Is there a disconnect between the general focus of health and medical research and population health perspectives?
Most people with a concern for population health would surely nominate health inequalities as a critical issue (defined by the WHO as “ differences in health status or in the distribution of health determinants between different population groups”). A Google Scholar search on “health inequalities” throws up hundreds of thousands of results.
Yet the issue doesn’t rate a mention in the recently released NSW Health and Medical Research Strategic Review, which confines most of its attention to health care and medical research. (Although, as previously noted at Croakey, it wouldn’t be the first time that a review of health and medical research takes a rather narrow view of what matters for health).
The review is clearly aimed at redressing NSW’s less than stellar performance in health and medical research, which Minister Jillian Skinner highlighted in a speech (which can be downloaded here) responding to the report.
NSW drags the chain
The review notes that:
■ There is a perception that the NSW Government and health services have not placed the same high value on health and medical research as their counterparts in other states, and as a consequence, NSW has a less robust research culture.
■ Although NSW Government research infrastructure funding is valuable, there is strong dissatisfaction with the quantum and inconsistent application of this funding within the research sector.
■ The lack of career pathways, poor remuneration for research workers in relation to other health and medical careers, lack of support for early to mid-career level researchers and job insecurity were identified by many stakeholders as pressing issues.
■ Clinician researchers are a limited resource and there is a perception that the time that clinical staff specialists dedicate to research has been eroded over time.
The review’s recommendations focus on translation and innovation from research and on building globally relevant research capacity.
The Minister’s response was focused very much on medical research and medical researchers, which is perhaps not surprising given her title as Minister for Medical Research. But it is surprising given that her other title is Minister for Health.
She committed to spending $70 million over four years to implement the Review recommendations, none of which are explicitly aimed at ensuring a fairer distribution of both health and the “prerequisites for health”.
Measuring success
The review suggests that the markers of successful implementation of its recommendations include:
■ A better health system and improved health.
Evidence that NSW is recognised nationally and internationally as a centre of excellence in fostering the use of research evidence and that research is routinely considered as part of health policy making and translated into practice
Ministry of Health and Local Health District annual research reports demonstrate effective research governance and development and transparent, effective investment in research
Research indicators in Local Health Districts show short turn-around times in ethical review and site specific authorisation.
Ministry of Health population health and performance reports indicate better health for the people of NSW and an improved health system that can be plausibly related to increased effectiveness of research
■ Globally-relevant high quality research.
NSW researchers have more highly-cited publications reflecting greater local, national and international collaboration
NSW attracts excellent researchers and receives a greater number of competitive grants and fellowships from the Australian Government and other prestigious resources
Shared research assets are sustainable and frequently accessed and utilised by the research community.
■ Increased investment and employment.
There is a significant increase in competitive national and international research funds flowing to NSW
NSW increases its investment in health and medical research based on the strategic priorities of the State
Clinical trials are seen as a good investment in NSW due to reduced start-up times and removal of other barriers to effective conduct
Medical devices developed in NSW demonstrate a return on investment through application and commercialisation
A greater number of researchers are based in NSW
Infrastructure investment demonstrates the research institutes and hubs are working in collaboration with greater accountability of public funds.
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Meanwhile, in the article below, Professor Sally Redman, CEO of the Sax Institute, suggests that Australia could learn from overseas efforts in promoting better partnerships between researchers, policy agencies and those who deliver services.
Plenty of room to improve our use of evidence
Sally Redman writes:
This week’s release of the NSW Health and Medical Research Strategic Review identifies many opportunities to strengthen research and ensure the community extracts the maximum possible benefit from its investment.
The Review itself – chaired by Peter Wills – and the allocation of additional NSW Government research funding in response, is welcome news for the sector.
Two critical strategies are central to the Review’s final report: fostering innovation and translation of evidence; and building our capacity to conduct research that’s globally relevant. Both of these strategies have national relevance.
From bench to bedside and beyond
In discussing research translation, the Review refers to the US National Institutes of Health’s respected roadmap, which outlines three stages of research translation. The Review explains these as:
T1 developing treatments and interventions,
T2 testing the efficacy and effectiveness of these treatments and interventions, and
T3 dissemination and implementation research for system-wide change.
T3 research is particularly significant for governments because it speaks directly to improving the efficiency of services and the way programs are provided.
Historically, it has received less attention than the other two, but current pressures facing health systems from the increasing costs of new technologies and an ageing population mean that research of this kind is more important than ever.
Governments need information to aid decisions about effectively targeting resources while continuing to improve the quality of health policies and services. The Review recognises the challenging task ahead, referring to “wise investment of scarce resources” and outlining key actions that could boost T3 level research, such as funding rigorous evaluation of policies and programs to ensure adherence to best practice.
International lessons
Our efforts in this area could draw on valuable international experience in promoting better partnerships between researchers, policy agencies and those who deliver services.
Programs run by the Canadian Health Services Research Foundation and the Canadian Institutes of Health Research, or the many innovative funding schemes developed by the UK National Institute for Health Research all provide useful models for what might work in Australia.
Our experience at the Sax Institute shows policymakers and service providers fully recognise the potential value of research to their work. Our survey of NSW policymakers, for example, found that most thought research should be used more often. But there are many barriers to using research effectively, including difficulty in accessing reviews of research evidence and the different timelines of research and policy making.
One of the most important barriers limiting the opportunity for research to inform policies, programs and system change, is a lack of the kind of research that would really be most useful. Too often, research describes problems rather than testing potential solutions. Or it tests solutions that are impossible or difficult to apply at a population level.
In a recent study led by Professor Simon Chapman from the University of Sydney’s School of Public Health, one policymaker reflected on this disconnect, saying, “It’s as if all these people are bashing away at all these social problems with the wrong tools … [generating] papers that describe and quantify rather than [being] helpful for solving problems”.
Getting it right
When it goes well, Australian scientists are leaders in delivering research that impacts rapidly on population health, policy and program decisions and how health services function. The Nutbeam Review of Public Health Research Funding for the NHMRC referred to Australian health policy and public health campaigns – and the research that underpins them – leading the world in achievements, such as reducing deaths from road injury, melanoma, SIDS, HIV/AIDS, tobacco use, firearms and breast cancer.
How can we increase this kind of research? Again, the Review offers some important suggestions, such as strengthening research assets like biobanks, population-based cohort studies and linked health records, all of which can be used as a collaborative resource.
My colleague Professor Emily Banks has already written about the importance to public health of long-term, large-scale research assets. She cited the 45 and Up Study as an example of researchers using the pooled resource of more than a quarter of a million people to conduct studies of greater statistical reliability to answer important questions about our health as we age.
Australia’s capacity to link routinely collected health data is unique internationally in terms of its size and scale, and holds great potential as a powerful research resource to help bridge the translational research gap.
Using data that are already collected allows faster research and more timely information for policymakers. Large numbers of participants or records mean that questions can be answered more quickly and the needs or experiences of particular groups within our community can be explored.
Putting demographic and lifestyle information together with information on health service use provides an opportunity to answer government questions about resources, how services are operating and who is at most risk of receiving poor care.
A time of change
The Strategic Review has occurred at a time of significant change in the way that our health programs and services are delivered.
The need to respond to the many pressures we face, including a better approach to translational research, is a challenge probably best summed up by Productivity Commission Chairman Gary Banks: “It is as important that we have a rigorous evidence-based approach to public policy in Australia today as at any time in our history … the good news is that there is plenty of scope for improvement.”
• This article was first published at The Conversation
