Interdisciplinary research and neglected areas

Chris Whitty Annual Lecture, Centre for Health Services Studies (CHSS) 2019, University of Kent

As an early career health services researcher, I was inspired by the recent public lecture given by Prof Chris Whitty, hosted by Centre for Health Services Studies (CHSS) at University of Kent.

He highlighted the predictive power of what we already know, covered some of the major issues faced across the UK, with a focus on those issues which are exacerbated in certain localities – as we face specific issues in rural communities, seaside towns, areas of high deprivation or migration. Learning from that the data we have, and the trends that we can already see, he pushed a strong agenda for change - the need for more policy engaged interdisciplinary research for neglected areas, grounding research in the communities where we live and work to address some of the major issues faced across the UK.

Data – and ‘foregone conclusions’

He opened by demonstrating the ‘stunning successes’ of biomedical sciences in reducing mortality rates and changing the demographics of the UK with data from the last 100 years across diseases and conditions. History shows us that there are no magic bullets, and grand interventions are not as grand or effective as the impact of science applied through multiple layers of intervention. These fantastic improvements across outcomes for heart disease, stroke, cancer and HIV, for example, are usually the result of multiple complex interventions.

While there is a strong case for the impact of biomedical sciences (for example, antiretroviral medication giving a complete turnaround in life-expectancy for people living with HIV over a very short period), it is equally important to recognise the impact of the full range of sciences enabling changes such as this. Professor Whitty stressed the importance and impact of ‘non-traditional’ sciences, using HIV treatment as an example, with vital social and political science contributions to the layering of interventions and the need for disciplines to work together, across traditional boundaries to achieve transformative effects.

However, acknowledging the challenges to this vision he discussed ways in which current funding structures direct towards ‘easy’, established and ‘the best science’ – if the market decides, strong fields get stronger. This does not address those problems in which a conventional biomedical approach is unlikely to be effective, nor does it encourage researchers to break out of their silos to form innovative collaborations.

Local issues, research solutions

Highlighting the challenges that we face locally – health outcomes in seaside towns, and links to deprivation, issues of aging and multimorbidity, migration both globally and internal, and the intersections between these issues – underscores some of the emerging research priorities. But local problems don’t exist in isolation. Key concerns around the provision of care links our local priorities to global shifts in life-expectancy, and workforce costs, mobility, supply and demand. We need to think about the sustainability of our current models, and it is clear that the NHS is not currently structured to deal with these challenges – compartmentalised pathways and disjointed structures need to be grappled with, and research can feed into these questions of what is going to help the health service to cope.

One problem that sparked audience discussion, was the increasing use of the NHS – a 6-7% rise in use of outpatient services over 10 years. Obviously, we can ‘do more stuff’ and there are reasonable shifts from in- to out-patient services, however, what we don’t want is more visits, and more strain on services, giving just the same outcomes. This is one clear example of the pressing need for research, to answer questions such as this – is this a cultural change, and what are the drivers, from the supply side? Or the demand side? Such multifaceted and complex problems call out for social science research to provide some understanding to shape NHS services for the future. Some of this work is underway, I am currently working on an in depth examination of the ways in which GP workforce, skill mix and team working factors, play out in terms of outcomes for patients and staff, and so how changes impact upon the health service and our changing population (https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/170834/#/).

Policy – difficult conversations

Understanding the need for all of this diverse evidence, then begs the question of how to get this into policy – and the impact we aim for.

Starting from the ‘iron triangle’ of project management, Prof. Whitty highlighted that where decisions are made on costs, if you can’t make an economic argument then you are unlikely to get a policy hearing. He expanded this to discuss his alternate triangle; if something is unpopular or expensive then there needs to be extremely robust evidence to carry it into policy or practice.

Returning to ideas of multidisciplinary research, and the ways in which different types of knowledge are positioned, he acknowledged that you have to work a lot harder to get good social science included in the policy dialogue, and that this needs to change.

As an early career researcher, and a medical anthropologist whose work crosses disciplinary boundaries, this talk was encouraging and a welcome call to push against the ‘headwind’ and work to integrate across traditional boundaries to combine evidence and inform policies which can transform health systems for our communities’ real and changing needs. Among different strands of work, I currently work with colleagues across a variety of social science disciplines, as well as pharmacy and biosciences here at the University of Kent, with links with International NGOs and a Universities in order to address global health challenges for different populations and feed into both policy and practice. Without these multiple perspectives it would be much harder to engage, and it is true that it is also necessary to bring these partnerships to local issues, where perhaps they are less common, and challenge silo-building definitions of disciplinary working, or compartmentalising the needs of people, policy or practice.