Health Research for the Population Health improvement – building capacities

1. Health Research for the Population Health improvement – building capacities Elena Varavikova, scientist, Department of Human Resources for Health Evidence and Information for Policy

2. Health research - definitions "Research is a system involving people, Institutions and processes. Its pursuit depends on systematic analysis, creativity and exploration" (Comission on health Research for Development, 1990)

3. Challenges for Kazakhstan • MDG by 2015 • State Program on reform and development of Public Health of the Republic of Kazakhstan 2005-2010 • Population Health analysis and improvement (LE, Infant & maternal mortality, CVD; etc) • Monitoring and Evaluation of the health system • Research, education and training

4. Working in the Public Health Field • Survey methods • Evidence-based recommendations, info. • Continuous education • Planning • Working with expert advisory group • Team building • Maximising health gain with available resources • Working conditions

5. Who are doing the job of population health analysis and evaluation? Education and Training? • MOH ? • National Public Health Institute? • Health leaders? • Politicians? • Professional Associations? • NGO's, Donors? • Who are working in this area and who prepared them? • System of continuous education – available?

6. WHO Knowledge for better Health - " know-do " gap • Research is an investment, not a cost • A broader, more inclusive view of health research is needed • Research should be applied to improve health equity • Research must be conducted according to universal ethical standards • Knowledge derived from research must be accessible to all • Civil societyhas a vital part to play in setting resear

7. Acute care hospital admissions per 100 Source: WHO/Europe, HFA Database, January 2005

8. Live births per 1000 population

9. Autopsy rate in %, for hospital deaths

10. SDR, diseases of circulatory system, 0-64 per 1000000 Source: WHO/Europe, HFA Database, January 2005

11. SDR, cerebrovascular diseases, 0-64 per 100000

12. SDR, trachea/bronchus/lung cancer, 0-64 per 100000 Source: WHO/Europe, HFA Database, January 2005

13. Role of PH Professional • To study, understand and report on the scale of the health situation and to raise public and political awareness • To interpret patterns of health and morbidity e.g smoking, alcohol, social dislocation • To advise on what should be done, drawing on best available evidence of effectiveness of interventions from different settings e.g. folic acid, community vs. hospital care • To monitor the impact of new policies, adapting them for changing circumstances

14. Understand Social Determinants of Disease and Outcomes • Lifestyle issues e.g. smoking, diet, exercise • Societal issues e.g. unemployment, family income • Complex mechanisms e.g. transition and self image • Widening social and regional inequities • Crucial roles of education, pensions, social policy, political economics, health policy • Partnerships to deal with complexity • Analysis and monitoring • What can the health system do to alleviate the negative results of individual and societal states?

15. Political and Societal Context • Shift toward market economy • Reduced job and societal security • Administrative decentralization (vs decapitation) • Undervaluing of health e.g. health expenditures as % GDP under 5% vs. 7-9 % in industrial countries • Reduced role of the state • Switch from Semashko to Bismarckian models • Stress on individual responsibility • Role of the hospital oriented health system vs. shift to community oriented system

16. What’s outside of the SPH’s walls? • Globalisation; social and economics instability • Changing role of the National Health Systems • Health Threats: HIV/AIDS, TB, Malaria ... • Macroeconomics and Health • 10/90 and Health Research • Evidence-based decision-making

17. What are objectives of KSPH ? • Centers of excellence – training, research, service • International standards and participation • Academic independence i.e. not a function of state • Attractive to students and stakeholders • Sustainability • Culture of quality • Acceptance by graduates and faculty • Accountability and reward - not by hours but program and results • Internal and external peer review

18. Potential Contribution of Schools of Public Health • Train people (skills and competencies) to: • Analyze health system and PH problems • Develop evidence-based policies • Assist governments in re-alignment of health priorities • Work with public and private sector • Research and develop tools to deal with new issues, e.g. globalization, communications technology, internet • Continuous professional and public education • Develop policy, programs, models and actions driven by national and community needs (e.g. poverty and inequity reduction) • Create a demand for professionalism in public health

19. Role of Research in SPHs • Set standards of evidence from past and current international experience • Identify avoidable morbidity/mortality in individual and population health • Identify individual and societal risk factors • Explore ways to prevent disease and promote health • Find the ways of improving primary prevention and delivery of health services (efficiency, effectiveness, evidence-based) • Promote quality in management in health systems

20. Research Capacity development • Careful selection of trainees • Capable scientific leadership • Continuity of research funding • Good equipment • Supplies in the institutions including communication facilities

21. Research in SPHs • Publications in local and international peer reviewed scientific journals • Develop culture of peer review and a self-critical attitude (Research Forum) for students and faculty • Disseminate findings to those who can benefit • If in national language, abstract in English invites comment and criticism from a wider audience • If funding of a SPH is tied to teaching hours, need to provide incentives and time for active research to be valued and rewarded

22. Conclusion • High mortality and morbidity from preventable diseases cannot be addressed without training large numbers of public health professionals • Need for research impossible overestimate • Attention to the cadres • Needs time, resources, international support, and adaptation from successful experience to local circumstances