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How public health is evolving - interview with Prof Dame Anne Johnson

Home > Videos > How Public Health Evolving Interview Prof Dame Anne Johnson

Prof Damn Anne Johson is Professor of Infectious Disease Epidemiology at University College London and i-sense Deputy Director.

After training in medicine in Cambridge and Newcastle, Prof Dame Johnson specialised in epidemiology and public health. She has worked in research in the epidemiology and prevention of HIV and sexually transmitted infections and other infectious diseases for over 35 years. Since 2014 she has been Chair of  the UCL Population and Lifelong Health Domain and Vice-Dean for External and International Relations. From 2007-14 she was Co-Director, UCL Institute for Global Health and from 2011-14 was Chair, UCL School of Life and Medical Sciences, Population Health Domain. From 2002-2010 she was Head of the Department of Primary care and Population Sciences and then Director of the Division of Population Health. She co-directed the Medical Research Council, UK Centre for Co-ordinating Epidemiological Studies of HIV and AIDS from 1985 until 1999. She was principal investigator on the 1990 first National Survey of Sexual Attitudes and Lifestyles (Natsal 1990), Natsal 2000 and on MRC/Wellcome Trust funded Natsal 2010. Her current research portfolio includes international HIV cohort studies, behavioural intervention studies and a community study of the epidemiological and immunological determinants of seasonal influenza transmission (MRC Fluwatch). 

Who encouraged you to pursue a career in science?

My career in science was encouraged by my parents and teachers, rather traditionally.

How has the field of epidemiology changed during your career?

The field of infectious disease epidemiology has changed enormously in the 35 years of my career. Most important has been the ability to detect infectious organisms much more sensitively with new techniques. One of the biggest technical breakthroughs has been the development of PCR, which enables us to detect very few copies of an organism, and to characterise them more accurately.

What would you say has been the most exciting part of your career to date?

The most exciting part of my career to date would have to be, the work I did in the 1980s, at the height of the emerging HIV epidemic. At that stage we had no idea exactly how HIV would spread, how far it would spread, or whether it would spread heterosexually. We didn’t have a vaccine, we didn’t have treatment, and there was a huge amount of research to be undertaken. To have seen that epidemic evolve from a disease that killed so many young men in the 1980s here in London; to seeing the transformation in treatment where people are now living a reasonably normal lifespan on antiretroviral drugs; and to seeing more sophisticated approaches to prevention, has been a really extraordinary journey.

How has interdisciplinary collaborations shaped your research?

Throughout my career I’ve always carried out interdisciplinary research. I’ve worked in behavioural epidemiology, and so that has involved working with social scientists, epidemiologists, statisticians, economists and policy makers. But I’ve also been really interested in integrating that with surveillance of infectious diseases, and I have worked with virologists, microbiologists, engineers, and computer scientists throughout my career. That has been essential for example to more recent work on flu and Ebola and of course to i-sense. When you are responding to a public health problem, you are always going to have to bring multiple perspectives to that problem in order to solve it.

What do you believe the future of the NHS will look like?

We’re at a point in the NHS where there are serious questions about sustainability and financing. We have an older population living with multiple morbidities. I have no doubt that we really need to harness the digital revolution to deliver health services in ways that are, on one hand more efficient, and effective, but in ways that people have more control over the services that they receive. These include services that are delivered outside of the formal healthcare settings, such as remote consultations, and provision of testing and care in people’s homes. Much more attention is needed around prevention and coordinated care, where there is proper interaction and communication between various aspects of the health service. I think that is a huge challenge and one we have to grasp now using new technologies and big data, but also addressing ethics and public communication if we’re going to have an NHS that is fit and sustainable for the future. Finally, there are huge inequality in health experience, access to health services, and quality of health services. So diminishing inequalities needs to be a major part of both public health strategy and NHS strategy  

What effect do you think i-sense has on the future of public health?

i-sense is unique in trying to build a pathway for use of new diagnostic technologies. A lot of effort tends to be focused on the technology itself, but what we have shown is that the way the diagnostic is used to support a pathway for diagnostics, treatment and prevention, and then fed into surveillance systems is critical to success in the future. That, I think, is an important contribution from i-sense.

Are there any priority areas you think public health needs to focus on for the future?

In public health, I think we have to be doing much more in some of the big up stream drivers of our health. The new discipline of planetary health that is looking at the relationship between the sustainability of global environments and the future health of human society. It considers the ecosystem that we live in, both in the natural and built environment. If we are going to improve the health of the public, we have to take into account all these environments that drive our health. That includes the natural and built environment, the economic, political and business environment, the educational environment, and the social and, cultural environment. Unless we address those issues alongside biology, genomics and healthcare we will not achieve the gains in health and wellbeing we would like to see in the coming years.