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My reflections on the Public Health Paradigm



The potential of public health research to impact on all our futures, and the future of the NHS, is huge.

The NIHR’s Public Health Research (PHR) programme spends approximately £12m per year on public health research. This is a fraction of what is invested in medical research and yet we know that the influence on population health from public health research is far more powerful. The power to prevent, rather than cure, through solid evidence and proof is what drives me to champion public health research. I want to fill the evidence gap so that non-NHS organisations, like local government and the third sector, can make informed decisions that will benefit the population for the long-term.

Building blocks to better futures

Non-NHS public health research is incredibly relevant to many of the long-term chronic diseases that we’re seeing more and more of. Obesity, diabetes, the impact of smoking – all of these can be prevented if they’re dealt with early enough at a population level by mitigating the causes.

In my role as Consultant Advisor, I advise on which public health research the NIHR should try to fund, and all of this is done with the goal of making it as relevant as possible to public health themes and needs.

There is a misconception, I think, that public health research should be focussed on educating individuals and trying to encourage decision-making changes. Of course, this is an element of it, but at the heart of the problem it is the environment that needs to change, which in turn will change the people.

We need to create better road systems, healthier housing estates, greater community bonds where the healthier option is the easier option. And this is a difficult task – we don’t want to take away people’s autonomy to make decisions for themselves, but we recognise the importance of the place they live and the impact it can have.

The smoking ban in public places, for example, people accept because they understand the health implications. So it’s about making healthier choices safer and more acceptable for people and getting them to understand what it will do for their futures. For instance, we need to design streets for people rather than cars, making walking and bike routes safer. When we focus on people first, we will inevitably make their futures better.

In Cambridge, a PHR project looked at the impact a new guided bus lane and cycle path had on the population. Researchers found a significant increase in physical activity levels, both through people using the cycle path and walking to and from the bus stops.

Embedding public health

Alongside embedding the importance of public health with the public, it needs to be embedded within the organisations who make decisions that will impact upon the population. I encourage academics and researchers to embed themselves within local government so that they are aware of changes and developments. In this way, we can nurture an environment of learning and evidence, which is often missing within local government’s decision-making when it comes to public health.

My role is to fill the evidence gap, to make sure that academics and researchers are connected to the work that’s happening throughout the UK and providing solid evidence to public health professionals.

PHR funded a study on street lighting and whether turning them off earlier would impact crime, accidents and the environment. What it showed was no increase in crime, no increased risk of accidents to the public but a drop in environmental impact. It is studies like these that will allow local authorities to make informed decisions that make a difference to all of our futures.  
Not only will it help to create healthier futures and reduce environmental impact, but it also means that money can be allocated and used in the right way. At a time when local government cuts are becoming harder, this has the potential to make sure that money goes to places where it will make a positive difference.  In my opinion, public health research is as important as medical research – it has the power to prevent so many health issues, funding problems and environmental damage.

Moving forward we need to be conscious of the funding portions that we allocate to medical and public health research. It must move towards a more even balance if we are to see a worthwhile impact. Without the evidence gained from it, we can’t make informed decisions. And without informed decisions we won’t see any meaningful impact. I’m excited to see the changes and remit expansion into public health by the NIHR and I would encourage academics and researchers to reach out to public health teams in local government. Go and have coffee, find out what problems they are facing and discover how they work. 

Once we do all of that, we can join the dots and really start pushing towards seeing meaningful change in public health.

More information on current PHR funding opportunities is available on the NIHR website.

To read more about the NIHR's research in public health, see the following blogs:


The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care.