All the medical Royal Colleges and the independent, standard setting institutions which are the homes of engineering, architecture and other major professions, award prestigious, often eponymous, honorary appointments. By this means, national institutions celebrate and incentivise the public good which their professions deliver. In this tradition, the Faculty of Public Health (FPH) has developed its new Bazalgette Professorship scheme.
Nowhere, perhaps, is such an incentive needed more, especially for academics and their teams. The disconnect between academic public health and public health practice is clear; this has happened gradually but its effects are profound. Among the most important of these are that public health research is less focused than previously on solving the problems encountered in public health practice and that, as a result, trainees in public health are rarely attracted by the research products of, and potential career advancing opportunities in, academic departments.
A cause of this problem is the geographical distance between places where public health trainees and academics work, exacerbated by the absorption of public health into local authorities. This is in sharp contrast to academics and trainees in other branches of healthcare. In primary care, emergency medicine, dentistry and orthopaedics, for example, trainees are co-located with academic departments based in the practices and hospitals where academics practice their art and craft. This co-location and integration of training, research and practice, led by academics whose research is prompted and sustained by the everyday challenges of practice, is a model from which public health has largely withdrawn.
The march of evidence informed practice was largely prompted, and certainly accelerated, by practitioners deeply worried about the effectiveness of treatments available for their own patients; practitioners who have learnt trials skills, and then championed evidence informed change for the better. Separate practice from research though, as has happened in public health, and this motivation dissipates, and the precious evidence ecosystem in medicine, in which evidence generation, synthesis and mobilization are joined, fractures. Crucially, John Snow identified a source of cholera in Victorian London and took the handle off the Broad Street pump.
This disconnect is having negative effects in other ways too. For example, public health academics, because they have become separated from public health practice, are less able to demonstrate the significant contributions to the delivery and development of services which are necessary to compete successfully for clinical excellence awards.
As another example, although alcohol misuse is a major public health problem, medical presence on the Home Office health and enforcement alcohol forum (formerly the alcohol strategy group) comprises three liver doctors, a psychiatrist and a maxillofacial surgeon – practitioner academics all – but no public health academic. This may reflect Home Office blinkers but might it also reflect concentration of alcohol research relevant to practice and policy, and also real concern about the life destroying impact of alcohol misuse, not in public health but in these other disciplines? Surprisingly to clinical academics in other specialties, there has been little academic public health interest in putting NIHR funded findings about alcohol licensing into local action.
From this perspective, solutions suggest themselves. Strategically, public health academic departments need a physical presence in local authorities; professors of public health need to be co-located with public health practitioners and policy makers so that problems can be solved, hypotheses formulated and tested, and evidence applied together. Crucially, this would also benefit trainees, their supervisors and their research teams and make their endeavours more relevant, impactful and valued by local authority chief executives. But achieving this co-location, and evidence co-production and implementation is a major challenge. Other solutions are also needed. This is why the concept of an FPH professorship scheme came about.
The new Bazalgette professorships commemorate and seek to maintain the tradition of Sir Joseph Bazalgette, chief engineer to London’s metropolitan board of works in the mid-19th century who, through implementing his design for an efficient sewage system, did much to eradicate cholera across the city. Importantly, throughout this work, Bazalgette continued to train young civil engineers and provide independent advice to other British towns and cities – as well as places as far apart as Budapest and Port Louis, Mauritius. Recipients of this FPH honour will be scholars who, especially as team leaders, have translated their research to the benefit of UK population health.
FPH will appoint no more than one Bazalgette professor in any calendar year during which the holder will hold the honorary title of professor. Appointees will be fellows of FPH in good standing who have made a major contribution or contributions to public health by translating their own research. Since research translation involves collaboration, appointees will have built and sustained translation teams. These teams might include, but would not be limited to, NHS, civil service or local authority colleagues.
Two comments galvanised my thinking on this: the assumption expressed at FPH by a distinguished professor of public health that academics and practitioners are entirely separate groups, and the spontaneous reaction of a senior public health academic in my own medical school to the question why academics don’t consider themselves practitioners, “Well, we’ve tackled cholera haven’t we?”
Written by Jonathan Shepherd, professor of oral and maxillofacial surgery at Cardiff University. Jonathan generated the idea of the Bazalgette Professorship and secured funding from the Alliance for Useful Evidence to fund it, for which FPH is most grateful. Jonathan is a fellow of the Royal College of Surgeons of England and the Academy of Medical Sciences, and an honorary fellow of FPH and the Royal College of Psychiatrists. He is a member of FPH’s Academic and Research Committee.
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