Public health: the gaping hole in the McKeon Review of Health and Medical Research
Public health experts are deeply disappointed by the consultation paper recently released by the McKeon Review of health and medical research.
What is missing from the McKeon Review? Let me count the omissions, and the missed opportunities…
Jon Wardle writes:
The McKeon Review into health and medical research recently published its draft paper for consultation (the Review), the eminent panel’s vision and recommendations for the future of health and medical research in Australia.
The Public Health Research Advisory Group (PHRAG) of the Public Health Association of Australia was one group that made comments on the Review’s draft consultation paper.
As a member of PHRAG, I’ll lay out a brief synopsis of the points made in the submission, peppered with some personal flair (i.e. all opinions my own, please see full submission for PHRAG viewpoint).
The full submission will be made available in due course, but in summary, it is fair to surmise that the public health community has been thoroughly underwhelmed by the review’s conclusions and suggestions.
Key to this concern was the Review’s definition of public health, which seemed at odds with the definition embraced by public health community itself.
The Review focused much more on medical research than it did on health, and consequently it viewed that the public health research it thought was most worthy of funding was medical research in public health priority areas, and not the research that Australia’s public health experts highlighted in their previous submission to the Review:
“Public health research is quite different from bio-medical research.
It focuses on the health of whole populations and is concerned with documenting the incidence of disease, understanding the origins of disease, determining what factors make for healthy populations and evaluating the impact of measures (including policies, programs and social changes) that keep populations healthy and free from disease.
Public health research is multi-disciplinary and includes epidemiology and the full range of social sciences (including sociology, psychology, economics, and anthropology). Public health research focuses on how social, economic, physical and natural environments shape health and health-related behaviours. It also includes much health services research, especially that which monitors the effects on whole populations.
Public health research addresses upstream structural drivers of health inequities (such as trade, macroeconomic policy, labour markets, environmental change etc) and conditions of daily living that affect health (health care, urban environment, working conditions and social relations). Public health research also covers evaluation of interventions, so as to determine what works in improving population health.”
Although all of the ‘high value’ interventions (those that achieve the most bang for their buck) in the Review’s Exhibit 2 fall within the remit of public health interventions, the accompanying paragraph makes no mention of using public health as a lever to improve health outcomes.
In fact, each of the three levers suggested focus solely on the delivery of clinical services – either by developing new interventions, making current interventions safer or translating clinical research into clinical service delivery.
The Review makes virtually no mention of public health at all. There is a mention, by default on page 25 (when the report discusses what public health research the NHMRC has already funded).
Public health research only gets a mention later under the vague heading “enhance the non-commercial pathway to impact”. Even then, the report defines public health through this clinical prism – it is interventions such as vaccination, safe sex programs and stop smoking programs.
These are undoubtedly important interventions, yet public health encompasses more than just interventions or monitoring and evaluating clinical service delivery.
It also focuses on the impact of the social and environmental determinants of health, and on the development of social, policy and other environments that support good population health outcomes.
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