The COVID-19 pandemic, and the greater risks it has posed to people with underlying health conditions, has put a spotlight on the role of preventable ill health. Our COVID-19 impact inquiry is looking at how people’s experience of the pandemic was influenced by their health and existing inequalities, and the likely impact of actions taken in response to the pandemic on people’s health and health inequalities – now and in the future.
Given its importance, you might think that out of the billions of pounds spent every year on the direct and indirect costs of ill health to society, research funders would allocate a significant proportion of their money to research on preventing ill health. This could enable us to find out the most effective ways to help people live in good health for as long as possible. Living longer healthier lives would be a good in itself, as well as reducing the burden of demand for health care.
In fact, health research funding is mostly directed towards diagnosing and treating ill health. Prevention research generally comes second to finding ways of addressing acute need. Of every £40 we spend on health-relevant research in the UK, we spend only £1 on primary prevention research. The shortage of research funding results in a lack of robust evidence on which to base, or assess, preventive action.
Primary prevention research 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. In 2018, an estimated £8.6bn was spent on health-relevant research and development in the UK (of which £4.3bn is from the pharmaceutical private sector). A small proportion of this, just £220m, was spent on research that supported primary prevention research.
Such research necessarily covers a wide range of topics. A recent report from the Medical Research Council (MRC) found that half of primary prevention research was targeted at health outside the UK, mostly studying health problems in low- and middle-income countries (LMICs). And a third of the 2018 primary prevention research portfolio was spent on work relating to vaccination programmes and/or the development of vaccines. These areas are of obvious importance, now more than ever. However, my concern is that this leaves very little funding – a mere £54m – available for research that deals with the wider determinants of health and population-level approaches to prevention in the UK. And we know that without evidence-based action on the wider determinants of health, we will not improve population health or reduce health inequalities.
It’s also worth noting that of the £54m spent in 2018 in the UK on research to prevent non-communicable diseases (such as diabetes, heart disease and depression), a third was spent on research in health care settings. It is puzzling that so little funding was allocated to prevention in community-based settings, such as the places and environments where people live, work or study. The MRC report highlights the need for ‘increased multi-disciplinary capability for research into whole-system influences on behaviour and public health’. This would lead to a better understanding of the complex influences and interactions required to develop effective population-level interventions.
However, there are grounds for cautious optimism. The proportion of total UK health research funding for prevention studies actually increased between 2004 and 2018, and since then it has grown further (in 2020, 5.9% of UK health research spending was on prevention of ill health, up 3.4% in real terms since 2004). The establishment of the UK Prevention Research Programme (UKPRP) in 2017 helped facilitate this progress.
The UKPRP has funded consortia and networks to develop capacity in prevention research. For example, the ActEarly consortium aims to improve the life chances of children by focusing on improving the environments that influence their health. The programme recognises the importance of evidence to inform policy and practice – by involving end users in research, among other things.
I hope that one positive outcome of the pandemic will be a growing interest in prevention research. Inequalities and the role of wider determinants of health have received greater attention this past year as explanatory factors for variations in morbidity and mortality from COVID-19. The MRC’s report also notes that there is a lack of prevention research around pollution, climate change or the built environment as determinants of health, and little also concerned with older people. I’d like to see future research funding priorities address these gaps.
Liz Cairncross is an Associate Research Manager at the Health Foundation.