representation of women and ethnic and racial minorities in private investing as of year-end 2022. In this chapter, we discuss where the numbers stand and how firms can bring a more diverse set of perspectives to the table.

The statistics indicate signs of modest advancement. Overall representation of women in private markets increased two percentage points to 35 percent, and ethnic and racial minorities increased one percentage point to 30 percent (Exhibit 6). Entry-level positions have nearly reached gender parity, with female representation at 48 percent. The share of women holding C-suite roles globally increased 3 percentage points, while the share of people from ethnic and racial minorities in investment committees increased 9 percentage points. There is growing evidence that external hiring is gradually helping close the diversity gap, especially at senior levels. For example, 33 percent of external hires at the managing director level were ethnic or racial minorities, higher than their existing representation level (19 percent).

Yet, the scope of the challenge remains substantial. Women and minorities continue to be underrepresented in senior positions and investing roles. They also experience uneven rates of progress due to lower promotion and higher attrition rates, particularly at smaller firms. Firms are also navigating an increasingly polarized workplace today, with additional scrutiny and a growing number of lawsuits against corporate diversity and inclusion programs, particularly in the US, which threatens to impact the industry’s pace of progress.

Fredrik Dahlqvist is a senior partner in McKinsey’s Stockholm office; Alastair Green  is a senior partner in the Washington, DC, office, where Paul Maia and Alexandra Nee  are partners; David Quigley  is a senior partner in the New York office, where Connor Mangan is an associate partner and Aditya Sanghvi  is a senior partner; Rahel Schneider is an associate partner in the Bay Area office; John Spivey is a partner in the Charlotte office; and Brian Vickery  is a partner in the Boston office.

The authors wish to thank Jonathan Christy, Louis Dufau, Vaibhav Gujral, Graham Healy-Day, Laura Johnson, Ryan Luby, Tripp Norton, Alastair Rami, Henri Torbey, and Alex Wolkomir for their contributions

The authors would also like to thank CEM Benchmarking and the StepStone Group for their partnership in this year's report.

This article was edited by Arshiya Khullar, an editor in the Gurugram office.

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