Developing an Agenda for Public Health Systems Research in BC

1. Developing an Agenda for Public Health Systems Research in BC Marjorie MacDonald, RN, PhD Professor, School of Nursing University of Victoria CIHR/PHAC Applied Public Health Chair On Behalf of the CPHFRI Team

2. 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

3. 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

4. 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

5. 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)

6. 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 PHSSR Population Health Research Public Health Research

7. 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

8. 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

9. History of CPHFRI Created 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 • Think Tank – Research Agenda April 2007 • Developed Principles of KU-Researcher Collaboration • 2008-2011 - Team Start-Up Grant – MSFHR & MoH • Grant Proposal preparation in line with research agenda

10. 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

11. Partnerships Equity Methods KTE Contextand Process of Implementation Core Public Health Functions Framework* Outcomes of PH Renewal Core Competencies for PH Equity Lens Integration Linking PH and PHC Initial Five Year Agenda - 2007 *21 Core PH Programs .Equity & Population Lenses .PH Strategies (prevention, promotion, protection, surveillance) .PH System Capacity (infrastructure, HHR) Evidence to Practice

12. Funding Received • 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

13. 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)

14. 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

15. 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

16. 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)

17. 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

18. 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.

19. 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

20. 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

21. 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)

22. KTE Equity Intersectoral/Multisectoral Collaboration Population & System * PH Decision-Making PH System Ethics PH Economics Pop Health Interventions ** Natural Experiments, Complexity Methods, PH Economics, Quick Strikes Partnerships Methods ** Complexity Outcomes *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. Data and Info Systems for PH PH Workforce Public Health PH System Organisation

23. Population & Public Health System* PH Ethics PH Workforce Pop Health Interventions Complexity PH Organization Outcomes Equity KTE Methods PH Decision Making Partnerships *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 Data & Info Systems for PH Intersectoral /Multisectoral Collaboration

24. PH Economics PH Organization Pop Health Interventions Intersectoral/Multisectoral Collaboration PHDecision Making Population & Public Health System Data & Info Systems for PH 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 Workforce KTE Outcomes Equity Methods Complexity Partnerships

25. 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

26. For more information about CPHFRI: http://web.uvic.ca/~cphfri/ Marjorie MacDonald: marjorie@uvic.ca or CPHFRI Coordinator: Heather Wilson Strosher hlwilson@uvic.ca