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Population health:Forget tech, modifying social structures should be our collective focus

Following the World Health Organisation/UNICEF Global Conference on Primary Health Care, Dr Luke Allen, from Oxford’s Department of Primary Care Health Sciences explains how to improve population health

I write from Astana – capital city of Kazakhstan. Hundreds of health ministers, policymakers, academics, and campaigners have braved the cold to reaffirm their commitment to a 40-year-old WHO/UNICEF declaration. The Declaration of Alma-Ata was forged in the geopolitical turmoil of the late 70s and committed countries to social, political, economic and health sector reform, propelled by a sense of democratic social justice.

Today health inequalities  continue to widen and the richest in our societies enjoy much longer and healthier lives than the most disadvantaged. Why?

We often tend to think that the main ingredient for better health is access to high quality healthcare: doctors, nurses, hospital beds and fancy scanners. In reality, healthcare is only responsible for around 10% of the health improvements we have experienced over the past 50 years or so. Genetics play a role, but much more important are non-medical factors like education, clean water, transport, the local food environment, access to green space, pollution, and cultural factors that influence the likelihood that locals smoke, drink harmfully, exercise, and eat healthily.

This ensemble of ‘social determinants of health’ are responsible for approximately 80% of deaths due to cardiovascular disease, chronic respiratory disease, type 2 diabetes, and cancers – earning this tetrad the moniker ‘socially transmitted diseases’. It stands to reason that however promising the next precision medicine blockchain nano-delivery VR widget is, interventions that do not fundamentally address socio-political building blocks of towns and neighbourhoods will only ever tinker at the fringes.

That’s not to say that medical tech can’t make big differences to individuals, it’s just that new tech breakthroughs often take a long time to reach the scale where they influence population means, and even then benefits are disproportionately enjoyed by the wealthy. Conversely, interventions aimed at socioeconomic conditions, e.g. welfare, smoke-free spaces, free school meals, fluoridising water or reducing salt in bread, often make a negligible difference to individuals but lead to large aggregate reductions in death and disability with the least advantaged benefitting the most.

The Alma-Ata Declaraton (and the new Astana Declaration) commit governments to the basic, slightly boring work of reorienting their health systems to focus investment on public health measures, communities, and the economic and political environment. This is potentially inflammatory for countries pursuing radical capitalist policies, and for autocracies that struggle with viewing individuals and communities as partners rather than potential threats to stability. Alma-Ata’s audacious vision for health systems also challenges the British health research paradigm, reminding us that even the biggest pharma RCTs are never going to make that much of a difference. We need more interdisciplinary research combining health, politics, economics, and social science, as well as better methods to understand which interventions are most effective in the messy, confounded, complex, and dynamic systems of public life.

Dr Luke Allen (@drlukeallen) is a GP academic clinical fellow working at the Nuffield Department of Primary Health Care Sciences in the Interdisciplinary Research in Health Sciences group. He is also a primary care consultant for the World Health Organisation.

Scientists swap labs for Westminster

Professor Deborah Gill from the Radcliffe Department of Medicine and Dr Luke Jostins-Dean from the Kennedy Institute at the University of Oxford recently swapped lab coats for legislation at the House of Commons for a week in Westminster. The week is part of a unique pairing scheme run by the Royal Society – the UK’s national academy of science, with support from the Government Science & Engineering (GSE) profession.

During her visit, Deborah, who is a Professor of Gene Medicine, and Co-Director of the Gene Medicine Research Group, shadowed Tony Whitney, senior policy advisor for Public Engagement with Science for the Department of Business, Innovation and Strategy. Dr Jostins-Dean shadowed local MP for Oxford East, Annaliese Dodds.

As well as attending seminars and panel discussions about how evidence is used in policy making, the two researchers also attended a mock Select Committee.

The visit provided the Oxford academics with a behind the scenes insight into how policy is formed and how their research can be used to make evidence-based decisions. It was also to give the politicians the opportunity to investigate the science behind their decisions and improve their access to scientific evidence.

Professor Gill said: 'Science is a shared endeavour in society and communicating with the public is crucial to agreeing future research directions. In my research, using gene technologies, responsible public engagement builds trust and transparency. The Royal Society pairing scheme is a fantastic opportunity see this in action.'

Speaking of his pairing, Dr Jostins-Dean said: 'In my research I work directly with patients' genetic and healthcare data, and my work is heavily influenced by government policy around data sharing, treatment decisions and confidentiality. I am excited to learn from Anneliese how new laws are made, and how we as scientists can provide evidence to help parliamentarians make and scrutinise government policy.'

'I'm very grateful to the Royal Society for pairing me with a scientist, for a second year. It has been really interesting to spend time with Dr Jostins-Dean, in order both for him to find out more about how parliament works but also for me to find out more about his life as a scientist! It is very important that we build more links between science and politics, and I think the Royal Society scheme is an excellent way of doing that. I am looking forward to getting some hands-on experience of Dr Jostins-Dean's work when I do the reciprocal visit with him back in Oxford,' added Anneliese Dodds.

The MP for East Oxford will find out about Dr Jostins-Dean research, which focuses on identifying genes that increase our risk of developing inflammatory bowel disease (IBD), and on coming up with new mathematical and experimental ways to understand how these genes impact the human immune system.

Tony Whitney will get hands on experience of Professor Gill’s work, which includes developing gene therapy for lung conditions such as cystic fibrosis, in a reciprocal visit next year. Researchers at the University of Oxford’s Radcliffe Department of Medicine also hope to learn more about engaging the public with their work during his visit.

The Royal Society’s pairing scheme, which started in 2001, aims to build bridges between parliamentarians, civil servants and some of the best scientists in the UK.

Shazeaa Ishmael, a Diamond CDT (Centre for Doctoral Training) student working within the NQIT programme

By Julia Flynn, NQIT Communications Manager

Earlier this month the Engineering and Physical Sciences Research Council’s (EPSRC) UK National Quantum Technology Hubs successfully delivered the third annual Quantum Technologies Showcase, demonstrating the technological progress emerging from the national research programme.

There were over 80 exhibits, together with briefing sessions that asked ‘Are you ready for quantum?’ For the exhibitors it was a chance to discuss their work and highlight the achievements in quantum technologies in what has been a coordinated national effort. The 700 plus visitors could see the advance of quantum technologies and the potential to benefit their businesses and organisations, as well as for society as a whole.  

Quantum Technologies ShowcaseQuantum Technologies Showcase

The Showcase was divided into zones, from transport to defence and healthcare and many more. The Networked Quantum Information Technologies Hub (NQIT), led by the University of Oxford, had nine exhibits showcasing the multiple approaches to building quantum machines based on high performance qubit systems, and emerging quantum information processing technologies. They also had a busy Hub stand that explained the whole work of NQIT, inbuilding the essential systems for the Q20-20 quantum computer demonstrator and creating a world-leading quantum computing economy in the UK.

Participants were able to see demonstrations, showing the enormous engineering progress being made to build the complex systems and components for scalable quantum computers based on different architectures  including ion traps and superconducting circuits.

One of NQIT’s stands ‘Create your own qubit in diamond’ demonstrated how its researchers are developing methods to write qubits into diamond using ultrashort laser pulses. Visitors were excited to be able to remotely connect to the laser writing lab in Oxford and control the set up to write their own quibits, creating a single Nitrogen Vacancy in a synthetic high quality diamond.

While many of the exhibits looked at the advances in research, hardware and engineering that are core to building a scalable quantum computer, NQIT spin out applications and companies were also present, such as the random number generator, a patented application from NQIT’s photonics work stream. Oxford Quantum Circuits, one of the three NQIT spinout companies, had a prototype quantum computer at the Showcase, giving visitors the opportunity to perform some quantum logic, based on superconducting quantum hardware.

As well as the buzz and interest in the many exhibits visitors also heard more about the UK Government’s pledge of a further £235 million to support the development and commercialisation of quantum technologies, including up to £70 million from the Industrial Strategy Challenge Fund, and £35 million to support a new national quantum computing centre. This investment is in addition to the government’s £80million extension of the Quantum Technology Hubs and takes overall funding for the second phase of the UK’s world-leading National Quantum Technology Programme to £315 million.

Phase I of the UK Quantum Technology Programme has been a pioneering programme that has transferred scientific leadership into innovation and technological leadership. Phase 2 will build on that work to make the UK the ‘go-to’ economy, creating opportunities for industry and the development of new skills geared toward exploiting these new quantum technologies.  

Image credit: Shutterstock

Human factors are responsible for a number of key environmental and species declines today, but has it always been the case? 

Oxford University researchers have published a comment piece in the journal Science asking this very question in relation to dwindling megaherbivore populations on the African continent (species of mammals that weigh more than 1000kg, such as Elephants, Giraffes and large Hippos).

In the article, Dr René Bobe a Research Associate at Oxford’s School of Anthropology & Museum Ethnography, and Dr Susana Carvalho, Associate Professor in Palaeoanthropology and a Fellow of St Hugh's College, offer a perspective on a paper featured in the same issue which suggests that human ancestors have played no role in the demise of these animals.

However, in their perspective the two challenge this perception and suggest that addressing the question of when humans or our ancestors begin to play a role in driving the largest mammals to extinction is key to determining any fault, whether direct or indirect.

Dr Bobe explains: ‘The article by Faith et al. detects the beginning of megaherbivore decline by 4.5 million years ago, at a time when our evolutionary ancestors were unlikely to have played a role. However, our perspective indicates that there are important gaps in our knowledge of early human ecology, and that species like Homo erectus may have played an indirect role in changing the landscape and triggering extinctions.’

Dr Carvalho adds: ‘There are other factors to consider in what was undoubtedly a complex process: What was the role of fires in changing the landscapes of human ancestors and the animals that lived with them? Did predation patterns change during times of drought to have a major effect herbivore species that reproduce slowly and have a long life span? When did humans begin to hunt very large species?’

In conclusion, the piece finds that the role that humans and our ancestors may have played in driving the largest African mammals to extinction remains an open question.

Demo Night 2018

By Leah Thompson

You would think that by the time you have done four events like this, that you would be cool, calm and collected, and ready for anything.  But of course, being entrepreneurial means that you are constantly tinkering and trying to improve the format . . . meaning that nothing is ever quite the same.  This event was no different. . . you spend half the time worrying that no one will show up, and the other half of the time worrying that everyone will show up! 

Demo Night 2018Demo Night 2018

Credit: John Cairns

And so began the fourth #StartedinOxford Demo Night, held in early November at Blackwell Hall, Weston Library.  21 startups, 16 sponsors and partners, and countless volunteers joined a full house of students, academics, local residents and businesspeople from Oxford and beyond in celebrating the Oxford entrepreneurial ecosystem.  There were early stage startups, spinouts and social enterprises with links to University of Oxford or Oxford Brookes University, and some who are based in Oxford (and a special guest slot for an Imperial College team!).  The strength and depth of the Oxford entrepreneurial scene really shone through

Demo Night 2018Demo Night 2018

By John Cairns

Each attendee was given 1000 #StartedinOxford dollars to "invest" in the startup they liked the most.  It was a great way to encourage the attendees to find out as much as they could about each venture.  After a welcoming introduction by Pro-Vice Chancellor (Research) at the University of Oxford, Professor Patrick Grant, the attendees were left to explore the hall, and to meet as many exhibitors as possible in the short time.   The ventures focused on everything from food, health, accessibility and shopping, to better cultural exchanges, data collection and creativity – using a massive range of innovative solutions.  In addition, there was a whole host of entrepreneurship support including The Careers Service, Begbroke Science Park, the Bioescalator, MPLS Enterprise and the Oxford Foundry, as well as external organisations such as the Oxford Hub, Oxfordshire LEP and Oxford Brookes Enterprise

Demo Night 2018Demo Night 2018
The hall was buzzing all evening; there were plenty of discussions between new friends and time to catch up with old ones too.  There were demonstrations, discussions, and exchanging of cards and information.  However it was soon time for the attendees to "invest" in their favourite startups, count up the cash, and declare the winners.  During the counting, we had two pitches: one from our previous winner, OxyClot (a medical startup developing a quick, non-invasive and accurate point of care diagnosis of DVT for use in GP practices) and Mitt (pictured), our guest team from Imperial College (a new type of prosthetic arm with a soft, comfortable socket with a range of simple, interchangeable hands designed for specific tasks).

Demo Night winners Common GroundDemo Night winners Common Ground

Credit: John Cairns

First prize went to Common Ground, the social enterprise pop-up café and social space supporting the community and student mental health. PodHealth, working on prevention-led, personalised healthcare, claimed second prize.  And third prize went to Wallaroo, providing nutritious fair-trade food snacks from community-based farms in compostable packaging. 

What made this evening so much fun was the relaxed atmosphere, and the ability of the attendees to speak directly with the startups.  Each person could directly ask questions, and interact with the teams, making it very personable and enjoyable.

A huge thank you to all the startups, our sponsors, the fabulous volunteers, and of course everyone who came and made the event a success! 

Leah Thompson (pictured at the top of the blog) is a Project Officer in the Knowledge Exchange and Impact Team, in Research Services.  She leads on Enterprising Oxford, a University of Oxford programme to connect and support entrepreneurship in the University and wider Oxford area.