As previously reported at Croakey (see here and here, for example), many questions have been raised about the Medical Research Future Fund, including what appears to be a narrow focus on medical research, rather than the wider determinants of health.
Submissions close today for those wishing to make suggestions for the Australian Medical Research and Innovation Strategy (Strategy) and related Priorities.
Meanwhile, a joint submission from a number of health groups makes a powerful argument for the Fund to prioritise research into the wider determinants of health and health inequalities, as Professor Fran Baum and Dr Matt Fisher write below.
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Fran Baum and Matt Fisher write:
The Medical Research Future Fund was established by a 2015 Act of Parliament to provide grants of financial assistance to support health and medical research and innovation.
Despite the Act citing “health” as one of its objectives, its focus appears to be firmly set on the “medical”.
A recent call for submissions from the MRFF Advisory board noted that grants would be given to “translate research findings into clinical practice, with the objectives of improving the health and well-being of all Australians”.
The Southgate Institute for Health, Society and Equity, the NHMRC Centre for Research Excellence on the Social Determinants of Health Equity and the Public Health Association of Australia have joined forces to challenge the MRFF to consider the evidence of what actually creates health and well-being and act on this in setting their research strategy and priorities.
Evidence suggests that health care services contribute somewhere around 20 percent to overall health, while broader social and economic factors account for most of the rest. It is time to bring this evidence into the mainstream of policy and research action for health and wellbeing in Australia.
Given that the MRFF would surely want to be based on evidence, we argue that the fund should be investing at least as much in public health research as in bio-medical research.
Medical research to identify treatments to prevent, delay or treat chronic disease has provided and will continue to provide many benefits to Australians and others, but on its own it will not achieve Australia’s National Science and Research Priorities to “build healthy and resilient communities” and implement “preventative strategies to improve physical health and wellbeing”.
Solutions-focused public health research
Our submission argued that biomedical research needs to be complemented by high quality, solution-focused public health research. This research needs to be based on the recognition that policies in all sectors (including industry, environment, regional development, education, justice) have significant impacts on population health.
Public health research is fundamentally different to medical research. It is concerned with understanding the health of whole populations and the incidence and origins of disease.
Indeed the most important risk factors for chronic disease – smoking, alcohol use, physical inactivity and unhealthy diet – are non-medical risks linked to social and behavioural determinants.
In turn these risk factors are largely created by what the President of the World Medical Association Sir Michael Marmot calls the “causes of the causes”; factors such as income and wealth distribution and the extent of publicly provided health, education and welfare services.
Public health research on social determinants can determine the social, behavioural and environmental factors that support good health or increases risk of disease, and through that understanding, design and evaluate measures and policies in all sectors to keep populations healthy.
While it seems that finding cures for diseases would make the biggest contribution to promoting health, this isn’t the case. Introducing preventive measures which make small changes in the non-medical risk across a whole population is much more effective at creating a healthier population.
There are strong economic arguments for investment in social determinants of health research. Few would argue with the dictum “prevention is better than cure”, yet in public policy and research it is ignored more than acted on.
Public health research to design, implement, evaluate and scale-up innovative, collaborative social determinants interventions to improve health and wellbeing among disadvantaged or at risk groups can and will have multiple flow-on benefits in other areas of social and health policy; for example, to improve employment prospects, support healthy child development, and reduce demands on health care systems due to premature chronic disease.
Research leading to improved action on social determinants will avoid expensive externalisations (including hospital and incarceration costs) from the action of other sectors (e.g. research to implement healthy urban planning has the potential to greatly reduce obesity).
A social determinants of health research agenda
The MRFF should fund a program of public health research to inform the design, implementation, evaluation and scaling-up of innovative social determinants of health interventions and policies that promote and improve good health; across broad population groups, or within groups subject to social, economic or locational disadvantages.
The program of research would include capacity-building schemes and long-term funded Centres that focus on social determinants research, and incorporate research projects to:
- Understand the policy processes by which action on the social determinants can be taken up in different sectors, and evaluate the implementation of such actions in sectors such as urban planning, education, environment, industry, justice;
- Understand the health gradient whereby health inequities operate across the socio-economic gradients and determine which universal policies best flatten this gradient;
- Assess the health and health equity impacts of public policies;
- Examine the impact of social determinants on groups facing high levels of disadvantage including Aboriginal people, migrants and refugees, people from a low social-economic background, people living with mental illness;
- Engage with Aboriginal and Torres Strait Islander leaders and community organisations to design, implement and evaluate Aboriginal and Torres Strait Islander-led strategies to improve health and empower communities through preventive primary health care, strong cultures, strategies to tackle racism and enhanced opportunities in education and employment;
- Develop and extend modes of health care services provision that address the impacts of the social determinants on users of the health care system (e.g. transport, lack of housing for people with mental illness);
- Design and implement large-scale area or need-group based interventions to improve health and wellbeing with time allowed to: engage multiple collaborating agencies/organisations; build engagement with affected communities; and combine actions across multiple modalities with complementary foci on building individual, family and community capabilities, and creating conditions to support good health;
- Use economic assessment of interventions to quantify savings to other areas of social policy or health service spending;
- Understanding the conditions and mechanisms needed to scale-up interventions demonstrating health and wellbeing improvements from pilot to universal programs.
With such a program of research Australia would have the evidence needed to become a healthier and more equitable society.
- Professor Fran Baum is a Matthew Flinders Distinguished Professor of Public Health and Director of the Southgate Institute of Health, Society and Equity at Flinders University, and co-director of the NHMRC Centre for Research Excellence on the Social Determinants of Health Equity.
- Dr Matt Fisher a Research Fellow with the Southgate Institute for Health, Society and Equity, and a researcher with the CRE.
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