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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.
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.
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.
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]).
Research by the School of Pharmacy has been used by the UK Government in their drive to improve the nation's public health. Our evidence base was used to inform the 2008 White Paper "Pharmacy in England: Building on Strengths — Delivering the Future". Healthy Living Pharmacies, recommended by the White Paper, have been piloted leading to improved engagement with local commissioners, further training for pharmacy staff, more cost-effective delivery of public health services, and an increase in public awareness and access to these services. In addition, the Government backed Pharmacy and Public Health Forum is utilising our research in its remit to develop, implement and evaluate public health practice in pharmacy.
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.
Public financing of health services in low income countries was challenged by the World Bank's Agenda for Reform in 1987, which advocated increased roles for private sector, private insurance and user fees. This was followed by a wave of reforms implementing this approach. McPake has been involved in researching the implications of this shift since this period and has published a series of influential articles that have had a demonstrable impact on this debate. Removal of user fees for all, or selected, services or for selected population groups has occurred in many countries, including 28 of 50 countries with the highest maternal and child health mortality included in a recent survey (http://bit.ly/17FUiDM). Witter is the lead researcher who has examined country level experiences of removing fees and it is demonstrable that her work has been applied in specific countries to shape the details of policy and has also had a major influence on the global debate.
Empirical evidence generated by UEL research has directly influenced the reform of health financing in two Indian states with total populations of 154 million through changes to provider behaviour, the organisation and use of funds, and treatment verification processes and package rates. The impacts of this work have been commended by the UK Department for International Development (DFID) and the World Bank, and attracted interest from states with similar healthcare schemes. More widely, it has helped policymakers in India and the UK recognise the importance of including high quality comprehensive primary care in India's strategic planning for universal health care, and the benefits to the UK in prioritising primary care collaboration with India.
This body of research, led by Plymouth University, has challenged the model used for NHS resource allocation because it does not promote `equal opportunity of access to health care for equal needs', a core principle of the NHS. The research has stimulated debate amongst policy makers on NHS resource allocation and the team's mental health estimates were used to allocate £8billion of NHS funding. The Department of Health described this as a "step-change improvement". Their research is also one of the factors which led to the end of the Four Block Model, the £29 billion formula grant at the centre of the local government finance system.
The populations of over 250 European and near Eastern cities are benefitting from closer integration of health and planning. As a result of research undertaken at the World Health Organisation Collaborating Centre for Healthy Urban Environments (WHO CC), built environment professionals have integrated concerns about public health into their decision-making and, correspondingly, public health professionals have engaged with how urban places affect health. Based on a long-term programme of empirical study, this has happened through our development, and subsequent operationalisation, of the concept of `Healthy Urban Planning'. The adoption of our models, assessment tools and appraisal methods, has fostered a new emphasis on urban development and planning at neighbourhood level; the implementation of which has resulted in more active lives, more inclusive communities and environments that support health.