Linda Bauld: ‘Our Future Health can win us the huge prize of disease prevention’
Professor Linda Bauld has built her career working on population-sized health research studies. So when she says she’s excited about a project, it’s worth sitting up and taking notice.
“The concept of a big research programme like Our Future Health is something that the medical field has discussed for a long time,” she says. “This feels like the moment we’ve all been waiting for.”
Prof Bauld is well-placed to comment, having worked in public health research for more than 25 years. As the chief social policy advisor to the Scottish government, she has a keen interest in how policy can improve the healthcare we all receive. Prof Bauld also holds the oldest academic chair in public health in the UK, and has previously worked as a scientific advisor to the UK government on tobacco control.
She says that throughout her career, she’s seen various studies try to move the needle on public health – but none have offered the significant wins that Our Future Health could bring.
“For me, Our Future Health does something that hasn’t been tried before,” says Prof Bauld. “Firstly, the scale is unprecedented. We’ve had population studies that recruit thousands or tens of thousands of people – but to aim for five million like Our Future Health is incredibly ambitious. It will deliver data at scale that researchers haven’t had access to before.
“Secondly, and just as importantly, Our Future Health is focusing on prevention as well as cure. In my view, a lot of previous research hasn’t looked at prevention or early detection enough. There’s an opportunity for this programme to help us either prevent disease or change the progression of disease.”
The prevention prize
As an expert in population health, Prof Bauld is accustomed to seeing statistics that tell the story of our nation’s battle with disease. For example, research suggests that 54% of people aged 65 or older live with two or more serious health conditions. By 2035, that figure is expected to rise to 68%.
Part of the problem, says Prof Bauld, is that up until now, a lot of energy has been spent on treating diseases, which explains why we’re living longer than ever before even though our later years tend to be spent in poor health. “Take cancer as an example,” she says. “Between 33% and 40% of cancers are preventable by reducing exposure to risk factors. Even if we can extend survival rates for people with those cancers through improved treatment, we’re still getting to them too late. The idea that we could actually prevent their cancer developing in the first place is incredibly exciting.”
Type 2 diabetes provides another example. The disease affects around 4.3 million people in the UK, with a further 2.4 million at risk. “Many of the risk factors for type 2 diabetes are the same as cancer and respiratory conditions,” says Prof Bauld. “There’s a huge amount of people in the country who will go on to develop the disease in the future, and we’re doing very little before they show symptoms.
“We know that the scale of non-communicable diseases [conditions like cancer, diabetes, stroke and dementia, which aren’t caused by infection] that are preventable is significant. Our Future Health will allow researchers to find new patterns and markers that mean we can help people earlier, before they show symptoms. Disease prevention is a huge prize.”
Why representation matters
As an advisor to the Scottish government, Prof Bauld champions research that can level-up the inequalities seen across different groups in the population. This includes ethnic minorities and people from lower socio-economic backgrounds.
It’s an area where there’s significant work to do. An independent report by the Health Foundation released in January this year found that there’s a 24-year gap in the time spent living in good health between people from the most and least deprived areas in Scotland. Men from the most deprived areas die, on average, 13 years earlier than men from the least deprived areas. For women, the difference is almost a decade.
“If you look at the relationship between deprivation and health, we have lots of data that describes the problem,” says Prof Bauld. “People who live with less resources often have a high prevalence of preventable medical conditions. When they experience healthcare needs, they’re less likely to have services that are accessible to them or take up available services. It means that their disease trajectory is worse at every stage, from screening, to detection to treatment.”
Our Future Health is committed to building a database of volunteers that truly reflects the nation, so everyone is represented in future discoveries. For people coming from groups that experience healthcare inequalities, Prof Bauld says the programme represents two opportunities in one. “Firstly, by joining up to Our Future Health, you can represent your community. We all care about the people around us – this is your chance to make sure that new medical treatments and techniques are designed to help the people you know and love.
“Secondly, you’ll get something back by joining. During your appointment with Our Future Health, you’ll learn about your blood pressure and cholesterol levels. In the future, there may be an opportunity to get more feedback. You might have the opportunity to help researchers investigate an approach that could be useful for your health, even if you’re young and you don’t think you’re going to be at risk of a particular condition.”
The healthcare of the future
What does Prof Bauld see healthcare looking like 20 years from now? “It will prioritise prevention,” she says without hesitation. “It will stop being something that people access just when they develop symptoms.
“A good example now is our approach to early years. The vast majority of children get a red book and it’s regularly updated during appointments with some kind of healthcare professional. Essentially, we’re tracking the child’s health, so if any red flags emerge that are cause for concern, they can be followed up quickly.
“We don’t do that with adults – but we could. We could have a way for people to be contacted by a programme from time to time, to help them limit their risk of getting disease. If we know someone is at risk of developing a certain disease, we could offer them a course in how to prevent it. That course might be behavioural – for example, suggestions around their diet. Or it could be in the form of a drug. To give one example, there’s a new drug available for type one diabetes which we think, for some groups, can delay the onset of the disease for around three years.
“If we could pick things up earlier, it would decrease the number of people who access healthcare when something is wrong. It would be better for all involved.”