Professor Martin White - UK Faculty of Public Health

Looking to the future, building on the past –
public health research in the 21 st Century
Faculty of Public Health Conference, July 2012
Martin White
Newcastle University
www.fuse.ac.uk

Public health research in the 21 st century
> What has happened to public health research over
the last 15 years
> How has public health research responded to
emerging challenges and opportunities
> What are the major, future challenges for public
health research
> How well is academia and its relationship with the
public health system placed to respond to these
challenges
> What next

What has happened to public health research
over the last 15 years
> Influential shifts in thinking:
• Models for intervention research (e.g. MRC framework)
• EBM movement, NICE public health guidance etc.
• Emergence of translational research
> Transformation of research funding
> Unprecedented expansion of capacity
> Loss of academic public health specialists
> Disconnection between public heath academia and
practice

Research on smoking in South Asian men
Problem
Definition
Solution
Generation
Innovation
Testing
Intervention
Demonstration
Intervention
Implementation
Epidemiological
study of
cardiovascular risk
among South Asian
ethnic minority
groups in Newcastle
Qualitative studies
of South Asian men
to gain deeper
understanding of
smoking in their
culture
Small scale
evaluative trial,
testing efficacy and
acceptability of
community based
intervention
RCT of community
outreach
intervention to
promote smoking
cessation among
South Asian men
Systematic review
on the cultural
adaptation of
interventions for
ethnic minorities
Review of evidence
of effectiveness for
smoking cessation
interventions
Qualitative study to
assess acceptability
and feasibility of
evidence-based
interventions
Bhopal et al. Heterogeneity in coronary heart disease and risk factors
in Indian, Pakistani, Bangladeshi and European origin populations.
BMJ, 1999; 319: 215-220.
Bush et al. Understanding influences on smoking in Bangladeshi and
Pakistani adults: a community based qualitative study. BMJ, 2003;
326: 962-6.
White et al. Quitting smoking and experience of smoking cessation
interventions among Bangladeshi and Pakistani adults: public and
professional views. J Epidemiol Community Health 2006;60:405-411.
Begh et al. Promoting smoking cessation in Pakistanis and
Bangladeshis in the UK: cluster randomised controlled trial of trained
community outreach workers. Trials, 2011;12:197
Liu et al. Adapting health promotion interventions to meet the needs
of ethnic minority groups: mixed methods evidence synthesis. Health
Technology Assessment (in press)

Research funding
> 2004 – National Prevention Research Initiative (NPRI) launched -
£33m invested in 74 projects by a panel of 16 funders, led by MRC
> 2005 – Public Health Research Consortium (PHRC) launched by
Department of Health - £7.7m invested over 10 years in research
on national policy priorities, including major evaluations
> 2005 MRC Population Health Sciences Research Network
established - £2.5m over 5 years
> 2008 – 5 Public Health Research Centres of Excellence funded by
a panel of 8 funders, under auspices of UKCRC – £41m over 10
years (+SCPHRP - £9m, 10 years)
> 2009 – NIHR Public Health Research programme
launched - £10m/year, >£30m to date
>£131m
> 2012 – NIHR School for Public Health Research
investment
launched - £20m over 5 years initially
in 12 years

Expansion of capacity
> NIHR Fellowships programme – doctoral, post-doc,
career development, career scientist
> Growth of public health masters’ programmes
> Capacity building initiatives – UKCRC PHRCoEs: >50
new staff, >50 PhD studentships
> Research project and programme funding =
significant expansion of research staff numbers
> RAE/REF and investment in higher education –
expansion of research intensive universities

How has research responded to challenges
and opportunities of last 15 years
> Major shifts in research focus:
• Emergence and development of behavioural
sciences
• Expansion of Intervention development research
• Systematic reviews underpinning intervention
research
• Natural experimental evaluations
• Translational research
• More rigorous methodological research

2008/09 Q1
2008/09 Q2
2008/09 Q3
2008/09 Q4
2009/10 Q1
2009/10 Q2
2009/10 Q3
2009/10 Q4
2010/11 Q1
2010/11 Q2
2010/11 Q3
Smoking prevalence: SHAs in England
25%
20%
15%
10%
5%
North East SHA North West SHA Yorkshire and The Humber SHA
East Midlands SHA West Midlands SHA East of England SHA
London SHA South East Coast SHA South Central SHA
South West SHA
England
0%

Domains to inform our understanding of what affects
midwives’ professional behaviours
Knowledge
Interaction
between
midwife and
pregnant
woman
Factors
influencing
the behaviour
of the
pregnant
woman

Evaluation of a modified care pathway to promote
increased smoking cessation rates among pregnant
women: a proposed randomised stepped wedge trial
Allocation
blocks
2012 2013*
Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
Area 1 (2
Trusts)
Area 2 (3
trusts)
Area 3 (1
trust)
Area 4 (2
trusts)
Control steps: full data collection, no intervention
Initial intervention delivery: training and implementation, leading to full fidelity
Full intervention delivery at full fidelity

What are the major, future challenges for
public health research
> Economy – global development , climate change,
epidemiological transition, demographic shifts, boom
and bust
> Globalisation – public health threats from
communicable diseases, climate change, environmental
disasters and degradation
> Inequality – widening due to economy and IGIs
> Corporate power – Big Tobacco, Big Alcohol, Big Food,
Big Health Care, Big everything...
> Evidence-free policy and practice –initiatives with no
prior evidence and no evaluation

How well is public health research placed to
respond to these challenges
> Infrastructure is strong and growing , but...
• Needs to be less inward looking, more outward
facing
• Needs to build relationships to address new kinds
of public health challenges
• Needs to intensify focus on translation
• Need to be more adventurous with policy
evaluation
• Needs to really grasp nettle of tackling health
inequalities

The Change4Life convenience store evaluation

Intervention-generated inequalities
“Unintended and unwanted variations in
outcomes for individuals or population
sub-groups that result from any element of
any [health] intervention”
White M, Adams J, Heywood P. How and why do interventions that increase health
overall widen inequalities within populations In Babones S (Ed.). Health, inequality
and society. Bristol: Policy Press, 2009.

The points in intervention pathways at which
socio-economic gradients can arise
Provision
Macro-needs
assessment
Provision of
services
Micro-needs
assessment
Provision of
Interventions
L H L H
L H
L H
Health Outcome
Long term
compliance
Efficacy of
intervention
Uptake of
intervention
L H L H L H L H
Response

Meta-analysis: odds of receiving surgery for lung
cancer - low versus high SEP

The relationship between water fluoridation and socioeconomic
deprivation on tooth decay in 5-year-old children
Jones CM, Worthington H. BDJ 1999; 186(8): 397-400

What next
> Academia needs to embrace the outside world,
including public health policy and practice
• More research in and for the real world
• Co-production of research with policy and practice
• Shared events
> UK PHR needs to decide how much to invest in
global health research
> Public health practice needs to ‘walk the talk’ with
evidence based public health
> Implications for public health training – in research
and evidence awareness and skills
> FPH has a role to play...

Links: flagship public health research initiatives
> PHRSN http://www.populationhealthsciences.org/
> UKCRC PHRCoEs http://www.esrc.ac.uk/about-esrc/what-wedo/our-research/ukcrc.aspx
> NIHR PHR http://www.phr.ac.uk/
> PHRC http://phrc.lshtm.ac.uk/
> NIHR SPHR http://www.sheffield.ac.uk/scharr/sphr
> NICE Public Health http://www.nice.org.uk/guidance/phg/

Thanks and more…
> Thanks to the many people who I have worked with over many years who have
shaped my thinking and collaborated on research, including members of: the Public
Health Research Consortium, UKCRC Public Health Research Centres of Excellence,
NIHR School for Public Health Research, NIHR Public Health Research Board, NICE
Centre for Public Health Excellence, MRC Population Health Sciences Research
Network, and my colleagues in the Institute of Health & Society, Newcastle
University.
> Contact details
www.fuse.ac.uk
martin.white@ncl.ac.uk
Skype & twitter: martinwhite33
Tel: +44 (0)191 222 6275
The author is funded in part by Fuse, the Centre for Translational Research in Public Health, a UKCRC Public
Health Research: Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK,
Economic and Social Research council, Medical Research Council, and the National Institute for Health Research,
under the auspices of the UK Clinical Research Collaboration, is greatly acknowledged. Opinions expressed in this
presentation do not necessarily represent those of the funders.