Area of Research: Public Health
Section 1: Summary of main strands/themes for research
Public health typically captures four pillars of: health improvement, health protection, health care public health and the wider determinants of health.
In October 2021, Public Health England (PHE) transferred its health protection functions into the UK Health Security Agency (UKHSA) and health improvement/healthcare public health functions into the Office for Health Improvement and Disparities (OHID) in the Department of Health and Social Care (DHSC), NHS England and NHS Improvement (NHSE/I) and NHS Digital (NHSD). OHID works across government, the healthcare system, local government, and industry to focus on preventing ill health, in particular in the places and communities where there are the most significant disparities.
To support OHID, the NIHR is increasing its investment in Policy Research Units (PRUs). It expects to fund a new unit focused on addictions as well as continue to fund several other units that, between them, cover the range of OHID’s responsibilities. While health protection and health improvement are not mutually exclusive (the NIHR also invests in a set of Health Protection Research Units (HPRUs), the focus of this PRU will be on health improvement but with scope to cover topics relevant to both domains e.g., air quality and climate change. Wider determinants of health and reducing health inequalities/disparities will be a key feature of this PRU.
Research is required to inform all stages of policy from policy development through to implementation and evaluation. The topics and themes of this unit will inevitably overlap with some of the other PRUs. This means that working with other units will be particularly important to avoid duplication or identifying opportunities where joint unit working would be valuable (see Section 4).
The following are indicative of the broad policy areas in which the Public Health PRU could make a useful contribution:
- Public health system - including overall impacts of services provided and system changes to meeting public health outcomes as well as exploring specific aspects of how the public health system operates nationally e.g., the Public Health Grant funding mechanism as well as local level.
- Preventable health risk factors - clustering of risk factors and how these factors can be modified. Risk factors can include behaviours such as smoking, drinking, low physical activity, diet and broader factors such as local environments and climate change.
- Behaviours across and at different points in the life course - health behaviours in adults, pregnant women, children and young people.
- Health inequalities/disparities - including how to reduce inequalities/disparities by identifying what works and how interventions could be targeted.
- Wider determinants of health – how these impact on population health and encouraging health improvement, including commercial determinants.
- Inclusion health - Inclusion health is an umbrella term for socially excluded and stigmatised populations that experience extremely poor health outcomes, such as vulnerable migrants, survivors of human trafficking and modern slavery, Gypsy, Roma and Traveller communities, people who experience homelessness, people who experience drug and alcohol dependence, sex workers, and people in contact with the justice system.
- Violence and abuse – experiencing violence and abuse, especially in childhood, can have a substantial impact on both physical and mental health
- Place – including how place can impact on health and how interventions might operate at a community level
- Social care – such as how health improvement and prevention interact with social care.
Section 2: Details of policy context and background
The public health landscape is complex, and the system has experienced significant change. The 2012 Health and Care Act abolished Primary Care Trusts and transferred much of their responsibility for public health to local authorities (LAs) from 1 April 2013. From this date LAs have had a new duty to take such steps as they consider appropriate for improving the health of the people in their areas. It was one of the most significant extensions of local government powers and duties and signalled an opportunity to change the focus from treating sickness to actively promoting health and wellbeing. As part of the 2012 changes, LAs inherited responsibility for a range of public health services previously provided by the NHS including sexual health services and services to address drug or alcohol misuse and these statutory duties have been funded by a ring-fenced Public Health Grant. Section 7A Services (mainly screening and immunisation services) continued to be commissioned/delivered by the NHS.
A recent change to the health and care system is that from 1 July the Health and Care Act 2022, established 42 Integrated Care Boards (ICBs). Each area has an Integrated Care Partnership (ICP), a joint committee which brings together the ICB and their partner local authorities, and other locally determined representatives (for example from health, social care, public health). The ICP is tasked with developing a strategy to address the health, social care and public health needs of their system, and being a forum to support partnership working. The Act requires research to be covered in ICB plans and provides a firmer legislative basis for embedding research in the health and care system.
The 2020 outbreak of COVID-19 has reinforced the need to focus on prevention, health inequalities and tackling the social determinants of health. The experience of the pandemic has also exposed the importance of national and local collaboration, partnership working and using evidence to understand what is most effective at scale and what works best in places. As outlined in Section 1, the purpose of OHID is to lead the government’s renewed health improvement and prevention agenda, with a remit to reduce pressure on the health and care system. It has a role to coordinate central and local government, the NHS and wider society to promote improvements in the public’s health.
Section 3: Justification for research topics
We anticipate that to deliver high quality research in these areas will require researchers from a variety of backgrounds with a range of methodological and subject expertise. This should include expertise in policy evaluation, as well as an ability to take a systems-thinking approach. There is a wealth of evidence around health improvement so expertise will be required to rapidly synthesise existing evidence in the form of reviews which are accessible to a policymaker audience.
Given the breadth of subjects that might need to be covered, applicants need to demonstrate they are able to draw on a wide range of collaborators.
Given that much of health improvement activity is delivered by local government; it will be important for this PRU to understand local government contexts.
Understanding individual, population level and commercial behaviour, and how to influence it, is fundamental for improving the public’s health so an appreciation of the contribution and application of behavioural science will therefore be important for this PRU.
Section 4: Other related research activity of which the Unit will need to be aware
The NIHR and other funders of health research already have significant investments in public health, such as the UK Prevention Research Partnership.
While the Addictions PRU will focus on behaviours which are harmful because they are addictive, the Public Health PRU will focus on health improvement, health disparities and wider determinants of health more broadly.
The Unit will be expected to develop links with several PRUs, for example, Healthy Weight, Healthy Ageing, Children and Families, Behavioural Science and Mental Health units as well as new units such as Reproductive Health. There will also be valuable linkages to be made with the Health and Care Systems and Commissioning, Economics and Policy Innovation and Evaluation units.
The Unit should also complement and make links, as appropriate, with other relevant NIHR investments e.g., the NIHR Public Health Programme, HPRUs and the NIHR School for Public Health Research.
Section 5: Other issues relevant to this programme of research
UK public health research has been undergoing substantial evolution following the publication of the Academy of Medical Sciences report Health of the Public in 2040 and establishment of the Strategic Coordination of Health of the Public Research (SCHOPR) Committee - sub-board of the Office for Strategic Coordination of Health Research (OSCHR). The NIHR has taken a strategic decision to widen its support to public health research and prevention, which typically needs to focus on non-NHS settings and local government, where many of the levers to affect population health improvements lie.
As part of a package of activities the NIHR has established six Public Health Intervention Studies Teams (PHIRST). The PHIRST initiative enables evaluation of schemes that local authorities already have in place, providing research evidence to meet local government needs. The funded research aims to help find out what impact these schemes have on the health and health inequalities experienced by local populations.
The NIHR is also in the process of commissioning an initial set of Health Determinants Research Collaborations (HDRC). NIHR HDRCs will be nationally recognised centres of research excellence, based in and led by local government, which receive core funding from the NIHR. Their focus will be on building research capacity and capability between local government and the academic sector. Each HDRC will support public health capacity building by enabling local authorities to become more research-active and thus more involved in shaping and driving forward the research agenda in a way that is most informative for the decisions and issues they face.