Policy polity research and the music of the

“Policy, polity, research and the music of the SPHERES” The SPHERE Project and some of its implications Aileen Clarke Associate Professor in Public Health and Health Services Research University of Warwick Medical School EUPHA Plenary Session 12. 10. 07. 17. 40 -18. 30 Halls A+B

Acknowledgements Mark Mc. Carthy Mary Gatineau and Olivier Grimaud, Grant Lewison, Róza Ádány, Stan Tarkowski, Walter Ricciardi, Paolo Durando, Roberto Gasparini, Guiseppe La Torre, Diane Delnoij, Peter Groenewegen, David Hunter, Gabrielle Harvey, Claúdia Conceição, Hans Stein, Piret Veerus, Dineke Zeegers, Lara Garrido Herrero, Gabriel Gulis, Margaret Thorogood, Nia Wyn Roberts, Paul Scourfield, Rodolfo Saracci, William Dab, Finn Kamper-Jorgensen, UKFPH, EUPHA, EPHA, DG Research EU FP 6 funding, and all our respondents

SPHERE Strengthening Public Health Research in Europe 2004 -2007 FP 6 support action www. ucl. ac. uk/public-health/spherehome. htm

SPHERE In this talk: • Introduction - title and definitions: policy polity spheres, harmony, public health research • Public health literatures • Public Health arrangements • Conclusions • SPHERE II • Questions

Policy – rule, plan, course of action, guiding principle – that which is done Polity – the aspect of society oriented to politics and government

The music of the Spheres: – Mathematical astronomical concept – Pythagoras – Spheres of movement of the planets thought to be equivalent to pure musical intervals – creating musical harmony. – Johannes Kepler, “the movements of the planets are modulated according to harmonic proportions” [Harmonice Mundi 1619] “Geometry in Art and Architecture, ” and Wikipedia http: //www. dartmouth. edu/~matc/math 5. geometry/unit 3. html#Music%20 of%20 the%20 Spheres

The music of the Spheres: The theory captures the imagination: ". . . then listen I To the celestial Sirens' harmony, That sit upon the nine infolded Spheres And sing to those that hold the vital shears And turn the Adamantine spindle round, On which the fate of gods and men is wound. "

SPHERE Public Health Research definition: • population level • generalisable knowledge • goal-orientated? • range of methods • multidisciplinary: epidemiology, sociology, statistics, economics

Public Health Research stakeholder competing voices Industry: health pharmaceutical, salt leisure Public Health Associations EUPHA Research funders International organisations WHO “Wider” PH organisations (Food, Transport Researchers and Exercise, environment) research Media Public Health training organisations NGOs Civil Society Organisatio ns organisations ERA, health strategy, countless publications… Voters Policy/polity level Ministries, governments National + EU

SPHERE – Public Health Research Describe (map / measure) Consult (talk / ask / triangulate) Discuss (influence / encourage)

SPHERE structure Management Board: UK FPH + EUPHA Consortium management National PH Associations PH Research Training Coordinator NGOs EUPHA conferences + external advisers National ministries International PH research Literature Overviews/reviews Health services research PH Management Genetic epidemiology Environmental PH Communicable diseases Health promotion

Public Health Research Literatures Public Health Research overview + language review Health services research PH Management Genetic epidemiology Environmental PH Communicable diseases Health promotion

European Journal of Public Health Vol 17: Supp 1

Methods: bibliometric studies • Definitions • Search strategies routine literature/citation databases • ~ 1995 -2005 • Research • DALYs • EEA and international comparators • Samples: in depth assessment of topics

14. 6% 3111 32. 3% 8. 8% 6862 1877 EEA US ACNZ other 44. 3% 9422 Average annual numbers of PH publications per year (N=~20, 000) for the European Economic Area (EEA), US and Australia, Canada, New Zealand (ACNZ). (Clarke et al 2007)

54 - 70 32 - 53 9 - 31 6 - 8 1 - 5 Average annual public health publications by country 1995 -2004 per million population (mid year 2000) (Clarke et al. 2007)

• Smaller countries and lower producers of public health research collaborated more • Steady 3. 5% of the public health publications published in a non-English language, German most common. (Grimaud et al 2007) • Language overview: French language journals tended to concentrate more on maternal and child health, less on chronic disease compared to DALYs (Grimaud et al 2007)

Health Promotion research published by level of Intervention % (n=2206)* 4. 6% 19. 7% Don't know 39. 8% 9. 7% Individual/Family Community/Group Regional/National Policy 26. 2% *% of random sample of publications examined in detail where intervention identifiable (Clarke et al 2007)

Communicable Disease publications EEA 19952005: total numbers (Gasparini, Durando et al 2007)

* * 19 countries: incl. Iceland, Bulgaria, Romania Adany et al 2007

Health services/systems research publications Problems studied 27% 10% Doing things right Doing the right things For the right people 7% 56% Efficiency/quality improvement Organisation, cohesion & arrangement Inequalities & distribution Other Delnoij, Groenewegen 2007

Environmental Health Publications EEA 1995 -2005 Tarkowski 2007

Public Health Management review • Very little research for PH management - effective interventions, effective decision-making, priority-setting • Underinvestment in PH Management research and infrastructure • Mix of quantitative and qualitative methods needs acknowledgement • Better picture needed of reasons for the perceived weakness and future direction of health management research Hunter 2007

Summary of the literature findings • Bibliometric approaches/literature searches • Definitions: completeness, accuracy, validity and reliability • EEA important producer on the world stage Increasing publication in every subject area (+ in other languages)

Summary of the literature findings • Northern and western European countries versus central and eastern countries: outputs and topics differ • Topics do not necessarily relate to need - tends towards the ‘fundamental and the observational’ rather than to the ‘practical and the interventional. ’ • Very little on PH management • Where interventions are researched may be at the wrong level (not policy but individual)

SPHERE Describe (map / measure) Consult (talk / ask / triangulate) Discuss (influence / encourage)

Public Health Research Arrangements National PH Associations PH Research Training NGOs National ministries International PH research

Ministries of health and science: • Public health research priorities poorly defined • % of National research spending on Public health research not clear National Public Health Associations • Considerable variation in the public health funding processes and development across Europe

NGOs: • have significant international PH experience • Public health priorities do not coincide with public health research themes of FP 7 Public Health Research training organisations: • Institutions with varying characteristics • A wide range of disciplines taught

International View • representation for health sciences at European level and internationally is stronger for biomedical, commercial and clinical research than public health research • USA, Canada and Australia have federal as well as local public health research programmes; structures and priorities differ

UK CRC Health research Analysis May 2006

We found that: Europe is an extremely important producer of Public Health research on the world stage …….

BUT…… • Relative Underinvestment in infrastructure and networks • Variations in topics, organisations, professions involved • Discontinuities between funders, policy makers, researchers, ministries, training organisations, NGOs, EU and WHO • Not enough coordination and commissioning for the public health problems we face

We need: • Effective commissioning + priority-setting • Better picture for better strategy • Better networking of research centres across Europe to – strengthen capacity and capability, provide more balance • National research programmes which match national policies and priorities

We found that: Public health research in Europe needs an active and caring approach (nurturing) and broad programmatic support

SPHERE Describe (map/measure) Consult (talk/ask/triangulate) Discuss (influence/encourage)

In SPHERE we: • described mechanisms for funding and supporting PH research across Europe + mapped research publications • initiated consultation and triangulated findings • Now we want to discuss our findings and influence and encourage debate on how to strengthen PH research

Important to get it right: • Why do Public Health research? • Wealth? • Health in its broadest sense

SPHERE II In depth: • case studies in areas where evidence is strong - of the relationship between research and policy across Europe • describe: – international concepts and models of good practice – systems for mutual exchange of information (researchers, research funders, policy makers) at national and European level

SPHERE II In depth case studies : • Stroke units • Patient experiences • Health behaviour change - salt and obesity • Public Health Genetics – new born screening • Children’s environmental health • New vaccines

SPHERE II • 26 members in 13 EU member states; tried and tested consortium of international experts • policy makers integral; closely associated with participating organisations in EUPHA

Spheres of Public Health Research Organisations and Stakeholders Media/ Research research publishers funders Public Health training organisations Businesses/ industry NGOs Civil Society Organisations Public Health Associations EUPHA “Wider” PH organisations (Food, Transport Exercise, environment) European organisations EU, DG Sanco, DG Research, WHO Ministries Researchers and governments Policy/polity research organisations

Questions • Is enough, good enough research being done? • How can research funders direct research to fields where health need and benefits are greatest? • How generalisable is public health research between countries? • How can public health researchers and NGOs (we) best contribute to setting policy and research agendas?

There's not the smallest orb which thou behold'st, But in his motion like an angel sings. . Wm. Shakespeare Merchant of Venice (Act V Sc 1)

THANK YOU

Underpinning Themes * • World Stage – Competitiveness, scientific excellence/patenting – Support to developing countries • Citizens – “Creating a knowledge society” informed consumers, knowledge transfer platforms • Business – productive links with industry • Research organisation and governance – Multi-disciplinarity, gender, capacity building * ERA and FP 7

Public Health Research topic priorities* Changing patterns of infectious disease Technologies, HTA, costs e. g. genetics Threats to health Accidents, war, violence, tobacco, alcohol Health Service delivery and organisation Consumers/users: Choice, information/ICT Energy Climate Change (sustainability) *adapted from FP 7 2007 -2013 People/ Populations, longer lives Environments, cities, migration, housing Food Transport Exercise

SPHERE: Average public health publications by country and cluster of countries (with 95% confidence intervals 1995 -2004) Clarke A. Gatineau M. Grimaud O. Devaux S. Wyn-Roberts N Le Bis I. Lewison G. SPHERE Bibliometric Report 2006 www. ucl. ac. uk/sphere

Myth, opinion, poor research, what we do now. Evidence-Based Medicine Choice Aware? Accepted? Applicable? Acted on? Agreed? Adhered to? Appropriateness EVIDENCE Research e. g RCTs Research/synthesis, Guidelines With apologies to Glasziou, Haynes, EBM 2005

Myth, opinion, poor research, what we do now. Evidence-Based Medicine Choice Aware? Accepted? Applicable? Acted on? Agreed? Adhered to? Appropriateness EVIDENCE Research e. g RCTs Research/synthesis, Guidelines With apologies to Glasziou, Haynes, EBM 2005

• Paucity of research for effective interventions, effective decision-making and priority-setting • Relative Underinvestment in research and infrastructure and networks • Diverse range of ministries, organisations and professions • Better networking of research centres across Europe to – strengthen capacity and capability – provide more balance • Roles of Europe level institutions (DGs SANCO and DG Research) • Better picture needed for better strategy- future direction of health research

Lomas J. Connecting research and policy. Can J Policy Res 2000; 1: 140 -4

Recommendations • • • “Improving co-ordination” “More international collaboration” “More collaborative work” “Collaboration and coordination” “Transboundary, cooperative research”

SPHERES of Public Health Research Organisations and Stakeholders Ministries governments Policy/polity Researchers and research organisations