Shining a light on the early years: inaugural lecture by Professor Saxena

Professor Sonia Saxena established Imperial's Child Health Unit in 2013

This week Professor Sonia Saxena will talk about the importance of early years primary care and the power of health data in her inaugural lecture.

A practising GP in South West London, Sonia Saxena was promoted to Professor of Primary Care last year and is Head of the Child Health Unit she set up in 2013. Her research uses routinely collected data to establish how contact with primary care can influence early life exposures to health risks, and improve health later in life. Her work has a particular focus on non-communicable diseases such as diabetes, asthma and obesity. 

The findings from her research have attracted attention from both media and policy with wide-reaching implications on a local and global scale.

Here she talks about her upcoming lecture, resilience in childhood and the importance of getting the research question right.

The title of your lecture ‘“Chickpeas of Iron”: How primary care can influence children’s health’ is quite enigmatic – can you explain?

Without giving too much away, “Chickpeas of iron” is an Indian metaphor that my great aunt gave me when I first told her I had got into medical school. In my lecture I refer to it in relating some of the challenges in my own career journey, and in the hope that we can build a strong and resilient future child population.

Why do you believe it is so important to look at early risk factors in life?

Children are healthier now than ever before and we have had global successes in combating many infectious diseases. However there are new emerging epidemics of non-communicable diseases such as asthma, obesity, diabetes and mental health, These are driven by our behaviours such as diet, sedentary lifestyle and risks to exposures that have come with changes in the wider built and social environment. It’s important to tackle the ones we can influence early, for our long-term health. 

Can you talk about your general approach to research and the advantages of using routinely collected data?

In the mid 1990s when computers came into the consulting room I realised that we potentially had the data at our fingertips to create birth cohorts by using coded routine information from every day encounters, such as symptoms, new diagnoses, prescriptions, vaccinations, treatments etc. I also realised we could harness the data to explore not just the burden of disease, but add to the science base on the effectiveness of treatments and interventions, converting everyday encounters into powerful epidemiological data.

Using data in this way has many benefits alongside traditional methods such as randomised controlled trials. As well as being cheaper, it can provide a rapid translation into practice and I also believe it has ethical advantages in that it removes the burden for patients and clinicians to provide and collect primary data. However, we have to ensure these data are used judiciously, protecting patients’ rights to privacy at all times and that it is only used to answer the research questions that can improve health.  But data does not provide all the answers. You have to match the method with the right research questions and get your questions right.

And how do you get the right research question?

The best way is to ask the patient. It’s important not to see the information as just a dataset to trawl but to remember where it has come from. It captures what doctors record from real encounters with patients but may not tell the story from their point of view. If you want to frame questions that are relevant to patients, it is best to start by asking them what matters. These are meaningful questions to which the public, the media and, policy makers want to know the answers. The answers to such questions often rely on common sense, but getting good science around what is a common sense solution is important because if it doesn’t work, we shouldn’t do it. Conversely if it does, we can encourage everyone to consider the solution.

Does your research work influence your work as a GP?

I’m always a GP first and foremost but increasingly my research is coming into my clinical work. I often discuss research findings with patients to try to help them to make informed decisions. For example, when children come to see me with a middle ear infection, I usually tell parents and carers it should settle with no treatment and that we would have to treat over 4000 children with an antibiotic to avoid one case of complicated ear infection. Most of them say they would rather their child avoided having to take antibiotics.

Looking to the future what can you see on the horizon of your work at Imperial?

As data becomes more integrated, there are more possibilities for new statistical analyses at Imperial and fantastic opportunities for collaborative research with many other academic and NHS partners both in the UK and abroad. It’s an exciting time with possible new opportunities through the campaign for the School of Pubic Health, which aims to raise £100 million to deliver a state-of-the-art building at White City. Last month the campaign received a gift of £25 million from Imperial alumna Marit Mohn that will establish a Centre for Children’s Health and Wellbeing. Such a donation gives a huge morale boost to those of us working in this area, putting Children’s Health and Wellbeing at the forefront of primary care research. It will have as a centrepiece a birth cohort created from the local community that I hope will both engage them with improving their own health and allow us to study many more early life exposures in an urban diverse population.

Last June I became the first GP at Imperial to be promoted to a professor and 2018 has been an amazing year for me. I think I have got to where I am through hard work and good teamwork, but I’ve also had some good breaks in my career. We have a great team at the Child Health Unit and I’m constantly looking to give people the same opportunities I had through mentoring and training. It’s such a pleasure to see people who have the potential and to give them a hand up to realise this.

Professor Sonia Saxena will deliver her inaugural lecture ‘Chickpeas of Iron: How primary care can influence children’s health’ on Wednesday 10^th October at 17.30 at the Brian Drewe Lecture Theatre, Reynolds Building, Charing Cross.