Will Public Health England lead research?
Authors: Mark McCarthy
Journal: The Lancet (2015)

Between 1990 and 2013, mortality rates in southeast regions of England fell below those of 18 comparison countries, whereas mortality rates in Scotland and Northern Ireland remained higher than all comparison countries except the USA. This headline can be gleaned from today's detailed report by Public Health England (PHE) and the Global Burden of Disease study (GBD) in The Lancet.1Newton JN Briggs ADM Murray CJL et al.Changes in health in England, with analysis by English regions and areas of deprivation, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2015; (published online Sept 15.)http://dx.doi.org/10.1016/S0140-6736(15)00195-6Google Scholar There are some caveats: analysis by region for the other 18 countries would also show a range around the national average; and the differences in mortality were greater for men than for women. England has lower mortality rates from self-harm and road injury, but higher rates of liver disease and mental disorders related to alcohol misuse, compared with the other countries. Regional mortality rates in England correlate closely with the national index of deprivation (the components of which are chosen to amplify such variation), yet many non-fatal causes of disability, including low back and neck pain, anxiety disorders, sense-organ diseases, and breast cancer, show little regional variation. With the lengthening life-span of the population, overall levels of disability also remained broadly unchanged, indicating the continued necessity for health care. Welcomed by The Lancet,2Horton R Metrics for what?.Lancet. 2013; 381: S1-S2Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar the UK Department of Health in 2013 drew on the GBD study data for the new preventive health strategy for England, Living Well for Longer.3UK Department of HealthLiving well for longer: one year on.https://www.gov.uk/government/publications/helping-people-live-well-for-longerDate: March 25, 2015Google Scholar The strategy set a political “ambition for England to have amongst the lowest rates of premature mortality in Europe” but focused on cancer, heart, stroke, respiratory, and liver disease; the existing low rates for injuries and self-harm and the prevalence of disabilities are not mentioned. Yet in 2013, the UK Government also transferred public health services from the National Health Service (NHS) into 152 higher-tier local authorities,4UK Department of HealthPublic health in local government—factsheets.https://www.gov.uk/government/publications/public-health-in-local-governmentDate: December, 2011Google Scholar whereas the national communicable disease control service was recast as PHE with a remit across all diseases and injury. How will public health work alongside the NHS? GBD has created a comprehensive resource of epidemiological data and has quantified estimates of attributable risk for mortality and disability. However, the causal pathways determining health, which population interventions are working, and in what contexts—for disability as well as for premature mortality—also need to be better understood. Why has London, with a higher deprivation index and more migration than other English regions, seen most improvement in mortality? Why do disability rates, some with relatively imprecise diagnoses, show less social variation than mortality? How do national policies affect personal health behaviours, and to what extent are national mortality trends a cohort effect from past policies? How do different economic priorities and characteristics of health-care provision across European countries affect mortality and disability? In August, 2015, PHE published a strategy for research, translation, and innovation.5Public Health EnglandDoing, supporting and using public health research.https://www.gov.uk/government/publications/doing-supporting-and-using-public-health-research-phe-strategyDate: Aug 18, 2015Google Scholar The “Priority One” objective of the strategy is to “focus researchers in PHE and elsewhere on research questions relevant to the evidence needed for public health”. The UK has a confident strategy for research in the life sciences,6UK Department of BusinessSkills and InnovationStrategy for life sciences.https://www.gov.uk/government/publications/uk-life-sciences-strategyDate: December, 2011Google Scholar promoting genomics, drug development, and medical technology. Funding for patient research through the Department of Health, Medical Research Council, Wellcome Trust, and medical charities is also substantial, but public health is only a small part of these medical research budgets.7National Institute for Health ResearchAnnual report 2013/14.http://www.nihr.ac.uk/about/nihr-publications.htmGoogle Scholar, 8McCarthy M Dyakova M Clarke M Public health research in the UK: a report with a European perspective.J Public Health (Oxf). 2014; 36: 325-335Crossref PubMed Scopus (4) Google Scholar In a recent Lancet Comment about research using UK Biobank, Thompson and Willeit9Thompson SG Willeit P UK Biobank comes of age.Lancet. 2015; 386: 509-510Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar suggested that “the challenge lies in how changes can be achieved rather than in removing any uncertainty in scientific understanding”. Further knowledge is needed of which interventions work in which contexts, how to scale them up, and what the effects will be.10Voss M Alexanderson K McCarthy M Tracing uptake of innovations from the European Public Health Programme.Eur J Public Health. 2013; 23: 19-24Crossref PubMed Scopus (2) Google Scholar Studies can draw on NHS big data and disease registers, investigate organisational changes and innovation in the health systems, and make longitudinal assessments of the effects of social change, national policies, and local practice (the Public Health Practice Evaluation Scheme is a relevant start). Much better systems are also needed to provide evidence of the consequences of decisions: as clinicians see patient outcomes in a matter of days, and finance officers see monthly spending, so public health practice needs to show effects at population-level through real-time measures of social change, policy contexts, and programme implementation. Determined coordination of an integrated, long-term budget for health research and innovation is required to match the dynamism that health metrics have generated and to develop a body of health knowledge comparable with clinical practice. The PHE study1Newton JN Briggs ADM Murray CJL et al.Changes in health in England, with analysis by English regions and areas of deprivation, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2015; (published online Sept 15.)http://dx.doi.org/10.1016/S0140-6736(15)00195-6Google Scholar has more than 60 UK authors, with almost as many affiliations, and shows the substantial UK capability to undertake research across a wide range of diseases and conditions, without commercial interests, patents, or spin-off companies. Can PHE bring all the partners together to achieve high-quality research on public health practice? I declare no competing interests. Changes in health in England, with analysis by English regions and areas of deprivation, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013Health in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. The gap in mortality rates between men and women has reduced, but marked health inequalities between the least deprived and most deprived areas remain. Declines in mortality have not been matched by similar declines in morbidity, resulting in people living longer with diseases. Health policies must therefore address the causes of ill health as well as those of premature mortality. Full-Text PDF Open Access