Leo Loman

Felix Feldman, Joshua Harris, Timothy Laurence et al.

Large language models (LLMs) achieve promising results on medical question answering benchmarks, yet their use in public health is constrained by hallucinations and the rapid evolution of official guidance. Retrieval-Augmented Generation (RAG) mitigates these risks by grounding responses in an explicitly maintained corpus, but end-to-end performance depends critically on retrieval configuration and on evaluation beyond multiple-choice formats. We extend PubHealthBench, a question answering (QA) benchmark of 7,929 questions derived from UK Government public health guidance, into a retrieval-augmented setting and systematically evaluate retrieval and generation choices. We compare dense, sparse, and hybrid retrieval across multiple embedding models and corpus variants, and show that hybrid retrieval consistently improves recall and ranking quality, with chunk length and topic interacting with ranking performance. Providing retrieved context substantially increases multiple-choice accuracy across a diverse set of LLMs, enabling smaller open-weight models to match or outperform larger models used without retrieval, with gains primarily driven by retrieval quality and careful context selection. To assess realistic free-form answering, we introduce a rubric-based LLM-as-a-judge covering faithfulness, completeness, clarity, and factual consistency, and validate it against dual human annotations. Judge-human agreement is strongest for faithfulness and completeness, while factual consistency and clarity are less reliably reproduced, motivating caution when interpreting those dimensions at scale. Overall, our results highlight retrieval as a primary lever for reliable public health QA and provide practical guidance for building and evaluating RAG systems grounded in official guidance.

Joshua Harris, Timothy Laurence, Leo Loman et al.

Advances in Large Language Models (LLMs) have led to significant interest in their potential to support human experts across a range of domains, including public health. In this work we present automated evaluations of LLMs for public health tasks involving the classification and extraction of free text. We combine six externally annotated datasets with seven new internally annotated datasets to evaluate LLMs for processing text related to: health burden, epidemiological risk factors, and public health interventions. We evaluate eleven open-weight LLMs (7-123 billion parameters) across all tasks using zero-shot in-context learning. We find that Llama-3.3-70B-Instruct is the highest performing model, achieving the best results on 8/16 tasks (using micro-F1 scores). We see significant variation across tasks with all open-weight LLMs scoring below 60% micro-F1 on some challenging tasks, such as Contact Classification, while all LLMs achieve greater than 80% micro-F1 on others, such as GI Illness Classification. For a subset of 11 tasks, we also evaluate three GPT-4 and GPT-4o series models and find comparable results to Llama-3.3-70B-Instruct. Overall, based on these initial results we find promising signs that LLMs may be useful tools for public health experts to extract information from a wide variety of free text sources, and support public health surveillance, research, and interventions.

Timothy Laurence, Joshua Harris, Leo Loman et al.

Foodborne gastrointestinal (GI) illness is a common cause of ill health in the UK. However, many cases do not interact with the healthcare system, posing significant challenges for traditional surveillance methods. The growth of publicly available online restaurant reviews and advancements in large language models (LLMs) present potential opportunities to extend disease surveillance by identifying public reports of GI illness. In this study, we introduce a novel annotation schema, developed with experts in GI illness, applied to the Yelp Open Dataset of reviews. Our annotations extend beyond binary disease detection, to include detailed extraction of information on symptoms and foods. We evaluate the performance of open-weight LLMs across these three tasks: GI illness detection, symptom extraction, and food extraction. We compare this performance to RoBERTa-based classification models fine-tuned specifically for these tasks. Our results show that using prompt-based approaches, LLMs achieve micro-F1 scores of over 90% for all three of our tasks. Using prompting alone, we achieve micro-F1 scores that exceed those of smaller fine-tuned models. We further demonstrate the robustness of LLMs in GI illness detection across three bias-focused experiments. Our results suggest that publicly available review text and LLMs offer substantial potential for public health surveillance of GI illness by enabling highly effective extraction of key information. While LLMs appear to exhibit minimal bias in processing, the inherent limitations of restaurant review data highlight the need for cautious interpretation of results.

Joshua Harris, Fan Grayson, Felix Feldman et al.

As Large Language Models (LLMs) become widely accessible, a detailed understanding of their knowledge within specific domains becomes necessary for successful real world use. This is particularly critical in public health, where failure to retrieve relevant, accurate, and current information could significantly impact UK residents. However, currently little is known about LLM knowledge of UK Government public health information. To address this issue, this paper introduces a new benchmark, PubHealthBench, with over 8000 questions for evaluating LLMs' Multiple Choice Question Answering (MCQA) and free form responses to public health queries. To create PubHealthBench we extract free text from 687 current UK government guidance documents and implement an automated pipeline for generating MCQA samples. Assessing 24 LLMs on PubHealthBench we find the latest private LLMs (GPT-4.5, GPT-4.1 and o1) have a high degree of knowledge, achieving >90% accuracy in the MCQA setup, and outperform humans with cursory search engine use. However, in the free form setup we see lower performance with no model scoring >75%. Importantly we find in both setups LLMs have higher accuracy on guidance intended for the general public. Therefore, there are promising signs that state of the art (SOTA) LLMs are an increasingly accurate source of public health information, but additional safeguards or tools may still be needed when providing free form responses on public health topics.