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Globally, many health research-funding organisations, public and charitable, felt the need to demonstrate to policymakers and the public how their investments in research were benefitting society. HERG's research on developing techniques for assessing the payback (or impact) from health research tackled this need. The payback stream of research itself has had significant, wide- reaching and cumulative impacts. First, internationally, health research funding bodies adopted the framework in their evaluation strategies, including to provide accountability. Second, many stakeholders made extensive use the findings of payback studies in public debate and private lobbying for public expenditure on health research. Third, governments, public research funding bodies and medical research charities, from the UK to Australia, used the findings from payback studies to inform decisions regarding the levels and distribution of health research funding, with the aim of increasing the health and economic benefits that come from investments in research.
Novel research into the cardiovascular and other health benefits of consuming flavanol-containing foods at the University of Reading prompted a multi-national food and confectionary producer, Mars Incorporated, to invest over £1.1 million in research into the absorption, metabolism and health effects of cocoa-derived flavanols in humans. This research informed the development of a cocoa-extract supplement drink and supplement extract, both widely available in the US since 2010. This in turn sparked interest from other multinational corporations looking to market flavanol- and other flavonoid-containing health products, resulting in an additional £917K investment by industry. Mars' cocoa-extract supplements currently hold a 1% share of all food and drinks marketed on a cardiovascular health platform in the US; a market worth US$3.1 billion in 2012. Research by Reading and others has provided evidence that consumption of these products can improve memory and cognition, cardiovascular health and digestive health for consumers. These and other research findings have been widely disseminated to the general public by the Reading researchers.
Our impact has been to protect the public by informing and influencing both the international policy debate on health claims associated with soy consumption, and the relevant regulatory risk assessment authorities.
Our research formed a key component of dossiers that resulted in the rejection of health claims by the European Food Safety Authority (EFSA, the EU agency responsible for the scientific substantiation of health claims) relating to soy isoflavones and a number of health endpoints including bone health, heart health and menopausal symptoms. Earlier work had underpinned decisions on comparable health claims in the US and UK.
Our soy isoflavone research also provided key scientific data on the absorption of isoflavones by the body (and dependence on age and food source) to the UK Government Committee on Toxicity (COT) policy review on the toxicity of chemicals with a specific focus on soy infant formula. This expands on COT advice in 2003, which used earlier Cassidy research and helped to inform the UK government's (Food Standards Agency) research programme on phytoestrogens /isoflavones.
Adults with learning disabilities (LD) often cannot adequately report illness and there is evidence that treatable illnesses go undetected. As a direct result of Cardiff University research on health checking adults in primary care, the Welsh Government and the Department of Health now provide funding for all adults with LDs across England and Wales to receive an annual health check that employs Cardiff University methods. Current data on take-up (N=78,000 per year) and evaluation of results show that nearly 250,000 adults with LDs have had new health needs identified and treatments initiated during the REF assessment period (2008-2013). Nearly 40,000 adults per year will have new health needs identified and treatments initiated as a result of the health checks, with approximately 3,500 of these being potentially serious conditions.
Health inequalities are recognised as a critical UK policy issue with life expectancy gaps of up to 28 years between the least and most deprived areas. This case-study demonstrates how Durham University research has led to: (a) changing health service commissioning (with County Durham and Darlington Primary Care Trust [PCT]): (b) influencing NHS funding policy (by generating Parliamentary debate); as well as (c) contributing to the development of the new public health system in England and Wales (as part of the Strategic Review of Health Inequalities in England post-2010 [Marmot Review]).
The `People in Public Health' (PIPH) study and related research on health trainers, health champions and volunteers has brought together evidence on rationales for lay engagement, effectiveness and models of support. Dissemination activities, supported by a Department of Health grant, have achieved reach into various policy arenas and national networks. At the same time there is evidence of research utilisation in public health practice. One of the impacts has been the establishment of `Active Citizens for Health', a national network of partner organisations to bring together evidence and learning that has been hosted by Leeds Metropolitan University.
Evidence about the need for and provision of health visiting services generated through research undertaken at King's College London (KCL) has underpinned major changes in national policies for health visiting. Our findings about health visitors' practice, availability and distribution of services and effectiveness in terms of parenting/child outcomes, revealed both shortfalls in provision and opportunities for improvement and led to the development of a new caseload weighting tool and funding model for service planning. The accumulated evidence from this research helped convince the UK Government in 2010 to commit to 4,200 more health visitors by 2015 — a workforce expansion of nearly 50% — in a time of austerity and restraint elsewhere in the public sector.
In November 2008, Professor Sir Michael Marmot and his team at UCL were asked by the Secretary of State for Health to chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England. The Marmot Review, published in 2010, has fundamentally shifted discourse on health inequalities in the UK and internationally. It has shaped public health services across England and around the world, guided government and international policy, and has given rise to a new commitment from service providers and health professionals to reducing health inequalities and addressing the social determinants of health.
The Department of Health seeks to distribute the NHS budget to local commissioning organisations to achieve equal access for equal need and reduce health inequalities. The formula upon which it bases this distribution must be evidence-based, robust and up-to-date. We summarise four pieces of applied econometric research undertaken at the University of Manchester (UoM) and commissioned by the Department of Health that have developed the methodology for setting budgets fairly and determined the content of the formula in use in England from 2008-date. Adoption of the findings of this research by government has led to a substantial redistribution of NHS funding between areas.
Strathclyde research underpinned formation of the Scottish Chikhwawa Health Initiative (SCHI) in 2006, to deliver tangible health benefits by reducing major causes of disease and death in Chikhwawa, Malawi. Health impact occurred through training of government personnel and community volunteers, combined with increased infrastructure capacity, at health facilities and in the community, producing improvements in water quality, sanitation and communicable disease control. Within the first 2 years of implementation among a population of 5700 people, a 30% reduction in diarrhoeal disease was achieved, and access to safe water improved through increased water points and improved water storage [1]. Initial success saw expansion of the initiative to 150 communities covering a population of 110,000.