MRC Social and Public Health Sciences Unit
Unit profile from the MRC Network publication issued Winter 2004.
Medical research is about more than laboratories and hospitals. People's social and physical surroundings and lifestyle all affect their health. The MRC Social and Public Health Sciences Unit has carved a research niche that epitomises the MRC's public health tradition.
The origins of the Social and Public Health Sciences Unit lie in the MRC's Obstetric Medicine Research Unit, set up at Aberdeen University in 1955 to look at how factors such as housing conditions and poverty affect women's reproductive health and childbirth. When Director Sir Dugald Baird retired in 1965, the Unit became the MRC Medical Sociology Unit. It moved from Aberdeen to Glasgow University in 1984, with Sally Macintyre as its new Director. In 1998 the Unit merged with the Scottish Executive Public Health Research Unit, which had also originally been established to explore social aspects of maternal and child health. The Unit's new name – the Social and Public Health Sciences Unit (SPHSU) – reflected its broader remit covering social and environmental influences on health. The SPHSU is jointly funded by the MRC and the Chief Scientist Office (CSO) at the Scottish Executive Health Department.
Evidence-based public health
The major UK and international health priorities, including cancer, heart disease, obesity, diabetes, and sexual and child health, all show strong social patterning. These differences reflect social, environmental, cultural and economic influences such as wealth and social status, social cohesion and exclusion, housing and working conditions, education, family life, gender, sexuality, age and ethnicity, and people's options and choices about how to live their lives. Although tackling health inequalities is a policy priority in the UK and abroad, until recently there has been little rigorous analysis of strategies to improve public health and reduce inequalities. However, evidence-based approaches to improving public health are becoming increasingly important in Government thinking. The Wanless report, Securing Our Future Health:Taking A Long-Term View (2004), highlights the need to assess the scale of the problems, to find out how people's circumstances and behaviour promote or damage their health, and to design and evaluate measures aimed at reducing inequalities. The SPHSU is ideally placed to address these priorities and to help bridge the gap between social science and policy-making.
The Unit has spent many years investigating social and environmental influences on health and its major contributions have gained international recognition. Its seven research programmes encompass diverse disciplines including psychology, anthropology, sociology, geography, and history, complemented by expertise in epidemiology, systematic review and statistics. The SPHSU's future research will build on its traditional strengths, with increased emphasis on the rigorous evaluation of interventions, and expanded geographical and historical coverage.
Research advantages of Scotland
Overall, people's health in Scotland is generally worse than in the UK, and Glasgow shows particularly stark contrasts between social groups. Areas of concentrated deprivation with double the UK death rate are found alongside neighbourhoods with the highest life expectancy. Such extremes make Glasgow a rewarding setting for SPHSU researchers.
In 1987 the Unit began the "West of Scotland Twenty-07 Study: Health in the Community", a 20-year study of three groups of people then aged 15, 35 and 55, to find out how social circumstances contribute to health and inequalities. The study has collected a wealth of data on people's health, lifestyle, and environment, and is one of the Unit's most important resources. Other SPHSU studies include one on teenage health that follows 2,500 11-18 year-olds, and "Children of the 1950s", a collaboration with the London School of Hygiene and Tropical Medicine, which is revisiting 12,000 people first studied in 1962 at the ages of 7-12 by the MRC Obstetric Medicine Research Unit.
Although it exploits opportunities afforded by its Scottish location, the SPHSU's work is ultimately of global relevance as it deals with social and biological processes that are common the world over. The Unit has an active and expanding programme of collaborations with researchers in other countries, which enables it to draw comparisons that can reveal common health determinants and patterns of inequalities, and set the UK situation in an international context.
Scotched myths
Have billions of pounds spent on urban renewal in the UK over the last 20 years measurably improved the nation's health? Do out of town supermarkets create 'food deserts' with reduced availability of affordable healthy food in poor areas? And is channelling additional resources to deprived neighbourhoods an effective way to benefit poor people and tackle health inequalities? If public health policy is to have a sound basis, it is important that answers to questions like these are based on scientific evidence rather than common assumptions. The SPHSU's work frequently involves scrutinising conventional wisdom, and often finds that what people take for granted is either unfounded, or more complex than expected. For example, one SPHSU study found that supermarkets were more likely to be found in poorer rather than richer areas of Glasgow. Another showed that in Scotland targetting the poorest 20 per cent of areas would miss more than half of unemployed people and two thirds of low income households. And while there are 30 per cent more deaths in Scotland in winter than summer, an SPHSU analysis has demonstrated that this seasonal increase is not linked to poverty.
Twenty-first century public health
The Government's goal of improving the nation's health through a new partnership with a public that takes greater responsibility for its own health is a considerable challenge. A policy framework that aims to change deeply rooted social inequalities and ingrained cultural attitudes to health will require improved data and designs for studying social factors. It will also require research into the thinking and behaviour that affects people's health and how to influence these effectively.The SPHSU's work is at the forefront of international progress in these areas. It will play an integral part in generating social scientific evidence to support new public health policies and in ensuring that the MRC's public health tradition continues to flourish.