Photo by Sami Salim on Unsplash

Are health policies backed by the latest science? – Expert Reaction

Health researchers are calling on the government to improve the way that research evidence informs health policies in Aotearoa.

A report by Healthier Lives National Science Challenge recommends that systems be put in place to ensure health policy makers have access to robust, up-to-date scientific evidence from our research community, and clear mechanisms for prioritising issues in the health system. It also highlights the importance of considering the lived experiences of people navigating our healthcare system when making policy changes.

The SMC asked experts to comment.

Dr Amohia Boulton, Director, Whakauae – Research for Māori Health and Development, comments:

“This report is incredibly timely given the changes that are being implemented within the health system, and those which we might expect to see arise from the recent Green Paper on the future of New Zealand’s research and science system. The Pathways report arguably sits at the nexus between these two major policy initiatives encouraging health researchers and policy-makers alike to consider how we translate the high quality health research that is currently being conducted in this country into meaningful, tangible and sustainable improvements in health outcome.

“The report notes that currently we “lack processes to ensure that promising research evidence is systematically considered for implementation in a timely way.” I would go further and argue not only do we currently lack the processes, oftentimes the very way in which we conduct our research establishes barriers to timely implementation. Our communities, iwi, hapū, whānau cannot afford to wait until the conclusion of a three-five year programme of research before they hear about the results of that research. Research conducted in partnership with communities, where local expertise and mātauranga is married with research skills and expertise provides opportunities for conducting research in a more timely and efficacious fashion. Communicating research findings to stakeholders throughout the life-span of a research project, not simply at the end of a piece of work, allows for greater transparency, rigour in the meaning-making of the results and the potential to pivot, to better meet a community’s (Iwi, hapū whānau) needs.

“This report challenges us to think about the conduct of research, to get the best from our efforts, not simply in terms of the dollars invested but in terms of the real change that is made in our communities.”

Conflict of interest statement: Amohia is a member of the Governance Group Kahui Māori for the Healthier Lives National Science Challenge. Amohia was not directly involved in the workshop from which this report draws.

Professor Robin Gauld, Pro-Vice-Chancellor and Dean, Otago Business School, comments:

“This is an excellent report. It is the latest in a long line of research and reports dating back for at least two decades into how to improve the uptake of research and evidence into policy. The area is a very complex one and has been subject to considerable scrutiny.

“Researchers and policymakers move at a different pace from one another and work within a different set of parameters. Policy makers are engaged in the art of decision-making which hinges on judgement; researchers are focused on specific methods and findings. The report does point to the clear need for a national initiative in the field.

“There has long been a gap in how policymakers access evidence and advice. Often, they request proposals through a competitive tender system. Most publicly funded, university-based researchers are not focused on working this way, creating further distance between them and policymakers. In many countries, there is a strong will amongst policy makers and public officials to directly engage with publicly funded researchers. This report hopefully will add further weight to the need to engage this way in New Zealand. With the new health system, the time for this has never been better.”

Conflict of interest statement: “I work at the University of Otago where some of those involved in producing the report I’ve comment on are based, albeit in other parts of the University.”

Dr Rawiri Keenan (Te Atiawa/Taranaki), Adjunct Senior Fellow, Medical Research Centre, Te Huataki, University of Waikato; Senior Research Fellow, Dept of Primary Care and General Practice, University of Otago Wellington, comments:

“This document points out many frustrations and limitations within the current processes of health policy and research. Overall the general recommendations around making the pathway for research and policy process more embedded and effective in the health system are great. The arguments are sound and the five guiding principles it uses align well with other documents such as Whakamaua (MoH Māori Health Action Plan) and even the HDC code to some level. So all good stuff. Like many things, “it’s in the doing” where the meaningful change needs to happen.

“Without being unduly pessimistic, I don’t share the optimism of the authors that the reforms in the health system, and even the review of the research system, will result in real change. This is primarily because of how much will rely on changes politically where the policy part of this document operates. In terms of why I don’t share that optimism, I see a couple key gaps in making meaningful change happen:

“One is the continual focus on cost effectiveness. I understand why, and the general need to make our health/research dollars go as far as possible. The issue I have is with the setting of the timeframe for the return of investment. When will we value health and education as investments rather than costs, which require a return like a stock or monetary investment? Then this of course all ignores the investment/cost required to get back/repair past damages by underinvestment and damages to health caused by other (government budget) areas i.e. housing and corrections.

“Another is research and evaluation of community and primary care. For many reasons community and primary care research is often lacking, especially in Aotearoa/NZ. Many attempts have been made via universities in particular, but a centralised funded approach is probably needed.

“I have a couple of comments on some of the “critical success factors” the report identified:

Big data: I would have liked to have seen the Māori data sovereignty aspects strengthened and I feel this is a key area, especially when the government departments themselves, such as the MoH already go against some of the key principles and use overseas based services like Amazon Web Services.

“Another interesting point here was the comment around primary care data not being linked to IDI. For my mind it is a reflection on the health reforms that they have not truly tackled community and primary care. Data collection from these services is something they intend to do through contracting. Community and primary care is something “purchased and commissioned”. It is seemingly not a true part of the system compared to the services delivered by Te Whatu Ora. Not to divert to commentary on the reforms, but I see this approach to community and primary care as a significant barrier to implementing some of what they hope to achieve (both for this document and incidentally the reforms).

Continuous review: I’m sure past members of the NZ Guidelines group would love to see a group like NICE established here. In the community and primary care space we do have a couple of bodies that do not get a mention – The Goodfellow Unit and the University of Auckland, BPAC inc, and Matui also.

A method to assess priorities: This would have to be one of the biggest concerns with a more nationalised and centralised Te Whatu Ora/HNZ. While the opportunity to stop unnecessary variation in care provision is exciting, the potential risk is for local grown/community driven priorities to get lost in the locality planning process(or waiting for a locality to be established in your part of the country) or funding priorities from the centre, not aligning with the locality any more than they already do.

“Overall, this is a document with many great recommendations, I’m sure there will be lots of discussion and indeed head nodding as much of this has been raised in the past. It is useful to have the summary and recommendations in a single place and we now need effort and advocacy from researchers, health professionals and the old and new health bodies (Manatu Hauora, Te Whatu Ora and Te Aka Whai Ora) within their own organisations but also Wellington.”

Conflict of interest statement: “Views are my own and not necessarily shared by any organisation I work for/am contracted to.” Rawiri is a Locum GP; Member, Te Rōpū Whakakaupapa Uruta; Member, Medical Council of New Zealand Cultural Safety, Partnership and Health Equity committee; Member, Health Quality and Safety Commission Patient Experience of Care Governance Group.