During a presentation to a group of architects two years ago, Dr Tolu Oni asked all those in the room who were health professionals to raise their hands. Only one responded. But after she had shared with them her research into understanding how urban environments contribute to health and how interventions in those environments may enable healthy choices, she asked the question again. This time, most of those in the audience raised their hands.
Tolu’s research prioritises health rather than disease and recognises that health promotion is a responsibility that must be widely shared amongst stakeholders and collaborators. It is this research that has brought her to the MRC Epidemiology Unit in Cambridge, where she is the joint lead for the Global Diet and Activity Research Group (GDAR). There she works with colleagues, including GDAR Director (and Wolfson Fellow) Professor Nick Wareham, studying the determinants of diet and physical activity in low- and middle-income countries. GDAR partners with researchers in several African and Caribbean countries with the goal of preventing non-communicable diseases such as diabetes, heart disease and cancer. And, of course, finding ways to build health into the fabric of cities globally.
“I don’t work on disease; I work on health.” – Dr Tolu Oni
From treating sickness to creating health
A Londoner with Nigerian roots, Tolu received her BSc in International Health from UCL, where she developed her interest in diseases of global importance and the interventions that influence health outcomes. She then went on to medical school at UCL, becoming a doctor in 2004.
After working as a clinician for five years, Tolu realised that she still had research questions that she wanted to explore in depth. A contact at the Royal Society of Tropical Medicine put her in touch with a colleague in South Africa, and in 2007 she became a Junior Research Fellow at the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town.
“I went to South Africa to work as a medical officer for 5 months, and I ended up staying for 12 years,” says Tolu.
Her time in South Africa involved a number of roles both academic and clinical. She was the Public Health Registrar for the Western Cape Department of Health, and a Lecturer, then Associate Professor at the University of Cape Town. In 2015, she founded the Research Initiative for Cities Health and Equity (RICHE). And she continued to do some clinical work, particularly with AIDS and TB patients.
“I would see patients with HIV and it felt very artificial to say, ‘I’ll treat your HIV but I see you also have high blood pressure, you need to eat better and get more exercise’. But that ignored what was happening outside the clinic walls, whether healthy food was available and if it was safe to move about. These factors impact people’s health, influence how they feel and help determine whether they prioritise their clinic appointments. I became increasingly interested in how this played out at a population level,” she says.
Tolu began to realise that over two-thirds of the factors that contribute to health exist outside the medical sector. These include the built environment, safety, economic opportunities, gender, social support, and more. The inequalities and pressures of urban settings can magnify these factors, especially in areas where cities are growing rapidly and without the infrastructure to prioritise well-being.
“The fastest-growing urban areas in the world are in Africa and Asia,” she says. “I am passionate about Africa and wanted to scale up my research to focus more broadly beyond South Africa. I want to know if we can better co-design our cities to create health for the entire population in the long term.” After a sabbatical period, Tolu realised that she needed to give this ambitious vision the time and space it required. “I saw that this research was the most pressing thing for me and if I didn’t give it the concentrated time it needed that I would regret it. I was also turning 40, which I think is a point when you stop being a ‘young scientist’ and ramp up the next stage of your career.”
Tolu first came to Cambridge in 2017, where she was connected with Dr Nigel Unwin, Clinical Director of Research in Global Public Health and joint lead for GDAR. She realised that MRC Epidemiology Unit had existing data collection capacity and methodology her research required. GDAR received funding from the National Institute for Health Research (NIHR) and she joined that autumn.
Earlier this year, Nick Wareham suggested that Tolu might be interested in becoming a Fellow at Wolfson, something that she hadn’t previously considered. “As all my training was in London, the concept of Colleges was a bit foreign to me. I didn’t know what it meant to be a Fellow,” she says. “The strategic reason behind my move to GDAR was to focus on my research and leave behind the faculty and institutional responsibilities.” But after meeting with Professor Jane Clarke and learning more about the cross-disciplinary initiatives at Wolfson, she realised that the Fellowship could actually foster collaborations that could increase understanding, policy and interventions for improved global urban health.
And now, COVID
Tolu joined Wolfson just as the pandemic was spreading and all College business became virtual. What impact has the situation had on her research?
“The crisis has obviously had an impact on some of our data collection. For instance, we are very interested in adolescents and youth and right now schools are closed across much of Africa. So we have to adapt some of our existing work in terms of how we collect information.”
Tolu wonders if responses to the pandemic may bring a new sense of agency to addressing existing problems.
“The pandemic has brought to the surface issues of health and health inequality that we knew about, but haven’t previously been able to mobilize and do anything about,” she says. “Can we leverage this attention to accelerate some of the work we are already doing? Suddenly we have private sector actors investing for public health in ways we wouldn’t have thought possible – car manufacturers making ventilators, for instance. So the emergency has triggered the imagination of what people thought is possible or doable. The innovation is in the process and not necessarily in the outcome.”
“Through this pandemic and beyond, I will continue to focus on ways to create health for people and the planet in the long term. I believe it is possible and I am driven by the potential for healthy cities in Africa and beyond.”
You can follow Tolu on Twitter @DrTolullah.