Policy, polity, research and the music of the SPHERES The SPHERE Project and some of its implication

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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
ResearchUniversity of Warwick Medical
SchoolEUPHA Plenary Session 12.10.07.
17.40-18.30 Halls AB
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Mark McCarthy 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 FP6 funding, and all our
respondents
Acknowledgements
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Strengthening Public Health Research in Europe
2004-2007 FP6 support action www.ucl.ac.uk/public
-health/sphere/spherehome.htm
SPHERE
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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

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

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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/math5.geometry/uni
t3/unit3.htmlMusic20of20the20Spheres
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• The music of the Spheres
• The theory captures the imagination
• ". . .then listen ITo the celestial Sirens'
  harmony,That sit upon the nine infolded
  SpheresAnd sing to those that hold the vital
  shearsAnd turn the Adamantine spindle round,On
  which the fate of gods and men is wound."
• MILTON Arcades lines 63-73)

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SPHERE

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

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Public Health Research stakeholdercompeting
voices
Industry health pharmaceutical, salt leisure
Public Health Associations EUPHA
International organisations WHO
Research funders
NGOs Civil Society Organisations
Public Health training organisations
Wider PH organisations (Food,
Transport Exercise, environment)
Researchers and research organisations
Media
Policy/polity level Ministries, governments
National EU
ERA, health strategy, countless publications
Voters
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SPHERE Public Health Research
Describe (map / measure) Consult (talk / ask /
triangulate) Discuss (influence / encourage)
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SPHERE structure
Management Board UK FPH EUPHA
EUPHA conferences external advisers
Coordinator
Consortium management
International PH research
National PH Associations
PH Research Training
National ministries
NGOs
Literature Overviews/reviews
Health services research
PH Management
Genetic epidemiology
Environmental PH
Communicable diseases
Health promotion
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Public Health Research Literatures
Public Health Research overview language review
PH Management
Health services research
Genetic epidemiology
Environmental PH
Communicable diseases
Health promotion
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European Journal of Public Health Vol 17Supp 1
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Methods bibliometric studies

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

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Average annual numbers of PH publications per
year (N20,000) for the European Economic Area
(EEA), US and Australia, Canada, New Zealand
(ACNZ). (Clarke et al 2007)
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? 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)
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• 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)

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of random sample of publications examined in
detail where intervention identifiable
(Clarke et al 2007)
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Communicable Disease publications EEA 1995-2005
total numbers (Gasparini, Durando et al 2007)
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19 countries incl. Iceland, Bulgaria, Romania
Adany et al 2007
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Health services/systems research publications
? Doing things right ? Doing the right things ?
For the right people
Delnoij, Groenewegen 2007
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Environmental Health Publications EEA 1995-2005
Tarkowski 2007
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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
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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)

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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)

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

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• NGOs
• have significant international PH experience
• Public health priorities do not coincide with
  public health research themes of FP7
• Public Health Research training organisations
• Institutions with varying characteristics
• A wide range of disciplines taught

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• 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

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UK CRC Health research Analysis May 2006
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We found that

• Europe is an extremely important producer of
  Public Health research on the world stage .

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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

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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

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We found that

• Public health research in Europe needs an active
  and caring approach (nurturing) and broad
  programmatic support

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

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

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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

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SPHERE II

• In depth case studies
• Stroke units
• Patient experiences
• Health behaviour change - salt and obesity
• Public Health Genetics new born screening
• Childrens environmental health
• New vaccines

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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

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

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• 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 Sc1)

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THANK YOU
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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 FP7

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Public Health Research topic priorities
Health Service delivery and organisation
Technologies, HTA, costs e.g. genetics
People/ Populations, longer lives
Changing patterns of infectious disease
Consumers/users Choice, information/ICT
Environments, cities, migration, housing
Threats to health -Accidents, war, violence,
tobacco, alcohol
Food Transport Exercise
Energy Climate Change (sustainability)
adapted from FP7 2007-2013
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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
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Research e.g RCTs
EVIDENCE
With apologies to Glasziou, Haynes, EBM 2005
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Research e.g RCTs
EVIDENCE
With apologies to Glasziou, Haynes, EBM 2005
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• 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

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Lomas J. Connecting research and policy. Can J
Policy Res 20001140-4
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Recommendations

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

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