Public Health Challenges. Identified by Public Health England

Transcription

1 Public Health Challenges Identified by Public Health England Environmental Public Health 1. Environmental Change and Health What environmental public health interventions can be identified and developed to support local and strategic decision-making? What is the scope for taking into account co-benefits across the system and differing time scales? How can we better understand the epidemiology and estimate the health impact related to weather and future climate change (including mental health and health inequalities) to ensure that new challenges are considered (e.g. the evidence outlined in the most recent IPCC report, and the new UKCP18 projections)? How can we better estimate direct and indirect weather impacts on noninfectious and infectious / vector borne diseases? How do we maximise the positive health role of the environment whilst minimising the negative impacts of climate change including consideration of co-benefits of strategies to mitigate climate change driven effects? How can social and behavioural sciences support the development of effective environmental public health policies and advice, ensuring their impacts are fair and non-discriminatory for all of society? What are the tangible impacts (both positive and negative, including population movement, invasive vectors and health economic impacts) of environmental public health interventions (e.g. air quality, heat/cold, flooding, housing, built environment, light) 2. Environmental Exposures and Health. What are the chemical physical (eg noise, electromagnetic fields) and particle pollutant exposures that impact the most on public health or cause the greatest public concern? What are the acute and longer-term health consequences of exposures (e.g. chemical and particle pollutant, environmental toxins, drugs of misuse) and how does our understanding of the mechanisms responsible allow risks to be quantified and reduced? What are the critical adverse outcome pathways and interactions between air exposures (bioaerosols, gases and particles) and disease, with a focus on asthma, to inform intervention prioritisation? 1

2 Can epidemiological evidence of air pollution effects on population health, in particular for neurological and perinatal health endpoints, be produced using exposure models of relevance to England for both acute and chronic scenarios? Can evidence be developed and validated on population health impacts of indoor air pollutants such as VOCs, and ingested persistent organic pollutants and other contaminants from land or consumer products. 3. Chemical and Radiation Threats and Hazards Can we define critical adverse outcome pathways from exposures to diseases for radiation (ionising and non-ionising, including UV) and chemicals (including poisons) to improve health risk evaluation for these agents? Can quantitative data on exposure-response relationships relating to the above adverse outcome pathways be obtained and integrated with population health datasets to better model disease risk and improve health risk evaluation, particularly for low-level exposures? Can the health risk assessment and risk/benefit balance for sources of ionising and non-ionising radiation (including UV light) be improved for public, medical and occupational exposures? Where radiation or chemical risks to health exist, can the assessment of the distribution of risk amongst the population (based on age, gender, genetic and other exposures/lifestyle factors) be improved? Can tests be developed and validated to assess individual susceptibility in order to improve health protection Can improved quantitative biomarkers of radiation and chemical exposures be developed and validated to inform health risk assessment, and to improve emergency management? How are exposures to neurotoxins and other highly toxic agents best assessed and their health impacts controlled in normal and emergency situations? What are the benefits and limitations of in vitro systems for chemical hazard and exposure assessment that permit the development of improved regulatory procedures and health protection? 4. Emergency Preparedness and Response How can new technologies and methods for data linkage and interpretation, risk assessment and monitoring support surveillance and response to outbreaks (including biological attacks) and pandemics? How can cutting-edge technologies and modelling capabilities better inform emergency preparedness, policy development and response for the low probability, high impact events identified in the National Risk Register that 2

3 would have serious health consequences, such as Chemical, Biological, Radiological and Nuclear (CBRN) incidents? What is best practice for risk management, including the assessment of risk, interventions, and risk and crisis communication for low probability, high impact events, including chemical and biological incidents? How can communication facilitate effective understanding of radiation and chemical health risks in target audiences, and encourage the adoption of protective behaviours in the event of incidents? How can we ensure that emergency preparedness exercises and training result in performance improvements at the individual, organisational and systems levels, and how can these improvements be maintained over time? How can we improve the identification, tracking and implementation of learning from real incident responses? What is best practice for rapid responsive research on the impacts of major incidents and emergencies, including psychological and behavioural impacts? What novel approaches, including behavioural science interventions and/or new technologies, can we use to improve engagement with, and the uptake of, pre-incident information and advice, to improve public preparedness and resilience and so mitigate the impacts of (major) health protection incidents? Infectious Diseases 5. Emerging and Zoonotic Infections Can we improve knowledge of the evolutionary traits of emerging pathogens, the host response to such infection and early (quantitative) diagnostics in order to develop horizon-scanning capacity and capabilities to respond to emerging threats at short notice? Can we develop approaches for rapid screening and development of interventions to respond to attack by biological threat agents? Can we develop methods for rapidly detecting emerging viruses and enhanced immune diagnostic capability for identifying zoonotic infections? Can we increase our understanding of the risk to public health from vectorborne diseases through investigation of disease exposure in the general population and at-risk groups with particular focus on tick-borne diseases including Lyme in England? Using existing and new data sources and collection systems, can we develop tools to track travel associated infections and measure the impact of travel and migration on the importation of new pathogens? Can studies of the public perception of public health interventions and communications be used to evaluate and improve the effectiveness of public 3

4 health messaging on travel-associated infections and endemic zoonotic diseases? 6. Blood borne and sexually transmitted infections How can molecular epidemiology be used to better delineate transmission networks and the targeting of clinical and public health interventions including the use of phylogeny, characterisation and phenotyping to inform effective treatment and control of viruses and STIs? What interventions would reduce health inequalities intrinsic to populations most at risk of BBIs and STIs (at different lifecourse stages)? What is the impact of STI aetiology on reproductive health and vaccine development? Can we better understand risk factors associated with infection and resistance among blood / organ donors? 7. Respiratory Infections Does evidence from WGS revise our understanding of TB transmission? How can this be used to stratify public health interventions? What is the burden of non-tuberculous mycobacterial disease and are there public health interventions that can mitigate this? Can we develop new approaches for establishing flu vaccine effectiveness in near real time (including refining methodology, estimating impact of drift on vaccine escape and accessing data linkage)? How do the dynamics of respiratory disease transmission differ in vulnerable communities? Can we develop rapid assessment methodologies to track evolutionary changes in respiratory viruses (including Influenza) and utilising generated evidence in the design and formulation of vaccines? 8. Gastrointestinal Infections Can integrating WGS with epidemiological, behavioural, and environmental data provide the most cost-effective prediction of GI disease outbreaks? Can we design an improved methodology for recovering pathogens from patient samples to meet the changes in NHS handling of GI infections? Does the microbiome link poor diet with the higher incidence of noncommunicable disease in more deprived populations? What can be done to reduce the burden of travel-associated GI disease? Can behavioural interventions improve public knowledge, perceptions and attitude towards public health control measures for GI illness and subsequent behaviour/action? Can this contribute to reducing health inequalities? 4

5 9. Hospital Acquired Infections and Antimicrobial Resistance (AMR) What are the best integrated, cost effective approaches for detection, surveillance, investigation and reduction of healthcare associated infections (HCAI) and AMR? Can data linkage improve analysis of multidimensional data in order to understand the at-risk population and the impact of large-scale interventions? What behaviour change interventions will improve infection prevention and control strategies, use of appropriate diagnostics and antimicrobial stewardship? How can we better understand the pathways of AMR transmission across domains (human, animal, environment) and the (extent of the) attribution of each domain to AMR in humans? What is the role of vaccination in reducing HCAI and AMR? 10. Vaccines/Immunisation What are the attitudes of specific patients and the public to specific vaccines and what drives these attitudes? What are the drivers of inequalities in vaccine uptake and which interventions, including behavioural interventions, are effective at reducing inequalities, including in under-served and vulnerable populations? Integrate discovery and analysis of correlates of protection for development and efficacy monitoring of new vaccines What barriers exist to vaccination programme delivery and what are the most successful programme delivery models? How should consent for immunisation be provided? How should immunisation information (including vaccine safety) be provided? What is the morbidity, mortality and economic burden of diseases potentially preventable by new vaccination programmes? What are the predicted effects of new vaccines or changes to vaccine schedules on burden of disease? What is the precise economic benefit of different vaccines or schedules? What is the effectiveness and population impact of new or improved vaccines? What are the best measures to optimise the delivery of immunisation programmes (to include identifying successful models, evaluating economic benefit)? 5

6 Cross-cutting Methodologies 11. Behavioural Science and Evaluation of Interventions How can we optimise the use of modern integrated models of human behaviour (change?) in the design of interventions for a wide range of priority health protection contexts (e.g. infectious disease prevention and control, reducing harmful environmental exposures, increasing adherence to public health risk messaging)? How can the communication of radiation and chemical health risks be improved to encourage accurate public perception of risk and to influence populations to adopt appropriate risk-reducing/health-promoting behaviours? How can evidence on effective environmental health interventions be evaluated and summarised systematically for use by decision-makers? Develop tools and methodologies for rapid evaluation to inform prompt health protection action, including evaluation of outbreak response and control using mixed methods approaches and behavioural evaluations. Improve understanding of the risk perceptions and behaviour of the population, patients and healthcare workers in infection transmission and in response to health protection interventions (for infectious diseases and environmental hazards) and use it to inform the design and evaluation of novel interventions. Support the evaluation of health protection interventions by providing a multidisciplinary resource with a strong behavioural science component and the effective use of technology and innovation. 12. Genomics and Enabling data Develop improved methods and algorithms for rapid and effective detection of genetic variants, and analysis of the impact of microbial genome sequencing on outbreak detection, investigation and monitoring, in particular, tracking real-time progression of the outbreak. What synthetic evidence methods and machine learning take account of the complex transmission dynamics of infectious diseases, using data from surveillance systems, population-based surveys, genetic sequencing, epidemiological data from contact tracing and behavioural data? Develop tools and methods for rapid collation, visualisation and analysis of microbial genomic data for robust characterisation and prediction of resistance, and linking data to reservoirs and sources of transmission to identify threats. 6

7 How can more granular data be achieved to enhance understanding of infections and drug resistance, devising policies and monitoring outcomes without significantly increasing data collection burdens? Develop genomics approaches for the assessment of hazard and disease risk (at individual and population levels) associated with environmental chemicals and radiations, and their application in toxicological testing. 13. Modelling and Health Economics Undertake economic evaluation and prioritisation of different approaches to case-finding for chronic asymptomatic infections How do the public value prevention of infection, in children and adults? Develop tools to facilitate modelling and analysis of infectious disease outbreaks together with approaches for developing a workforce capable of using these tools appropriately. Model pressures on health services including development of methods to synthesise data sources, make local predictions of timing and magnitude, and assess the impact of interventions to mitigate pressures. Develop tools to undertake modelling of dispersion of pollutants, and modelling the impacts of climate change and mitigation strategies. 7