Tackling inequality through data: the professor of primary care
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r118 (Published 10 February 2025) Cite this as: BMJ 2025;388:r118
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Dear Editor
Data collection is probably an attractive area of research to present day computer savvy generations and the work of Azeem Majid has already inspired many of them to take up this career opportunity so vital to tackling the huge inequalities in all area of UK society.
But what must not be lost is actual contact with the real people who are being researched. Perhaps there could be time set aside in training and ongoing to visit people in damp and mouldy housing for example , see for themselves the consequences on parents and children of these embedded inequalities mentioned by Carla Delgado. This would bring a reality into the work to inspire a passion which investigating data sets alone cannot achieve albeit invaluable . If communities are to be asked to provide very detailed information on their medical records about sometimes undignified areas of lives the reasons needs to be made transparent so hopefully there would be an opportunity to get more involved not only as data providers but as equal participants.
Competing interests: No competing interests
Robust data: crucial for guiding public health
Dear Editor,
Professor Majeed makes a very important point that we fully agree with – “We need to guide the NHS and our public health system and that’s best done by using data”. Public health data is complex, often making it challenging to separate causal relationships from trivial correlations and multiple interrelated factors. Cautious, expert analysis is required so as to effectively target impactful indicators.
We therefore strongly believe that robust data needs to be collected from a variety of sources using both effective epidemiological tools across wider determinants of health and expert mathematical analysts.
Public health history has some trailblazers who used data in innovative ways that continue to influence current practice. This includes John Snow’s groundbreaking spatial analysis work on cholera, William Farr’s rigorous analysis showing health inequalities and appalling levels of mortality, and Florence Nightingale’s Coxcomb Chart work on mortality in hospitals.
Important uses of data in public health includes:
1) assessing need and setting priorities,
2) planning,
3) monitoring,
4) evaluation, and
5) raising public and professional awareness in order to promote action.
Public health data can change the way we think and alter what we focus attention on. For example, in the past the UK had a world leading Home Accident Surveillance System (HASS), that was used successfully to identify current and new hazards in the home.(1) Unfortunately, the HASS system ceased operation in 2002. Since then there have been repeated calls for reinstatement of such data collection by home safety professionals from local and national organisations.
A recent state of the art report produced by the Royal Society for the Prevention of Accidents (RoSPA) suggested that there was a “host of holes” in the UK’s existing accident data collection regime.(2) Specifically, they stated that there are a range of datasets collected by different agencies, using different methodologies and published in different ways, and notably there are gaps in what is required. RoSPA recommended that there was a need for a more consistent and rigorous approach to data collection and monitoring and that the Government should commission an independent, expert review of accident statistics.
Transforming the way we think about health could be brought about by collecting evidence-based positive health indicators with clear impacts on health.(3-6) Examples include: percentage of children visiting a dentist regularly; percentage of adults undertaking enough exercise per week; and percentage of drivers wearing a seatbelt. At a district level indicators can also be developed, for example in relation to swimming pools, cycle lanes, and health promoting schools.
Positive health indicators can be identified in relation to:
• individual behaviour and health knowledge,
• the physical environment, and
• socio-economic conditions.
Crucially, collecting and promoting positive health indicators could result in a paradigm shift in our thinking away from purely sickness and ill health, towards positive visions of health.(5,6) In addition, having a new positive information base may help the country to focus and provide resources for socio-economic and environmental factors rather than purely focusing on treatment services and individual lifestyle issues.
Professor Majeed has witnessed health problems that were rooted in deprivation and if we want to improve public health then poverty, housing and occupation are important issues to be considered.(7-10) Data has the potential to guide our NHS and public health systems. However, it is crucial that we develop and monitor the right datasets so that we can shine a light on the solutions to the health problems that individuals, families and communities face.
References
1) Ward H and Healy G. Feasibility of Establishing a UK Wide Injury Database. Birmingham: RoSPA, 2009.
https://www.rospa.com/rospaweb/docs/advice-services/home-safety/injury-c...
2) Royal Society for the Prevention of Accidents (RoSPA). Safer Lives, Stronger Nation: Our Call for a National Accident Prevention Strategy Birmingham: RoSPA, 2024.
https://www.rospa.com/news-and-views/preventable-accidents-in-the-uk-are...
3) Catford JC. Positive health indicators – towards a new information base for health promotion. Community Medicine. 1983; 5: 125-132.
4) Watson M C, Watson E C. Time to focus on positive health indicators to reduce health inequalities BMJ 2013; 347 :f4210 doi:10.1136/bmj.f4210.
https://www.bmj.com/content/347/bmj.f4210
5) Watson M C, Neil K E. Social determinants of health: a positive manifesto for public health BMJ 2024; 385 :q1275 doi:10.1136/bmj.q1275.
https://www.bmj.com/content/385/bmj.q1275
6) Watson M, Neil K. Positive health promotion: the Ottawa Charter approach. Perspectives in Public Health. 2025;145(1):11-13. doi:10.1177/17579139241266174
https://journals.sagepub.com/doi/10.1177/17579139241266174
7) British Medical Association. Health at a price: reducing the impact of poverty. London: BMA, 2017.
https://www.bma.org.uk/media/2084/health-at-a-price-2017.pdf
8) Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. Health equity in England: the Marmot review 10 years on. Feb 2020.
https://www.health.org.uk/reports-and-analysis/reports/health-equity-in-...
9) Watson M C, Neil K E. Our leaders must urgently implement comprehensive policies to reduce harm caused by homelessness BMJ 2024; 384 :q651 doi:10.1136/bmj.q651.
https://www.bmj.com/content/384/bmj.q651
10) Marmot M, Noferini J, Allen J, Alexander M, Whitewood-Neal J. Building health equity: the role of the property sector in improving health. London: Institute of Health Equity, 2024.
https://www.instituteofhealthequity.org/resources-reports/building-healt...
Competing interests: No competing interests