Issue date: 29 March 2004
Threat to public health research
A national strategy is urgently needed to foster and enhance research into major public health problems which threaten the UK population, according to a report from some of the country's leading public health experts.
Scientific evidence is essential to investigate the best ways of responding to the threat of biological or chemical attacks as well as tackling outbreaks of diseases, such as SARS and BSE and confronting the problems of obesity, smoking and sexually transmitted infections. But the report warns that this area of research is "seriously under-resourced" with a lack of infrastructure that deters talented young academics from seeking a career in public health sciences.
The study, "Public Health Sciences: Challenges and Opportunities" ( www.wellcome.ac.uk/phs) was carried out by an independent working party commissioned by the Wellcome Trust, one of the world's leading biomedical research charities. The 15-strong working group was chaired by Professor Stephen Frankel, Professor of Epidemiology and Public Health at the University of Bristol.
The report addresses a major issue identified in the recent Treasury-led study by Derek Wanless* which said that the NHS must focus more on health improvement and disease prevention rather than just treating ill-health. By doing so, the NHS could save itself £30 billion by 2022, equivalent to half the current expenditure of the NHS.
Too often, policies to tackle public health problems are put in place with insufficient evidence that they are likely to work, or in a way that makes it impossible to test later if they have been successful. Wanless pointed to "the almost complete absence of an evidence base on the cost-effectiveness of public health interventions."
Public health scientists are essential if this evidence base is to be enhanced, but the field is neglected, today's report states.
This is borne out by the fact that in 2003, just 0.4 per cent of UK biomedical research publications were relevant to public health interventions.
Professor Frankel's working group outlines the enormous contribution that public health science has made to health improvement, from the profound impact of sanitary reforms in the 19th century through to uncovering the dangers of smoking and more recently highlighting the risks and benefits for women undergoing hormone replacement therapy.
The huge number of public health issues that need to be addressed requires a wide range of specialists. For example, the independent expert group tasked with assessing possible health risks from mobile phones included a physicist, a statistician, an epidemiologist, a neuroscientist, a radiobiologist, a neurosurgeon and an engineering and telecommunications expert.
However, the report spells out that public health sciences research is largely ignored until times of crisis.
"Specialists from a variety of disciplines coalesce when there are perceived or real threats to the public health. The precautionary principle can mean that each threat may require a forceful response.
"However, once the threat is dealt with, these groups disband and there is no collective memory or patterns of work that could be built upon to permit smoother and more rapid deployment of the relevant scientific teams in the event of the same or similar threats", say the authors.
The Government's concern about public health is evident in the publication last week of its consultation paper on the Ten Year Investment Framework for Science and Innovation, which includes questions about how the lack of evidence base in public health research can be addressed. It will also issue a White Paper on public health in the summer.
"We need to invest now in the next generation of specialist public health scientists to prepare for the increasingly important role they will need to play, given the high prominence public health is currently receiving from Government", the authors of today's report urge.
Yet despite the obvious need to attract talented young researchers, the report claims that scientists are deterred by ever-growing levels of bureaucracy. Permission to obtain data, patient information and biological samples could be hampered by, amongst other things, the Data Protection Act, the Human Rights Act, the Clinical Trials Regulations and the Human Tissue Bill that is currently working its way through Parliament.
"The permission processes can now be so protracted that an individual researcher's investment in attempting to mount such research could be seen as an unwise career choice."
To give the vital support needed to the public health sciences, the report urges the introduction of a programme to bring together the research information needed, the expert staff to interpret that information and a system which allows the research results to underpin public health policies.
To achieve this, the report recommends:
• Establishing a top-level funders' group which focuses on public health research needs.
• Identifying the regulatory barriers that may hamper public health research.
• Investing in the long-term in the academic infrastructure at undergraduate, postgraduate, research fellow, lecturer and professorial levels.
• Establishing Public Health Centres to bring together the different scientific disciplines needed to address public health issues.
• Developing an informed dialogue between scientists, the public and the media to convey a better understanding of health risks.
• Developing evidence-based policy.
Dr Mark Walport, Director of the Wellcome Trust, said: "Publication of this report presents an opportunity to re-prioritise public health research in the UK and improve the implementation and evaluation of interventions. For its part, the Wellcome Trust will continue to build on its existing support for the public health sciences. One of the new streams in the Trust's reorganised science funding structure will concentrate on Population and Public Health research, recognising the central role this area plays in improving human health."
Professor Frankel commented : "Few things are as important as the public's health.
"This report highlights the extraordinary gap between the importance of the public health sciences in improving public health and the strategic interest that is taken in these subjects. We hope that the long term investment in these crucial subjects will now be forthcoming."
Ends
Media contact:
Barry Gardner
The Wellcome Trust
Tel: 020 7611 7329; 07711 193041
E-mail:
b.gardner@wellcome.ac.uk
The Wellcome Trust is an independent research-funding charity established in 1936 under the Will of tropical medicine pioneer, Sir Henry Wellcome. The Trust's mission is to foster and promote research with the aim of improving human and animal health. The Trust spends more than £400 million a year funding biomedical research in the UK and overseas.
Members of the Public Health Sciences Working Group
Professor Stephen Frankel (Chair)
Professor of Epidemiology and Public Health, Department of Social Medicine, University of Bristol
Professor Sir Michael Rutter
Deputy Chairman, The Wellcome Trust
Professor Sir John Pattison
Director of Research and Development, The Department of Health, England
Professor Sian Griffiths
President, The Faculty of Public Health
Professor Sir William Stewart
Chairman, The Health Protection Agency
Professor Klim McPherson
Academy of Medical Sciences
Professor Nick Day
Professor of Public Health, MRC Biostatistics Unit, Department of Public Health, University of Cambridge
Professor Sally MacIntyre
Director, MRC Social and Public Health Sciences Unit, University of Glasgow
Professor Andy Haines
Professor of Public Health and Primary Care and Dean of London School of Hygiene and Tropical Medicine
Professor Kay-Tee Khaw
Professor of Clinical Gerontology, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge
Professor Ian Harvey
Academic Registrar, The Faculty of Public Health
Professor Jon Cohen
Dean, Brighton and Sussex Medical School
Professor Rod Griffiths
Director of Public Health for the West Midlands, The Department of Health
Dr Mala Rao
The Department of Health
Professor John Frank (International adviser)
Scientific Director, Institute for Population and Public Health, Canadian Institutes of Health Research and Professor, Department of Public Health Sciences, Faculty of Medicine, University of Toronto
Eleanor Boddington (Secretary)
Executive Assistant to the Director of the Wellcome Trust