1. Owing to the generosity of Sir WJ Thomas an Institute of
Preventive Medicine was built in 1921 for the Department of
Public Health and the School of Preventive Medicine.
Sir William Osler:
“
I think we can look forward with
hope to the inauguration of a really great
School of Preventive Medicine…that will
be an example to the world….
…The Professor must have a burning
enthusiasm for research.”
2.
3. Professor Edgar L Collis
Inaugral Lecture: ‘Finem Respice’ Lancet 1920;i:6-11
• ‘The task to be accomplished:
‘What is then the task which lies before the Welsh National
School of Medicine. It has to train a whole and complete
medical service for the Principality so that there may be
established throughout Wales a capable and well-equipped
band of apostles preaching the gospel of health on hill and
dale, in hamlet, village and town.’
‘I am undertaking a heavy responsibility in that I am the first
occupant of the only chair in the country devoted entirely to
the subject of preventive medicine. There is no tradition to
guide, no precedent to refer to…’
4. “… I mean the prevention of disease. This side presents a
point of view which centres thought on the positive entity,
Health, rather than on the varied manifestations of lack of
health which we sum up in the negative term, disease…
but each member of the community is only interested in
these matters in a half -hearted way… ”
5. Research
EL Collis again… Inaugral Lecture: ‘Finem Respice’
‘The Institute stands not only for teaching, but also research
and the spirit of research….The Institute must be
acquainted with the health conditions of Wales and be
prepared to direct research to meet the needs of the
Welsh nation; it must have knowledge of social
conditions with which health is so intimately associated; …
it must note variations in sickness and mortality in
different districts and be prepared to assist in searching out
the causes and finding ways to remove them…. Its scope
must, as far as medicine is concerned, be broad… and
claim all knowledge for its own.’
6. 1919 First Professor of Preventive Medicine appointed
1921 Institute of Preventive Medicine opened
1925: Stevens Committee of Enquiry
“You have got these fancy departments
these men are
(Preventive Medicine and Tuberculosis)…
running your place and they have more to
say that the men who are doing the real work
of the hospital… they are luxuries”
Referring to the Institute of Preventive Medicine….
“…the block will be exceedingly useful for
other work”
10. World Health Organisation and English
Department of Health fund work at National
1978 Perinatal Epidemiology Unit, Oxford, UK to
assemble a register of controlled trials in
perinatal medicine
Outline plans drafted in Cardiff, Wales, UK for
1976 systematic reviews of controlled trials in
perinatal medicine
Identification of controlled trials in perinatal
1974
medicine begins in Cardiff, Wales, UK
Publication of Archie Cochrane's '
Effectiveness and Efficiency: random reflections
1972 on health services' , which drew attention to our
collective ignorance about the effects of health
care
11. 2000 UK Parliament Health Committee
Press Notice No. 13 of Session 2000-01, dated 27 March 2000
"Public health" is not a term understood by the majority
of the public. It can be variously defined so as to cover
trends of disease in a population, the provision of
preventive and health improving care, or a range of
health-impacting factors including or excluding the NHS.
In a key note speech delivered as the annual LSE health
lecture on 8 March 2000, the Secretary of State for
Health himself drew attention to the problems in
defining public health and the implications of those
problems and said:
"The time has come to take public health out of
the ghetto."
12. House of Commons Select Committee
on Health: Second Report, 2001
Leadership in Public Health
para We agree with the Secretary of State that
102 health authorities are not solely responsible
for improving health, however we consider
that the strategic lead for public health must be
clarified. The “plethora of partnerships”
make it vital that there is clear strategic of
public health at a local level. Whatever
arrangements are made, leadership should be
strong, explicit and should have clear lines of
accountability.
13. April
Public Health Group registered
2008
Mar
Chinese Cochrane Centre registered
1999
Nov Sexually Transmitted Diseases Group
1998 registered
Mar
HIV/AIDS Group registered
1998
14. The Spirit of Public Health Research in Wales
• a collaborative model
▫ draw together researchers from health sciences, sociology,
psychology, engineering, architecture, economics and
business studies, geography, informatics and others.
• Build on the successes and strengths of health research in Wales
• Take new opportunities, new partnerships (eg ONS now in Wales),
new technology for record linking large routine health datasets for
public health studies of the whole Welsh population Wales).
▫ (HIRU/SAIL) and multi-sectoral datasets (WISERD) and
Web based epidemiology.
15. Designed for Life
• A New Policy Context
• The vision which drives this renewal is shaped by the paradigm
embraced in the Welsh Assembly Government’s constitution -
Sustainable Development.
• “We remain one of the few administrations in the world to have
such a statutory duty, and it gives us an opportunity to develop
Wales, as a small, smart nation, in ways which contribute
sustainably to people’s economic, social and environmental
wellbeing, now and in the future”
• “the central organising principle of public service – because public
service must be about achieving benefits for the whole of society
and for the long term.”
16. Sustainable Communities
– a new paradigm for Public Health!
“I want a Wales fit for generations
to come …
What motivates me is doing my
very best to ensure a brighter,
sustainable future for [my
grandchildren and their
grandchildren] and every other
child growing up in Wales today …
[Therefore], top of the list … of our
priorities which will continue to
improve the quality of life for
people today and in the future …
is sustainability”
First Minister, 8 February 2008
18. Preliminary Analysis - Smoking
SMOKING STATUS CASES % CONTROLS
(n) % (n)
Smoked YES 76.9 (70) 48.8 (106)
before NO 23.1 (21) 51.2 (111)
Pregnancy
Smoked YES 70.3 (64) 44.2 (96)
during first NO 29.7 (27) 55.8 (121)
12weeks
Unadjusted Odds Ratios (95%Confidence Intervals).
Smoking before pregnancy : 3.3 (1.82, 6.05)
Smoking during first trimester: 2.8 (1.63, 4.98)
19. Preliminary Results: Alcohol
ALCOHOL CONSUMPTION CASE % (n) CONTROL% (n)
Typical number of 0 22.2 (20) 38.6 (83)
units per week in < 14 48.9 (44) 51.2 (110)
first trimester
>14 28.9 (26) 10.2 (22)
Binge drinker (> 6 Yes 51.6 (47) 37.0 (80)
units in one sitting/ No 47.3 (43) 62.0 (134)
day)
Don’t know 1.1 (1) 0.9 (2)
Unadjusted Odds Ratio (95%CI)
< 14 units per week: 1.6 (0.83, 2.95)
> 14 units per week: 4.7 (2.07, 10.71)
Binge Drinking: > 6 units in one sitting/day: 1.8 (1.00, 2.97)
20. Preliminary Analysis:
Recreational Drug use
DRUG USE STATUS CASES% (n) CONTROLS%
(n)
Ever used illegal YES 48.4 (44) 30.9 (67)
substances No 51.6 (47) 69.1 (150)
Used prior to YES 20.9 (19) 7.4 (16)
knowledge of pregnancy No 79.1 (72) 92.6 (201)
Used during first 12 YES 15.4 (14) 5.1 (11)
weeks of pregnancy NO 84.6 (77) 94.9 (206)
Unadjusted Odds Ratios (95%Confidence Intervals)
Ever used illegal substances: 2.0 (1.15, 3.35)
Used illegal substances before pregnancy: 2.9 (1.39, 6.19)
Used illegal substances during first trimester: 2.7 (1.17, 6.29)
21.
22.
23.
24.
25. Towards Evidence Based Public Health
RESEARCH EVIDENCE PUBLIC
Evaluation Assessment Political
Process
Surveillance Synthesis
IMPLEMENTATION POLICY LEGISLATION
26. RCT Results: 74 intervention homes versus 72 control homes
• Improvement in breathing at 6 mths 52% v 2%
• Reduction in medication at 6 mths 41% v -17%
• Reduction in wheeze affecting act’ 31% v 7%
27. The proposed functions of the “Institute”
• Evidence Centre
• Coordinate public health knowledge management.
• Identify knowledge gaps and develop research priorities.
• Provide a strategic link between academic public health researchers,
PHW, WAG, NHS and LAs.
• Manage the Wales public health research programme and stimulate
and where appropriate coordinate multicentre and multidisciplinary
research, especially exploiting natural experiments.
• Drive the timely use of national datasets and surveillance systems
for maximum public health gain, possibly embracing the Wales
Observatory.
• Promote and coordinate use of public health and mathematical
modelling to assist decision making.
28. The proposed functions of the “Institute”
• Public Health Training
• managing the all Wales public health training
programme under the direction of the Postgraduate
Dean.
• Liaison with academic training centres such as Cardiff
University MPH Programme and UWIC/HPA
International training Centre for Chemical Hazards.
• Policy and Programmes “Laboratory”
• Create an evidence-policy “space” which would be a
forum for debate and development of advice.
• Test new ideas for new prevention policies, programmes
and projects.
