The power of the slow reveal: why good research takes time
Long-term research is a valuable resource in developing good health policy: it takes time but produces compelling evidence.
It’s second nature to reach back and put on a seatbelt as soon as we sit in a car, but it wasn’t always that way.
Although the first petrol-powered car was sold in Australia in 1897, it took more than 70 years before the individual states introduced legislation for the compulsory wearing of seat belts.
While there was some recognition of the need for car restraints in the early 1900s, it wasn’t until the 1950s and 60s that studies into seat belts began and researchers started collecting data.
These longitudinal studies provided a foundation for the efficacy of seatbelts. Beginning in 1970, legislators in Australia implemented new laws mandating the compulsory wearing of the restraints.
The case for compulsory seat belts took time to establish, but the impact of the research and subsequent legislation is unequivocal. Between 1965 and 2013, seat belts reduced Australia’s road death toll by 67%. Increasing public awareness of road safety and improving the design of vehicles and roads undoubtedly played an important role in reducing the number of fatalities, but the widespread use of seat belts is recognised as having a dramatic impact on the road toll.
When it comes to making big-impact social change, like reducing road fatalities, long-term evidence, like patience, is indeed a virtue.
The impact of longitudinal studies
Numerous studies have demonstrated the value of taking a long-term view on social change and health promotion issues. In the United States, the US Nurses’ Health Study, which was established in 1976, and is now in its third generation, has collected data from more than 275,000 participants.
A pooled resource means researchers don’t need to reinvent the wheel every time they want to conduct research.
Links between cigarette smoking and cardiovascular disease, postmenopausal obesity and breast cancer, together with the impact of diet on health have all been discovered by the study, and many of the results have been translated into action.
Closer to home, Australia’s 45 and Up Study is the largest ongoing study of healthy ageing in the Southern Hemisphere, examining more than a quarter of a million people.
“This is a great example of how Australian population health surveillance will give us information to help plan for the future, such as facilitating healthy retirement and promoting independence in old age,” says Dr Jessica Hateley-Browne, Principal Program Officer, Knowledge at VicHealth.
Long-term, large-scale studies such as these create a rich source of data, without the labour- and resource-intensive mechanisms needed to recruit participants and secure funding for short-term research projects.
“Such a pooled resource means researchers don’t need to reinvent the wheel every time they want to conduct research relevant to this population,” writes Professor Emily Banks, the Scientific Director of the 45 and Up Study at the Sax Institute.
Public health research: a marathon, not a sprint
Many social and health problems have complex causal factors and thus require careful tracking and complex interventions. “These issues are not going to shift quickly,” says Hateley-Browne. “It’s like turning around the Titanic – movement will be slow because an effective intervention often needs to be at personal, community, societal and governmental levels.”
As one example, the change in social norms with regards to sun protection over the last 40 years is evident on many levels.
The program had strong support from both sides of politics, and Hateley-Browne says this is vital to an initiative’s success.
“Having governmental commitment to ongoing long-term research is so important because it can deliver great insights and enact change from the data.”
The time frame between discovery and adoption in public health and health promotion is often measured in years or tens of years.
“Discovery is the first study that shows something can work,” says Adrian Bauman, Professor of Public Health at The University of Sydney. “Then over the years you need to repeat that to show it can work under different conditions. Then you move from those replication studies to asking if the project can be scaled up.”
Taking the long view on big issues
Greg Ford, VicHealth’s Principal Policy Officer, points to tobacco control in Australia as a striking example of how change in health promotion can take time.
“Research clearly showed the harm from smoking long before action was taken,” he says. “We are now seeing the same with obesity.”
Obesity is a significant concern in Australia and Hateley-Browne notes there are complex causal factors involved: for example, it can be related to an intergenerational issue.
“If you’re conducting a family intervention, that might be delivered through schools, local government or even industry,” she says. “You may track the weight status of adults and children and this is all related to very complex interpersonal interactions. Even if the intervention goes along as intended, you might not see outcomes until those children are young adults.”
Greatest impact for the greatest number
For policymakers in charge of constructing health programs and establishing new strategies for health promotion, long-term research can be a key to determining the best way forward for the greatest number of people.
When data is collected and analysed over the long term, decision-makers are able to survey the evidence and make predictions about future risks and where resources should best be directed.
One of the keys to successfully using research for policy change is to present solutions to decision-makers rather than focusing on problems.
“Long-term research will often shed light on a public health problem,” says Ford, “and good policymaking uses that research to come up with solutions that are backed by evidence. A long-term perspective, backed by evidence, strengthens the case for change and increases the likelihood of success.”