Public health needs an injection of genuine impact

The past few decades have seen an exponential rise in the number of publications produced by public health academics. Yet this inexorable rise cannot possibly be said to have led to exponential improvements in public health. Today’s academic institutions are far from maximising their potential for catalysing social change.

Currently, academia values innovation at the expense of implementation, and academic research output is only loosely related to social value. Researchers pursuing limited faculty positions are driven to identify niche areas that demonstrate novelty and differentiate their work from that of peers. But while the resulting publications, citations, grant income and conference invitations are important indicators of academic standing, they say little about the societal value of research.

Communities that provide researchers with their time, knowledge, data and biological material – often taking on considered risks to help evaluate experimental interventions – should rightfully expect to benefit from the results. But we typically assess the social value of research in somewhat tokenistic and irrelevant ways.

For instance, academics are often asked to state how many policies will result from their research, or how much disease will be averted as a result of implementing new interventions. But this ignores the fact that academics lack training in policymaking and advocacy, and that most policies take years, if not decades, to implement – assuming political will, financing and social acceptance are there.

Tobacco research is a case in point. Firm evidence of a causal association between tobacco smoking and lung cancer has existed since at least the 1950s. In recent decades, many countries have demonstrated the health benefits of tighter regulation and more extensive public health interventions around smoking. Despite this, globally we still consume more cigarettes than at any point in history. But the social value of tobacco research undoubtedly extends far beyond estimates of deaths and cancers averted. It also encompasses societal discussions around health resources allocation, health and gender inequalities, individual choice versus public good, use of scientific evidence by corporations and public institutions, and industry lobbying and misconduct.

Corporations’ market share or stock value provide some indication – admittedly not always optimal – of their performance. In contrast, there is little external validation of the social value of academic output. Our focus on metrics of volume and prestige also disadvantages precisely those individuals who can most contribute towards a more inclusive, representative and progressive research community. Rewarding publication in leading international journals, for example, favours researchers from well-resourced institutions in richer countries.

Globally, low- and middle-income nations experience two-thirds of all deaths and three-quarters of disease burden. According to Elsevier data, scientific output from Africa quadrupled between 1996 and 2012, but this still represents only a doubling in the continent’s share of global scientific output, to 2 per cent, meaning that inequalities in scientific publication have decreased only modestly over time.

Even in rich countries, women and ethnic minorities are under-represented in senior public health positions. For instance, only a third of US schools of public health have female deans, even though 45 per cent of the global disease burden falls on women. Research indicates that male and female leaders pursue starkly different health and development priorities, so this lack of diversity can significantly affect which areas of research are prioritised, limiting impact. Countless female academics can attest to the under-prioritisation of gender-specific health issues.

There are some signs of positive change, including innovative funding opportunities for research that integrates a gender dimension when addressing urgent social challenges, and research impact assessment methods for assessing gender bias and equity.

But more needs to be done. Academic institutions spend inordinate amounts of time evaluating their values, missions, visions and research priorities. But the mission of public health and global health institutions should already be clear from the United Nations’ 17 Sustainable Development Goals, which specifically mention universities as key players.

These global goals should be emblazoned across the lobbies of every school of public health, and researchers, institutions and funding agencies should be judged on their contribution towards meeting them. Graduate programmes should prioritise training in community-based participatory research, in which communities are involved in everything from developing relevant research questions to the interpretation and implementation of findings. This can make research more directly relevant, and provide a mechanism to address health issues specific to underserved populations. Citizens’ juries, for example, are increasingly used in some settings to adjudicate on the value of public health policies, while contributing to social engagement in scientific discourse.

Many research funders have recently implemented open-access mandates to make research more accessible. They have also moved to boost reproducibility by requiring the accessible archiving of research data. It is now time to make research more accountable.

Clarence Tam is an assistant professor and Vittoria Offeddu is a research fellow in the Saw Swee Hock School of Public Health at the National University of Singapore. Teck Chuan Voo is an assistant professor in the NUS Centre for Biomedical Ethics. Neisha Sundaram is an assistant professor in the department of global health and development at the London School of Hygiene and Tropical Medicine.