Philippa Howden-Chapman

Translating research findings into health policy.

Evidence of the influence of research on health policy is paradoxical. While there is scant evidence that research has had any impact on the direction or implementation of widespread health reforms, research on evidence-based medicine has dramatically increased, despite limited evidence that it has affected clinical practice. These developments have occurred in the context of a general decline in state intervention and provision and a post-modern questioning of researchers authority. Models of the relationship between research and policy range from one where empirical research rationally informs decision-making, through research incrementally affecting policy, to an enlightenment or infiltration model, which may operate on a conceptual level. Health research that contributes to large-scale socio-political change may require more methodological pluralism and greater focus on key institutional structures. Case studies reviewed suggest that dissemination is enhanced if researchers involve managers and policy-makers in the development of the framework for and focus of research and if investigators assume a responsibility for seeing their research translated into policy. Public health research is more influential if topical, timely, well-funded and carried out by a collaborative team that includes academics. Evaluations are more influential if, in addition, they are commissioned by health authorities but based on local collection of data, and instruments and incentives to implement policy are available. In some areas, such as the recent policy focus on careers in the community, researchers were largely responsible for raising this policy issue, whereas in other areas, such as the relationship between unemployment and health, researchers are just one of the groups of experts making competing claims about causality. In conclusion, clear research findings are not always a passport to policy, but researchers can reframe the way health policy issues are seen, and collaboration with policy-makers initially can enhance implementation later.

National infant mortality rates in relation to gross national product and distribution of income.

We examined the relation between infant mortality rates, gross national product, and income distribution. Our findings support the hypothesis that average measures of population health are influenced by the distribution of income within societies.

Does the frame affect the picture? A study into how attitudes to screening for cancer are affected by the way benefits are expressed

Objective To find out how presenting information about the benefits of screening for cancer in different ways affects an individuals decision to accept or reject screening. Methods A telephone survey of the Wellington region, New Zealand was carried out. Results A response rate of 75.6% was obtained. Respondents were most likely to accept screening when the benefits of screening were presented as a relative risk reduction. They were most likely to reject screening when the benefits were presented as numbers needed to screen to save one life. Conclusions An individuals decision about screening for cancer is affected by the way the benefits are framed. Health professionals must choose between framing the benefits of screening in the most positive light, to enhance participation rates, and presenting information in such a way as to reduce framing effects—for example, by expressing the benefits in a variety of forms. Clearly there may be a tension between these approaches; the former is arguably manipulation, and the latter may enhance informed choice, but may also reduce participation rates in screening programmes.

Association between the number of home injury hazards and home injury.

Although the home is a major setting for injury morbidity and mortality, there are few proven effective interventions for reducing home injury risk. To inform future research or interventions, this study measures associations between home injury hazards and home injury from a sample of New Zealand households. Logistic regression was used to assess the association between injury hazards identified by a building inspection and injuries requiring medical or associated services that occurred to household members prior to the inspection. There was an estimated increase of 22% in the odds of injury occurrence associated with each additional injury hazard found in the home (with 95% CI: 6-41%). This research suggests that addressing injury hazards in the home may be effective in reducing home injury. There are a number of potentially confounding factors that may affect relationships found between the existence of home hazards and injury occurrence. These need to be taken into account when future evaluations are planned.

Shopping for health: purchasing health services through contracts

The 1993 New Zealand health service reforms were based on the purported efficiencies of the purchaser/provider split. Purchasers are required to contract for services that will maintain, improve and restore the health of the populations they serve. The purchasing role, which requires the development of contracting skills as well as the setting of strategic directions and priorities, is new and as yet poorly developed. This paper describes the role of purchasing agents in setting priorities, the different approaches that are being taken to contracting for services and some of the problems that have arisen in the first year of contracting. It explores the trade-off that is evident between the potential for improving efficiency through contestable contracting and the need to minimise transaction costs associated with the contracting process. The purchasers accountability to the public and the Minister is analysed in the broader political context of the purchasers role in shaping a public health service and improving the health of the population.

Survey of drug and alcohol use by lesbian women in new zealand

The objective of this study is to describe the prevalence of alcohol and drug use and attitudes towards alcohol use in a group of New Zealand lesbian women. The method used is 1,222 copies of a postal questionnaire (the Lesbian Mental Health Survey [LMHS]) were distributed via lesbian newsletters over a 4-month period. Responses were received from 561 women, an estimated response rate of 50.8%. The respondents were predominantly New Zealand European, highly educated, urban women in the 25- to 50-year age bracket; 30.1% smoked cigarettes, and 90.2% had drunk alcohol at some time in the past year, over half once per week or less. The median number of drinks per week was 1.5 drinks, equivalent to 22.5 ml alcohol per week. Despite a comparatively low reported use of alcohol, 48.1% of respondents expressed the view that alcohol is used excessively in the lesbian community; 75.8% had used cannabis at least once, 32.6% in the past year; 30.8% had used recreational drugs other than cannabis and alcohol at some time, 4.5% in the past year.

Doing the splits: contracting issues in the New Zealand health service

The purchaser-provider split is an integral part of the New Zealand and UK health care reforms. The split is seen as an opportunity to introduce competition by increasing the number of players. The assumption is that competition among providers, purchasers or indeed funders, increases efficiency and provides more consumer choice. This paper looks at the issue of contracting in the New Zealand health services within the framework of transaction cost analysis. It examines evidence about the effects of formal contracting rather than the more traditional, informal negotiations that take place within a hierarchy. A number of potential problems with an indiscriminate provider split are highlighted and the conclusion drawn, that the outcome of such a split is likely to be more unpredictable than official expectations. In the absence of pilots, monitoring the implementation will be critically important to be able to compare the outcomes of different ways of organising the health care system.

Housing and health: The relationship between research and policy

There is a long tradition of using housing interventions to promote public health, despite causative factors being unclear. This article reviews the research evidence on the key aspects of poor housing such as inadequate maintenance, over crowding, low temperatures and dampness, that have been identified as contributing to the impact of housing on health. Possible intervening factors such as house dust mites and fungi are also reviewed. This evidence is discussed in the context of possible confounding factors such as housing location and tenure. Conclusions are drawn about the adequacy of the research evidence as a basis for changing building regulations and other policy measures as a way of improving health.

Tokelau: a unique low allergen environment at sea level

Background Previous studies have shown that children in Tokelau have a lower prevalence of asthma and atopy compared to Tokelauan children resident in New Zealand. We hypothesized that the low asthma and atopy prevalence in Tokelau may be associated with low indoor allergen levels.

Blood ties: accountability for blood quality in New Zealand.

Blood donations are gifts that do not fit easily into a more market-oriented health care system. The new commercial organisational arrangements in New Zealand for the collection, manufacture and distribution of blood and blood products are compared in this paper with the old organisational arrangements. The particular case of screening blood for hepatitis C is examined. A socio-legal framework, which looks at the regulation of social institutions, is used to explore the different ways in which people have tried to maintain the quality of blood and blood products, both in New Zealand and internationally. One conclusion drawn is that blood production and distribution cannot be commercialised without affecting supply and quality.