Health research: making the dollars count

Australian health policy and public health campaigns – and the research that underpins them – leading the world in achievements. Penny Clay/AAP

This week’s release of the NSW Health and Medical Research Strategic Review identifies many opportunities to strengthen research and ensure the community extracts the maximum possible benefit from its investment.

The Review itself – chaired by Peter Wills – and the allocation of additional NSW Government research funding in response, is welcome news for the sector.

Two critical strategies are central to the Review’s final report: fostering innovation and translation of evidence; and building our capacity to conduct research that’s globally relevant. Both of these strategies have national relevance.

From bench to bedside and beyond

In discussing research translation, the Review refers to the US National Institutes of Health’s respected roadmap, which outlines three stages of research translation. The Review explains these as:

  • T1 developing treatments and interventions,
  • T2 testing the efficacy and effectiveness of these treatments and interventions, and
  • T3 dissemination and implementation research for system-wide change.

T3 research is particularly significant for governments because it speaks directly to improving the efficiency of services and the way programs are provided.

Historically, it has received less attention than the other two, but current pressures facing health systems from the increasing costs of new technologies and an ageing population mean that research of this kind is more important than ever.

Governments need information to aid decisions about effectively targeting resources while continuing to improve the quality of health policies and services. The Review recognises the challenging task ahead, referring to “wise investment of scarce resources” and outlining key actions that could boost T3 level research, such as funding rigorous evaluation of policies and programs to ensure adherence to best practice.

International lessons

Our efforts in this area could draw on valuable international experience in promoting better partnerships between researchers, policy agencies and those who deliver services.

Programs run by the Canadian Health Services Research Foundation and the Canadian Institutes of Health Research, or the many innovative funding schemes developed by the UK National Institute for Health Research all provide useful models for what might work in Australia.

Our experience at the Sax Institute shows policymakers and service providers fully recognise the potential value of research to their work. Our survey of NSW policymakers, for example, found that most thought research should be used more often. But there are many barriers to using research effectively, including difficulty in accessing reviews of research evidence and the different timelines of research and policy making.

One of the most important barriers limiting the opportunity for research to inform policies, programs and system change, is a lack of the kind of research that would really be most useful. Too often, research describes problems rather than testing potential solutions. Or it tests solutions that are impossible or difficult to apply at a population level.

In a recent study led by Professor Simon Chapman from the University of Sydney’s School of Public Health, one policymaker reflected on this disconnect, saying, “It’s as if all these people are bashing away at all these social problems with the wrong tools … [generating] papers that describe and quantify rather than [being] helpful for solving problems”.

Getting it right

When it goes well, Australian scientists are leaders in delivering research that impacts rapidly on population health, policy and program decisions and how health services function. The Nutbeam Review of Public Health Research Funding for the NHMRC referred to Australian health policy and public health campaigns – and the research that underpins them – leading the world in achievements, such as reducing deaths from road injury, melanoma, SIDS, HIV/AIDS, tobacco use, firearms and breast cancer.

How can we increase this kind of research? Again, the Review offers some important suggestions, such as strengthening research assets like biobanks, population-based cohort studies and linked health records, all of which can be used as a collaborative resource.

My colleague Professor Emily Banks has already written about the importance to public health of long-term, large-scale research assets. She cited the 45 and Up Study as an example of researchers using the pooled resource of more than a quarter of a million people to conduct studies of greater statistical reliability to answer important questions about our health as we age.

Australia’s capacity to link routinely collected health data is unique internationally in terms of its size and scale, and holds great potential as a powerful research resource to help bridge the translational research gap.

Using data that are already collected allows faster research and more timely information for policymakers. Large numbers of participants or records mean that questions can be answered more quickly and the needs or experiences of particular groups within our community can be explored.

Putting demographic and lifestyle information together with information on health service use provides an opportunity to answer government questions about resources, how services are operating and who is at most risk of receiving poor care.

A time of change

The Strategic Review has occurred at a time of significant change in the way that our health programs and services are delivered.

The need to respond to the many pressures we face, including a better approach to translational research, is a challenge probably best summed up by Productivity Commission Chairman Gary Banks: “It is as important that we have a rigorous evidence-based approach to public policy in Australia today as at any time in our history … the good news is that there is plenty of scope for improvement.”