Back on April 1, when the Croakey Register of Unreleased Documents was launched, it included mention of an NHMRC review of public health research which was conducted last year and whose findings have been widely anticipated. At the time, the NHMRC’s ceo Professor Warwick Anderson told us that the report would be released “next week”.
Well, it’s still not out and now Professor Don Nutbeam, who chaired the committee which produced the review, has had enough.
Nutbeam, professor of public health, provost and deputy vice-chancellor at the University of Sydney, has taken the unusual step of publicly releasing a letter to the public health community expressing his frustration about the delay.
You don’t have to read too closely between the lines to determine where his message is directed. It sounds like Anderson has been ready to release the report for some time but has been waiting for sign-off from Roxon’s office. It’s all very ironic given some of the review’s recommendations, as outlined in the letter below.
Nutbeam’s concerns will be outlined further in a story at Crikey today.
Letter from Professor Don Nutbeam:
Dear colleagues
NHMRC Review of Public Health Funding in Australia
I wrote a letter that appeared on the NHMRC web site December 2008 explaining that publication of the Report on the Review of Public Health Funding was to be delayed in order that it could be released concurrently with the Draft NHMRC Plan early in 2009.
I’m writing to you again six months on.
Following substantial consultations, wide-ranging feedback and a receipt of a large number of formal submissions during May to September 2008, the report was completed on schedule and provided to NHMRC by the Review Committee in final draft form in October 2008. It was subsequently considered by NHMRC Research Committee in November 2008. A draft response from NHMRC was prepared soon after. I attended the Research Committee meeting, and was provided with a late draft of the formal NHMRC response. Both were very positive, and suggested to me that the NHMRC, led by CEO, Professor Warwick Anderson, were taking very seriously the issues identified in the report, and were diligently responding to all of the recommendations.
The Report provides an overview of the different sources of research income for public health research in Australia, including a particular focus on the contribution of the NHMRC. It also offers an appraisal of the quality and impact of public health research in Australia. It concludes that the quality of research is impressive, both in terms of scientific quality and public health impact. Public health research in Australia is among the most cited in the world scientific literature – by some measures having the highest impact of any of the health and medical research disciplines in Australia. It has lead to important discovery and innovation in tobacco control, prevention of SIDs, preventing skin cancer, and in HIV/AIDS control.
Despite these important gains, the Committee was concerned that both quality and impact of research are threatened by a lack of coordination nationally, inflexibility in funding schemes and assessment processes, and a lack of transparency in the use of research, especially research funded by State and Federal governments.
Among the key recommendations are:
• The creation of a national public health research forum, and national public health research strategy under the oversight of NHMRC to provide better coordination, and more strategic investment in public health research in Australia
• A much stronger focus on intervention research with more practical application in addressing identified public health priorities
• Greater flexibility in funding schemes and important refinements to the peer review process in response to the feedback we received
• Improved transparency through the creation of a national register of public health research, mirroring the clinical trials register supported by NHMRC
• Redevelopment of the role of NHMRC as an important source of credible and independent advice to the public on a wide range of significant public health issues.
It had been my hope that we would have had the opportunity by now to debate the report, its findings and recommendations, and that we may have seen some practical responses to the recommendations by NHMRC and governments in Australia. Instead, the recent budget announced the axing of funding for the Public Health Education and Research Program (PHERP). This Program was regularly referred to in our consultations and in the Report as one of the factors that has supported success in public health research in Australia. We appear to be going backwards not forwards in response to the success of public health research in Australia.
It is not clear to me why the release of the report has been delayed for so long. Any advantage that might have been realized by the release of the report with the draft NHMRC Plan has dissipated in disappointment, concern and suspicion among the public health community.
Whilst I have no reason to believe that there is anything other than an unnecessarily cumbersome bureaucratic process that is causing this exceptional delay, I write this letter in frustration that the goodwill, enthusiasm and commitment displayed by the public health community during the public consultation is not being respected and appropriately rewarded.
As some of you will know, part of my frustration is due to the fact that I will be leaving Australia to take a new position in the UK in August. It had been my hope that I would have been able to participate in a productive discussion with the public health community on the findings and recommendations of the report, and would be able to advocate for the improvements to public health research that are proposed in the report. Regrettably the opportunity for this will be very limited.
You may wish to make your views known to the Minister, Nicola Roxon (Nicola.roxon.mp@aph.gov.au) both about the delayed release of the report, and about the axing of PHERP.
Finally, I would like to take this opportunity to recognise the contribution of my fellow Review Committee members: A/Prof Toni Ashton, A/Professor Emily Banks, Professor Alan Cass, Professor Mike Daube, A/Professor Steve Farish, and Professor Rob Sanson-Fisher. Professor Judith Lumley also contributed to the early meetings of the Committee.
With best wishes
Professor Don Nutbeam
Huge kudos to Don Nutbeam for kicking this into the public arena. Everything I have heard about Nicola Roxon’s office, including the conversations I’ve had with staff, suggests that there is the best fit we have seen since Neal Blewett’s time as federal health minister between political will and the population-health perspective. The Preventative (sic) Health Task Force reports are mostly brimming with visionary analysis and recommendations. She is getting great advice.
So why this inexcusable delay with the Nutbeam report which would seem to dovetail with so much else that’s on high simmer? Is it the perennial horsemen riding the Rule of Rescue toward the inexhaustible agenda of acute care crises that we should look to in trying to understand why prevention and public health always get tickets in the back stalls, far away from the real action on centre stage? When prevention gets a soulmate in the health ministry, hopes are high for this to change. When will the curtain finally rise to show something different?
Simon Chapman
Thank you for making this public.
We were very distressed by the recent decision axing of PHERP – its frustrating to know that this evidence and evaluation was sitting there at the time this decision was made.
Let us hope this flushes out a response and the release of the report – certainly there will be some awkward questions to be answered in Senate Estimates next week.
For the record the Greens have been calling for PHERP to be continued …