sphere: gastein health forum research for the citizens of europe science europe health mark mccarthy...

SPHERE: Gastein Health ForumSPHERE: Gastein Health Forum

Research for the Citizens of Research for the Citizens of EuropeEurope

Health

Europe

Science

Mark McCarthy

Professor of Public Health

University College London

A thought experimentA thought experimentThe European Director General for The European Director General for Health, a fit, handsome man, Health, a fit, handsome man, defines obesity as a key issue for defines obesity as a key issue for European health policyEuropean health policy --- ---

And so …And so …


What evidence?What evidence?

Laboratory – overfeeding kills ratsLaboratory – overfeeding kills rats Human – obesity reduces the Human – obesity reduces the

lifespanlifespan Economic – affluence leads to Economic – affluence leads to

indulgenceindulgence Environment – people don’t Environment – people don’t

exercise enoughexercise enough

Working with WHO, an expert committee concurs ‘from the evidence, this is a key health issue.’


But what is to be done?But what is to be done? DeterminantsDeterminants of obesity include of obesity include

food, built environment, transport, health food, built environment, transport, health systemsystem

ImpactsImpacts of obesity are: of obesity are:diseases – heart, diabetes, arthritis, diseases – heart, diabetes, arthritis, health health care system – surgery, utilisation, costcare system – surgery, utilisation, cost

PoliticsPolitics of obesity include: of obesity include:regulatory (eg labelling), regulatory (eg labelling), economic (eg regeneration), economic (eg regeneration), trade & private sector (eg road lobby)trade & private sector (eg road lobby)


Research questionsResearch questions What interventions?What interventions? Under what circumstances?Under what circumstances? Will achieve what effects?Will achieve what effects? Over what period?Over what period? At what cost?At what cost?


Let’s use the literatureLet’s use the literature Mostly from USA Mostly from USA European literature - local languages? European literature - local languages? Studies not designed as interventionsStudies not designed as interventions Studies not coordinated across Studies not coordinated across

culturescultures Replication difficult and not rewardedReplication difficult and not rewarded


Can we mobilise European Can we mobilise European research?research?

DG Health - limited research budgetDG Health - limited research budget DG Research - limited calls for health DG Research - limited calls for health

policy in policy in FP6FP6o biomedicine directed towards biomedicine directed towards

‘genomics’‘genomics’o disease dominated by cancerdisease dominated by cancero and environment, food, transport, and environment, food, transport,

informatics - all have their own informatics - all have their own agendas agendas


Member states …Member states … ‘‘Let’s leave health research to our Let’s leave health research to our

profitable pharmaceutical industry’ profitable pharmaceutical industry’ ‘‘Why pay for research if others Why pay for research if others

don’t?’don’t?’ ‘‘Will the results conflict with Will the results conflict with

domestic policies?’domestic policies?’ ‘‘Other European countries don’t Other European countries don’t

have domestic political impact’have domestic political impact’


Looking westwardsLooking westwards Task Force on ObesityTask Force on Obesity DHHS pays for NIH, AHQR, CDCDHHS pays for NIH, AHQR, CDC Research linked to project Research linked to project

interventions (both funded)interventions (both funded) Multidisciplinary – laboratory, Multidisciplinary – laboratory,

environment, economics, environment, economics, modelling, observational, modelling, observational, sociology, health promotion …sociology, health promotion …


Another thought experimentAnother thought experiment A bold, handsome Prime Minister A bold, handsome Prime Minister

decides that public services should decides that public services should be privatised, and health care is be privatised, and health care is an excellent market opportunityan excellent market opportunity

What is the evidence – ?What is the evidence – ?


Public health researchPublic health research Influence policiesInfluence policies Knowledge from practiceKnowledge from practice Good designs, strong Good designs, strong

comparisonscomparisons Multiple disciplinesMultiple disciplines Multiple partnersMultiple partners


Public health research Public health research organisationsorganisations

Not disease causation – even Not disease causation – even inequalities – but interventions inequalities – but interventions

Require special support to Require special support to understand MS differencesunderstand MS differences

Capable of competition but also Capable of competition but also require foundationsrequire foundations

Public sector must engage where Public sector must engage where pharma doesn’tpharma doesn’t


SPHERESPHERE Discussion of FP6Discussion of FP6 A call - ‘support action for FP7’ A call - ‘support action for FP7’ Engaging partners Engaging partners Creating structures - a European Creating structures - a European

Research Market needs Research Market needs organisation and playersorganisation and players


SPHERESPHEREStrengthening Public Health Research in Strengthening Public Health Research in

EuropeEurope

Health

Europe

Science

sphere: gastein health forum research for the citizens of europe science europe health mark mccarthy...

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