The 6th Population Health Autumn School is the latest in a series of successful annual schools, traditionally held in Cork, and jointly organised by the University College Cork, the Institute of Public Health in Ireland and the Southern Health Board, Republic of Ireland.  Breaking with tradition this year the Autumn School was held in Queen’s University Belfast on the 1-2 October and jointly organised by the HRB Centre for Health and Diet Research (Cork), The Institute of Public Health in Ireland (IPH) and the UKCRC Centre of Excellence for Public Health (Northern Ireland).

The Autumn School focused on how researchers, practitioners and policy-makers might better understand complex public health interventions.  It attracted over 150 delegates from Ireland and welcomed visitors from Sweden and the Netherlands.  A slate of internationally renowned speakers helped us get better traction on the question “When is a simple answer sufficient”.  
Please find below an overview of the Autumn School together with links to podcasts of speaker presentations.

1st October
The event was opened by the Centre of Excellence Management Board Chairman, Dr Chris Gibson, OBE who welcomed the Vice Chancellor Professor Gregson to offer his support for the School.  The Vice Chancellor commended the Centre of Excellence for its important work in capacity building in public health science.  He welcomed international guests to Northern Ireland and to Queen’s University Belfast and underlined his support for the Centre.
The Chief Medical Officer for Northern Ireland, Dr Michael McBride, added his support for the important work of the Centre in bridging the gap between research, policy and practice.

Dr McBride reminded delegates of how public health was now at the centre of the Review of Public Administration (RPA) in the health sector reforms and that there is an urgent need to build capacity in the public health workforce.  He saw the recent introduction of a new Masters in Public Health course by the Centre as a welcome boost to capacity building.  It highlighted the need for more evidence based policy and more effective mechanisms for translational public health research to gain traction and make a difference to the health of the population.  

He stated “It is vital that we look outwards across borders, and this school is a prime example of good North South cooperation and I commend the role of the Institute of Public Health in the sterling job that they do, not just in supporting and facilitating, but also driving cooperative action.”  

Dr Gibson invited Professor Frank Kee, Centre Director, to Chair the first session and give an overview of why the theme of the School had been chosen.  In the first session Professor George Kaplan (Director of the Centre for Social Epidemiology and Population Health, Michigan USA) and
Dr Jeffrey Koplan (Director Emory Global Health Institute, Atlanta USA) each gave their own perspectives on the need to face up to complexity in Public Health and their own attempts to address it and generate useful evidence to make a difference.

Professor Kaplan illustrated how relatively new methods, such as agent based modelling, give us the opportunity to more flexibly simulate the impact of policy interventions to tackle conditions such as obesity and diabetes.
http://www.mediator.qub.ac.uk/ms/producer/frankkee/georgekaplan.htm

Dr Koplan briefly reviewed the ten most significant public health interventions of the last century and offered us a memorable metaphor to answer the question “When is a simple answer sufficient” i.e. when we are able to recognise the bigger picture in a jigsaw puzzle and carefully identify where our own problem “piece” fits in helping to reveal “the answer”.
http://www.mediator.qub.ac.uk/ms/producer/frankkee/jeffreykoplan.htm

The second session focused on novel approaches to design methods, and chaired by Professor Bernie Hannigan (Director of Research and Development, Health and Social Care NI).  Professor Hannigan warmly welcomed Professor Mike Kelly (Director, Public Health Excellence Centre, National Institute for Health and Clinical Excellence) and Professor Ann Louise Kinmonth CBE (Foundation Professor of General Practice, University of Cambridge) to share experiences and examples of applying novel approaches and design methods to their areas of work.

Professor Kelly’s presentation centred on applying novel methods to population based approaches to reduce levels of obesity. He began by clarifying the distinction between the ontological and epistemological differences in individual and social causal pathways.  Although the individual and social levels of analysis explain different things, his presentation demonstrated that the outcomes of interventions can be counted as successful at a variety of levels.
http://www.mediator.qub.ac.uk/ms/producer/frankkee/mikekelly.htm.

Professor Kinmonth spoke about the application of psychological theories and models in designing and interpreting behaviour change interventions at population, community and individual levels. She referred to the successful ‘Proactive’ case study - a theory based intervention designed to promote physical activity among adult sedentary relatives of people with type 2 diabetes.
http://www.mediator.qub.ac.uk/ms/producer/frankkee/annlouisekinmouth.htm.

The third session focused on the challenges of designing more effective policy on health inequalities. This session was chaired by Dr Jane Wilde CBE (Chief Executive, Institute of Public Health in Ireland) who welcomed Professor Margaret Whitehead, (WH Duncan Chair of Public Health, University of Liverpool) and Professor Mark Petticrew, (London School of Hygiene & Tropical Medicine).

Professor Whitehead began her discourse by referring to the WHO Commission on Social Determinants of Health and posed the question ‘what can be learnt from other countries about ways of addressing health inequalities?” She identified three overarching recommendations; (i) to improve the conditions of daily life, (ii) to tackle the inequitable distribution of power, money and resources, and (iii) to better measure and understand the problem and assess the impact of action.

Professor Petticrew followed this by stating that designing policies on health inequalities needs to involve ‘looking up’ and ‘looking across’ – ie upstream and across all sectors (transport, employment, education, welfare, crime and justice, housing etc). He argued that developing policy requires researchers to provide guidance not just on what works but on the extent to which current evidence can be extrapolated to other settings.

2nd October

The morning session of the second day was opened by Mr Andrew Elliot (Department of Health, Social Services and Public Safety, Northern Ireland) and Mr Brian Mullen (Department of Health and Children, Dublin) who jointly launched the report: One Island One Lifestyle?  Health and Lifestyles in the Republic of Ireland and Northern Ireland: Comparing recent population surveys (Slan 2007 and NIHSWS 2005). This report, produced by the Division of Population Health Sciences at the Royal College of Surgeons in Ireland (RCSI) compares a profile of lifestyles, health, attitudes and behaviours, together with activities that promote or damage health, in the Republic of Ireland and Northern Ireland.

Dr Jane Wilde welcomed Professor Hannah McGee (Department of Psychology, Royal College of Surgeons in Ireland), a lead author of the report, to share her views about the findings. Professor McGee presented data on topics such as mental health, cancer screening, breastfeeding, body weight and weight management. Some important differences across the jurisdictions included the fact that almost twice as many women in Northern Ireland (30%) had been tested for cervical cancer in the past 12 months, compared to (16%) in the Republic of Ireland. Also one in ten respondents in the Republic of Ireland reported drinking above the recommended upper limit, compared to one fifth in Northern Ireland. There were also many similarities, including the fact that the majority of respondents in both jurisdictions rated their quality of life as “very good” or “good”.
http://www.mediator.qub.ac.uk/ms/producer/frankkee/hannahmcgee.htm

The fourth session, chaired by Mr Enda Connolly (Chief Executive, Health Research Board, Ireland), dealt with the concept of ‘knowledge brokerage’. Mr Connolly invited Professor John Frank, (Director, Scottish Collaboration for Public Health Research and Policy) and Professor Laurence Moore (Director, UKCRC Centre of Excellence, DeCIPHER, and the Cardiff Institute of Society, Health and Ethics, Cardiff University) to discuss knowledge management from their experience and perspectives of working in Scotland and Wales.  Professor Frank began by asking the question “what is knowledge transfer for public health?”, and “how is it best facilitated?” He answered this question by reference to work and evidence from the Canadian Health Services Research Foundation, and emphasised several key principles needed for successful knowledge transfer in health services and public health.
http://www.mediator.qub.ac.uk/ms/producer/frankkee/johnfrank.htm.

Professor Moore identified barriers to this enterprise, such as the separation of the research and policy and practice communities, and the limited opportunities for ongoing dialogue. Among his recommendations was a plea for more ‘Transdisciplinary Action Research’ to help breakdown the divide between “academic” intervention research and ‘local’ evaluation activity.
http://www.mediator.qub.ac.uk/ms/producer/frankkee/laurencemoore.htm

Session five focused on “worked examples” of successful interventions. This was chaired by Dr Mary Black (Assistant Director, PHA) who attended the session on behalf of Dr Eddie Rooney (Chief Executive, Public Health Agency, Northern Ireland). Dr Black warmly welcomed Professor Rona Campbell (Department of Social Medicine, University of Bristol) and Professor Eileen Kaner (Institute of Health & Society, Newcastle University).

Professor Campbell began by illustrating some findings of the successful smoking prevention programme – ASSIST. Her presentation concentrated on factors required for successful wider implementation, emphasising the need to ensure that results were “accessible” to decision makers, and for recommendations to be detailed and explicit. She highlighted the importance of having a ‘champion’ to push forward interventions.
http://www.mediator.qub.ac.uk/ms/producer/frankkee/ronacampbell.htm.  ...  

Professor Kaner spoke about successful “brief interventions” to reduce heavy drinking. Such interventions usually incorporate a FRAME analysis (feedback, responsibility, advice, menu, empathy, self efficacy). She noted that the delivery of such interventions is socially influenced and factors such as gender and socio economic status play an important role. Referring back to the original question posed by the Autumn School, she ended her discussion by noting that nothing is ever simple, but that ‘relative simplicity’ often suffices, and that we may not need to know “everything” about an intervention, if it works.
http://www.mediator.qub.ac.uk/ms/producer/frankkee/eileenkaner.htm

The conference closing remarks were made by Professor Ivan Perry (HRB Centre for Health and Diet Research, University College Cork). He thanked the speakers and contributors on the high calibre of presentations and subsequent discussions and welcomed the opportunity for Cork to rise to the challenge of a further Autumn School next year.

Autumn School Evaluation
Evaluation sheets were completed by delegates, and a total of 92 forms were returned. A brief summary of the results follows. 76% felt that the School was mostly or highly relevant to their work; 90+% stated that the quality and clarity of the presentations were good or excellent and 90+% stated that the organisation of the event was good or excellent.

Some of the free text comments include:  
“It was wonderful to see the range and quality of work. It was also wonderful to have some ‘thinking space’ and a place to contextualise the impact and possible improvement that could be made”.  
“I have gained a much greater understanding of complex interventions, the theory, evidence and translation that's required. The choice of speaker was excellent, it was an extremely well thought out programme, the questions posed were very well answered by the speakers, they were very approachable”.
“I feel excited about the influence of the new Public Health Agency on public health policy in practice”.