Be Part of Research: Exploring public health research

In this episode we are exploring public health research - what it is and how it can help people to live healthier and longer lives.

For many people their only experience of public health research will be related to infection prevention and protection during the COVID19 pandemic.  But that's just one area of public health research and this podcast explores the bigger picture of what public health research is and how it can benefit us all.

Our host, Professor Turi King chats with Professor Jane West who is NIHR national speciality lead for public health and director of public health research at Bradford Institute for Health Research and also Professor Rosie McEachan who is director of the Born in Bradford research study about the work they are doing.
Episode show notes and transcript.

Transcript

Professor Turi King:
Hello, and welcome.  You are listening to the Be Part of Research podcast.
I’m Professor Turi King, your host and today’s podcast is about public health research: what it is and how it can help people to live healthier and longer lives.

We heard a lot about public health during the COVID pandemic and today we will explore how public health research is helping us to understand the factors that determine population health and inequalities more broadly.

My guests today are Professor Jane West who is NIHR national speciality lead for public health and director of public health research at Bradford Institute for Health Research and also Professor Rosie McEachan who is director of the Born in Bradford research study.

So, Jane, for many people their only experience of public health research will be related to infection prevention and protection during the COVID19 pandemic.  So, can you tell us more about the bigger picture of what public health research is and how it helps to benefit people’s health and their lives?

Professor Jane West:
Yes, so public health is all about keeping people well and keeping people healthy and out of hospital.  It’s very, very broad.  It touches on all areas and specialities of health really, but most of it falls within three main categories.

The first is health protection and that is the one we are all really familiar with from the COVID pandemic, so that is around protecting people from infectious diseases and other threats to their health.

The second one is health services so that is things like funding for services, prioritising health services, ensuring that they’re safe and ensuring that they are of high quality and then the third is all about prevention and improving health.  So, that’s about keeping people healthy and it’s about trying to reduce the unfair differences that we see in health between different groups and populations and it’s about trying to create better and healthier environments for people to live and be in really.

So, that includes things like transport, housing, education, lifestyles and those are all things that we call the wider determinants of health.  Most of those fall within the scope of local authorities so that makes public health research a bit different to the type of research that we see in the NHS or clinical research. 

Professor Turi King:
So, it is quite a broad thing, isn’t it?  So, it’s getting messages across to people...it’s the usual things like don’t eat too much sugar, you know get more exercise and that kind of thing but behind all of that obviously research is going on.  So, can you tell us more about how prevention and public health research is carried out?  You know how do you involve people in that process to get this information?

Professor Jane West: Yeah, well…well lots of public health research doesn’t involve individual people so it’s looking at whole communities or whole populations rather than individuals in the way we do research in the NHS. 

So, to do that uses often routine data that is collected through health services or it is collected through local government so that might be things like educational attainment, it might be air quality measures, it might be the number of road traffic accidents in a particular area, for example.  So, people consent to their data being used in that way but it’s often used in a way where you can’t identify individual people so it would be what we would call anonymised data.

Professor Turi King:
It’s quite a big picture obviously then.

Professor Jane West:
It is, yeah.  And sometimes we want to dig a bit deeper so we might want to know what people think about changes in their particular area.  So, we might use questionnaires or surveys or we might interview them either on a one to one basis or in a group just to get their perspective of what the changes are like in their area and how well received they are and whether they think they are making a difference and that sort of thing. 

Professor Turi King:
So, how do we see the impact of this?  So, public health research is carried out.  How do we see the change in practice happening?

Professor Jane West:
I suppose the first thing to say is that prevention and public health research is a different type of research to what we see in health care and health services.  So, it’s not always trying to see if something works.  Sometimes it’s around describing communities, describing populations, describing their health so that we can identify where change needs to happen so to kind of inform research questions.

So, for example, if we were trying to reduce obesity rates, all kinds of things influence people’s weight so it would be really, really hard to try and quantify what one individual activity, what effect that has on obesity really.   So, it’s quite a different sort of research and really important in that process is making sure that we don’t make that gap between the most and least advantaged communities worse than it already is.

Where we make population changes, so where we do that change at a population level, it is easier to benefit everybody from that, so for example, a clean air zone or where we have the smoking ban in public places, it affects a lot of people at the same time and not just those who respond well to health messaging.

So, really important for inequalities and the Transport for London junk food advertising ban is a really good example of that so that was introduced in 2019 and NIHR researchers have evaluated the impact of that.

Even 10 months in they found that families were buying 7% less unhealthy and high energy food than we would expect them to have bought had the ban not been in place so that can really start to make a difference to families and population health which is really important.

Professor Turi King:
So, it sounds like a very broad set of research areas but one of the things you have been talking about is about how you can make it specific to a particular area and obviously the focus of public health research is going to differ across different places.       

And the region we are looking at today is Bradford, so home to the Born in Bradford research study which is one of the largest public health research studies in the world.  Rosie, you are the director of the study and an applied health researcher at the NIHR Yorkshire and Humber Applied Research Collaboration.  Can you tell us about this project?  What’s the study?

Professor Rosie McEachan:
Okay, so as you said, Born in Bradford is one of the biggest health studies in the world.  We are based in Bradford which is, I have to say to your listeners, the most amazing place to live and work and I am a proud Scottish Bradfordian having lived here for many years. 

But a place based approach is really important because actually the health needs of different populations do vary according to where you live and you need to really understand that complexity and the nuance in order to give yourself the best chance of improving the health of local communities.

So, the Born in Bradford programme cohort study was set up back in 2006 and that was at the time where Bradford, like many other urban cities, had and continues to experience very high levels of deprivation.  We have families living in Bradford who are living in very difficult circumstances and we know that deprivation is one of the biggest influences on our health across pretty much every health outcome you can think of.

So, the Born in Bradford cohort study was set up to really shine a spotlight on what is happening within Bradford to describe and explain the reasons why some families stay healthy and why other families fall ill but crucially to use that information as a force for good in the city.
So, I always say when I am talking about Born in Bradford, we are not a dusty shelf academic research study, we are really woven and integrated within the fabric of the city and we use the results of our study to make improvements. 

So, just to give you some idea of the numbers behind the study,      so we are a birth cohort study, essentially what that means is that we recruit families when mums are pregnant and we follow up the health of mums and children and dads and other family members until children grow up and are adults themselves so this is a really long term study.
 
And with the support of NIHR applied research collaboration and various other NIHR research streams we have been able to recruit over 12,500 mums to the project.  Those mums had over 13,500 children and we’ve been following up the health of those children ever since. 

The oldest children are now turning 15 and you know are in secondary schools across the region and there is never a boring moment working on a birth cohort study because every year is different.

So, where at the start of the project we were focussed on maternal mental health, we were focussed on birth outcomes and Jane did a lot of work looking at growth as well, growth trajectories of children then all of our children started attending primary schools across Bradford.
 
We had 13,500 children in primary schools across Bradford, the focus had changed to how that interplay between education and health and how you can use primary schools as settings to improve health and now we have a big focus on adolescence and secondary schools. 

So, it’s been a really great evolution.

Professor Turi King:
And that is really fantastic because not only are you looking at different generations so you’ve got these mums and you are looking at them and then you are looking at the kids and it sounds like a really nice, kind of, holistic long term study because you are getting to follow these children through.  You are seeing what education they get.  You are seeing how their health is as they are going through time, so what have you found?  So, what are some of the key findings that you have found so far coming out of this?

Professor Rosie McEachan:
So, you are right to say we…we study a lot of different factors within Born in Bradford and one of the benefits of having a cohort study like this which is really rich and you have lots of information, we have DNA, we have blood samples, we have hair, saliva but we also have lots of questionnaire surveys.  We link to routine data like Jane mentioned earlier as well.

That means we can look at pretty much anything and everything.  But I think for me some of the really exciting findings that came out from the study which I have seen make an impact on our city in Bradford, has been the work we’ve done around pollution and air quality.  We were very lucky to be invited to participate in various EU consortiums and collaboration focussing on this issue so we were able to, you know really work with the brightest minds globally on this issue and we have shown really clearly the impact that pollution has on mental health of parents and children, of our children’s growth and even on our children’s DNA and that really helped us make the case to city decision makers about the need to tackle that problem.

We’ve also… done a lot of work around growth.  We’ve been looking at levels of overweight and obesity.  We find…one of the great things about the Born in Bradford cohort study is that it is reflective of our very diverse multi-ethnic city and actually 50% of our cohort participants are of South Asian origin.

And what this means is that it gives us a really great way of exploring differences between different cultural groups that you can’t do elsewhere in the country.  So, we found that rates of overweight and obesity differed across the two key ethnic groups in our city – white British families and South Asian families and we were particularly worried about South Asian families and levels of obesity and how these were rising over time. 

This led to work with Public Health England and the local government to implement our obesity trailblazer project in the city where we are now working with faith settings, mosques and madrasas across the city to develop ways of obesity prevention.

So, it is things like that which make this project really exciting to work on. 

Professor Turi King:
It sounds really fascinating because having all of that data as you say it means that you can start to partition things out and that can go, “Okay, so this particular population needs more advice around this and this population needs a bit more advice around this,” and you can really sort of target, I suppose, your advice to different populations.

Professor Rosie McEachan:
Yes, absolutely and I think what we can do with our study is actually look at some of the structural factors within our city and other cities which actually make it really difficult for people to lead healthy lives. 

So, if we take our environment, for example, our research has shown the negative impact of pollution.  We’ve shown the negative impact of noise and lack of green space but we also know that within our city the most deprived areas are the most polluted, the noisiest and the places where we have less access to green space.

You’ve got like that triple whammy there, of problems and I think a study like Born in Bradford can really help to make that case.  So, yes there are things and there is research that we can do working with individuals to get them to change their behaviour but actually some cases citywide interventions are needed.

Professor Turi King:
And it’s changing government policy essentially.  So, I know that in Bradford the local authority has recently introduced a clean air zone, following recommendations from a NIHR research study that you led.  So, tell us a bit more about that study and how it has influenced the policy locally.

Professor Rosie McEachan:
This has been a really rewarding project to be part of in the city.  We first started working with Bradford Council about 10 years ago when we were working on some of our early projects on the impact of pollution on health and we found that they were very concerned about the issue and really receptive to the findings that we were able to present back.

In 2018, Bradford was identified by the government as one of their 28 areas that had illegal levels of pollution and therefore were mandated to do something about that.  Now, that was a great opportunity for us to be able to work with the council to really have that evidence focus and that really research led focus on the development of their plans.

So fast forward four years.  We were involved in the development of the Bradford clean air plan and that has resulted in a very ambitious clean air zone within the city which was switched on, and as part of our NIHR funded evaluation we are going to be looking at the health impact of that across the entire Bradford population.

So, what we are interested in is looking to see whether the reductions in pollution that we might expect as the result of the zone impact on levels of breathing difficulties amongst the population.  You know we would expect to see less families turning up at our accident and emergency or our GP practices with problems.  We are also looking at heart health, birth outcomes so a whole host of health outcomes that we can assess from routine data but crucially we are also going to look at the economic impact.

So given the costs that are involved in implementing a big policy like this, do we exceed the savings from our NHS of savings on the cost of having to treat these illnesses many of which are entirely preventable.

 Professor Turi King:
You’ve shown that you think that this might make a difference and then presumably your next thing is looking to say what is the impact of that?  Are there any changes or tweaks that need to be made?  Are we seeing benefits coming out of this?

Professor Rosie McEachan:
Yeah, I think you are exactly right.  So…so part of the remit of Public Health Research is to look at you know how can policies be better implemented and what works and what doesn’t work.  It’s really important to have that balance.

So, what we are hoping particularly from our evaluation of…of the work that is going on in Bradford around pollution is that there are lessons for other local authority areas.  There are many other local authority areas who are now going to be in the process of rolling out clean air zones so we’re hoping you know that when our findings come that it’s going to be really helpful for those other areas. 

Professor Turi King:
It must be incredibly rewarding. 

Professor Rosie McEachan:
Yes, it is.  I think this is the best project to work on anywhere.  I love it but I think for me this is you know when I talk about Born in Bradford, I see it as a people powered project and I think it is really important to…to say that.  Community engagement is a core part of what we do in this project as well as all of that time, weaving in with the fabric of stakeholders and decision makers within our city.

And what I want to do with Born in Bradford is turn the tables in a sense on how research is funded.  So, you know often in the past research is funded by what our people in offices and grant funding bodies think this is important, well actually what we do in Born in Bradford is turn it on its head. 

We go out to communities and say, “What is important for you?”  We make the case, then we get the money from the funders and it’s a virtuous circle.

Professor Turi King:
It just sounds incredibly rewarding and working with people, I mean that is so important and that is why you need people to take part in research.  So, we know a bit about the research that is happening in Bradford, but Jane, you know if people did want to get involved in prevention and public health research in their area, how can they do that and can you give an idea of what they might be asked to do whilst they are taking part in public health research?

Professor Jane West:
Yeah, so public health research we’ve kind of talked about already haven’t we, how it touches on lots of different areas. It’s often within the scope of local authorities and sometimes that makes it a little bit hard to find. The Be Part of Research site is a really good place to start and there’s lots of work happening at the moment to get more and more public health research included in Be Part of Research so that is definitely a good starting point.

What being involved might include could be all kinds of things because it is such a broad topic so it could be very specific community type things that Rosie has talked about where you are involved in community groups or helping to co-produce research.  It could be more around that you’ve given access to your data to be used where we’ve talked about using big routine data sets to do public health research or it could be in the funding processes like the public health research programme does and I think it reflects how broad public health is that it could almost be anything and everything being part of public health research.

Professor Turi King:
So, if there is one thing you would like people to remember from this podcast what would it be, Jane?

Professor Jane West:
I think probably that public health is really around keeping us all well so that we all live longer and healthier lives.  It’s better for all of us if that happens but it’s also better for the NHS and the sustainability of the NHS if we can stop people becoming unwell in the first place and keep them healthy.

It’s also really about reducing those unfair differences that we both touched on between the most advantaged communities and the least advantaged communities, and unfortunately there are still quite marked differences and we’ve not done that well at reducing those and it’s likely that our current situation with the cost of living crisis is going to worsen that even more.

So, yeah, we’ve got lots of work to do.

Professor Turi King:
I mean it sounds trite but it is genuinely about making the world a better place for everybody.  That is what this is about.

Professor Jane West:
It definitely is, yes, and sometimes where we try and take public health population level actions, they make the biggest difference and you know the Clean Air Zones hopefully will be a good example of that, but the smoking ban as we mentioned previously is a good example of that.  It affects everybody.  It doesn’t rely on people having to make those choices and decisions because those choices and decisions are harder for some people than they are for others so when we take that approach, we tend to see the best benefit for as many people as possible.

Professor Turi King:
And Rosie, how about you?  What would you like people to remember from the podcast?

Professor Rosie McEachan:
So, for me it is remembering that actually public health research is a proper partnership. It is a proper partnership between communities and researchers and decision makers and only if you can get all of those people working together can you make real change and I think I would also want people to know the voices of communities are being heard and acted upon and a lot of public health research priorities is coming directly from our communities so people’s voices is really important that you speak out.  You let us know what you want to research and that we as researchers make those efforts to get out there into our communities and find out what is important.

Professor Turi King:
So, Jane and Rosie, I think the thing that kind of…I love doing this podcast because you can just feel it coming off of you the passion with which you are carrying out this research and that you really enjoy working with people and you are genuinely working hard to make honestly the world a better place and I think that is…that has been really lovely to listen to.

So, it’s been so great to talk to you both about this…this topic and about how science and research can really influence and make a healthier life for people.  
 
Thank you for making this podcast possible and opening the door on public health research.  We hope you’ve enjoyed listening.  
 
If you would like to read the show notes for this episode and listen to the other podcasts in these series visit bepartofresearch.ac.uk.