Source: London School of Hygiene & Tropical Medicine
On the ground: gathering data in the field is essential to a firm statistical basis for research
The gilded snake, rat, mosquito and bedbug displayed on the balconies around the London School of Hygiene and Tropical Medicine’s elegant art deco building in Bloomsbury may make a striking architectural feature, but they also give a rather one-sided picture of what the school is about today.
There is still a Faculty of Infectious and Tropical Diseases, which has many joint clinical appointments with the nearby Hospital for Tropical Diseases. Mosquito larvae are kept in the basement and fed on Heinz breakfast food. Brave volunteers come and offer their arms so that the mosquitoes can drink blood, as they prefer, direct from bodies. Yet the two other faculties, of Epidemiology and Population Health, and Public Health and Policy, focus much of their efforts on the UK and Europe, rather than the tropics. Major areas covered, says vice-director (and professor of health economics and policy) Anne Mills, include “cancer epidemiology”, “obesity and exercise”, “sexual health”, drug abuse, gender violence and the specific health issues of “hard-to-reach populations”.
Professor Mills started her career as a health economist at the Ministry of Health in Malawi in 1973 but moved to the LSHTM six years later. She still devotes a day a week to research, currently including a project on expanding coverage in health services in South Africa and Tanzania. She recently organised a conference called Health Economics: Coming of Age to celebrate the school’s “central role in the development of the discipline” and to reflect on the challenges that lie ahead.
“Health economics has been growing rapidly since the 1970s,” she says, “after it was recognised that health is a very significant sector in the economy, and so something natural for economists to study. We have the largest group of health economists in the world – around 30-40 academic staff – working on issues of health in lower- and middle-income countries [LMICs]. They look at how best to finance health services; the relative performance of public and private providers; how you expand access to health services; and different financing sources such as user fees, insurance and general taxation.”
Although they do little direct consultancy for governments, Professor Mills believes that their research is a crucial resource for LMICs, where there is often “enormous scope to implement interventions that are very cost-effective”.
A number of factors contribute to the LSHTM’s success in these areas. One, in Professor Mills’ view, is “well-consolidated partnerships in those countries and over 100 staff based overseas on a long-term basis, embedded in local universities, research institutions and public health foundations”.
Equally important is a deep commitment to multidisciplinary research. This often enables the school to bring together a core team of a health economist, an anthropologist or sociologist, a clinician, an epidemiologist and a statistician who can examine the acceptability as well as the cost-effectiveness of healthcare interventions.
Health economists working in LMICs also face a number of specific challenges. One is often a lack of good information systems and government statistics, so research has to include much basic data-gathering out in the field. Professor Mills also notes that “much funding comes from those interested in direct policy implications, so it has been much harder to do the more methodological and theoretical research. In the UK, it has been easier to build health economics as a discipline, but you can’t easily transfer the lessons, because of the structure of the economy, the extent of poverty, the level of government capacity and so on.”
The past decade has been a good time for medical research, with increasing funds coming into the school from the research councils, the European Union, the Gates Foundation, ring-fenced NHS and international development budgets and other sources. Since the LSHTM is a postgraduate, highly research-intensive institution, where teaching activity accounts for only about 15 per cent of academics’ time, Professor Mills is acutely aware of the need to “retain research income in what will at some point become a more adverse environment” and cautiously supports the idea that they should be “more active in consultancy work, commissioned research, some of the more commercial activities such as an insecticide-testing service”.
But for the moment, the financial base remains solid and the school continues to maintain its place at the centre of debates about health economics and public health more widely.
In numbers
15% - Amount of academics’ time spent teaching at the LSHTM
matthew.reisz@tsleducation.com
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