Developing an Agenda for Public Health Systems Research in BC Marjorie MacDonald, RN, PhD Professor, School of Nursing University of Victoria CIHR/PHAC.

Developing an Agenda for Public Health Systems Research in BC

Marjorie MacDonald, RN, PhDProfessor, School of Nursing

University of VictoriaCIHR/PHAC Applied Public Health Chair

On Behalf of the CPHFRI Team

Funders

• Michael Smith Foundation for Health Research• Canadian Institutes of Health Research • CIHR-PHAC Applied Public Health Research

Chair to Marjorie MacDonald• BC Ministry of Health, PHABC, BC Health

Authorities• Public Health Ontario, Ontario MOHLTC, six

health units in ON

Co-Authors• Trevor Hancock, Professor and Senior Scholar, School of

Public Health and Social Policy, University of Victoria

• Bernie Pauly, Associate Professor, School of Nursing, University of Victoria & Scientist, Centre For Addictions Research of B.C. (CARBC)

• Warren O’Briain, Executive Director, Communicable Disease Prevention, Harm Reduction and Mental Health Promotion, BC Ministry of Health

• Heather Wilson Strosher, CPHFRI Coordinator, University of Victoria

Purpose of Presentation

• To define PHSSR and argue for its importance in the overall context of public and population health research

• To describe the first efforts in Canada (BC) to establish the field of PHSSR, present the initial research agenda, and report on progress

• To present an emerging agenda for PHSSR in BC• To attract new researchers to the field from across

the country

What is PHSSR?

• In the US, initially called Public Health Systems Research (PHSR) - “the investigation of the dynamic properties and interactions of the public health system, its infrastructure, and their effect on population health status” (Van Wave, 2010)

• Then, to capitalize on the research and methodological developments of health services research, the word “services” was inserted into the title (PHSSR)

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What is PHSSR?Public health systems and services research (PHSSR) is defined as “a field of study that examines the organisation, funding and delivery of public health services within communities, and the impact of these services on public health”

Mays, Halverson & Scutchfield, 2003, p, 180

Population Health

Research

Public Health

ResearchPHSSR

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• Funding for health services research is directed primarily at the health care system in general, and not at public health services per se. This creates a “public health system knowledge disparity.”

Honoré, P.A. & Amy, B.W. (2005). “Public Health Finance: Advancing a Field of Study Through

Public Health Systems Research” Journal of Public Health Management & Practice, 11(6), 571 -573

Core Public Health Functions Research Initiative (CPHFRI)

A collaborative program of Public Health Systems and Services Research in BC involving long-standing and strong partnerships between knowledge users and researchers

History of CPHFRICreated to conduct research on Core Functions Framework implementation in BC• 2006 - Conceptualization of the idea and

development of team • 2006-07 - Team Planning Grant – MSFHR & MoH o Think Tank – Research Agenda April 2007o Developed Principles of KU-Researcher Collaboration

• 2008-2011 - Team Start-Up Grant – MSFHR & MoHo Grant Proposal preparation in line with research agenda

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Overarching Goals of CPHFRI

• Public health systems renewal in BC and Canada• Advancing public health systems/services research in BC

and Canada• Methodological development for studying complex

public and population health interventions & systems• Training public/population health researchers• Contributing to evidence-informed practice and public

health practice improvement• Improving the health of the population and promoting

health equity

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KTE

Equity

Partnersh

ipsM

ethods

Core Public Health

Functions Framew

ork* Context and Process of Implementation

Outcomes of PH Renewal

Core Competencies for PH

Linking PH and PHC

Equity Lens Integration

Evidence to Practice

Initial Five Year Agenda - 2007

*21 Core PH Programs.Equity & Population Lenses.PH Strategies (prevention, promotion, protection, surveillance).PH System Capacity (infrastructure, HHR)

• Since its inception in 2006, CPHFRI has attracted close to $6 million in peer-reviewed funding

• All of the initial priority areas identified at the 2007 Think Tank have been funded

• 13 PHSSR proposals submitted, 12 were funded

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Funding Received

Funded Projects Over 7 Years

• 2 completed MSFHR infrastructure grants (2006-11)

• 7 completed CIHR projects (1 operating grant, 2 knowledge syntheses, 2 MPDs, 1 PHIR grant, 1 KT supplement - 2008-12)

• 1 CIHR/PHAC Applied Public Health Chair (2008-14)

• 2 CIHR programmatic grants in progress– Renewal of Public Health Systems (REPHS) Emerging Team

Grant (2009-2014, with extension to 2015)– Equity Lens in Public Health (ELPH) Pathways to Health

Equity Grant (2011-2017)

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Critical Success Factors

• An opening policy window (post-SARS)• An identified need by knowledge users for

evidence and research to guide new policy initiatives

• Methodological innovation and risk taking• CIHR – IPPH Strategic Plan • Integrated KT at its best - a truly collaborative

relationship between KUs and researchers

Critical Success Factors

• A collaborative, systematically designed research agenda with KU buy-in

• Capitalizing only on funding opportunities consistent with research priorities

• A rigorous training platform integrating students at all levels

• Collaborative dissemination by both KUs and researchers in multiple forms

• A critically reflexive process

Challenges

• Of success (research burden)• Different research/organizational cultures

(needs, rewards, expectations)• Methodology (slow, labour intensive,

privacy/ethics issues)• Resources (infrastructure, costs)• Sharing results (needed sooner rather than

later; initially not nimble enough)

Renewing the Agenda

CONTEXT:• All initial research priorities funded• Well established relationships/collaborations• Shifting public health context and policies• The name CPHFRI no longer resonating for the

team or relevant in current policy context• Thus, a Think Tank was held to renew the

research agenda for another 5 years

Goals of Think Tank

• Celebrate the successful launch of a PHSSR agenda in British Columbia that began in 2007;

• Develop consensus on a PHSSR agenda for BC for the next 5 years;

• Start a process to revision and rename CPHFRI; and

• Expand the network of PHSSR researchers and supporters.

Think Tank Participants

45 Participants representing:– 4 BC Universities – 7 BC Health Authorities (including FNHA)– BC Ministry of Health– CIHR: IPPH & IHSPR– NCCDH– MSFHR– US National Coordinating Center for PHSSR– London-Middlesex HU

New Issues

• Expanding the definition of the “public health system” to include non-PH providers and non-traditional partners and places– E.g., NGOs, business, faith organisations,

municipalities• Multisectoral approaches, partnerships,

coalitions• ROI/ PH economics

New Issues (cont.)

• Community interests/engagement• Research on decision-making• Intervention research• Link to outcomes–Positive health measures – viz FNHA

• PH data and info systems• More nimble research (Quick Strike studies)

KTE

Equity

Population &

System *

Intersectoral/Multisectoral Collaboration

PH Decision-Making

PH System Ethics

Pop Health Interventions

PH Economics

Data and Info Systems for PH

PH Workforce

PH System Organisation

Public Health

Complexity

Partn

erships

Outcomes

Met

hods **

** Natural Experiments, Complexity Methods, PH Economics, Quick Strikes

* The collective infrastructure and actions of individuals and public, private and voluntary organizations that contribute to local, regional, provincial, national and global health and wellness through promotion, prevention and protection.

* The collective infrastructure and actions of individuals and public, private and voluntary organizations that contribute to local, regional, provincial, national and global health and wellness through promotion, prevention and protection.

PH Economics

PH Organization

PH Decision

Making

PH Workforce

Pop Health

Interventions

Intersectoral

/Multisectoral

CollaborationData

& In

fo

Syst

ems f

or P

H

PH Et

hics

The collective infrastructure and actions of individuals and public, private and voluntary organizations that contribute to local,

regional, provincial, national and global

health and wellness through promotion, prevention and protection.

PH Economics

PH Workforce

Data & Info Systems for PH

PH Decision Making

Intersectoral/Multisectoral Collaboration

Pop Health Interventions

PH Organization

Future Plans

• Re-visioning and renaming CPHFRI• Completing KT plans• Expanding our researcher – knowledge

user base• Securing infrastructure funding• Pushing forward on a Pan-Canadian PHSSR

agenda• International Collaborations

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For more information about CPHFRI:

http://web.uvic.ca/~cphfri/

Marjorie MacDonald: [email protected] or

CPHFRI Coordinator: Heather Wilson [email protected]