Research for a healthy life

Dr Graham Love, Chief Executive of the Health Research Board, joins us today to reflect on our October theme and talk about why he believes research is vital for a healthy life. This week, in collaboration with the Irish Research Council, the HRB launched their PPI Ignite Awards 2017 to support and promote capacity building for high quality public and patient involvement in health research.

Research saves lives. How do you know? Well, let’s take an endpoint that is black and white, one that is not open to interpretation. Death is black and white, a clear endpoint not open to ‘spin’. Last year a paper was published that compared death rates in patients admitted to emergency departments in hospitals with a research culture versus hospitals without such a culture.

Guess what? There was a significantly higher death rate in the non-research hospitals. So the message is clear: being treated in a healthcare setting where research is part and parcel of healthcare delivery enhances your health outcomes. End of.

And, should we be surprised? Let’s face it, being treated by a medical team that is up to speed with the latest advances & technology in medicine is much more likely to deliver a positive outcome than one that is not. Participation in research not only means being aware of best treatment options but is directly linked to the adoption of such treatment options in delivering healthcare services.

So why isn’t research part and parcel of every healthcare setting’s culture, in every hospital, GP practice and so on? I think there are many answers to this question: service overload, poor incentives, wrong structures – the list goes on and on. Perhaps the bigger question is: why is evidence not enough? Why do some people have difficulty accepting that vaccines are a great way to prevent illness? Why do so many of us eat badly, drink too much and smoke, when the evidence to the contrary is pretty clear?

There’s no silver bullet, but here I’m going to point at a significant part of the problem: there is too big a gap between those generating the evidence and those for whom the evidence applies. In the commercial world there is a tight coupling between the need of consumers and the producers of products & services. The better that coupling, the more the consumers are served, the better the producers do. It’s more complex in the world of public services, particularly publically funded research and, especially, health research. There are more complex ‘consumer’ needs, longer timeframes and so on. But, ultimately, in order for the public need to be served effectively, there needs to be a tighter coupling between the generation of research/evidence and the use of such research/evidence in the field. The research world tends to come outside the walls to ask taxpayers for money, then it retreats back inside the walls, identifies the topics to be researched, performs the research, and then comes back outside the walls to offer the evidence. And to ask for more funding.

When you look at our research world this way it is not that surprising that we struggle to get the evidence into real world policy and practice. Most of us researchers believe that we have the support of the general population. We do. But not to the extent we tell ourselves. Jo Public will usually be supportive of research that is, for example, trying to improve our health. But when Jo Public faces a choice between preventing pension cuts, averting local A&E closures or funding a study that will add to the body of evidence that might change a healthcare intervention in 10 year’s time which do you think falls off the list?

Traditionally researchers have defined the questions to be asked, crafted the proposals, evaluated which should be funded, decided who takes part, who gets published & if the objectives have been achieved. This happens in research funders and performers all over the world. Funding agencies like the one I lead, the Health Research Board, play a significant part in this in my view. We are part of the gap. We need to change. Recently we have taken tentative first steps in addressing the gap in the HRB. We have committed to making Public and Patient Involvement (PPI) integral to our research. We interpret PPI as research being carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them. Make no mistake, this will take a long time, culture change always does. But we have started down this road in a meaningful fashion and we aim to mainstream it into HRB funding. If done well, this will contribute to narrowing the gap between research and need. It will provide for a much broader and stronger support base for what we do. And it will provide significantly more effective research for a healthy life.