The current approach to public health research in the UK needs a radical upgrade to allow us to fully address the many complex health challenges the UK population will face in the next 25 years, the Academy of Medical Sciences has said in a report published today.
The health challenges associated with an ageing and growing population, rising obesity levels and environmental and economic change cannot be addressed in isolation. Thanks to past improvements in public health, and advances in medical care, technology and our understanding of health, more and more of us have the opportunity to live longer, healthier lives. Today, for example, half of people diagnosed with cancer in England and Wales survive for ten years or more.
However, the benefits of these advances are not reaching everyone equally, and the health gaps between some sectors of society are increasing. In 2011-13 men living in the most affluent areas of England were likely to live nearly 12 years longer than those in the most deprived and women were likely to live almost 7 years longer (Office for National Statistics).
But it is not just wealth determining these figures. Our health is shaped by a wide range of factors, some of which we can influence ourselves, but many of which are beyond the individual’s control. Not just the genes we are born with, but also the food we can get, the places we live, the transport we use, the air we breathe, and where we learn and work. We do not know enough about how these factors come together to determine our health and how they might be changed to improve it.
We need a rethink in our approach to and understanding of public health to take all these factors into account and give the public more control over its health. Only by taking this approach can we deliver the focus on prevention and build on the efficient and effective use of resources identified in the NHS' Five Year Forward View.
Professor Dame Anne Johnson DBE FMedSci, Academy Fellow and Chair of the working group that produced the report, commented:
"Public health measures such as smoke-free and clean air legislation, safer food and workplaces, and vaccination have resulted in major advances in the health of the public. However society is evolving rapidly and new challenges are emerging that require a change in our understanding of public health.
"We need a public health system, and the research to support it, that takes account of the wide range of interacting factors that affect health to develop effective prevention measures that result in a healthier, fairer future for all.
“The health of the public shouldn’t just be at the heart of Department of Health policies - it should be at the heart of all government policies.”
The report, ‘Improving the health of the public, by 2040’ calls for more co-operation across different disciplines and areas of research expertise. This approach will require a new breed of researchers, able to work far beyond the traditional boundaries of biomedical and public health research. It will also require a workforce of health and social care professionals with the skills to understand and tackle the many factors that create health problems.
Dame Anne added, “The public health leaders of tomorrow are the students of today. We must act now to create a healthcare and research workforce equipped to collaborate with others not normally considered within public health, such as lawyers, architects, city planners, transport specialists, data scientists and programmers, engineers and climate scientists. These new public health leaders must be equipped with knowledge about how factors interlink to determine health.
As we focus on all the different aspects of our lives that impact on health, we also need to capitalise on the wealth of information about individuals and society that technology and the digital revolution can provide. To better understand the health of the public, the report highlights the importance of large-scale analysis of data from both inside and outside the health sector. A continued debate across society is needed to ensure these data can be used ethically and with appropriate regulation.
The report also calls for health to be put at the heart of all relevant government policy, and it recommends the introduction of health of the public fellowships to help facilitate this. The report calls for more collaboration between researchers and health professionals on a regional scale, and a body of funders that will identify the gaps in our public health knowledge and channel funds to the most relevant research.
Alongside the report, the Academy, with the support of Wellcome, have launched a £1M funding programme to enable researchers in the social sciences and medical humanities to address issues raised in the report by increasing our understanding of the social, behavioural, political and cultural issues that contribute to health inequalities.
Join the discussion on social media using #health2040.
A number of stakeholder were supportive of the report:
Speaking on behalf of the Research Councils, Professor Sir John Savill, Chief Executive Officer at the MRC, said:
“I strongly support this very timely report, in particular its focus on prevention, which is a major priority for many funders of health research including the MRC.
"The Research Councils are already making good progress in taking forward many of the issues highlighted in the report, in particular, we plan an increased focus on health and biomedical informatics that will help address global challenges to the health of the public in the UK and further afield.”
Wellcome Director, Dr Jeremy Farrar, said:
"The factors impacting public health have changed unrecognisably in the last 25 years, and will do further over the next 25.
"As this report highlights, our approach to addressing public health must match this evolution – harnessing the latest technology, working in an ever-more cross-disciplinary way, and ensuring health is a key consideration in all relevant policy areas.
"I hope that the support we are providing in partnership with the Academy of Medical Sciences for early career researchers to explore the scientific, social, political, cultural and behavioural issues impacting public health will embed a new approach in this critically important field.”
RCP Academic Vice President, Professor Margaret Johnson, welcomed the report's call for stronger collaboration between sectors in this area.
"The RCP has a strong history of improving public health, with the most recent achievement being the ban on smoking in cars with children. As such, the recommendation in this report for greater cooperation and collaboration between sectors in order to improve the nation’s health are extremely welcome - as we know that research and long term public health successes are best achieved in partnership with others.
"The reports’ additional calls to aid physicians to access public health research throughout their career, reflect our own recommendations from our 2016 report, ‘Research for all’. We strongly agree that if we are to see innovation in this area physicians must be given the time, funding and support to actively engage in research. We will work with the Academy of Medical Sciences to ensure such skills are utilised for the benefit of public health research in the future.
"Finally, we must not forget that though research and legislative change are important factors in improving the health of the public, we need to ensure that we engage the public and patient groups if we are to achieve sustainable change."
Professor John Newton, Chief Knowledge Officer, Public Health England, said:
“We very much welcome this report from the Academy of Medical Sciences which reinforces the importance of a system that works together to transform the health of our communities.
“Tackling the health challenges we will face in the next two decades requires research using innovative methodologies, robust assessment of new technologies, a workforce with the right research skills and above all increased collaboration among existing agencies – all of which PHE is committed to supporting.
“We look forward to considering the report’s recommendations in more detail”