Acknowledgements

2. “Policy, polity, research and the music of the SPHERES” The SPHERE Project and some of its implicationsAileen ClarkeAssociate Professor in Public Health and Health Services ResearchUniversity of Warwick Medical SchoolEUPHA Plenary Session 12.10.07. 17.40-18.30 Halls A+B

3. 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

4. SPHERE Strengthening Public Health Research in Europe 2004-2007 FP6 support action www.ucl.ac.uk/public-health/sphere/spherehome.htm

5. 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

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

7. 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 Mundi1619] • “Geometry in Art and Architecture,” and Wikipedia • http://www.dartmouth.edu/~matc/math5.geometry/unit3/unit3.html#Music%20of%20the%20Spheres

9. 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." MILTONArcades lines 63-73)

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

11. 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

12. SPHERE – Public Health Research Describe (map / measure) Consult (talk / ask / triangulate) Discuss (influence / encourage)

13. SPHERE structure Management Board: UK FPH + EUPHA EUPHA conferences + external advisers Coordinator Consortium management International PH research National PH Associations PH Research Training Nationalministries NGOs Literature Overviews/reviews Health services research PH Management Genetic epidemiology Environmental PH Communicable diseases Health promotion

14. Public Health Research Literatures Public Health Research overview + language review PH Management Health services research Genetic epidemiology Environmental PH Communicable diseases Health promotion

15. European Journal of Public Health Vol 17:Supp 1

16. Methods: bibliometric studies • Definitions • Search strategies routine literature/citation databases • ~ 1995-2005 • Research • DALYs • EEA and international comparators • Samples: in depth assessment of topics

17. 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)

18.  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)

19. 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)

20. Health Promotion research published by level of Intervention % (n=2206)* 4.6% 19.7% Don't know Individual/Family Community/Group 39.8% 9.7% Regional/National Policy 26.2% *% of random sample of publications examined in detail where intervention identifiable (Clarke et al 2007)

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

22. * * 19 countries: incl. Iceland, Bulgaria, Romania Adany et al 2007

23. Problems studied 27% 10% 7% 56% Efficiency/quality improvement Organisation, cohesion & arrangement Inequalities & distribution Other Health services/systems research publications Doing things right Doing the right things For the right people Delnoij, Groenewegen 2007

24. Environmental Health Publications EEA 1995-2005 Tarkowski 2007

25. Public Health Management review • Very littleresearch 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

26. 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)

27. 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)

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

29. Public Health Research Arrangements International PH research National PH Associations PH Research Training Nationalministries NGOs Public Health Research Arrangements

30. 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

31. 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

32. 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

33. UK CRC Health research Analysis May 2006

34. We found that: Europe is an extremely important producer of Public Health research on the world stage …….

35. 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

36. 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

37. We found that: Public health research in Europe needs an active and caring approach (nurturing) and broad programmatic support

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

39. 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

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

42. 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

43. 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

44. 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

45. Spheres of Public Health Research Organisations and Stakeholders NGOs Civil Society Organisations Media/ research publishers Research funders “Wider” PH organisations (Food, Transport Exercise, environment) 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

46. 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?

47. 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)

48. THANK YOU

49. 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

50. 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