Why is the Born in Bradford cohort study important for child health?

Publication Summary

The health inequalities highlighted in the Royal College of Paediatrics and Child Health’s ‘State of Child Health in the UK’ report and the ‘Health equity in England: The Marmot Review 10 years on’ have come as no surprise to those of us working in communities and on the National Health Service front line. The current COVID-19 pandemic and the economic risks associated with Brexit will only widen these inequities. If we are serious about solving our ‘wicked’ public health problems then we need to understand our population by looking beyond the biomedical model of health to take account of the dynamic complexity of the wider social, economic and environmental determinants that shape our children’s health. The Born in Bradford (BiB) longitudinal birth cohort study was established in 2007 to investigate the impact of genetic, metabolic, clinical, nutritional, sociodemographic and environmental factors on the physical and mental health of our children. The original recruitment of 13 818 children from birth has been expanded in subsequent cohort followups to over 20 000 children. Bradford is one of the poorest cities in the UK, but it is rich in its ethnic, religious and cultural diversity. It is a city with some of the highest levels of child poverty and illhealth and some of the lowest levels of educational achievement and healthy life expectancy in the UK. What distinguishes BiB from other birth cohorts is its focus on change and community empowerment. BiB was designed from the start not just to describe problems, but to provide useful evidence to policy makers and practitioners and ways of partnership working to develop solutions. Research is embedded within routine clinical practice, local government, schools and communities to promote the translation of evidence into practice from conception through childhood, and into adulthood. It is a ‘peoplepowered’ research programme working closely with communities to set research priorities to ensure that our outputs are relevant to realworld issues. So why is BiB important for child health and what lessons have we learnt that are applicable to other cities? Here are our top 10 reflections. 1. Building a unified platform for multidisciplinary child health research. The collegial nature of BiB has allowed researchers from diverse backgrounds including epidemiology, public health, education, psychology, sociology, genomics, health services research, data science and economics to work together on health problems within diverse communities. It has been a fertile ground, sparking novel ideas, hypotheses and approaches. 2. Encompassing the whole of the life course from birth to adulthood including parents and families. This recognises the importance of early life exposures to later adult physical and mental health, and highlights this critical period for upstream prevention. 3. Appreciating the importance of strong community engagement. From the very start BiB’s goal was coproduction with parents, children and young people. Children are at the heart of the study and their increasing involvement is central to ensuring that BiB remains their research study. This provides a virtuous circle—the more interesting and relevant we can make the research the greater the ownership and participation in future studies. For example, our community priority setting shapes our research projects, our young people design our schools research programmes and our young citizen scientists have helped develop the Bradford Clean Air Zone and its evaluation. 4. Harnessing the power of connected health and education data to improve health. BiB collects a huge amount of research data from biosamples to detailed computerised assessments. However the most valuable and informative data have come from the most mundane—our everyday clinical, social, environmental and educational data sets. By working with city partners we have been able to improve the quality of routinely collected data to enable more sophisticated analyses of health, education and social trajectories to inform service provision. 5. Linking biosamples with population health. BiB has a built a biobank with over 300 000 biological samples providing gene microarray and sequencing (n=19 689), epigenetics (n=7340), metabolomics (n=19 369) and proteomics (n=500) data. This biobank is available to national and international research groups and enables us to bring together bioscientists, clinical researchers and population health experts to work on cuttingedge research challenges. 6. Recognising the importance of wider determinants of health and the ecosystem. This includes the contribution of the types of homes people live in, the design of roads and high streets, the availability and quality of parks and green spaces and of recreational opportunities, the types of shops and businesses people are exposed to, pollution levels and opportunities to mix with others. For children living in deprived areas, a whole raft of environmental, economic and social factors create a vicious circle leading to illhealth. If we are to develop a more holistic approach to health then we need to understand and address these wider influences. 7. Redressing the imbalance of medical research that values the urgent over the important. This means acknowledging the importance of research in cancer, heart disease and diabetes but looking for potential markers and interventions in early life to develop preventative strategies. From its inception, BiB research has attempted to restore the balance of investment and has been a catalyst for over £100 m of funding in child health research and interventions embedded within our city, including £49 m for Better Start Bradford, £16 m for the Bradford Opportunity Area, £10 m for the Sport England JU:MP (Join Us: Move, Play) programme and £40 m for the Bradford Clean Air Zone. 8. Understanding the importance of place and diversity. Place is important in shaping research to meet local needs, and for providing a sense of identity for participants and placebased cohorts have a distinct advantage over national cohort studies. Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK