Fresh thinking about the evidence needed for a healthier UK

The Health Foundation is working with Dr Harry Rutter from the London School of Hygiene and Tropical Medicine to develop a new model of evidence that will inform public health research, policy and practice. 

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As part of this work Dr Rutter and co-authors from the Health Foundation have published a new Viewpoint paper – The need for a complex systems model of evidence for public health – in The Lancet, which outlines the need for new approaches to designing and evaluating population-level interventions to improve health.

Key points

  • We are faced with many big health challenges in our society. Their complex nature is an ongoing problem for public health research and policy.
  • Such challenges often involve multiple factors operating over many decades in systems that adapt as changes occur. For example, the distribution of obesity in a population might be impacted by changes to food, employment, transport or economic systems.
  • The traditional linear model of research is not suited to tackling these challenges. This is because it focuses largely on changes in individuals, not the population as a whole, and because it tends to look at isolated interventions rather than the contexts in which they take place.
  • There is growing recognition that we need a new evidence model that looks at public health problems, and our potential responses, in terms of a complex systems approach.

Full reference: Rutter, H. et al.  The need for a complex systems model of evidence for public health The Lancet, 13 June 2017

Related: Building a new system for the generation and use of public health evidence

 

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PHE Research 2015 to 2016

The Public Health England research annual review for 2015 to 2016 includes information about strategy, funding and peer reviewed publications.

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In 2015 Public Health England (PHE) research improved treatment of Ebola, changed vaccine policy, reduced antibiotic prescribing, mapped the burden of disease in England and much more besides.

This report highlights some of the best research work PHE does.
More than 770 papers were published in peer reviewed literature by PHE staff during 2015 covering more than 300 journals, improving on 2014 when 669 papers were published in around 200 journals.

The publication sets out PHE’s research achievements for 2015 to 2016. These include:

  • £20.5 million in external research income
  • significant contributions to the evidence base for public health policy and practice

Improving the health of the public by 2040

The Academy of Medical Sciences has published a report ‘Improving the health of the public by 2040’.

Over the coming decades, the UK population will face a wide range of complex health challenges and opportunities, many of which can only be fully addressed through strategies to secure and improve the health of the public as a whole. The  report explores how to organise our research environment to generate and translate the evidence needed to underpin such strategies.

This report concludes that while public health research has provided fundamental insights into human health, there remains much we do not know about the complex array of interlinking factors that influence the health of the public, and about how to prevent and solve the many health challenges we face as a population.

Solving these challenges will require shifting towards a ‘health of the public’ approach, involving disciplines that would not usually be considered to be within the public health field. This is turn requires six key developments:

  1. Rebalancing and enhancing the coordination of research.
  2. Harnessing new technologies and the digital revolution.
  3. Developing transdisciplinary research capacity.
  4. Aligning perspectives and approaches between clinical and public health practice.
  5. Working with all sectors of society, including policymakers, practitioners, the commercial sector and the public.
  6. Engaging globally.

Read the report here
Read the press release here

Vitamin D for the management of asthma

The Cochrane Database of Systematic Reviews have published a review ‘Vitamin D for the management of asthma’.

The review question asked ‘Does vitamin D prevent asthma attacks or improve control of asthma symptoms or both?’.

Low blood levels of vitamin D (the ‘sunshine vitamin’) have been linked to an increased risk of asthma attacks in children and adults with asthma. Several clinical trials have been conducted to test whether vitamin D might prevent asthma attacks and improve control of asthma symptoms in children and adults, but results from studies with the most scientifically sound designs have not previously been evaluated as a group.

This study included seven trials involving 435 children and two trials involving 658 adults. Of these, one trial involving 22 children and two trials involving 658 adults contributed to the analysis of the rate of severe asthma attacks. Study duration ranged from four to 12 months, and the majority of those taking part had mild or moderate asthma. All of the studies compared vitamin D with placebo.

People given vitamin D experienced fewer asthma attacks needing treatment with oral steroids. The average number of attacks per person per year went down from 0.44 to 0.22 with vitamin D (high-quality evidence). Vitamin D reduced the risk of attending hospital with an acute asthma attack from 6 per 100 to around 3 per 100 (high-quality evidence).

Vitamin D had little or no effect on lung function or day-to-day asthma symptoms (high-quality evidence). We found that vitamin D did not increase the risk of serious adverse events at the doses that were tested (moderate-quality evidence).

All of these findings were based on studies judged to be of high quality.

The authors concluded that vitamin D is likely to offer protection against severe asthma attacks. Further trials focusing on children and people who experience frequent severe asthma attacks are needed before definitive clinical recommendations can be made.

Read more here

Living positively with dementia

Aging & Mental Health Volume 20, Issue 7, 2016

Objective: Little is known about how and to what extent people with dementia live positively with their condition. This study aimed to review and carry out a synthesis of qualitative studies where accounts of the subjective experiences of people with dementia contained evidence of positive states, experiences or attributes.

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image source: Adrian Cousins,  Wellcome images//CC BY-NC-ND 4.0

Methods: A meta-synthesis was undertaken to generate an integrated and interpretive account of the ability of people with dementia to have positive experiences. A methodological quality assessment was undertaken to maximize the reliability and validity of this synthesis and to contextualize the findings with regard to methodological constraints and epistemological concepts.

Findings: Twenty-seven papers were included. Three super-ordinate themes relating to positive experiences and attributes were identified, each with varying and complementing sub-themes. The first super-ordinate theme related to the experience of engaging with life in ageing rather than explicitly to living with dementia. The second theme related to engaging with dementia itself and comprised the strengths that people can utilize in facing and fighting the condition. The third theme captured how people with dementia might transcend the condition and seek ways to maintain identity and even achieve personal growth.

Conclusions: This review provides a first step towards understanding what conceptual domains might be important in defining positive outcomes for people who live with dementia. Highlighting the potential for people to have positive experiences in spite of or even because of their dementia has important implications for de-stigmatizing dementia and will enhance person-centred approaches to care.

Full reference:  Wolverson, E.L. et al. Living positively with dementia: a systematic review and synthesis of the qualitative literature  Aging & Mental Health. Volume 20, Issue 7, 2016 p. 676-699

Healthcare Public Health in England: Capacity and Capability Review

The Health Services Committee of the Faculty of Public Health has completed a report summarising the responses of around 110 directors of public health, training programme directors and specialty registrars who responded to survey and focus-group work exploring their views on the state of the healthcare public health function – particularly that delivered back into the NHS.

Full report: Healthcare Public Health in England: Capacity and Capability Review

School For Public Health Research Case Studies

The National Institute for Health Research School for Public Health Research (NIHR  SPHR) has published a collection of case studies that reflects the complexities that public health research faces today .

These case studies highlight research in programmes for example, for preventing diabetes, improving sex education and investigating whether community empowerment could lead to health improvements for individuals in deprived communities.

Read more here