“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 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
SPHERE
Strengthening Public Health
Research in Europe
2004-2007
FP6 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
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 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 andExercise, 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
Coordinator
Consortium
management
National PH
Associations
PH Research
Training
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)
5000
Epidemiology and
surveillance
Prevention and control
4000
3000
2000
1000
ch
ild
O
th
er
t
er
O
th
D
s
ST
re
si
s
D
ru
g
Va
cc
i
ne
s
0
All published papers by regions in Europe where "genetic epidemiology" appeared
in the title or abstract
25
papers published in the EU 15
papers published in the EU +10
Number of published papers
20
papers published out of EU
*
all papers published in Europe
15
10
5
* 19 countries: incl. Iceland, Bulgaria, Romania
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
0
Years
Adany et al 2007
Health services/systems research publications
Problems studied
Cumulative number of HSR references 1996-2004
40000
30000
27%
20000
10000
0
1996 1997 1998 1999
2000 2001 2002 2003 2004
 Doing things
right
 Doing the right
things
 For the right
people
10%
7%
56%
Efficiency/quality improvement
Organisation, cohesion & arrangement
Inequalities & distribution
Other
Delnoij, Groenewegen 2007
Environmental Health Publications EEA 1995-2005
2500
Number of
publications
2000
1500
1000
500
y
lic
Po
ca
t
io
n
s
le
Lo
gp
k
R
is
ne
ra
b
Vu
l
ss
es
Ill
ne
re
s
po
su
Ex
O
cc
up
.
0
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
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 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
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 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*
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 FP7 2007-2013
People/
Populations,
longer lives
Environments,
cities, migration,
housing
Food
Transport
Exercise
Country
SPHERE: Average public health publications by country
and cluster of countries
BE
NZ
CH
NO
DK
ES
FI
IT
FR
NL
SE
DE
AU
CA
ACNZ
UK
EU15
EU25
EUR28
US
Wld
0
5000
10000
15000
20000
25000
per year
(with 95%Publications
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? Able? 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? Able? 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