Introduction by Croakey: Associate Professor Lesley Russell recently published a comprehensive analysis of the Medical Research Future Fund (MRFF) – read Part 1 and Part 2 at Croakey.
This investigation included examining the MRFF’s funding sources, expenditure patterns, governance processes and evaluation mechanisms. It revealed some serious inconsistencies in reported expenditure, an overall lack of transparency and accountability, and significant gaps in the scope of research funded and the input from consumers and affected communities.
In responding to this analysis, Dr Arnagretta Hunter, a physician and cardiologist from the Australian National University, calls for a “radical rethink and restructure” to transform health and medical research in Australia.
Arnagretta Hunter writes:
The Medical Research Futures Fund represents an extraordinary opportunity to invest in the long-term health of Australians. A fund of $20 billion, the MRFF allocates around $500 million each year to research, making it the dominant source of funding for medical and health research in Australia.
Does its current structure facilitate the best outcomes for investment?
MRFF plans activities according to Strategies and Priorities that were defined when the fund was established and have been subsequently reviewed.
The current strategies are: strategic and international horizons, data and infrastructure, health services and systems, capacity and collaboration, trials and translation and commercialisation. In 2020 there was a public consultation when the priorities framework was updated.
The priorities identified through this process were:
- Antimicrobial resistance
- Global health challenges such as pandemics
- Aboriginal and Torres Strait Islander people’s health
- Ageing and aged care
- Digital health tools
- Comparing the value of different health interventions
- Primary care research
- Support for health professionals to conduct their own research
- Identifying gaps where research does not address the lived experiences of patients, and fixing these
- Using existing drugs for new purposes
- Testing public health interventions to reduce chronic disease
- Supporting Australian biomedical and medical device development.
It’s hard to dispute the value of any of these points individually – all useful issues for the health and wellbeing of Australians. But what should the priorities of the MRFF be and how does the fundamental structure of the MRFF facilitate the best health outcomes for Australians in the future?
Opportunity
The MRFF represents a remarkable opportunity. Starting with the big strategic picture, the central mission should be to improve the health and wellbeing of Australians.
To achieve this, investment should be across all elements of health and wellbeing: the biology of disease, the social determinants of health and the environmental context in which we are all living. Biology, Society and Environment: this should be the primary foundation on which our health future is built.
On this foundation, priorities such as primary care, digital health, pandemics, antibiotic resistance etc sit easily. Conditions such as cardiovascular disease have underlying mechanisms seen through biology, society and environment. Ageing and dementia can be modified through biology, society and environment.
It is hard to address the challenges of these conditions without working across biology, society and environment. This is true for much of the burden of disease in Australia.
The biological focus allows our remarkable scientists to find new mechanisms of disease and new treatments. Much of our medical research is focused on the biology of diseases.
Social and environmental determinants
The social determinants of health deserve as much attention.
Without recognising and addressing the cultural determinants of wellbeing, socioeconomic disadvantage, rural and regional contexts, educational attainment, work and relationships, we know we cannot achieve the healthiest community.
The final piece of the jigsaw is the environment: the planet that provides the air we breathe, the food we eat and the water we need to survive. And the way we interact with the environment: where and how we live.
A full view of health and wellbeing
The current MRFF strategy and priorities framework does not facilitate a full view of health and wellbeing. The most obvious omission is environment with negligible investment in environmental influence on health.
Unfortunately, it can feel that politics influences this omission.
Could our current Federal Government aim to underplay the influence of environment on our health? Does our Federal Government recognise the immense health threat of climate change over the decades ahead? The absence of a federal Climate Change and Health Strategy may offer an answer.
Climate change and environmental issues are not just absent from the MRFF Strategies and Priorities, but were also missing from the Department of Health Long-Term National Health Plan.
Striking omission
If we consider the influence of air pollution alone on cardiovascular disease and mortality, it is a striking omission. As we look toward an increasingly extreme climate over coming decades, the adverse impact of the environment on our health and wellbeing will only grow.
Funding for environmental influence on health is woeful. After Black Summer’s devastating bushfires, hazardous air pollution from bushfire smoke affected at least the short-term health of more than 12 million Australians.
The MRFF allocated only $5 million for research in this area: less than one percent of its annual budget; no project received more than around $500,000. There is no investment in long term population assessment and follow-up after Black Summer.
More recently, the NHMRC Special Initiative in Human Health and Environmental Change allocated only $10 million dollars over five years to an initiative that is designed to work across many academic sites.
In practice this process saw politics and competition emerge between different institutions – for what is a very small amount of funding for each particular group.
Again, the opportunity for MRFF and NHMRC to lead the world in facilitating research to genuinely appreciate the relationship between our health and the changing climate was missed.
Pressing questions
Lesley Russell raises 24 pressing questions about the MRFF. Questions about accountability and prioritisation of resource allocation and decision-making transparency in relationship between MRFF funding and politics.
These questions need answers. Interestingly, this call for answers sits in a time in Australian politics where the call for accountability in politics is growing and the need for a national Integrity Commission is clear.
The central question is whether the MRFF structure and function is fit for purpose. Does the funding approach achieve better health for Australia’s future?
The current structure offers a somewhat patchy and piecemeal approach and does not account across the full spectrum of biology, society and environment.
A radical rethink and restructure could transform health and medical research in Australia and provide global leadership during a period of remarkable challenge for humanity. Health funding across biology, society and environment, just imagine what we could achieve?
Dr Arnagretta Hunter is a cardiologist and a Senior Clinical Lecturer and Human Futures Fellow at Australian National University
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