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Improving the health of the public by 2040

Optimising the research environment for a healthier, fairer future

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. This report explores how to organise our research environment to generate and translate the evidence needed to underpin such strategies.

Challenges and opportunities

The environments in which we live are already determining our health in 2040. Health is shaped by a confluence of myriad factors, including the air we breathe, the food we eat, the work we do, the taxes we pay, the places we live, and the people we know. We can anticipate ongoing improvements to the health of the UK public as a result of enhanced knowledge, technological developments, and innovation in health and social care. We can also expect rises in educational attainment, levels of employment and yearly earnings, all of which are likely to contribute to health gains.

Set against this are changes that present grave challenges to our health and to the sustainability of our health and social care systems, both nationally and globally. We face a growing and ageing population with multiple morbidities and more years spent in ill health, resource depletion, persistent inequalities, climate change, a rise in obesity and sedentary behaviour, and emerging and resistant infectious diseases. Our aspiration for 2040, around a generation’s time, is for health gains which significantly exceed those we might expect based on current trajectories; for a future in which the UK population experiences substantial and ongoing improvements in physical health, mental health, health-related quality of life and health equity, and in which the UK contributes to the global endeavour for similar improvements. Through public engagement activities we found widespread support for our assumption that this aspiration is of inherent societal value. To realise this, we must take a much broader view of the drivers of health and the types of evidence we need to intervene – now and in the future – for the promotion
of health and the prevention of disease.

‘Health of the public’ research: a new paradigm

Public health research has provided fundamental insights into human health and how it can be improved. It has underpinned many major health achievements, such as identifying smoking as a major cause of cancer and cardiovascular disease. It has also been instrumental in developing the randomised controlled trials that guide the assessment of benefits and harms of a range of interventions, and in establishing epidemiological studies and models to identify social, environmental and genetic determinants of health and health inequalities.

Yet 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, including obesity, diabetes, dementia, depression, cancer and persisting and emerging infections. We do not yet have a robust understanding of the long-term impacts of many of the wider drivers of health that cut across local, national and global environments, from political and economic change to technological development and demographic shifts.

Biomedical research as currently conducted does not have the capacity to address these increasingly diverse and complex issues that transcend disciplinary, sectoral and geographical boundaries. We need to move towards a ‘health of the public’ approach, involving disciplines that would not usually be considered to be within the public health field; an approach integrating aspects of natural, social and health sciences, alongside the arts and humanities, which directly or indirectly influence the health of the public. We must drive forward an ambitious research agenda to realise the aspirations of successive policymakers and leaders of health and social care — aspirations to shift our focus to prevention and early intervention at scale, and to thereby optimise the use of resources.

Adopting a health of the public approach will require six key developments:

1. Rebalancing and enhancing the coordination of research
There have been a number of funding initiatives for health of the public research in recent years, but they have been relatively small-scale and fragmented. We recommend creating a body to enable greater strategic coordination of research funding and delivery. Our proposed UK Strategic Coordinating Body for Health of the Public Research (SCHOPR) will drive population-level questions to be addressed in transdisciplinary ways, at scale, and embrace the range of interventions from the fiscal and legislative to the behavioural and biomedical. It will bring together a broad range of funders, from beyond the traditional biomedical sphere, to identify health of the public research priorities with practitioners and policymakers.

2. Harnessing new technologies and the digital revolution
Novel computational approaches and the ability to link datasets across environments have the power to transform our understanding of the full spectrum of health determinants and to catalyse the adoption of new methods for evaluating the health impacts of individual- and population-level interventions. Innovative technologies, from sensors to wearable devices to artificial intelligence, will also present great opportunities to transform the delivery of health and social care, and to help us achieve the shift towards prevention and early intervention. However, we will need access to data generated by a wide range of individuals and public and private organisations if we are to capitalise on the digital revolution for health. It will also require us to collectively address issues associated with data access, ethics, trust, regulation and skills. We therefore call for ongoing efforts by research funders and key stakeholders to stimulate new research programmes and approaches, and to invest in the necessary transdisciplinary training, for the integration, manipulation and analysis of these data within appropriate ethical and regulatory frameworks.

3. Developing transdisciplinary research capacity
The health of the public research leaders of 2040 are in education and training today. This means we must act now to develop a UK-wide transdisciplinary research capacity with a holistic understanding of the wide range of determinants of health, and the skills and approaches necessary to address them. We therefore describe how to reconfigure the current training pathways to provide the workforce we require for the future, through the development of joint modules for undergraduates and postgraduates between public and population health courses and other disciplines relevant to the health of the public.

4. Aligning perspectives and approaches
Better alignment between public health and clinical practice is needed if we are to achieve the necessary shift to prevention. Our health and social care workforce must be equipped to understand the fundamental principles of ‘health of the public’ and the continuum of interventions from population to individual. We set out how to achieve this through changes to training and continuing professional development. Our recommendation on the establishment of regional hubs of engagement will catalyse more structured, long-term and effective connection between practitioners and researchers, and ensure that health and social care is based on best available evidence. We also set out how to support decisions on wider implementation of, or disinvestment in, interventions by recommending that all major policies and programmes which impact health and health equity should have independent effectiveness and economic evaluation built in from the start.

5. Working with all sectors of society
The full societal value of research for the health of the public will not be realised until it is translated into improved health and health equity. This will require iterative and meaningful engagement with all sectors of society, including policymakers, the commercial sector and the public. We must ensure, for instance, that health is considered in all relevant policies through greater engagement of health of the public researchers in policy development and evaluation. Our proposed Health of the Public Policy Fellows, who would be embedded in Government departments to build reciprocal relationships, mutual understanding and long-term networks, will help achieve this aim.

6. Engaging globally
While the focus of this report and our remit is on UK health of the public research, we believe this cannot be seen in isolation. Many of the drivers of our future health are global, and UK-funded research has had major global impact. Our recommendation for strategic coordination of future health of the public research must therefore take a global perspective and include the UK contribution to the challenge of global health sustainability and security.

A grand challenge

Meeting our aspiration is a grand challenge. Securing the health of the public must build on but also go beyond public health as it is currently configured. We challenge all those working in fields that affect human health to come together with the public in pursuit of our aspiration for a future in which the UK experiences substantial, sustainable and ongoing improvements in health and health equity. A future that significantly surpasses current expectations.