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Why is the Born in Bradford cohort study important for child health?
  1. John Wright,
  2. Rosemary McEachan,
  3. Mathew Mathai
  1. Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, Bradford, UK
  1. Correspondence to Professor John Wright, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ, UK; John.wright{at}bthft.nhs.uk

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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.1 The original recruitment of 13 818 children from birth has been expanded in subsequent cohort follow-ups 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 ill-health and some of the lowest levels of educational achievement and healthy life expectancy in the UK.2

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 ‘people-powered’ research programme working closely with communities to set research priorities to ensure that our outputs are relevant to real-world 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 co-production 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.3 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 cutting-edge 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 ill-health. 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 place-based cohorts have a distinct advantage over national cohort studies. Child health priorities might be similar across countries and continents, but we experience them at a local level within a plurality of cultures, worldviews and communities. BiB represents families from over 40 different countries, but while its cultural heterogeneity is something to celebrate, its scientific strength lies in its ethnic homogeneity. Around 45% of BiB children are of Pakistani heritage and 40% are of white British heritage. This allows us to avoid a common mistake of grouping different ethnic groups together in epidemiological analyses, and providing more tailored interventions that provide better cultural adaptation.

  9. Demonstrating how research can change policy and practice. The strapline for BiB is ‘Research that Changes a City’. The success of BiB lies not in the number of scientific papers that it has produced, but in how it has promoted the application of scientific evidence from these papers to change policy and practice. We encourage all our research collaborators to ask the question: what difference does it make? Examples of BiB research impact on clinical, educational and social policy include the introduction within the city of universal screening for gestational diabetes, the establishment of a regional congenital anomalies register, early life interventions for obesity prevention and physical activity, the redesign of mental health services to improve detection and support for children with autism, changes to school admission policy for children born prematurely, and the design and evaluation of an ambitious clean air zone in the city to reduce pollution.4–6

  10. Embracing a whole, complex systems approach to health. BiB started life with a very clinical focus—in maternity and paediatric care—but has grown to encompass primary care, communities and schools, and links closely to local government and decision makers. The study has provided a catalyst to build a ‘City Collaboratory’ that will provide a test bed to support the identification, implementation and evaluation of upstream interventions that tackle the wider determinants of health within a whole system city setting.7

We face unprecedented health and social challenges over the next 10 years. As citizens, researchers, health workers and policy makers we have a unique opportunity to create both a personalised as well as a community-based health and care system. Birth and family cohorts such as BiB provide the gravitational force to create a solar system of child health intelligence, research and improvement, but they can be costly and challenging to set up. We are currently working with other cities to develop efficient and generalisable methods of recruitment of mothers and children to birth cohorts (Born and Bred In) using embedded informed consent within routine antenatal care and electronic patient records. This approach has the potential for every district to establish sustainable maternal and child health learning health systems that promote genuine public and staff engagement.

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Footnotes

  • Twitter @docjohnwright, @drrosiemc, @ma1hew

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer JW and RM are partly funded by the National Institute for Health Research Yorkshire and Humber ARC. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care. No funders influenced the content of this paper and the views expressed in the paper are those of the authors and not of any funders acknowledged above.

  • Competing interests None declared.

  • Patient and public involvement statement Born in Bradford is only possible because of the enthusiasm and commitment of the Children and Parents in BiB. We are grateful to all the participants, health professionals, schools and researchers who have made Born in Bradford happen.

  • Provenance and peer review Commissioned; externally peer reviewed.