Funding for rural health research from the Australian Research Council: A missed opportunity?

Objective:  To determine the number of projects, and level of funding, for rural health research from the Australian Research Council (ARC).
Design:  Analyses of ARC searchable datasets of completed, and new and ongoing projects from 2001 to 2008.
Main outcome measures:  Number of rural health research projects as a proportion of total funding; level of funding for rural health research projects as a proportion of total funding.
Results:  Only 46 of 6498 ARC completed projects were classified as rural health research projects. This represents 0.7% of the total number of projects, and 0.39% of the total funding allocated. Only 25 of 4659 ARC new and ongoing projects were classified as rural health research projects. This represents 0.54% of the total number of projects, and 0.27% of the total funding allocated. None of the 832 completed fellowships were classified as rural health. Only five (0.52%) of the 953 new and ongoing fellowships were classified as rural health.
Conclusions:  The level of under-funding for rural health research could be partially addressed by directing applications towards the ARC, in addition to the National Health and Medical Research Council. With a few exceptions, rural health researchers are not yet competitive in the national funding arena.     

Health research systems: promoting health equity or economic competitiveness?

International collaborative health research is justifiably expected to help reduce global health inequities. Investment in health policy and systems research in developing countries is essential to this process but, currently, funding for international research is mainly channelled towards the development of new medical interventions. This imbalance is largely due to research legislation and policies used in high-income countries. These policies have increasingly led these countries to invest in health research aimed at boosting national economic competitiveness rather than reducing health inequities. In the United States of America and the United Kingdom of Great Britain and Northern Ireland, the regulation of research has encouraged a model that: leads to products that can be commercialized; targets health needs that can be met by profitable, high-technology products; has the licensing of new products as its endpoint; and does not entail significant research capacity strengthening in other countries. Accordingly, investment in international research is directed towards pharmaceutical trials and product development public-private partnerships for neglected diseases. This diverts funding away from research that is needed to implement existing interventions and to strengthen health systems, i.e. health policy and systems research. Governments must restructure their research laws and policies to increase this essential research in developing countries.     

Public health research systems in the European union

Background

Strengthening health research is an important objective for international health organisations, but there has been less attention to support for health research in Europe. We describe the public-health (population and organisational level) research systems in the 27 European Union countries.

Methods

We developed a typology for describing health research structures based on funding streams and strategies. We drew data from internet sources and asked country informants to review these for consistency and completeness. The structures were described as organograms and narratives in country profiles for each of the 27 EU member states. National public-health research structures included public and independent funding organisations, 'mixed' institutions (which receive funds, and both use and allocate them) and provider institutions.

Results

Most health research is funded through ministries of science or science councils (and sometimes foundations), while parliaments and regions may also contribute. National institutes of public health are usually funded by ministries of health. Many national research organisations both determine research programmes and undertake health research, but there is a move towards public-health sciences within the universities, and a transition from internal grants to competitive funding. Of 27 national research strategies, 17 referred to health and 11 to public health themes. Although all countries had strategies for public health itself, we found little coherence in public-health research programmes. The European Commission has country contact points for both EU research and health programmes, but they do not coordinate with national health-research programmes.

Conclusions

Public-health research is broadly distributed across programmes in EU countries. Better understanding of research structures, programmes and results would improve recognition for public health in Europe, and contribute to practice. EU ministries of health should give greater attention to national public-health research strategies and programmes, and the European Union and the World Health Organisation can provide coordination and support.     

Federal Expenditures on Maternal and Child Health in the United States

The goals of this study are to estimate federal maternal and child health (MCH) expenditures and identify their sources. This analysis is intended to provide a broad view of MCH funding appropriations and a basis for discussion of whether funds could be better utilized for the benefit of the population served. Data on federal maternal and child health expenditures for fiscal year (FY) 2006 were derived from examining federal legislation, department/agency budgets, and various web-based program documents posted by federal agencies. Based on selected criteria, we identified programs targeting children under 21 or pregnant/parenting women within the United States. The funding levels of agency programs for maternal and child health activities were determined and the programs briefly summarized. The identifiable funding for maternal and child health programs in FY 2006 approached $57.5 billion dollars. Funding sources for maternal and child health were concentrated within the U.S. Department of Health and Human Services, but spread across several different agencies within the department and in the Departments of Defense, Education, Agriculture, Housing and Urban Development, and the Environmental Protection Agency. Multiple agencies and offices often funded related activities, without evidence of a common underlying strategy. Federal maternal and child health funding mechanisms may lead to a fragmentation in maternal and child health activities. The funding and service delivery apparatus would benefit from an integrative MCH infrastructure approach to pediatric research, service delivery, and data collection/access that incorporates life-course and social/environmental determinants perspectives.     

Rural and remote health research: Does the investment match the need?

Objective

To determine the percentage of research projects funded by the National Health and Medical Research Council in the period 2000–2014 that aimed specifically to deliver health benefits to Australians living in rural and remote areas and to estimate the proportion of total funding this represented in 2005–2014.

Design

This is a retrospective analysis of publicly available datasets.

Setting

National Health and Medical Research Council Rural and Remote Health Research 2000–2014.

Outcome measures

‘Australian Rural Health Research’ was defined as: research that focussed on rural or remote Australia; that related to the National Health and Medical Research Council's research categories other than Basic Science; and aimed specifically to improve the health of Australians living in rural and remote areas. Grants meeting the inclusion criteria were grouped according to the National Health and Medical Research Council's categories and potential benefit. Funding totals were aggregated and compared to the total funding and Indigenous funding for the period 2005–2014.

Results

Of the 16 651 National Health and Medical Research Council‐funded projects, 185 (1.1%) that commenced funding during the period 2000–2014 were defined as ‘Australian Rural Health Research’. The funding for Australian Rural Health Research increased from 1.0% of the total in 2005 to 2.4% in 2014. A summary of the funding according to the National Health and Medical Research Council's research categories and potential benefit is presented.

Conclusion

Addressing the health inequality experienced by rural and remote Australians is a stated aim of the Australian Government. While National Health and Medical Research Council funding for rural health research has increased over the past decade, at 2.4% by value, it appears very low given the extent of the health status and health service deficits faced by the 30% who live in rural Australia.     

Corporate Philanthropy Toward Community Health Improvement in Manufacturing Communities

Virtually all large employers engage in corporate philanthropy, but little is known about the extent to which it is directed toward improving community health. We conducted in-depth interviews with leaders of corporate philanthropy from 13 of the largest manufacturing companies in the US to understand how giving decisions were made, the extent to which funding was directed towards improving community health, and whether companies coordinate with local public health agencies. We found that corporate giving was sizable and directed towards communities in which the manufacturers have a large presence. Giving was aligned with the social determinants of health (i.e., aimed at improving economic stability, the neighborhood and physical environment, education, food security and nutrition, the community and social context, and the health care system). However, improving public health was not often cited as a goal of corporate giving, and coordination with public health agencies was limited. Our results suggest that there may be opportunities for public health agencies to help guide corporate philanthropy, particularly by sharing community-level data and offering their measurement and evaluation expertise.     

Who gets how much: funding formulas in federal public health programs.

Federal public health programs use a mix of formula-based and competitive methods to allocate funds among states and other constituent jurisdictions. Characteristics of formula-based allocations used by a convenience sample of four programs, three from the Centers for Disease Control and Prevention and one from the Health Resources and Services Administration, are described to illustrate formula-based allocation methods in public health. Data sources in these public health formulas include population counts and funding proportions based on historical precedent. None include factors that adjust allocations based on variations in the availability of local resources or the cost of delivering services. Formula-funded activities are supplemented by programs that target specific prevention needs or encourage development of innovative methods to address emerging problems, using set-aside funds. A public health finance research agenda should address ways to improve the fit between funding allocation formulas and program objectives.     

Towards the inclusion of gender and sex in health research and funding: an institutional perspective

In this commentary, we reflect on the challenges of incorporating gender and sex into health research and funding and discuss some of the strategies we have employed in our efforts to overcome them. We write from our vantage point within Institute of Gender and Health, one of the 13 institutes that comprise the Canadian Institutes of Health Research, Canada's national health research funding agency.     

What are the relative merits of the sources used to identify potential research priorities for the NHS HTA programme?

The NHS Health Technology Assessment (HTA) Programme runs an annual process of identifying suggestions for health technology assessment. The objective of this paper is to describe and evaluate the relative importance of the different sources used by the program in 1998 to identify potential priorities. There were four different sources: a) a widespread consultation of healthcare commissioners, providers and consumers; b) research recommendations from systematic reviews; c) reconsidering previous research priorities which had not been taken forward for funding; and d) horizon scanning. Collectively, the four sources generated just over 1,100 HTA suggestions. By far the largest source of suggestions and priorities was the widespread consultation. However, the success rate of this source, in terms of being commissioned, was low. Research recommendations from systematic reviews provided the second largest source of priorities and the best success rate of all sources. Value was found from different sources for different healthcare areas.     

Research in support of health systems transformation in South Africa: the experience of the Centre for Health Policy

We describe the role and experience of the Centre for Health Policy (CHP), a university-based research unit established in 1987, in influencing and supporting health systems transformation in South Africa over two decades. During 2010, we analyzed relevant documents and conducted interviews with 25 key informants. CHP's research has contributed directly to health policy development and implementation while also changing the way government understood or approached policy issues. Key success factors for policy influence are: research quality and trustworthiness, strategic alliances and networking, and capacity building. CHP's challenges include identifying new funding sources and sustaining a high public profile. The lessons for other countries are to: conduct good quality, relevant research based on strong ethical values; build and maintain open and honest relationships with government; recognize and adapt to changes in the policy environment; develop capacity as part of a continuous programme; and seek core funding that ensures research independence and public accountability.     

Federal Sponsorship of Cost-Effectiveness and Related Research in Health Care: 1997–2001

OBJECTIVES: To describe recent federal sponsorship of cost-effectiveness and related health economics research to provide insight into the functioning of existing research support systems and assess the roles of federal health agencies. METHODS: Using the PubMed database, we identified cost-effectiveness and related publications citing support from a US government entity and published during the period of 1997 through 2001, and audited them for information on funding sources, study type, and content focus. RESULTS: Five Department of Health and Human Services agencies and centers and the Veterans Administration are cited as funders in 74% of 520 federally supported health economics publications we identified. Three-fourths of federally supported publications address five areas of high disease burden: infections, cancer, HIV/AIDS, cardiovascular disease, and substance abuse. Other high burden diseases, including mental health, diabetes, and injuries, receive less attention. Federal support of health economics studies of health education and care delivery-intervention types underexamined in the field-is relatively strong but most often focuses on substance abuse or mental health services. Each of the top federal funders has a distinct funding pattern, but there are substantial areas of overlap within which we could not identify content domains specific to one funder or another. CONCLUSIONS: Federal support of health economics research has paralleled growth in the field. Federal funders support projects consistent with their mission and focus on high-burden disease areas. However, overlapping funding areas, ambiguity concerning agency interests within overlapping content areas, and gaps in some disease and intervention areas suggest that the coordination of health economics research funding could be improved.     

The public health rationale for promoting plant protein as an important part of a sustainable and healthy diet

Sustainable diets are proposed as a means to improve public health and food security and to reduce the impact of the food system on the environment. Guidance around sustainable diets includes a reduction of animal products in order to move towards a more plant‐based diet, meaning that plant‐originated foods are a predominant, but not the sole component of a diet. The main principles of a sustainable diet (as provided by the Food and Agriculture Organization of the United Nations/World Health Organization) are to consume a variety of unprocessed or minimally processed foods, mainly as wholegrains, pulses, fruits and vegetables, with moderate amounts of eggs, dairy, poultry and fish and modest amounts of ruminant meat, which are consistent with the current UK healthy eating recommendations (e.g. Eatwell Guide). The aim of this review was twofold: (i) to discuss public health challenges associated with consumers’ knowledge regarding protein sustainability, healthier protein sources and protein requirements, and (ii) to review potential approaches to facilitate the shift towards a more sustainable diet. Consumers would benefit from receiving clear guidance around how much protein is needed to meet their daily requirements. The public health message directed to a consumer could highlight that desired health outcomes, such as muscle protein synthesis and weight control, can be achieved with both sources of protein (i.e. animal and plant‐based), and that what is more important is the nature of the ‘protein package’. Health promotion and education around the benefits of plant‐based protein could be one of the strategies encouraging the wider population to consider a shift towards a predominantly plant‐based diet.     

Implementation of the Henry J. Kaiser Family Foundation's Community Health Promotion Grant Program: A Process Evaluation

The Community Health Promotion Grants Program, sponsored by the Henry J. Kaiser Family Foundation, represents a major health initiative that established 11 community health promotion projects. Successful implementation was characterized by several critical factors: (1) intervention activities; (2) community activation; (3) success in obtaining external funding; and (4) institutionalization. Analysis of the program was based on data from several sources: program reports, key informant surveys, and a community coalition survey. Results indicate that school-based programs focusing on adolescent health problems were the most successful in reaching the populations they were targeting. The majority of the programs were able to attract external funding, thereby adding to their initial resource base. The programs were less successful in generating health promotion activities and in achieving meaningful institutionalization in their communities.     

Shortchanged? An assessment of chronic disease programming in major US city health departments

A self-administered survey was distributed to members of The Big Cities Health Coalition, a group of Health Officers/Commissioners from 17 of the largest US metropolitan health departments. The survey asked participants about their chronic disease priorities, data sources, budgets, and funding sources as well as examples of successful chronic disease interventions. Members of the Coalition discussed the survey results in a scheduled conference call. Chronic diseases account for 70% of all deaths nationwide on average, yet the health departments surveyed allocated an average of 1.85% of their budgets to chronic disease. Average chronic disease spending per inhabitant was $2.33, with a median of $1.56. Among the group’s top chronic disease priorities were asthma, diabetes, tobacco, cancer, and cardiovascular disease (CVD). Nearly half of the group’s chronic disease spending was on tobacco. Chronic disease funding sources varied across localities, but direct federal funding was minimal. In 14 cities serving a combined 37 million people (13% of the US population), direct federal chronic disease funding totaled $8.7 million, an average of $0.24 per capita. The group described successful chronic disease interventions, particularly related to tobacco and asthma. The Big Cities Health Coalition members: John M. Auerbach, MBA (Boston Public Health Commission); Peter Beilenson, MD, MPH (Baltimore City Health Department); Matthew Carroll, AB, JD (Cleveland Department of Public Health); Mary DesVignes-Kendrick, MD, MPH (Houston Department of Health and Human Services); John F. Domzalski, JD, MPH (Philadelphia Department of Public Health); Franklin Judson, MD (Denver Public Health Department); Mitchell H. Katz, MD (San Francisco Department of Public Health); Alonzo Plough, PhD, MA, MPH (Seattle/King County Public Health); Eleni Sfakianaki, MD, MSPH (Miami-Dade County Health Department); Adewale Troutman, MD, MPH (Fulton County Department of Health and Wellness); Jonathan B. Weisbuch, MD, MPH (Maricopa County Department of Public Health); Judith West, MPH (Detroit Department of Health); John L., Wilhelm, MD, MPH (Chicago Department of Public Health); Steve Wilson, MD, MPH (Dallas County Department of Health and Human Services).     

我国卫生政策与体系研究科研项目及经费现状分析

目的：描述我国卫生政策与体系研究领域科研项目及经费现状,分析存在的问题,为促进研究能力提高提供建议。方法：通过问卷调查和关键人物深度访谈,从科研项目数量及分布、主题情况等方面进行分析。通过公开资料梳理,从项目数量与分布、主题情况等方面对国家自然科学基金的资助情况进行分析。结果：2015—2017年平均每个机构每年开展科研项目26.25项,涉及主题为卫生筹资、服务提供、卫生人力等;平均每个机构每年的科研经费为529.00万元;63.16%的研究机构来自国内的经费资助多于来自国际的经费资助,政府来源经费占全部经费比例为44.23%;财务管理方面,科研经费通常由上一级机构的财务管理部门通过预决算机制进行管理。2008—2017年,共有116家机构获得国家自然科学基金资助,平均每个机构获得项目数为4.81项、所获得资助金额为169.06万元,主要研究为卫生服务提供相关主题。结论：我国卫生政策与体系研究科研项目数量及经费快速增长,但主要集中于发达地区的研究机构,存在地区不平衡现象;国际资助呈现下降趋势,国内来源占比越来越高;经费管理机制在逐步调整,但不同机构落实方面存在差异。     

A Niche for Infectious Disease in Environmental Health: Rethinking the Toxicological Paradigm

Objective

In this review we highlight the need to expand the scope of environmental health research, which now focuses largely on the study of toxicants, to incorporate infectious agents. We provide evidence that environmental health research would be strengthened through finding common ground with the tools and approaches of infectious disease research.

Data sources and extraction

We conducted a literature review for examples of interactions between toxic agents and infectious diseases, as well as the role of these interactions as risk factors in classic “environmental” diseases. We investigated existing funding sources and research mandates in the United States from the National Science Foundation and the National Institutes of Health, particularly the National Institute of Environmental Health Sciences.

Data synthesis

We adapted the toxicological paradigm to guide reintegration of infectious disease into environmental health research and to identify common ground between these two fields as well as opportunities for improving public health through interdisciplinary research.

Conclusions

Environmental health encompasses complex disease processes, many of which involve interactions among multiple risk factors, including toxicant exposures, pathogens, and susceptibility. Funding and program mandates for environmental health studies should be expanded to include pathogens in order to capture the true scope of these overlapping risks, thus creating more effective research investments with greater relevance to the complexity of real-world exposures and multifactorial health outcomes. We propose a new model that integrates the toxicology and infectious disease paradigms to facilitate improved collaboration and communication by providing a framework for interdisciplinary research. Pathogens should be part of environmental health research planning and funding allocation, as well as applications such as surveillance and policy development.     

Public health initiatives in South Africa in the 1940s and 1950s: lessons for a post-apartheid era.

Inspiration drawn from South African public health initiatives in the 1940s played an important role in the development of the network of community and migrant health centers in the United States. The first such center at Pholela in Natal emphasized the need for a comprehensive (preventive and curative) service that based its practices on empirical data derived from epidemiological and anthropological research. In addition, community consultation preceded the introduction of new service or research initiatives. The Institute of Family and Community Health in Durban pioneered community-based multidisciplinary training and developed Pholela and other sites as centers for service, teaching, and research. Several important lessons for South African health professionals emerge from the Pholela experience. First, public health models of the past need to be reintroduced locally; second, the training of public health professionals needs to be upgraded and reoriented; third, appropriate research programs need to respond to community needs and address service demands; fourth, community involvement strategies need to be implemented early on; and fifth, funding sources for innovation in health service provision should be sought.