X Factor: What history, hip hop and human interaction can teach us about evidence in public health policy making

Last night, the Health Foundation hosted a unique and lively event called ‘X Factor for evidence for the public’s health’. Based very loosely on the popular television programme, the aim was to launch a conversation about diversifying the evidence and reasoning that we use for addressing pressing and complex public health issues and health inequalities.

It is now widely accepted that public health interventions must be trans-disciplinary and go beyond the bio-medical sciences. But in policy making, the most widely accepted public health policy interventions are often still individual level bio-medical interventions based on systematic reviews of randomised control trials (RCTs) or one important RCT. In fact, one of the reasons that public health issues are a hard nut to crack is that the RCT-based interventions are not proving to be fully effective or sustainable. Other disciplines like sociology or anthropology are often brought in to provide insight into why they are not working or improve adherence to the intervention. But could other disciplines and professional practices offer different evidence paradigms, other research methods, different kinds of findings and different reasoning or logic moving from evidence to action?

Trans-disciplinary public health research and interventions

Multi-disciplinary work is hard to do, especially if the attempt is to work across the natural and social sciences, or the sciences and the humanities. Nevertheless, we know that without such trans-disciplinary engagement, health interventions can often be less effective, unsustainable, or fail completely.

Such engagements are particularly needed for addressing health challenges that have their roots in social environments or ‘upstream’ factors. This is precisely the reasoning of the funders behind the new £50m UK Prevention Research Partnership that aims to build and support interdisciplinary research teams to ‘develop, implement and evaluate generalisable and scalable preventive policies, practices, designs and interventions which will enable change within complex adaptive systems to prevent NCDs.’ The same reasoning is behind UK Department for International Development’s £1.5bn Global Challenges Research Fund that aims to address pressing problems faced by developing countries.

Given the current environment of evidence-based policy making, and primacy given to RCTs in health policy recommendations, alternative multi-disciplinary policy recommendations have to be as or more compelling. One of the central and preliminary steps to building interdisciplinary partnerships is to understand how different potential partners understand evidence, and how they reason about moving from evidence to action.

The Health Foundation has commissioned more than 15 representatives of different disciplines and professional practices to describe how they think about evidence and action using the case study of childhood obesity. Five of them presented their essays last night. Each had 5 minutes to explain to an audience of more than 60 senior public health researchers and practitioners as well as hundreds of online viewers how their disciplines think.

Who presented what?

Alex Mold, a respected historian of public health, discussed how historians use evidence to understand the context in which things happen and why. She also offered some lessons from previous public health efforts in the UK, and reminded us how the concept of childhood obesity – and responses to it – are not fixed and have changed over time.

Brendan McGetrick is the director and curator of the annual Global Grad Show that exhibits graduate works from the world’s leading design and technology schools. He discussed how a designer or design team moves from concept to production, and interestingly, about the role exhibitions could play as interventions.

Marisa De Andrade is Associate Director of the Edinburgh Centre for Creative-Relational Inquiry. She discussed the possibility of co-producing evidence with people, particularly the most marginalised. And more fundamentally, she argued that the arts are a way to co-produce evidence about the reality of people’s lived experience that is as compelling as quantitative metrics. A highlight of the night was Marisa asking if The Lancet would accept a hip hop rap for publication, to capture the lived experience of childhood obesity – an idea well-received by the audience and panel alike.

John Coggon, a professor of law at the University of Bristol Law School, described the role of reason, rules and principles as evidence in guiding philosophers and lawyers working with public health issues. He remarked, ‘Public health is a science, but it is also an art.’

Corinna Hawkes is Director of the Centre for Food Policy at City University of London. She spoke about the emerging discipline of food policy, and the kinds of systems-led reasoning being used to design and evaluate food-related health interventions. She challenged us to consider the stories and the politics behind the food we eat.

All five speakers illustrated the different types of evidence that could be used to inform decision making on issues concerning the public’s health. The audience were asked to select a winner based on the following question: Which speaker convinced you the most about the possibility of diversifying the evidence and reasoning used to address public health issues?

The panel made some compelling points. A recurring theme was why we should (and how we can) put the individual at the centre of public health. Illona Kickbusch emphasised the importance of understanding the politics and ideologies behind public health policy making. And Richard Horton, as always, made a provocative observation that the ‘stranglehold of traditional epidemiology’ meant that the hierarchy of evidence used in health policy wrongly treats lived experience as the least valid form of evidence.

How can I find out more?

Keen to see what the expert panel said about the presentations and who the winner was? Visit the event roundup page, where a video of the event will be available soon. Here you can also read a roundup of the event, download the essays and find out more about the Health Foundation’s healthy lives work.

Sridhar Venkatapuram (@sridhartweet) is Senior Lecturer in Global Health and Philosophy at King’s College London