“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

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

Strengthening Public Health Research in Europe

2004-2007FP6 support action

www.ucl.ac.uk/public-health/sphere/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

SPHERE

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/math5.geometry/unit3/unit3.html#Music%20of%20the%20Spheres

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)

Public Health Research definition:• population level

• generalisable knowledge

• goal-orientated?

• range of methods

• multidisciplinary: epidemiology, sociology, statistics,

economics

SPHERE

Public Health Research stakeholdercompeting voices

“Wider” PH organisations (Food, TransportExercise, environment)

“Wider” PH organisations (Food, TransportExercise, environment)

NGOs Civil Society Organisations

NGOs Civil Society Organisations

International organisationsWHO

International organisationsWHO

Public Health AssociationsEUPHA

Public Health AssociationsEUPHA

Researchers and research organisations

Researchers and research organisations

Research funders

Research funders

Industry: health pharmaceutical, salt leisure

Industry: health pharmaceutical, salt leisure

Public Health training organisations

Public Health training organisations

ERA, health strategy, countless publications…

ERA, health strategy, countless publications…

Policy/polity level

Ministries, governments

National +EU

Policy/polity level

Ministries, governments

National +EU

MediaMedia

VotersVoters

Describe (map / measure)Consult (talk / ask / triangulate)

Discuss (influence / encourage)

SPHERE – Public Health Research

SPHERE structure

National PH Associations

NGOsPH ResearchTraining

Literature Overviews/reviews

Health services research

Genetic epidemiology

PH Management

Communicable diseases

Environmental PH

EUPHA conferences+ external advisers

CoordinatorConsortium management

National ministries

International PH research

Management Board: UK FPH + EUPHA

Health promotion

Public Health Research Literatures

Public Health Research overview + language review

Health services research

Genetic epidemiology

PH Management

Communicable diseases

Environmental PH

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

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)

9422

1877

3111

6862

EEAUS

ACNZ

other

32.3%

44.3%

8.8%

14.6%

Average annual public health publications by country 1995-2004 per million population (mid year 2000)

(Clarke et al. 2007)

54- 70

32- 53

9- 31

6- 8

1- 5

• 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)

*% of random sample of publications examined in detail where intervention identifiable (Clarke et al 2007)

Health Promotion research published by level of Intervention % (n=2206)*

4.6%

39.8%

26.2%

9.7%

19.7%

Don't knowIndividual/Family

Community/Group

Regional/National

Policy

0

1000

2000

3000

4000

5000

Vacci

nes

STDs

Other

Drug re

sist

Other

chi

ld

Epidemiology andsurveillancePrevention and control

Communicable Disease publications EEA 1995-2005: total numbers (Gasparini, Durando et al 2007)

All published papers by regions in Europe where "genetic epidemiology" appeared in the title or abstract

0

5

10

15

20

25

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

Years

Nu

mb

er

of

pu

blis

he

d p

ap

ers

papers published in the EU 15

papers published in the EU +10

papers published out of EU

all papers published in Europe*

* 19 countries: incl. Iceland, Bulgaria, Romania

Adany et al 2007

Health services/systems research publications

Cumulative number of HSR references 1996-2004

0

10000

20000

30000

40000

1996 1997 1998 1999 2000 2001 2002 2003 2004

Problems studied

56%

27%

10%

7%

Efficiency/quality improvement

Organisation, cohesion & arrangement

Inequalities & distribution Other

Doing things right Doing the right things For the right people

Delnoij, Groenewegen 2007

Environmental Health Publications EEA 1995-2005

0

500

1000

1500

2000

2500Number ofpublications

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 stageIncreasing 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)

Describe (map / measure)

Consult (talk / ask / triangulate)

Discuss (influence / encourage)

SPHERE

Public Health Research Arrangements

National PH Associations

NGOsPH ResearchTraining

National ministries

International PH research

Public Health Research Arrangements

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 FP7

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 AnalysisMay 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

Describe (map/measure)

Consult (talk/ask/triangulate)

Discuss (influence/encourage)

SPHERE

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

Public Health training

organisations

Research funders

European organisationsEU, DG Sanco,DG Research,

WHOMinistries governmentsPolicy/polity

NGOs Civil Society

Organisations

Public Health Associations

EUPHA

“Wider” PH organisations

(Food, TransportExercise,

environment)

Researchers and research organisations

Spheres of Public Health Research Organisations and Stakeholders

Businesses/ industry

Media/research publishers

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 orbwhich thou behold'st, But in his motionlike an angel sings..

Wm. Shakespeare Merchant of Venice (Act V Sc1)

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 FP7

Public Health Research topic priorities*

Threats to health -Accidents, war, violence, tobacco, alcohol

Threats to health -Accidents, war, violence, tobacco, alcohol

EnergyClimate Change(sustainability)

EnergyClimate Change(sustainability)

FoodTransportExercise

FoodTransportExercise

Health Service delivery and organisation

Health Service delivery and organisation

Consumers/users:Choice, information/ICT

Consumers/users:Choice, information/ICT

People/Populations, longer lives

People/Populations, longer lives

Changing patterns of infectious disease

Changing patterns of infectious disease

*adapted from FP7 2007-2013

Environments,cities, migration, housing

Environments,cities, migration, housing

Technologies, HTA, costse.g. genetics

Technologies, HTA, costse.g. genetics

0 5000 10000 15000 20000 25000

WldUS

EUR28EU25EU15

UKACNZ

CAAUDESENLFRITFI

ESDKNOCHNZBE

Co

un

try

Publications per year

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

SPHERE: Average public health publications by country and cluster of countries

(with 95% confidence intervals 1995-2004)

Aware? Accepted? Applicable? Able? Acted on? Agreed? Adhered to?

Research e.g RCTs

EVIDENCE

Appropriateness

Evidence-Based Medicine

Choice

Research/synthesis, Guidelines

Myth, opinion, poor research,

what we do now.

With apologies to Glasziou, Haynes, EBM 2005

Aware? Accepted? Applicable? Able? Acted on? Agreed? Adhered to?

Research e.g RCTs

EVIDENCE

Appropriateness

Evidence-Based Medicine

Choice

Research/synthesis, Guidelines

Myth, opinion, poor research,

what we do now.

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”

Ministries governmentsPolicy/polity Researchers and

research organisations

SPHERES of Public Health Research Organisations and Stakeholders