Developing a Research Agenda for Public Health Services in Canada
Funders • Canadian Institutes of Health Research • Ontario Agency for Health Promotion and Protection • Public Health Agency of Canada • CIHR Applied Public Health Chair Awards to MacDonald and Paradis • BC Centre for Disease Control • University of Western Ontario
Background • A series of PH Emergencies in Canada (SARS, tainted blood scandal, Walkerton water contamination) • Decimated public health infrastructure • Need identified to define Core Functions of PH • Need to renew and reform PH Systems • Renewal process initiated across the country
Background • Core Functions Framework developed in BC • Interdisciplinary team of researchers and decision makers created with infrastructure funding • Think Tank held to develop PHSR priorities • Leveraged $3M for research 2006-2011 • Challenges in finding funding to support PHSR – falls through funding agency cracks
Purpose of Project • To expand PHSR agenda Canada wide • To identify PHSR research priorities in Canada • Establish consensus on agenda • Develop a strategic plan to advance the agenda • Develop a national network of PHSR researchers, practitioners and decision makers
Purpose of Presentation • To present preliminary findings of literature search and survey • To identify some implications arising from the literature review and survey that might inform our deliberations over the next two days
Literature Review Purpose 1. Identify work being done to define PHSR, scope, potential, benefits 2. Describe the nature of PHSR being done in Canada 3. Identify PHSR priorities in the 5 countries under review (Can, US, UK, NZ, Aus)
Review Methods • Comprehensive search strategy using keyword searches in major databases, hand searching relevant journals, gray literature internet searches, key website searchers, reference lists of key articles • 1000 articles identified, 800 coded and abstracted
• Only 38 articles specifically used the term PHSR or PHSSR • Only 14 articles made reference to or discussed establishing a research agenda for PHSR
Article Types TYPE Can US UK NZ Aus Empirical 18 201 15 2 11 Theoretical 26 130 23 5 12 Review 17 101 19 3 9 Opinion/Editorial 19 107 13 9 14 Report 8 54 2 1 0 TOTAL 88 593 72 20 46
PHSR Topic Areas Topics Can US UK NZ Aus Partnerships 26 169 19 3 8 PH Infrastructure 24 122 10 5 9 EB Practice 21 82 21 3 13 Policy/Legislation 21 121 24 5 14 Health Disparities 19 95 20 7 15 Ph Workforce 15 147 15 4 8 PH Performance 12 155 10 7 4 Core Functions 9 124 9 2 8 *Top 3 priorities highlighted in red
Brainstorming Survey • Developed brief 10 minute online survey based on priorities identified in preliminary literature review • Not intended to be a population-based representative sample • Distributed widely through a variety of public health listserves across the country • N=338
Respondent Position
Work Level
Familiarity with Concept Mean Min Max St. Dev PH Systems/services 7.8 1 10 1.95 PH Research 6.7 1 10 2.10 PH Systems/services 5.8 1 10 2.32 research
Familiarity with PHSR by Employment Category Mean Min Max St. Dev Academics 7.0 2 20 1.96 Practitioners 5.3 1 10 2.27 Managers/Admin 5.4 1 10 2.38 Policy Makers 6.2 2 10 1.95 Policy Analysts 6.1 2 10 2.06 Consultant 6.1 1 10 2.08 Other 5.9 1 10 2.08
PHSR Priorities
Canadian PHSR Priorities Survey Literature Evidence-based practice Partnerships PH Performance PH Infrastructure PH Infrastructure Evidence-based practice Health Disparities Policy/Legislation Core PH Functions Health Disparities
Summary &Implications • Only in the US has there been explicit, collaborative efforts to define the field • Shift in language from PHSR to PHSSR to link the field explicitly with health services research • Is this a good thing? Are there any drawbacks to making this connection? If we do want to link our agenda to HSR, how do we do this?
• Similarities and overlaps between Population Health Intervention Research (PHIR) and PHSR • “the use of scientific methods to produce knowledge about policy and program interventions that operate within or outside of the health sector and have the potential to impact health at the population level” • PHIR brings issue of intersectoral collaboration to the table
• PHSR literature is more focused on describing and defining what it is that PH people do, rather than what it is they should be doing • A limited literature emerging that explores broader issues related to how societies can create the conditions in which people can be healthy • Is this a focus we want to ensure gets integrated into a Canadian PHSR agenda?
• The need to identify the key infrastructure elements and capacity necessary to address the PH goal of reducing health inequities by focusing on the SDOH is more prominent in the Canadian, Australian, UK and NZ literature. • It does appear in the US literature but has not yet attained such a prominent role. • To what extent do we want to orient our agenda to reduction of health inequities?
• Empirical literature has a strong focus on “traditional” methodologies, primarily quantitative • We need innovative and creative methodologies that can take the systems focus into account – and this means explicit attention to context
• People are more likely to understand the concept of public health research than public health services/systems research • What are the implications of this finding for moving the agenda forward?
• Survey findings reflect a high priority on health disparities/inequities, but this it is less of a priority for practitioners and managers than for other respondents • How do we move an equity research agenda forward if this is not a priority for those PH professionals closest to practice?
What is missing? • There is nothing at all in the PHSR literature about public health ethics, yet many ethical concerns arise and are identified • Is this an issue that we want to see integrated into our agenda? • What else is missing?
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