Developing a Research Agenda for Public Health Services in

CanadaMarjorie MacDonald, Trevor

Hancock, Gilles Paradis, Anita Kothari

Funders

• Canadian Institutes of Health Research• Ontario Agency for Health Promotion and

Protection• BC Centre for Disease Control• Public Health Agency of Canada• CIHR Applied Public Health Chair Awards to

MacDonald and Paradis• University of Western Ontario

Background

• A series of PH Emergencies in Canada (SARS, tainted blood scandal, Walkerton water contamination)

• Dessimated 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 convincing funders to support

PHSR – falls through funding agency cracks

Health Emergency Management

Environmental Health

Prevention

Cor

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Public Health Strategies

Health Improvement

Pop

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CORE FUNCTIONS FRAMEWORK

Health Promotion

Develop healthy public policy; advocate/create supportive environments; strengthen communities; develop personal skills; build partnerships

HealthProtectionLegislate, Regulate, Tax, Inspect, Enforce, Punish

Preventive InterventionsImmunize, Screen, Counsel, Support behaviour change, Treat

Health Assessment & Disease Surveillance

Public health epidemiology, clinical epidemiology, health lab networks, analysis and dissemination

Programs that work to reduce a wide range of health problems. Include a focus on reproductive health, healthy development, creation of healthy communities, enabling adoption of healthy patterns of living, food security, and promotion of mental health.

Programs that focus on specific disease, disabilities, and injuries that contribute significantly to the burden of disease (e.g. chronic diseases, injuries, mental health problems, addictions, communicable diseases)

Programs that work to protect people from environmental hazards, both from natural causes and human activity (e.g. clean water and air, safe food, community sanitation, and environmental health)

Programs that ensure the public health sector is fully prepared and able to respond effectively to severe outbreaks of communicable disease, natural or human-induced disasters, major accidents, terrorism, etc.)

System Capacity/Infrastructure

Legislation, funding, education and training, information systems,

research, planning, performance management etc

Purpose of Project

• To expand PHSR agenda to national level• 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

Plan

• National Think Tank in May 2011• Funded by CIHR• Broad range of Canadian participants• International experts in PHSR – US and UK• Preparatory work – a comprehensive

literature review and “brainstorming survey”

Purpose of Presentation

• To present preliminary findings of literature search and survey

• To compare PHSR priorities across 5 countries based on literature

Literature Review

Purpose1.Identify work being done to define PHSR,

scope, potential, benefits2.Nature of PHSR being done in Canada3.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, coded, and abstracted

Article Types

TYPEEmpiricalTheoreticalReviewOpinion/EditorialReportTOTAL

Can US UK NZ Aus18 201 15 2 1126 230 23 5 1227 101 19 3 919 107 13 9 14 8 54 2 1 0 88 593 72 20 46

PHSR Priorities

PriorityPartnershipsPH InfrastructureEB PracticePolicy/LegislationHealth DisparitiesPh WorkforcePH PerformanceCore Functions

Can US UK NZ Aus26 169 19 3 824 122 10 5 9 21 82 21 3 13 21 121 24 5 1419 95 20 7 15 15 147 15 4 8 12 155 10 7 4 9 124 9 2 8

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

PH Systems/services

PH Research

PH Systems/servicesresearch

Mean Min Max St. Dev

7.8 1 10 1.95

6.7 1 10 2.10

5.8 1 10 2.32

Familiarity with PHSSRby Employment Category

AcademicsPractitionersManagers/AdminPolicy MakersPolicy AnalystsConsultantOther

Mean Min Max St. Dev 7.0 2 20 1.96 5.3 1 10 2.27 5.4 1 10 2.38 6.2 2 10 1.95 6.1 2 10 2.06 6.1 1 10 2.08 5.9 1 10 2.08

PHSR Priorities

Priorities by Job Category

AcademicsPriority %EB Practice

30.7PH Performance 30.7Health Disparities

30.7PH Infrastructure 24.9Partnerships 20.5

PractitionersPriority %EB practice 35.5PH Performance 28.3PH Infrastructure 27.5Core Functions 21.7PH Workforce 16.7

Priorities by Job Category

Managers/AdminPriority %PH Performance

35.7PH Infrastructure 29.6Core Functions 24.5EB Practice

22.4Health Disparities 19.4

Policy MakersPriority %EB practice 35.3PH Performance 31.4PH Infrastructure 23.5Core Functions 23.5PH Workforce 19.6

Priorities by Job Category

Policy AnalystsPriority %Health Disparities

30.0EB Practice 26.0Core Functions 22.0Partnerships 22.0Policy/Legislative 22.0 Development

ConsultantsPriority %Health Disparities 30.4Assess/Surveillance 25.0EB Practice 23.2PH Infrastructure 21.4Partnerships 21.4

Next Steps

• Complete literature synthesis• Hold National Think Tank, Montreal May 2011• Hold workshop at CPHA conference in June to

engage a broader audience and expand our fledgling network

• Report preliminary agenda to Canadian PH community and seek feedback/confirmation

• Work with funders to develop strategic RFPs for PHSR research