There is a growing consensus – as evidenced by Jon Wardle’s comments on Croakey that the McKeon Review of health and medical research so far has missed the boat with respect to public health and prevention.
The Australian Primary Health Care Research Institute has highlighted that point in the submission it has filed with the review, writes institute senior research fellow, Lesley Russell.
The McKeon panel’s vision is for ‘better health through research’, but the draft report misses many opportunities to tackle the wide range of factors beyond healthcare that impact on health.
Indeed the paper consistently confuses ‘health’ and ‘healthcare’ and is largely focused on the latter; there is little focus on public health, prevention, and the role of the social determinants of health (eg housing, the environment, education and social justice) in determining health outcomes and addressing health disparities.
If the intent is to focus only on those aspects of public health that are dealt with through the activities of the Department of Health and Ageing, then the ability to successfully impact and improve the health status of all Australians will be severely compromised.
For example, tackling the current obesity crisis and closing the gap on Indigenous health – an issue specifically raised in the review as needing specific research attention – will require efforts beyond those delivered through healthcare services.
Australia already lags in the resources committed to research in prevention, healthcare systems and healthcare delivery, and there
is little in this paper that will improve this situation.
Without sustainable funding and long-term investments in these areas, they will continue to lose out to the biomedical and clinical sciences.
Moreover, there needs to be recognition that research processes, controls, outcome measures and cost-effectiveness analysis in these
areas are different, and cannot be based on those developed for biomedical and clinical studies.
The draft report calls for the establishment of Integrated Health Research Centres. The paper acknowledges the role that healthcare services such as Local Hospital Networks, Medicare Locals, aged care facilities and community-based clinicians potentially have in health / healthcare research but offers no suggestions as to how these bodies / individuals could be incentivised to be involved.
One model to consider is the Australian Primary Health Care Research Institute, which has been responsible, as part of the federal Primary Health Care Research, Evaluation and Development (PHCRED) strategy, for building research capacity in primary
care since it was established in 2002.
The Institute distributes research funding in a competitive process for primary care health services research, and has built up a network
of primary healthcare researchers across Australia.
Public health
research at risk of still playing second fiddle
Currently, the Institute funds eight Centres of Research Excellence in primary health care, all with clear links to current policy, and
with a remit to ensure that research findings are effectively translated.
Many of the issues needed to improve health outcomes – work on health in areas beyond healthcare, interactions with policy makers, patients empowerment, and addressing efficacy, quality and safety and disparities – do not sit well with the current role of the NHMRC.
Proposals to hand over responsibility for all these new research aspects to the NHMRC, whose primary responsibility is biomedical and clinical research, gives rise to concerns that the new responsibilities will play second fiddle to the old and that non-clinical
research areas and non-publication work such as that required in health policy development will continued to be under-valued.
The final report must also consider how Australia could establish a climate of continuous innovation and continuous improvement in
health and healthcare services and delivery.
Failure to do this means that we are condemned to an endless cycle of pilot programs, the results of which never get incorporated into the healthcare system.
One model to consider in this regard is that of the Center for Medicare and Medicaid Innovation recently established within the United
States Department of Health and Human Services under the provisions of the Affordable Care Act.
In summary, the APHCRI submission urged the McKeon Review to incorporate recommendations for addressing research gaps in prevention, health services research, research translation, and consumer and community engagement in a deliberate and comprehensive way that acknowledges the wide range of societal and socio-economic factors that determine health status across the lifespan.
The research that generates breakthroughs in biomedical and clinical areas must continue to be supported, but the benefits to individuals and the nation of a sustained commitment to prevention and public health argue for its acceptance and implementation at a comparable level.
