Developing an Agenda for Public
Health Systems Research in BC
Marjorie MacDonald, RN, PhD
Professor, School of Nursing
University of Victoria
CIHR/PHAC Applied Public Health Chair
On Behalf of the CPHFRI Team
Funders
• Michael Smith Foundation for Health Research
• Canadian Institutes of Health Research
• CIHR-PHAC Applied Public Health Research
Chair to Marjorie MacDonald
• BC Ministry of Health, PHABC, BC Health
Authorities
• Public Health Ontario, Ontario MOHLTC, six
health units in ON
Co-Authors
• Trevor Hancock, Professor and Senior Scholar, School of Public
Health and Social Policy, University of Victoria
• Bernie Pauly, Associate Professor, School of Nursing,
University of Victoria & Scientist, Centre For Addictions
Research of B.C. (CARBC)
• Warren O’Briain, Executive Director, Communicable Disease
Prevention, Harm Reduction and Mental Health
Promotion, BC Ministry of Health
• Heather Wilson Strosher, CPHFRI Coordinator, University of
Victoria
Purpose of
Presentation
• To define PHSSR and argue for its importance in the
overall context of public and population health
research
• To describe the first efforts in Canada (BC) to
establish the field of PHSSR, present the initial
research agenda, and report on progress
• To present an emerging agenda for PHSSR in BC
• To attract new researchers to the field from across
the country
What is PHSSR?
• In the US, initially called Public Health Systems
Research (PHSR) - “the investigation of the dynamic
properties and interactions of the public health
system, its infrastructure, and their effect on
population health status” (Van Wave, 2010)
• Then, to capitalize on the research and
methodological developments of health services
research, the word “services” was inserted into the
title (PHSSR)
What is PHSSR?
Public health systems and services research (PHSSR) is defined as
“a field of study that examines the organisation, funding and
delivery of public health services within communities, and the
impact of these services on public health”
Mays, Halverson & Scutchfield, 2003, p, 180
PHSSR
Public
Health
Research
Population
Health
Research
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• Funding for health services research is directed
primarily at the health care system in general,
and not at public health services per se. This
creates a “public health system knowledge
disparity.”
Honoré, P.A. & Amy, B.W. (2005).
“Public Health Finance: Advancing a Field of Study Through
Public Health Systems Research”
Journal of Public Health Management & Practice, 11(6), 571 -573
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Core Public Health Functions
Research Initiative (CPHFRI)
A collaborative program of Public Health
Systems and Services Research in BC involving
long-standing and strong partnerships between
knowledge users and researchers
History of CPHFRI
Created to conduct research on Core Functions
Framework implementation in BC
• 2006 - Conceptualization of the idea and
development of team
• 2006-07 - Team Planning Grant – MSFHR & MoH
o Think Tank – Research Agenda April 2007
o Developed Principles of KU-Researcher Collaboration
• 2008-2011 - Team Start-Up Grant – MSFHR & MoH
o Grant Proposal preparation in line with research agenda
Overarching
Goals of CPHFRI
• Public health systems renewal in BC and Canada
• Advancing public health systems/services research in BC
and Canada
• Methodological development for studying complex
public and population health interventions & systems
• Training public/population health researchers
• Contributing to evidence-informed practice and public
health practice improvement
• Improving the health of the population and promoting
health equity
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Initial Five Year Agenda - 2007
Outcomes of PH Renewal
Core Competencies for PH
Equity Lens Integration
Core Public Health
Evidence to Practice
Functions Framework*
Context and Process of Implementation
*21 Core PH
Programs
.Equity & Population
Lenses
.PH Strategies
(prevention,
promotion,
protection,
surveillance)
.PH System
Capacity
(infrastructure, HHR)
Linking PH and PHC
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Funding Received
• Since its inception in 2006, CPHFRI has
attracted close to $6 million in peer-reviewed
funding
• All of the initial priority areas identified at the
2007 Think Tank have been funded
• 13 PHSSR proposals submitted, 12 were
funded
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Funded Projects
Over 7 Years
• 2 completed MSFHR infrastructure grants (2006-11)
• 7 completed CIHR projects (1 operating grant, 2
knowledge syntheses, 2 MPDs, 1 PHIR grant, 1 KT supplement
- 2008-12)
• 1 CIHR/PHAC Applied Public Health Chair (2008-14)
• 2 CIHR programmatic grants in progress
– Renewal of Public Health Systems (REPHS) Emerging Team
Grant (2009-2014, with extension to 2015)
– Equity Lens in Public Health (ELPH) Pathways to Health
Equity Grant (2011-2017)
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Critical Success Factors
• An opening policy window (post-SARS)
• An identified need by knowledge users for
evidence and research to guide new policy
initiatives
• Methodological innovation and risk taking
• CIHR – IPPH Strategic Plan
• Integrated KT at its best - a truly collaborative
relationship between KUs and researchers
Critical Success Factors
• A collaborative, systematically designed
research agenda with KU buy-in
• Capitalizing only on funding opportunities
consistent with research priorities
• A rigorous training platform integrating
students at all levels
• Collaborative dissemination by both KUs and
researchers in multiple forms
• A critically reflexive process
Challenges
• Of success (research burden)
• Different research/organizational cultures
(needs, rewards, expectations)
• Methodology (slow, labour intensive,
privacy/ethics issues)
• Resources (infrastructure, costs)
• Sharing results (needed sooner rather than
later; initially not nimble enough)
Renewing the Agenda
CONTEXT:
• All initial research priorities funded
• Well established relationships/collaborations
• Shifting public health context and policies
• The name CPHFRI no longer resonating for the
team or relevant in current policy context
• Thus, a Think Tank was held to renew the
research agenda for another 5 years
Goals of Think Tank
• Celebrate the successful launch of a PHSSR
agenda in British Columbia that began in
2007;
• Develop consensus on a PHSSR agenda for BC
for the next 5 years;
• Start a process to revision and rename
CPHFRI; and
• Expand the network of PHSSR researchers and
supporters.
Think Tank Participants
45 Participants representing:
– 4 BC Universities
– 7 BC Health Authorities (including FNHA)
– BC Ministry of Health
– CIHR: IPPH & IHSPR
– NCCDH
– MSFHR
– US National Coordinating Center for PHSSR
– London-Middlesex HU
New Issues
• Expanding the definition of the “public health
system” to include non-PH providers and nontraditional partners and places
– E.g., NGOs, business, faith organisations,
municipalities
• Multisectoral approaches, partnerships,
coalitions
• ROI/ PH economics
New Issues (cont.)
•
•
•
•
Community interests/engagement
Research on decision-making
Intervention research
Link to outcomes
– Positive health measures – viz FNHA
• PH data and info systems
• More nimble research (Quick Strike studies)
** Natural
Experiments,
Complexity
Methods, PH
Economics,
Quick Strikes
Intersectoral/Multisectoral Collaboration
Data and Info Systems for PH
PH Workforce
PH Decision-Making
PH System Ethics
PH Economics
PH System Organisation
Pop Health Interventions
Population &
Public Health
System *
* The collective
infrastructure
and actions of
individuals and
public, private
and voluntary
organizations
that contribute
to local, regional,
provincial,
national and
global health and
wellness through
promotion,
prevention and
protection.
* The collective
infrastructure and
actions of individuals
and public, private
and voluntary
organizations that
contribute to local,
regional, provincial,
national and global
health and wellness
through promotion,
prevention and
protection.
Future Plans
• Re-visioning and renaming CPHFRI
• Completing KT plans
• Expanding our researcher – knowledge
user base
• Securing infrastructure funding
• Pushing forward on a Pan-Canadian PHSSR
agenda
• International Collaborations
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For more information about CPHFRI:
http://web.uvic.ca/~cphfri/
Marjorie MacDonald: marjorie@uvic.ca or
CPHFRI Coordinator: Heather Wilson Strosher
hlwilson@uvic.ca
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