Utvecklingsplaner och perspektiv inom Hälsa, välfärd och medicin

1. Utvecklingsplaner och perspektiv inom Hälsa, välfärd och medicin Mikael Fogelholm, Sc.D., Adjunct Professor Director, Academy of Finland, Health Research Unit

2. MikaelFogelholm Present Status and Future Potential for Medical Research in the Nordic CountriesNordic White Paper on Medical Research(FINAL Draft March 2011) • The paper has been prepared by the Joint Committee of the Nordic Medical Research Councils (NOS-M), which is a collaborating body for the Nordic Research Councils that finance medical research. NOS-M serves as a forum and network for important information exchange of national research policies, funding and development. • Academy of Finland, Finland • RANNÍS - The Icelandic Centre for Research, Iceland • Swedish Research Council, Sweden • The Danish Council for Independent Research | Medical Sciences • The Research Council of Norway

3. MikaelFogelholm Aims of the Nordic White Paper: • The aim of the White Paper is to show opportunities for strengthening medical research jointly and individually amongst the Nordic countries. • The paper also indicates what actions are needed in the Nordic countries to maintain a competitive position globally [in medical research] and respond to the Grand Challenges facing today’s society [by medical research]. • The paper is complementary to EMRC’s White Paper on Medical Research

4. MikaelFogelholm Background (1): Grand challenges in health • Ageing of the population • Alzheimer’s disease, cancer, functional disabilities • Changes in lifestyle (diet, physical activity, sleeping, etc.) • Obesity, type 2 diabetes, mental distress, depression • Globalization and climate change • Infectious diseases, resistance to antibiotics

5. MikaelFogelholm Background (2): Grand challenges in ethics and socio-economic equity • Genomics, epigenomics, metabolomics, etc. • Personalised treatment and prevention • Privacy issues? Genetic counselling? • Stem cells • Debate on humanembryonicstemcells • Health-care • Prioritization • Health inequity: health difference between socio-economic groups

6. MikaelFogelholm SWOT-analysis: Strengths • People (scientists!) • National and Nordic Centres of Excellence • Nordic public health care system • well-organised and –equipped • high standard • accessible to the entire population • Nordic health registries and biobanks (+ personal identification nr.) • at least potentially excellent research infrastructure for gene-environment research cohorts and investigator-driven clinical trials • Public ownership of universities and university hospitals

7. MikaelFogelholm SWOT-analysis: Weaknesses • Medical researcher’s career opportunities are weak • challenging to compete with the salaries in the health care system • research merits are not valued as part of a clinical career • clear need for a defined tenure track • Balance of researchers in different stages of the career is not ideal • far too many positions for doctoral students compared to post doctoral and young investigators as disclosed by the 10:1 ratio in some Nordic countries • Funding of infrastructures for medical research is clearly inadequate in international comparison, and not well-coordinated • Specific funding for Nordic co-operation is not adequate

8. MikaelFogelholm SWOT-analysis: Opportunities • Improving the position and possibilities of clinical researchers • Enormous potential for synergy if we can take advantage of our similarities: combining the data, resources and brain power opens new possibilities • More incentives, such as increased funding to strengthen Nordic medical research, are needed • Adequate funding on basic (“bottom-up”) research • Researcher mobility should also be supported in a wider international perspective and emphasis should be put on recruiting back the best young researchers to their home region after visits abroad.

9. MikaelFogelholm SWOT-analysis: Threaths • Growing demands of clinical specialist training, in combination with a strong focus on delivering efficient and economical health care services ( research is seen as a “disturbing”, non-profit element) • The prerequisites for performing high quality medical research may become critical if the investments in basic research are further reduced (in anticipation of quick results and innovations from applied research) • Development of data protection legislation is becoming more and more bureaucratic, hence making it more difficult for the researchers to perform human studies and especially to access health care information and data banks.

10. Recommendations Efforts should be extended to increase and improve Nordic cooperation in medical research and research policy. Flexible funding opportunities should be made available to allow greater mobility among Nordic researchers. There needs to be a recognised career path for clinical researchers. There is an urgent need at the political level to solve legal and ethical hurdles that are arising in areas such as biobanking and databases that could seriously hinder effective medical research in a number of key areas. There needs to be greater use of the Nordic biobanks, and health registries to exploit their maximum potential, including greater cooperation between these infrastructures.

11. Norianet for Health and Welfare • [Preliminary] conclusions and recommendations: • Not a priority area for funding organizations • Concentrates of a few institutions in each country (not too scattered) • Main research focus: health vs. socioeconomic position • Only little Nordic collaboration • Collections of data into databanks  Nordic infrastructure funding • Clear potential for Nordic CoE  Nordic funding Mapping of research and funding: • A review of the scientific publications on research on distribution of health, conducted in Nordic countries 2005-2010 • Main collections of data in each country • An overview on funding and funding systems

12. Norianet Nordic Evaluation of Sports Sciences • [Very preliminary] conclusions: • Countries have somewhat different research focuses • Institutional setting: some concentration, but also great scatter • Nordic collaboration not prioritized (above other international) Evaluation of the focus and quality of research, researcher training and career, and research funding in three “research domains”: • Basic physiology and applied sports sciences • Health related reserach and traumatology (sports medicine) • Social sciences, behavioural sciences, humanities

13. So what? • Collaboration • Potential to combine different expertise/focus to create quality, not only quantity •  CoE, multidisciplinary research programs Registries, databanks, biobanks • Potential for large collections among 25 mio, rather homogenous population • Also to study rare diseases • Huge interest per se and as a partner (cluster) in large EU-projects etc. •  infrastructure funding, harmonization of data(collection), legislation