Created on Monday, 26 Nov 2018. Posted in Public Health
NIHR blog from Professor Frank Kee on Public Health Research
As Einstein said: “We can't solve problems by using the same kind of thinking we used when we created them”. We need new ways to tackle issues affecting public health as many fall into the category of life’s wicked problems.
I have been associated with the NIHR PHR Funding Committee since its inception, as a committee member and for the last three years, as its chair. Over that time, the programme has matured and evolved, forging relationships with other funders and sustaining NIHR’s reputation for supporting high quality research focussed on real world challenges. Over the last decade we have also witnessed trends in public health science, so we have adapted and harnessed the best of these to ensure that scientific excellence continues. I highlight a few of these trends here, to acknowledge that funders need to be visionary, nimble and occasionally take risks.
Our research questions must not be borne from disciplinary traditions but rather must be problem based. Thus our Prioritisation Committee, made up of practitioners and policy makers, use their knowledge and experience of real world public health practice to ensure prioritised proposals will result in usable evidence.
We place great importance on applicants having a broad disciplinary mix in their team, who can bring appropriate methods and insights to answer their research questions. I am encouraged to see evidence that universities increasingly value institutional collaborations to attract research funding and to build transdisciplinary capacity.
There is a growing recognition that the “gold standard” randomised controlled trial (RCT) design is ill suited to the evaluation of the rather messier real world issues that we face. Thus we have witnessed a growing number of applications that use alternative approaches such as natural experiments, realist evaluations, stepped wedge designs and difference in difference methods, to name but a few. Applicants to our programme need not be shy in making a case for their chosen approach when a conventional RCT can be justified as unfeasible or unethical.
The PHR programme is not receiving enough applications that aim to test interventions that harness a population or systems perspective - this is one of our highest priorities. We have funded some excellent applications in this category - such as the evaluation of minimum unit pricing for alcohol and a study of the effects of reduced street lighting – but we want more! For decades, prevention science has been dominated by a focus on individual level research which arguably has diverted public policy away from the upstream determinants of population health. Leading scientists in our field have called for a more nuanced complex systems perspective.
Francis Galton’s ‘Quincunx’ provides an example of how emergent phenomena can arise as a result of such complex systems. What organises the distribution of the beads, is not the innate qualities of the “elements” (a metaphor for the people we are trying to help with our interventions), but the shape and placement of both the funnel and the pegs of the Quincunx. Together, these features (a metaphor of the way society is structured) determine which beads can pass through the pegs and their possible pathways (and health outcomes). Interventions based solely on individuals place too much emphasis on the elements (people) cascading through the Quincunx, rather than the system generating the distribution itself. Although individual level interventions and evaluations are still valuable, combining structural, population-wide interventions with individual based approaches could help maximise both effectiveness and health equity.
Since the release of the MRC Complex Intervention Guidance we have learned a lot about how important it is to adopt a careful and staged approach to intervention development and testing. If we are to have scalable translatable public health interventions that can have traction in different settings, we must understand the elements from which they are built and how they are put together. It is a cliché to say that science never stands still and while new methods are emerging, all the i’s have yet to be dotted and t’s crossed with respect to intervention development. This is why in 2013 the MRC instigated the Public Health Intervention Development (PHIND) funding scheme.
To conclude, if you are planning to apply to PHR please consider the above. We want to see more upstream, population-focused approaches to tackling public health problems. Make sure you engage with your public health community, develop a multi-disciplinary team, and don’t be afraid to use innovative research designs where the gold standard RCT doesn’t fit.
To aid you in the development of an application to PHR the Funding Committee have produced this short video of key elements to be aware of when applying. Good luck!
View our latest funding opportunities and submit your applications.
To find out more about the PHR Programme, read the blog from Professor Martin White (Programme Director).