Growing Health Innovation with Dr Natalie Walker

26 August 2019

NIHI turns 30 this year. That’s 30 years of ground-breaking work that has help shape research, informed policy and driven innovation. In the lead up to our conference celebration, we spoke to the team and found out more about the people behind the work. Next, we spoke to Assoc. Professor Natalie Walker, Lead for Tobacco and Addiction.


Thinking back to when NIHI was first formed, what were you doing at the time?

I took a gap year away from University in 1989, so was back-packing around Canada.  

Since that time, what do you see as the biggest advance in public health/research/technology?

I'd have to say the single biggest advance is the mobile phone - it's been a game-changer for public health. Mobile phones are now ubiquitous. Researchers at NIHI were among the first in the world to see the opportunity to deliver brief interventions via a mobile phone to promote public health. Thirty years later, NIHI is still a leader in the field designing and testing the effectiveness of mhealth interventions.

What are you working on now that would have been unthinkable 30 years ago?

I never thought I'd be working in the Addiction field, but here I am. Also, we now have mobile phones, electronic data capture for clinical trials, and e-cigarettes - three things that were unthinkable in 1989.

Why did you choose to join NIHI?

I was in Wellington working in the field of infectious disease and environmental epidemiology at ESR:Health. I knew that in order to grow my career, I needed to have a PhD.  A colleague told me to contact Dr Anthony Rodgers at the Clinical Trials Research Unit in Auckland, as he was considered something of a 'rock star' in the cardiovascular epidemiology field - and he may be keen to take on a PhD student. So I contacted Anthony and subsequently moved to Auckland to undertake a PhD at the CTRU (with Anthony and Stephen MacMahon as my supervisors). I've been here ever since! 

What are your fondest memories from your time at NIHI?

The people - they create the memories. Some of my favourites are things like celebrating our wins, brainstorming and laughter. When we secured funding for our research or had a big publication, there is a great acknowledgement of a lot of hard work by all concerned. Before we get to that point, there's nothing more fun than brainstorming ideas with a group of people around the table. Nothing is too crazy, anything goes, starting with the line "what if we could...", then finding the way to make the "what if" actually happen. And finally, laughter: late Friday afternoons, Gary Whitlock and a few of the guys at the CTRU would play cricket in the hallway outside my office. Noisy and fun.

What is exciting to you about research/technology/public health today?

Public health: I love the way we can engage with NZ policymakers so easily, to ensure our research is policy-relevant.
Technology: I love the rapid innovation occurring in the health tech field.  
Research: cross-disciplinary research - I see the greatest advancements coming from working across disciplinary fields  

What do you see as the biggest challenge you face in your work today?

The two biggest challenges are time and money. There are so many ideas, and not enough time to explore them all. Even with a great idea, but if you can't get the money to undertake the research around the idea, it can be frustrating.

How do you see global issues playing out in New Zealand, and how are we approaching solutions for them?

The biggest issue I believe is the spread of 'fake news' - slowly eroding people's trust in science. Moral panic is popping up everywhere. I'm not sure of the best way to address this. It's even creating division within academia and science. A good example of this is the topic of e-cigarettes.

What predictions do you have for the next 30 years?

After discussing this question with my two very savvy teenage children, this is what they predict for health care:

- We will carry our health data with us (e.g. in a wrist band or implant), rather than having it housed solely within the healthcare system.
- There will be other ways to receive community-based health care, eg. we will be able to connect, via mobile phone or computer (anytime, anywhere), with a virtual doctor to undertake basic health screening tests - and visit pods/rooms located throughout the community (eg. in malls, on the street) to provide blood and urine sample for testing, or pick up medication. Visiting a real doctor will be further up the escalation pathway.
- Minimal health care will be offered to those over 75 years - in 30 years from now too many people will be in this age group (clearly their geography lessons have informed this), but there will not be enough resources to look after them, especially if they are in rural areas.  Actually, I see this already happening (my father is over 80 and rural living).
- Voluntary euthanasia will be available in NZ.
- Climate change will bring a whole lot of new health issues into play: eg. Mosquito-borne diseases will appear in the Upper North Island of NZ, extreme weather events will mean we need to redesign how we live to reduce the risk of death.
- There will be fewer tobacco-related death and disease in 30 years, given the decline in smoking prevalence in the previous 30 years.
- Alcohol-related harm will still be a major concern because there is no political will to change the current environment  

I do hope we solve some of these issues in the next 30 years. How we act now will inform what is possible.

Join us in celebrating 30 years of NIHI. Growing from humble beginnings, our ground-breaking work has shaped research, informed policy and driven innovation. More information about, and registration for, our upcoming conference can be found here.