Public Health Research aims to shed light on the influence of the determinants of health, i.e. factors (genetic, environmental, social, etc.) which determine population health. The objective is to use this knowledge to propose interventions and policies, based on scientific evidence, to help improve health and well-being, and reduce health inequalities.
In practical terms, public health researchers study:
- population health, well-being, disability and loss of independence
- the determining factors for these statuses, whether biological, behavioral, social or environmental
In addition, they develop and assess:
- interventions aiming to improve population health, prevent disease, and compensate for disabilities and loss of independence…
- innovations in terms of the organization of health services, social services and medical/social services
More than 110 Inserm teams are dedicated to public health research.
Multidisciplinary research with specific instruments
Public health research is characterized by its multidisciplinary and cross-cutting approach. It draws on epidemiology, biostatistics, human and social sciences applied to health, biology, genetics, and toxicology… It usually entails the analysis of data on population samples, on varying scales, depending on the purpose of the research. Hence, the main "instruments" used by public health research scientists are:
These involve monitoring a group of individuals sharing a number of common characteristics over time, so as to identify the occurrence of a health event of interest (disease or physical dysfunction). Individual monitoring evidences risk factors or protective factors for the health event studied.
For example, the E4N study aims to examine health in relation to the environment and modern lifestyle among subjects belonging to the same family, with a shared genetic predisposition and environment. E4N will ultimately bring together three generations: the women in the E3N cohort and the fathers of their children constitute the first generation, their children the second generation, and their grandchildren, the third generation. The E4N study should involve nearly 200,000 individuals in total.
These involve recruiting individuals presenting the health event of interest and control subjects not presenting this event. Data are collected on all participants in the two groups, with the aim of highlighting risk factors or protective factors for the health event studied.
Hence, study EGEA aims to identify genetic and environmental factors associated with asthma, bronchial hyperresponsiveness and atopy, with a view to developing preventive measures and new treatments for patients. This study is based on the analysis of data relating to nearly 400 asthmatic patients and their families, together with 415 non-asthmatic controls.
These observational studies serve to describe the characteristics and exposure concerning a population, at the time of recruitment into the study. These may be repeated over time, so as to compare the data obtained and thus analyze their changes over time.
For instance, national cross-cutting perinatal surveys are regularly conducted in France, to determine the main indicators for maternal and neonatal health, medical practices during pregnancy and childbirth, together with the associated risk factors. This information notably serves as guidance for public health decisions and for evaluation of health actions in the perinatal field (public measures, professional recommendations). Five surveys have taken place, in 1995, 1998, 2003, 2010 and in March 2016. In practical terms, each survey entails the collection of data on all births registered in France over the equivalent of a week.
These are exhaustive databases, on one or more health events occurring in a geographically defined population. A number of registries exist in France, on cancer, cardiovascular and neurovascular disease, congenital abnormalities, and rare diseases, etc.
Created for non-research purposes, these databases are of particular interest to public health research scientists. For instance, the Caisse nationale d’assurance vieillesse (CNAV) database sheds light on individuals' career paths, and thus provides information on occupational exposure, potential risk factors. The vast French national health insurance scheme (Assurance maladie) database, which comprises all reimbursed procedures (medicinal products, hospital admissions, etc.), notably enables scientists to examine the patient health-care process.
Inserm and the National Health Data System
The health system reform law namely led to the creation of the Système national des données de santé (SNDS, national system for health data). This system notably consists of:
- national health insurance scheme data (SNIIRAM)
- hospital data (PMSI database)
- medical causes of death (CépiDc-Inserm)
- data on disability (sourced from the MDPH - CNSA data)
- a sample of data sourced from top-up health insurance organizations
Unique of its kind in Europe, or indeed the world, the SNDS represents a major milestone: these data, covering practically the whole French population, represent an immense opportunity in terms of health research. Any individual or public/private, for-profit/non-profit organization may, in 2017, have access to SNDS data further to authorization from the CNIL, with a view to conducting a study, research or evaluation of public interest.
Governance of this system is expected to include data producers, including Inserm. In more practical terms, the Centre d'épidémiologie sur les causes médicales de décès (CepiDc, epidemiology center on medical causes of death), an Inserm service unit, is responsible for extracting and supplying data for research.
For more information, refer to the Système national des données de santé (SNDS) website
Epidemiology-France website, French health data catalog
Implementation at the Aviesan alliance multi-organization theme-based institute on Public Health, the Epidemiology-France website provides an online catalog of the main French-sourced individual health databases, beneficial in the development of research and expertise in public health (excluding clinical trials).
This instrument is part of a scientific data sharing movement: the aim is to allow all scientists to get the most out of the available data, and thus accelerate the generation of new knowledge.