A detailed analysis of the UK landscape of prevention research has been published by the Medical Research Council (MRC). Here, Professor Nick Wareham, Director of the MRC Epidemiology Unit, Cambridge and Chair of MRC’s Population Health Sciences Group (PHSG); and Dr Gavin Malloch, MRC Programme Manager for Public Health Partnerships, tell us more about why this is important and what they found. This article was originally published on the MRC Blog on 02 February 2021.
After many years of steady improvements in population health, the past decade has seen a marked slowdown, so that the UK now has among the lowest annual improvements in life expectancy at birth compared to other OECD (The Organisation for Economic Co-operation and Development) countries. This slowdown in population health improvement is coupled with a persistence of large inequalities in health outcomes.
In laying out its strategy for Population Health Improvement in 2018, the Secretary of State articulated an ambitious goal to improve healthy life expectancy by at least an extra five years by 2035 and to close the gap between the richest and the poorest through co-ordinated action by local and national government, health and social care services, employers and civil society and people themselves. Such action needs to be underpinned by research, but funding for prevention research has previously been limited.
An Academy of Medical Sciences report in 2016 concluded that the UK had a strong and diverse research portfolio for population health research and that in the 10 years from 2004 public spend on prevention research had increased threefold, but still only accounted for 5.4% of all public spend on health research.
In 2019 MRC PHSG set out to analyse the research funding landscape for primary prevention in order to inform its future strategy and to share those finding with its partners in the UK Prevention Research Partnership (UKPRP). This partnership is formed of 12 research funders, including MRC, and is aimed at supporting research into new ways of addressing the upstream determinants of health.
We took advantage of the UK-wide analysis of health research in 2018, led by the UK Health Research Analysis Forum. We used the existing Health Research Classification System (HRCS) and identified primary prevention awards made by 49 of the 146 HRCS funders. The definition of primary prevention research in this context was research that aims to develop or evaluate interventions (including strategies and policies) to maintain human health and prevent illness or injury from arising in the first place.
MRC PHSG designed a new coding system which was applied to all 1156 HRCS-coded primary prevention awards to establish a more complete picture of UK funder support for prevention research. This allowed us to discriminate between different types of primary prevention research separating out those projects aimed at developing and evaluating interventions that operate at the individual level from those aimed at the social and environmental determinants of health like social networks, ethnicity, marketing and the built environment.
The 1156 awards live in 2018 represented a total spend of £220 M. Half of this research was targeted at health overseas, mostly at studying health problems in low- and middle-income countries. Half of all primary prevention funds were spent on infection, with a third of all the primary prevention portfolio supporting work that included research into vaccination programmes, including laboratory-based vaccine development; this was pre-COVID-19.
We found that in 2018, only £54 M was spent on non-communicable diseases (NCDs) in the UK, which is just 2% of all health research spend. We also found that little research takes account of the wider social and environmental determinants of health. Around half of the spend on primary prevention related to research at the population level, with the remainder aimed at individual-level prevention.
We also examined spend on research aimed at the earliest detection of disease in asymptomatic individuals (secondary prevention). We found 349 awards in this category, accounting for £42 M spend of which £10 M was for global health problems. The largest proportion of spend (43% of all secondary prevention research) was for the evaluation of potential diagnostics in humans, with studies developing new methods, or improving the uptake of existing methods for population screening amounting to 21% of spend, which tended to be smaller awards.
These were Gavin and Nick’s reflections at the end of this complex project:
I found it highly rewarding to do this analysis and did not expect the findings we came up with. For example, while we knew that the spend on primary prevention has steadily increased since 2004, the analysis made it very clear that in 2018, only a quarter of this spend was looking at NCDs in a UK context, making me realise that setting up UKPRP was absolutely the right thing to do”.
It is encouraging to see the growth in research spending on primary prevention in the UK and much has been achieved. However, the magnitude of the challenge of worsening population health and persisting inequalities in health outcomes, creates a clear case for a step change in investment in prevention research through a concerted national effort”.
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