Priorities in Medical Research: elite dynamics in a pivotal episode for British health research.

Priorities in Medical Research (PMR) was published in 1988 by a select committee of the House of Lords. The report ushered in an era of NHS research and development (R & D) that lasted from 2001 to 2006. The inquiry's origins lay in concerns about academic medicine in the United Kingdom, yet PMR gave relatively little attention to this subject. Instead the report focused critically on the disconnect between the Department of Health and the NHS in R & D. This, the committee argued, had led to the neglect of research into health services and public health. To sidestep the report's unwelcome proposal for a National Health Research Agency, the department eventually grafted R & D management onto structures created as part of wider NHS reforms. The Medical Research Council successfully pursued a strategy of keeping the committee's attention away from sensitive aspects of its own programme. The final focus of PMR was shaped by an alignment between committee members with an industrial view of research and champions of health services research. The actions of the various actors involved are interpreted using elite models of the state, and the applicability of these models is critically examined.

'All the stars were aligned'? The origins of England's National Institute for Health Research.

BACKGROUND: In 2006, the research and development (R&D) activity of England's national healthcare system, the National Health Service, was reformed. A National Institute for Health Research (NIHR) was established within the Department of Health, the first body to manage this activity as an integrated system, unlocking significant increases in government funding. This article investigates how the NIHR came to be set up, and why it took the form it did. Our goal was a better understanding of 'how we got here'. METHODS: We conducted oral history interviews with 38 key witnesses, held a witness seminar, and examined published and unpublished documents. RESULTS: We conclude that the most important forces shaping the origin of NIHR were the growing impact of evidence-based medicine on service policies, the growth of New Public Management ways of thinking, economic policies favouring investment in health R&D and buoyant public funding for healthcare. We note the strong two-way interaction between the health research system and the healthcare system - while beneficial for the use of research, challenges for healthcare (such as stop-go funding) could also produce challenges for health research. CONCLUSIONS: Understanding how and why England came to have a centralised health service research system alongside a long-established funder of biomedical research (the Medical Research Council) helps us interpret the significance of the English health research experience for other countries and helps English policy-makers better understand their present options. Learning lessons from the features of the English health research system calls for an understanding of the processes which shaped it. Firstly, the publicly funded, nationally organised character of healthcare promoted government interest in evidence-based medicine, made research prioritisation simpler and helped promote the implementation of findings. Secondly, the essential role of leadership by a group who valued research for its health impact ensured that new management methods (such as metrics and competitive tendering) were harnessed to patient benefit, rather than as an end in themselves. A policy window of government willingness to invest in R&D for wider economic goals and buoyant funding of the health system were also effectively exploited.

International Health Research and the Emergence of Global Health in the Late Twentieth Century.

An influential policy network emerged from two overlapping developments of the 1970s and 1980s: new research programs focusing on tropical diseases and debates about how to implement the concept of primary health care at the World Health Organization. Participating actors came together in an informal network that, by the late 1980s, expanded advocacy to include the promotion and reorganization of all forms of research that might improve health in the Global South. This goal became associated with a search for new research methods for determining priorities, a quest that reached a peak in the early 1990s when the World Bank entered the picture. The bank brought money, economic analyses, and neoliberal ideology to the research advocacy movement and helped stimulate an upsurge of cost-effective forms of economic thinking in global health (GH) circles. This expanded research network provided some of the conceptual foundations and leadership for several of the most emblematic institutions of the new GH. These included new organizations to bring together and coordinate public and private actors in pursuit of common aims and new forms of economic rationality. The network's advocacy work contributed as well to a massive expansion of GH research at the turn of the century.

Mapping the historical development of physical activity and health research: A structured literature review and citation network analysis.

Little has been published about the historical development of scientific evidence in the physical activity (PA) and public health research field. The study aimed to examine the evolution of knowledge in this field. A structured literature review using formal citation network analysis methods was conducted in June-2016. Using a list of influential PA publications identified by domain experts, a snowball sampling technique was used to build a compact citation network of 141 publications that represents the backbone of the field. Articles were coded by study type and research team characteristics, then analyzed by visualizing the citation network and identifying research clusters to trace the evolution of the field. The field started in the 1950s, with a health sciences focus and strong North American and European leadership. Health outcome studies appeared most frequently in the network and policy and interventions least. Critical articles on objective measurement and public policy have influenced the progress from an emphasis on health outcomes research at early stages in the field to the more recent emerging built environment and global monitoring foci. There is only modest cross-citation across types of study. To our knowledge, this paper is the first to systematically describe the development of research on PA and public health. The key publications include fundamental ideas that remain citable over time, but notable research and dissemination gaps exist and should be addressed. Increasing collaboration and communication between study areas, encouraging female researchers, and increasing studies on interventions, evaluation of interventions and policy are recommended.

Health-promotion research over three decades: The social-ecological model and challenges in implementation of interventions.

AIMS: This debate paper traces the development of innovative methods for undertaking health promotion research with a socialecological orientation, with a few examples drawn from 30 years of research on adolescent health promotion research at the University of Bergen. CONCLUSION: We aim to show how the social-ecological model is becoming more evident as a guide to research, using three cases that illustrate progress and potential. The first case is the Norwegian part of the European Network of Health Promoting Schools. The second case is a project just underway, The COMPLETE study, which is a community-led effort to promote students' mental health and create a good psychosocial learning environment. The third case is a developing idea for the next generation of social-ecological research on adolescent well-being, using an asset approach to foster social inclusion and sense of community in multiple settings.

[An approach to research in the political agendas of the health sector in Colombia between 1990 and 2010]. / Una aproximación a la investigación en las agendas políticas del sector salud en Colombia entre 1990 y 2010.

OBJECTIVE: To understand health research in Colombia in the context of governmental and legislative agendas related to the health sector between 1990 and 2010. METHODS: Official sources were used such as development plans, bills and institutional documents. RESULTS: The National Government, the Ministry of Health and Social Protection (MSPS by its acronym in Spanish) and the Colombian Congress have focused their attention on health research as a public concern at certain presidential periods due to their interest in reducing the gap between research and health needs. In the 1990s, government plans showed greater interest in formulating a Science and Technology (S&T) policy in health led by the Ministry, an entity that had directorates, commissions and committees responsible for promoting and planning health research. In Congress, some health system reform projects included initiatives to formulate a health research policy that were not approved. DISCUSSION: Health research is recognized as a fundamental tool to help solve health problems. However, said recognition by governmental and legislative actors has not been constant and the institutionality in the health sector has been precarious considering that there is no permanent interest in formulating an S&T policy in health.

OBJETIVO: Entender la investigación en salud en Colombia como parte de agendas gubernamentales y legislativas relacionadas con el sector salud entre 1990 y 2010. MÉTODOS: Se usaron fuentes documentales oficiales como planes de desarrollo, proyectos de ley y otras publicaciones institucionales. RESULTADOS: El Gobierno Nacional, el Ministerio de Salud y Protección Social (MSPS) y el Congreso colombiano han puesto la atención a la investigación en salud como un problema público en diferentes periodos presidenciales debido al interés de reducir la brecha entre la investigación y las necesidades en salud. En los planes gubernamentales durante los años noventa se presentó mayor interés en la formulación de una política de Ciencia y Tecnología (CyT) en salud liderado por el MSPS, entidad que contaba con direcciones, comisiones y comités encargados de promover y planear la investigación en salud. En el Congreso, algunos proyectos de reforma al sistema de salud incluyeron iniciativas para formular una política de investigación en salud que no fueron aprobadas. DISCUSIÓN: La investigación en salud es reconocida como fundamental para contribuir a solucionar los problemas de salud. Sin embargo, este reconocimiento no ha sido constante por parte de los actores gubernamentales y legislativos, la institucionalidad en el sector salud ha sido precaria y no hubo insistente interés por formular una política de CyT en salud.

Laudatio zur Salomon Neumann-Medaille 2016: RKI Abteilung Epidemiologie und Gesundheitsmonitoring.

The German Society for Social Medicine and Prevention (DGSMP) confers the Salomon-Neumann-Medal for outstanding merits in the field of Preventive and Social Medicine. Salomon Neumann (1819-1908) was one of the most renowned representatives of Social Medicine, whose phrase "Medicine is a Social Science" is punched oh the medal. The Salomon Neumann-Medal 2016 was awarded to the Health Monitoring Unit of the Robert Koch-Institute (RKI), i. e. the Department for Epidemiology and Health Monitoring with its head Bärbel Maria Kurth. The article documents the honorific speech which stresses the importance of Health Monitoring for evidence informed policy making.

A mixed methods contribution to the study of health public policies: complementarities and difficulties.

The use of mixed methods (combining quantitative and qualitative data) is developing in a variety of forms, especially in the health field. Our own research has adopted this perspective from the outset. We have sought all along to innovate in various ways and especially to develop an equal partnership, in the sense of not allowing any single approach to dominate. After briefly describing mixed methods, in this article we explain and illustrate how we have exploited both qualitative and quantitative methods to answer our research questions, ending with a reflective analysis of our experiment.

A "Child's Rights Perspective": The "Right" of Children and Young People to Participate in Health Care Research.

As all human beings are consumers of health care provision across the life span and in receipt of care delivered by accountable health care professionals, all should have the right to be involved in shaping the future of their own health care. Rights-based participation, when applied successfully, has the potential to inform and influence the delivery of child health care, the child's experience of health care, plus children's nursing education (Coyne & Gallagher, 2011). The "right" of every child and young person to participate in research that relates to their own health care is also sustained by the author's lead position as a Senior Lecturer in Higher Education for pre-registration children's nursing in Northern Ireland and the appreciation of their voice when practicing as a registered children's nurse and ward sister. The report provides an insight into seminal work on human and child rights; the historical context of children in Western society, and the evolution of children's nursing amid the child's right to participate in shaping their own health care.

Administrative health data in Canada: lessons from history.

BACKGROUND: Health decision-making requires evidence from high-quality data. As one example, the Discharge Abstract Database (DAD) compiles data from the majority of Canadian hospitals to form one of the most comprehensive and highly regarded administrative health databases available for health research, internationally. However, despite the success of this and other administrative health data resources, little is known about their history or the factors that have led to their success. The purpose of this paper is to provide an historical overview of Canadian administrative health data for health research to contribute to the institutional memory of this field. METHODS: We conducted a qualitative content analysis of approximately 20 key sources to construct an historical narrative of administrative health data in Canada. Specifically, we searched for content related to key events, individuals, challenges, and successes in this field over time. RESULTS: In Canada, administrative health data for health research has developed in tangent with provincial research centres. Interestingly, the lessons learned from this history align with the original recommendations of the 1964 Royal Commission on Health Services: (1) standardization, and (2) centralization of data resources, that is (3) facilitated through governmental financial support. CONCLUSIONS: The overview history provided here illustrates the need for longstanding partnerships between government and academia, for classification, terminology and standardization are time-consuming and ever-evolving processes. This paper will be of interest to those who work with administrative health data, and also for countries that are looking to build or improve upon their use of administrative health data for decision-making.

[A history of men's health--on the origin of a field of research]. / Männergesundheitsgeschichte--Zur Entstehung eines Forschungsfeldes.

This contribution traces the conditions surrounding the emergence and development of a new field of research since the millennium. It primarily presents research initiated by the Stuttgart Institute for the History of Medicine: starting with the (re)discovery of sources and the setting up of bodies of sources for a gender-sensitive, patient-oriented history of health (autobiographies, diaries, correspondence) it moves to issues such as health lifestyles, workers' masculinity, the use of medical services, health experiences during particular stages of life such as childhood or youth, as well as prevention, healthcare, mental health and the gender gap in life expectancy. In conclusion the article discusses possible theoretical frameworks and perspectives.

EUROCOURSE lessons learned from and for population-based cancer registries in Europe and their programme owners: Improving performance by research programming for public health and clinical evaluation.

UNLABELLED: Population-based cancer registries (CRs) in Europe have played a supportive, sometimes guiding, role in describing geographic variation of cancer epidemics and comparisons of oncological practice and preventive interventions since the 1950s for all types of cancer, separate and simultaneously. This paper deals with historical and longitudinal developments of the roughly 160 CRs and their programme owners (POs) that emerged since 1927 and accelerating since the late 70s especially in southern and continental Europe. About 40 million newly diagnosed patients were recorded since the 1950s out of a total of 100 million of whom almost 20 million are still alive and about 10% annually dying from cancer. The perception of unity in diversity and suboptimal comparability in performance and governance of CRs was confirmed in the EUROCOURSE (EUROpe against cancer: Optimisation of the Use of Registries for Scientific Excellence in research) European Research Area (ERA)-net coordination FP7 project of the European Commission (EU) which explored best practices, bottlenecks and future challenges of CRs. Regional oncologic and public health changes but also academic embedding of CRs varied considerably, although Anno 2012 optimal cancer surveillance indeed demanded intensive collaboration with professional and institutional stakeholders in two major areas (public health and clinical research) and five minor overlapping cancer research domains: aetiologic research, mass screening evaluation, quality of care, translational prognostics and survivorship. Each of these domains address specific study questions, mixes of disciplines, methodologies, additional data-sources and funding mechanisms. POs tended to become more and more public health institutes, Health ministries, but also comprehensive cancer centres and cancer societies through more and more funding at project or programme basis. POs were not easy to pin down because of their multiple, sometimes competitive (funding) obligations and increasing complexity of cancer surveillance. But they also rather seemed to need guiding principles for Governance of 'their' CR(s) as well as to appreciate value of collaborative research in Europe and shield CRs against unreasonable data protection in case of linkages. Despite access to specialised care related shortcomings, especially of survival cohort studies, European databases for studies of incidence and survival (such as ACCIS and EUREG on the one hand and EUROCARE and RARECARE on the other hand) have proved to be powerful means for comparative national or regional cancer surveillance. Pooling of comparable data will exhibit much instructive variation in time and place. If POs of CRs would consider multinational European studies of risk and prognosis of cancer more to serve their own regional or national interest, then progress in this field will accelerate and lead to more consistent funding from the EU. The current 20 million cancer survivors and their care providers are likely to appreciate more feedback. CONCLUSION: Most CRs remain uniquely able to report on progress against cancer by studies of variation in incidence (in time and place), detection and survival, referral and treatment patterns and their (side) effects in unselected patients, the latter especially in the (very) elderly. Programming and profiling its multiple and diverse clinical and prevention research is likely to promote involvement of public health and clinical stakeholders with a population-based research interest, increasingly patient groups and licensed 'buyers' of oncologic services.