During the past few weeks, Nesta has been making recommendations to government about how new Research and Development (R&D) funding should be spent to fuel innovation and tackle the UK’s most pressing problems. One of these is rising inequalities in health and wellbeing, which is why Nesta’s Health Lab has argued for a radical shift in investment, infrastructure and approach to prevention R&D.
We’re proposing the creation of a new centre of innovation and research excellence that would provide the profile and leadership needed to put the health of the nation at the top of the political agenda and equip policy makers, practitioners and communities with the knowledge they need to address the social, environmental, behavioural, economic and wider determinants of health. We have suggested calling it ‘The Nightingale’, in honour of Florence Nightingale’s vital contribution to public health research and practice.
With health inequalities growing, life expectancy stalling and the number of people living with long-term physical and mental health conditions increasing, we are long overdue a step-change in research investment and a more experimental and participatory approach. Just 5% of the investment into health research is spent on prevention. This tells us quite a lot about the scale of the problem, but very little about solutions.
The new Government’s commitment to increasing R&D spending as a percentage of GDP creates a unique opportunity to put more investment into prevention research and address the imbalance of spending between preventative and biomedical research. We also proposed that the Nightingale should promote and develop a wide range of research methods to generate and test new ideas and solutions, including transdisciplinary approaches, real-world experimentation, and participatory research in partnership with communities. These approaches can be more effective in ‘messy’ and complex real world systems. Importantly, these approaches can involve building relationships with marginalised communities and conducting action research that can contribute to social and health justice.
At two recent participatory workshops, we brought together over eighty people from different backgrounds and professions to discuss the future of health research and our Nightingale proposal. Academic researchers, research funders, representatives from community groups and charities, policy-makers, service designers, systems thinkers, citizen scientists, architects, public health practitioners, patient advocates and more shared their insights into the current barriers and enablers of research exploring the social, behavioural and environmental causes of ill-health, and the implementation of evidence that already exists. For academics and public health specialists, lack of long-term funding, siloed working, and the pressure to prioritise publications over action means that they lack incentives to work in partnership with communities and find it a challenge to work differently. For community groups who are often conducting community-led research and action (listen to our Podcast for an example of this from the youth sector) they struggle to get their work heard, scaled or to maintain their funding to implement the solutions that communities generate.
We were lucky to have three people present examples of what the future of research could look like through their emerging innovative work. Professor Kate Pickett spoke about a new transformational, city-wide collaborative programme of research and action on child health equity in Bradford called ‘Act Early’. The aim of ActEarly is to create a fairer society for all children in Bradford by ‘acting early’ and identifying, co-producing and implementing system-wide preventative solutions. Kate was followed by Professor Rob Copeland who talked through the soon to open ‘Advanced Well-Being Research Centre’ in Sheffield. This houses a city-wide approach to encouraging physical activity, including their ‘move more’ programme which works closely with different communities. Rob explained some concrete examples of how they’ve used participatory systems mapping to understand the connections between the issues, map community assets and ensure community members’ insights shape the centre’s research priorities and actions. Finally, Belinda Moreau-Jones from Nesta presented Southampton Collective’s breathing space initiative which draws on citizen science and community action to create better health by tackling local air pollution.
Our workshop participants were enthusiastic about the Nightingale proposals, with a clear consensus that a lot more investment is needed to research and address the social, economic, environmental and behavioural determinants of health. Many people felt that a new entity was needed to provide high-profile leadership, to influence policy and funding and shift priorities and practices. However, people felt that it would need to be well networked across the UK, and could even comprise a number of satellite Nightingales distributed across the four nations. A fear of a ‘shiny new building in London’ was clearly expressed and heard.
Overall, there was overwhelming support for valuing different forms of research and development, notably the importance of systems thinking, transdisciplinary approaches and prioritising engagement with communities at all stages - from prioritisation through to design, experimentation and evaluation. There was a recognition that many community groups and charities are already doing this work on a small scale and their expertise should not be overlooked.
The final part of the workshop asked participants to imagine they were reporting the highlights of the Nightingale’s work in ten years time. The multi-disciplinary working groups visioned the headlines of the day with bold ambitions such as ‘research shows the recipe for a mentally healthy city’ and ‘ecological and well-being benefits demonstrated through communities and people power’.
These ‘headlines’ indicate just some of the possibilities for the future of health research and how it can be used to solve the big challenges of our times. At Nesta we are committed to taking this agenda forward and will be campaigning in collaboration with others for this crucial step change in health research investment, ambition and approach .
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