Research into policyResearch into policyA dialogue of the deaf?A dialogue of the deaf?

Martin McKeeEuropean Observatory on Health Care Systems

& London School of Hygiene and Tropical Medicine

www.observatory.dk

What drives health research?

Curiosity Money

But what drives the money?

What drives research funding?

• The pursuit of more money– Pharmaceuticals– Biotechnology

• Threats– Diseases that we have a reasonable chance of

getting (e.g. cancer, cardiovascular disease)• Civil society

– but whose interests?• Idiosyncrasy

– The syndrome of the living donor

What doesn’t drive research funding?

• Diseases we are unlikely to get– Diseases affecting poor people or migrants

• Unless their illness threatens us– Some infectious diseases– Mental health – because they might kill us

What questions get asked?

• Easy questions– Does smoking cause lung cancer?

• Questions we already know the answers to

• Questions using established methodologies

• Questions that don’t challenge the scientific consensus

• Questions that don’t need to be answered

What questions don’t get asked?

• Difficult ones, using unorthodox methods, such as:

• What are the health effects of:– Social transition– Globalisation of trade– Climate change

• What should a health system look like if it is to enhance health gain?

Who decides what should be funded?

• “Experts”– In traditional topics– Using traditional methods

• Would they have funded Galileo, Copernicus or Newton?

The research community

– Ignores context – why study physician behaviour in Germany when we know what influences physicians (in the US)?

– Struggles to understand practical questions – and even why they need to be asked

– Avoids risk– Judges performance on ability to attract funding,

and publish in high impact journals – whose peer review process is dominated by the same experts.

What do policy makers want?

• Simple answers to difficult questions

• Delivered yesterday

• Proposing actions that will deliver results tomorrow

• Set out in three bullet points on half a sheet of paper

• Costing as little as possible

The policy community

• Willing to leave research prioritisation to research community

• Unwilling to interfere in research funding arrangements

• Unwilling to fund research synthesis• Unwilling to fund dissemination• Unwilling to expend effort in understanding what

research can and cannot do• Unwilling to accept uncertainty

The UK Foresight Programme

Examples of current activities

• Cyber Trust

• The Lifecycle of Products

• Land Use

• Energy for the Future

• Untreatable Infectious Diseases

• 21st Century Infrastructure

• Knowledge Exploitation

• Creative Leisure

• The UK Foresight programme brings together key people, knowledge and ideas to look beyond normal commercial time horizons to identify potential opportunities from new science and technologies and actions to help realise those opportunities.

The European Observatory on Health Care Systems

• Focus on research synthesis

• Asking difficult and messy questions

• Balance of country specificity and generalisability

• Understanding context

• Building capacity

• Dedicated resources for dissemination

Pity the researcher who simply wants to make the world a better place