Tackling public health challenges
Instigating step changes in public health, both in the UK and internationally.
In 2014, NHS England’s Chief Executive Simon Stevens set out an ambitious five-year plan for the health service; central to this forward view is improving the way the NHS prevents disease, empowers patients and engages with communities.
Here at the University of Southampton, our research is having a tangible and positive impact on all of these areas. We are improving the prevention and treatment of a wide range of conditions, from osteoporosis, which leads to nearly nine million fractures annually worldwide, to liver disease, which is becoming more prevalent in the UK due to increasing alcohol consumption. We are also working with patients and communities to help people use social networks and local resources to improve their health. And, as well as the UK, our research is having wider impacts globally, for example through tools we are creating with the World Health Organization (WHO).
Understanding origins of disease to improve prevention
The Medical Research Council (MRC) Lifecourse Epidemiology Unit at the University of Southampton focuses on the idea that conditions of the musculoskeletal and metabolic system have their origins in the earliest stages of development. Our researchers are at the forefront of improving our understanding of these conditions throughout people’s lives, and through that understanding to develop preventive strategies.
“Our research has had international impact in demonstrating a developmental contribution to the origin of musculoskeletal disorders such as osteoporosis, the commonest bone disorder worldwide, osteoarthritis, the commonest joint disorder, and sarcopenia, the commonest deficiency of muscle,” says Cyrus Cooper, Professor of Rheumatology and Director of the MRC Lifecourse Epidemiology Unit.
Over the past decade, the MRC Lifecourse Epidemiology Unit has provided a detailed understanding of how the maternal environment modulates fetal development and how this leads to an increased risk of these disorders in later life. Its research has also led to preventive strategies during different stages of the lifecourse to minimise the risk of these non-communicable diseases in later life.
One example of this integrated approach is in reducing the risk of osteoporosis. Research from the MRC Lifecourse Epidemiology Unit has shown that if a mother has inadequate vitamin D in her diet during pregnancy, this can result in poor bone development in the offspring, who then becomes at increased risk of osteoporosis, particularly if they were born in the winter.
“We have shown that the diet of a mother during pregnancy, and even before pregnancy, alters the development of musculoskeletal structures and function, predisposing the child to develop osteoporosis or sarcopenia when they reach adulthood decades later,” says Cyrus.
The research team has also developed interventions further throughout the lifecourse. “For example, our research has shown that exercise is important late in adult life to prevent hip fractures, as well as the importance of calcium and vitamin D supplementation in mid-life for reducing the risk of fracture,” says Cyrus. This has resulted in risk-assessment tools, developed in collaboration with the WHO, that identify those at the greatest risk of fracture.
“Our integrated approach to reducing the burden associated with osteoporosis – from before birth, through childhood, adulthood and into old age – is what makes our lifecourse approach unique, and we are also using this approach with other conditions such as childhood obesity and diabetes,” says Cyrus.
This research has had many national and international policy impacts, for example recent guidance by the WHO, consensus documents on prevention of childhood obesity and national guidance on preventive strategies against osteoporosis and sarcopenia.
Our research has had international impact in demonstrating a developmental contribution to the origin of musculoskeletal disorders such as osteoporosis, the commonest bone disorder worldwide, osteoarthritis, the commonest joint disorder, and sarcopenia, the commonest deficiency of muscle.
Tackling chronic liver disease
Our researchers are at the forefront of a range of public health issues. A key example is liver disease, which is one of the few chronic diseases in which mortality is rising in the UK, largely because of the extent of alcohol misuse.
“Our research involves understanding the patterns of liver disease and how we can detect and treat it earlier. We are also investigating alcohol in society, how we are misusing it and how we could intervene to reduce its harms, which as well as liver disease would have a positive impact on myriad health problems stemming from alcohol misuse,” says Paul Roderick, Professor of Public Health.
Severe liver disease, which is most commonly due to chronic alcohol misuse, often presents at a late stage as an emergency and has a high rate of mortality. Paul is working with primary care and hepatology colleagues to detect liver disease earlier using new diagnostic methods to enable them to intervene before the condition worsens.
“Community pharmacists are well placed to give advice on alcohol consumption as they see people regularly when they collect prescriptions,” says Paul. “We are working with pharmacy colleagues to find out whether screening and giving brief health advice in pharmacies on alcohol misuse would be effective. We are also trying the same approach in sexual health services, given the strong link between alcohol and sexual health, which targets a relatively young population that is less likely to be in contact with other services.”
The global issue of antimicrobial resistance is another of our areas of research focus. “GPs prescribe 80 per cent of the antibiotics for acute infections in our healthcare system. We have done several trials looking at alternatives to antibiotics, or delayed prescribing, and the results of these trials are now informing policy around antibiotics and trying to change prescribing patterns,” says Paul.
We are now implementing such science into clinical practice, working with GPs, practice nurses, commissioners of healthcare and patients to try and shift the norms, for example to be a less antibiotic-demanding and less antibiotic-prescribing culture.”
This research links with work being carried out by a multidisciplinary network of researchers from across the University – including engineers, physical scientists, life scientists, social scientists and clinicians – who are developing technologies to help reduce levels of infection. These include developing new microbe-resistant materials for instruments, dressings and catheters, devising new minimally invasive procedures, improving decontamination and waste disposal, and developing and patenting a revolutionary new cleaning system, StarStream technology.
We are working with pharmacy colleagues to find out whether screening and giving brief health advice in pharmacies on alcohol misuse would be effective.
Working with patients and communities
The impacts of our public health research extend beyond primary healthcare settings: we are helping people to make the most of social networks in the community to improve their health and wellbeing.
“In the UK there has been a significant policy shift towards self-care; that is, encouraging people to change their own lifestyle to manage their conditions. We were brought in to evaluate this approach by Public Health England’s Expert Patients’ Programme, and we found that it puts a heavy burden on the individuals themselves and can be isolating,” says Anne Rogers, Professor of Health Systems Implementation and Director of the NIHR CLAHRC Wessex. “Social isolation causes as many problems to health as obesity or smoking, so this is a vital issue to address.”
Social networks are a powerful influencer of health behaviour and practices: for example, research has shown that people give up smoking and lose weight better if they do it together. So, Anne and her team have developed an online mapping tool called Genie, which people can use in their homes to help them make optimal use of social networks. This is linked to tailored support that people have access to – including leisure activities and community groups as well as formal healthcare resources.
The team has trialled Genie on the Isle of Wight and across Europe for supporting people with type 2 diabetes. This approach can be applied to other public health problems; for example, people who have alcohol problems may need to modify their social networks. “There is no point going through a detox programme if you go back to the pub with your friends, so it’s the awareness of the social networks that could be contributing to health problems and moving people on to the resources that are out there,” Anne explains.
“These varied activities, coupled with our lifecourse excellence, have been brought together by our integrated approach to developing a nationally reputable centre of public health research. They also bring together our expertise in economics, social sciences, health psychology, life sciences and medicine in our newly established Global Health Research Institute,” concludes Cyrus.
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