Keep a close eye on NZ’s new health strategy
A new health research strategy could finally direct our scant health resources where they're most needed, but we'll need to watch its implementation closely, writes Victoria University's Jacqueline Cumming
Last month, Health Minister Jonathan Coleman and Science and Innovation Minister Paul Goldsmith launched New Zealand’s first Health Research Strategy. Such a strategy is long overdue; without it we cannot be sure of getting the results we want from the near $300 million we spend annually on health research.
The strategy document points to key strengths in our health research and innovation system, including positive direct impacts on health in New Zealand, strong Māori research and world-leading longitudinal studies.
It also recognises weaknesses such as limited strategic oversight leading to mixed signals and incentives and no clear direction for addressing the health needs of New Zealanders and achieving health equity; a lack of balance between basic, clinical, applied and translational research; a lack of translation of research into policy and practice; and limited evaluation of interventions and research to inform quality improvement and patient safety.
The strategy’s vision is that by 2027 “New Zealand will have a world-leading health research and innovation system that, through excellent research, improves the health and wellbeing of all New Zealanders”.
It sets out four strategic priorities—investing in excellent health research that addresses the health needs of all New Zealanders; creating a vibrant research environment in the health sector; building and strengthening pathways for translating research findings into policy and practice; and advancing innovative ideas and commercial opportunities.
Beneath these priorities sit 10 actions, including investing in research to address the health needs of all New Zealanders, including Māori and Pacific peoples; prioritising investments; developing and sustaining a strong health research workforce; and strengthening the clinical research environment and health services research.
Strategy implementation is to be overseen by the Health Minister and the Science and Innovation Minister. An advisory group with representation across the health research and innovation system will advise on implementation.
I have worked in health research for 24 years and have regularly been awarded funding from the Health Research Council (HRC) and a range of other agencies, including district health boards. My interest is health services research—aimed at improving the efficiency and effectiveness of the health system and exploring issues related to financing, organisation, technologies, access and behaviours.
The health research environment has changed dramatically since I started out. It has become much harder to establish and sustain a health research career.
Until recently, HRC funding had remained static, with grant success rates falling from 30 percent to less than 10 percent in recent years. The number of health professionals and academic researchers desiring—and encouraged to seek—funding to support their practice and careers has increased significantly.
The grant application process is costly, however, with many grant proposals written and consulted upon, budgeted and reviewed through assessing panels and peer reviewers, but not able to be funded. And in New Zealand, it can be hard to find alternative sources of funding if key public good funds turn you down.
Over the years, the HRC has expanded its scope from medical research to fund more public health and some by-Māori, for-Māori health and health services research.
However, many areas of research remain virtually impossible to get funding for: health services research has not been generously funded, but worse off have been nursing, allied health, disability, primary health care, mental health, health system and Pacific research areas.
The strength of a strategy such as this will be in ensuring we target our scarce health research resources to agreed priorities. However, that prioritisation process will be challenging, given the many different views on where our investment should be targeted and the many researchers competing for funding.
The strategy points out that a key weakness is “a lack of balance between basic, clinical, applied and translational research”, noting clinical and health services research as areas that need strengthening and identifying some key groups—such as health practitioners with an interest in research, Māori, Pacific, disability, biostatisticians, health economists and multi-disciplinary researchers—as workforce areas that need further investment.
Funding these new areas will require careful attention to where current strengths lie; building a qualified workforce through a mix of funding to support leadership, programmes, projects and career development; and paying attention to how to retain researchers over the longer term.
These new investments will require significant new and sustained resources. Analyses have shown New Zealand to be well behind levels of funding supporting health research in other countries (in 2012, Australia spent 3.4 times the amount in New Zealand; the United Kingdom 4.5 times; and the United States 9.7 times). The very limited funding available here leads to significant gaps in our knowledge and ability to develop policy and practice based on New Zealand evidence and to support local populations, as well as limiting our economic development.
It is to be hoped the strategy will be successfully implemented, with strategic priorities flowing right through to funding decisions and key actions completed. There is much that is good in the strategy, but it will involve sustained attention, reconfiguration of key decision-making processes, greater engagement with a wide range of groups and time to implement. Ongoing monitoring of how it is proceeding is essential.
Those working on the strategy are to be congratulated for bringing it to this stage and we will be watching its implementation closely.