Published: 16 April 2019
The importance of place - where we live, work and play - as a determinant of health and well-being has long been recognised. Whether that be the huge improvements in health achieved by the sanitary reforms in the 1800s, the modern day health challenges of urbanisation around the world, or how climate change is threatening the health and wellbeing of humankind through its transformative effect on our habitats.
And now the NIHR Public Health Research (PHR) Programme has released a call for funding, under the topic ‘Understanding the potential of place to impact health and health inequalities’ and are making an innovative offer of support to researchers through a webinar and virtual ‘clinics’.
Last September, I was contacted by Rebecca Wilkinson, a Public Health Registrar on placement at the NIHR. Rebecca was helping to develop a research brief for place-based health interventions. NIHR were keen to hear from academics about the key issues relating to such research, including the barriers to funding of place-based research through existing research funding streams. Being a geographer turned public health professional, who has always seen public health through a place-based lens, I was delighted to hear that NIHR were taking an interest in this important area.
The socio-ecological approach to public health recognises the complex system that determines health and wellbeing, including not just individual characteristics and lifestyles, but also social, community, environmental, political, and cultural factors. Probably the most famous illustration of this is Dahlgren and Whitehead’s 1991 diagram. More recent work, including Barton and Grant’s 'Health Map' has reiterated the complex nature of how place impacts on health and wellbeing. And who could forget the famous spaghetti mind map produced as part of the Tackling Obesities: Future Choices report?
The inherent complexity of a systems based approach to studying the impact of place on health and well-being offers a challenge for research and researchers. Pressures to follow traditional research methods, which offer rigour but not necessarily the flexibility to research complex systems, have often led to a research focus on individual elements of place (which lend themselves to a more linear exposure-outcome approach), rather than attempting to assess the impact of place as a whole. Certainly this was our experience when we conducted the evidence review for Public Health England’s Spatial Planning for Health evidence resource. And while building evidence on the health and wellbeing impacts of individual elements of place is important, it does not reflect the realities of how place as a complex system impacts on those inhabiting it.
Through this research call, the PHR Programme wants to commission research that will lead to further understanding of the potential of place as an integrated whole to impact on health and health inequalities. A focus on whole systems and upstream approaches is encouraged. It signals a move away from the focus on individual elements of place.
In a very welcome move, NIHR has recognised the difficulties associated with research in this area, and have put in place support for applicants with a new proactive model of commissioning. There will be much more dialogue between NIHR committee board members and applicants, to try and address issues that may stand in the way of funding. This dialogue will be in the form of virtual clinics, held in June, with applicants invited to book a slot. This support will be on top of that already available through structures such as the NIHR Research Design Service (RDS). A webinar on Friday, 26 April, 2019, will also support applications.
The NIHR recognises that research in this area needs to be relevant to practitioners (such as planners and local authority public health professionals) and are encouraging applicants to include such colleagues as funded members of the research team. As such they should also be involved in the virtual clinics.
If we are to confront the public health challenges of the twenty-first century, we need to engage with place-based research. We have to be prepared to think about research and evidence in different and imaginative ways, we have to engage across disciplinary boundaries, and we have to build genuine research partnerships with practitioners and local populations. It will not be easy. But the potential rewards for health and wellbeing are huge.
A webinar on the new call 'understanding the potential of place to impact health and health inequalities' runs from 10.30-11.30am on Friday, April 26, 2019.
To find out more about the PHR Programme read an NIHR blog written by Professor Frank Kee.
*The NIHR’s Policy Research Programme (PRP) have launched a separate call on health inequalities which runs until 21 May, 2019.