Towards a new model of evidence for population health improvement

Dates: December 2015 – December 2016
Funder: The Health Foundation
ECOHOST staff involved: Harry Rutter, Keti Glonti

Despite large amounts of investment in research, knowledge translation, policy development, and practical action the UK, along with almost all other nations, faces a growing epidemic of non-communicable diseases. Despite major efforts we are no closer to solving the obesity crisis than we were a decade ago, and the recent emergence of e-cigarettes has seen public health experts at odds with one another in heated but unresolved arguments about the best way to respond.
The majority of biomedical research is conducted within a dichotomous hypothesis-testing paradigm, trying to establish whether or not an intervention ‘works’. Human behaviour is, however, shaped by multiple factors interacting within complex systems. Understanding how to influence it is rarely this simple, and requires different approaches and methods from clinical research. The time has come to supplement epidemiology and other aspects of biomedical research with new tools and approaches in order to provide better methods for (a) understanding if something ‘works’ and (b) how it works in any given context.

This need to change the way in which evidence is generated and used by actors across multiple sectors to improve public health is gaining increasing recognition among research funders and policy makers, but there are strong structural ties to the existing evidence based medicine paradigm. Moving on from this dominant approach will require a major effort to overcome organisational inertia and professional resistance, but if we are to move towards genuinely upstream responses to population level health problems it will be essential to embrace complexity science and whole system approaches.

This project aims to initiate a process akin to that of the establishment of the evidence-based medicine movement around 25 years ago.