The case for local & contextual research in public health
Written by Medhavi Gupta, PhD student The George Institute for Global Health. The article was originally published in the BMJ Global Health Blogs. Excerpts from the blog are reproduced here with due permissions.
What is our objective when we conduct research in public health? We conduct public health research to reduce disease and injury incidence. We conduct public health research to have a real impact on people on the ground and save lives.
For public health research to be impactful on the ground, it needs to be applied in contexts where it is most needed. A key concept in the implementation of solutions to public health problems is contextual adaptability, where policy and ground-level interventions need to be adapted to the local context in which they are implemented. Hence, each time a public health solution is developed for a region or population group, a range of studies need to be conducted in that local context to understand it.
The development and publishing of context-specific research appears to be disincentivised in the academic system, with increasing focus on the external validity of studies.
Academia is obsessed with novelty. Unfortunately, local research may not always add some new theoretical insight – often it provides insights on how existing and well-established public health solutions and principles may be applied to a new context. Many journals and peer reviewers may not find this novel enough as its additional contribution to the literature is limited.
Academia is also overly interested in generalisability – reviewers often want to know where else study findings can apply. The underlying assumption to this question is that by finding generalisable evidence for the development and effectiveness of public health solutions, we can skip a few steps in other contexts when applying public health solutions. However, often even when we think our findings from one context can be applied to another, this still needs to be checked in case there are contextual differences.
Another issue with disincentivising local and contextual research is that it is inequitable against local researchers. Much of the local research is done by researchers based in low-and middle-income countries (LMICs) with lower levels of funding, but who have great depth of knowledge in their context. Enabling these researchers to publish local research also develops their track records and provides opportunities for LMIC researchers to be more competitive in much-needed grants for these low-resource contexts.
Lastly, disincentivising local and contextual research prevents us from building a strong evidence base for effective interventions. Take my own field of study, child drowning. Most of the ‘effective’ interventions identified by the World Health Organization have not been rigorously evaluated through the gold standard of randomised controlled trials (RCTs), or even non-randomised trials. These trials need to be incentivised by the academic ecosystem.
Public health research can benefit from addressing discrimination against local and context-based research. It is an issue of equity, a requirement in order to build stronger evidence bases for effective interventions, and an opportunity for the field to showcase the real change it can bring to people’s lives.