Strategies for public health research in European Union countries

The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. doi:10.1093/eurpub/ckt153 . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . Strategies for public health research in European Union countries

Introduction: 'Health' is an identifiable theme within the European Union multi-annual research programmes. Public Health Innovation and Research in Europe (PHIRE), led by the European Public Health Association, sought to identify public health research strategies in EU member states. Methods: Within PHIRE, national public health associations reviewed structures for health research, held stakeholder workshops and produced reports. This information, supplemented by further web searches, including using assisted translation, was analysed for national research strategies and health research strategies. Results: All countries described general research strategies, outlining organizational and capacity objectives. Thematic fields, including health, are mentioned in some strategies. A health research strategy was identified for 15 EU countries and not for 12. Ministries of health led research strategies for nine countries. Public health research was identified in only three strategies. National research strategies did not refer to the European Union's health research programme. Conclusions: Public health research strategies of European countries need to be developed by ministries of health, working with the research community to achieve the European Research Area.

Introduction
The World Health Organization (WHO), in its Strategy on Research for Health, 2 states 'Each country has a responsibility to develop its own agenda for research in order to respond to the health needs important to its population within its own social, political and environmental setting'. WHO and European Union (EU) member states have supported global meetings for ministers of health and of science, 3 and the Council for Health Research and Development has emphasized capacity development, 4 including funding.
Research and innovation together have an important place in current European policy. 5,6 The EU Seventh Framework Research Programme allocated around two-thirds of its research funds to cross-national collaborative research on specific themes, totalling around E650 million per annum for health research, 7 and within this E30 million per annum for public health research. 8 European research funding has been available for strategic approaches 9 : Research Infrastructures enable collection of European data for open analyses; ERA-NETs enable coordination on topics between national research organizations; and Joint Programming enables researchers across countries to collaborate on specific fields. In Joint Programming for Neurodegenerative Diseases, research priorities range from life sciences to health and social care. 10 A second tranche of European Union funds for research and innovation has been available to national governments through the European Structural Funds. Much of this funding has gone to the new EU member states. There has been strong emphasis on use of these funds for industry, but little has gone to public health research. 11 Yet most European research is undertaken with, and funded by, European country national funds. The EU consults on member states' views of European research themes, but has less knowledge of member states' own research strategies. This article describes the national health research strategies, and compares broad approaches by country.

Methods
PHIRE was a collaborative project with leadership of the EUPHA. 12 In the first phase, country informants reported on national uptake of selected public health innovations, and national public health associations identified public health research programmes and calls and reviewed national public health research systems. In the second phase, materials were provided for national public health associations to hold stakeholder workshops and to make national reports.
This report draws together information on national research strategies and health research strategies within the PHIRE national reports following stakeholder workshops. 13 To gain information for all EU countries (and Switzerland), they were supplemented through reports on research systems from STEPS, 14 data from the European Commission's webpage ERAWATCH 15 and targeted Internet searches. The available materials were tabulated in comparative form (Supplementary Table S1), and reviewed for health research strategies and public health research strategies, respectively. Results below include quotations from the materials tabulated and indicative years of publication.

Health within broader research strategies
Health research strategies were sought across 27 EU countries and listed by general research strategy and health strategy. For all countries, except Portugal, there was a general strategic document setting out the broad approach to funding and support to research. Countries were tabulated by health research strategy (Table 1). Health research strategies or priorities within programmes were identified for 15 countries. Health was within general research strategies in six countries; four countries without formal strategies had health research priorities; and there were health priorities within general research programmes of four countries. A further two countries, as well as six included in the previous groups, had research strategies and programmes led by ministries of health. No health research strategies or priorities with programmes were found for 12 countries. Examples of national health research strategies are shown in Table 2.
Health was identified within general research strategies in six countries. In Denmark, 'Health and Prevention' (including the sub-topics 'Chronic disease between prevention and rehabilitation' and 'Healthy Lifestyles-what creates change?') was one of six themes in the strategy. In France, the National Research and Innovation Strategy had 'Health, care, nutrition and biotechnology' as one of three priority areas. The Science Council of Ireland publication 'Towards better health; achieving a step change in health research in Ireland' (2006) identifies health research as a key function within the Irish health service. The Netherlands Organization for Scientific Research (NWO) Strategy (2010) has 'six themes' of which the first is 'Healthy Living: prevention, cure and long-term care'. In Sweden the Research Council Research strategy includes the Scientific Council for Medicine and Health 'subject list': 'Tomorrow's challenges include aging population and lifestyle-related diseases, and need for competence in health economics, epidemiology and records research, as well as 'coordinating centres of excellence'. The UK Medical Research Council strategic plan 'Research changes lives' has broad aims, including 'research priorities likely to deliver improved health outcomes; bringing benefits to all sections of society; and international health research'. No strategy could be found in some other countries with otherwise strong health research activity, including Finland and Spain.
In four countries, the national research strategies and priorities identified health research priorities. The Czech Republic Research Policy Priority area 5 considers the 'healthy population to be a cornerstone of an economically, socially and humanly successful society'.

Strategies for health research led by ministries of health
The Danish National Board of Health supports 'research focusing on the effects, organization and implementation of various initiatives to prevent disease and promote health. This applies to population-based initiatives and those oriented towards individual people'. Priorities for international cooperation include quality of health care, health technology, environment and health, research on interventions, controlling non-communicable diseases, health information technology, organization of health systems and combating social inequality in health. The Danish capital region also has a health research strategy.
The In Ireland, the health research board is organized under the Ministry of Health. Its strategic Business Plan 2010-4 goals are as follows: biomedical research, within a coherent health research system; population health sciences research and health services research; national health information systems; and synthesizing evidence, and promoting the application of knowledge. Ireland has also made a comprehensive review of public health research In the Netherlands, NWO-the national research councildirectly supports research on the molecular basis and epidemiology of disease, and research related to medical or health technology assessment. NWO together with the Ministry of Health supports ZonMW (Netherlands Organizations for Health Research and Innovation) across a series of 'Themes', including integrated care; ICT and e-health; rare diseases and orphan drugs; mental health; pregnancy and birth; youth; elderly; palliative care; sports, exercise and nutrition; participation; diversity; and efficiency.
The Swedish Council for Working Life and Social Research (FAS) has 'Targeted investments in the core areas of public health and social sciences', which include migration and ethnicity, alcohol and drugs, functional impairment, intervention research on the effects of social measures, implementation of evidence-based knowledge, health economics research on health care systems, as well as environmental, social policy and social insurance, disability and drug abuse research. In

Discussion
There was considerable variation in the quality of national information available. The analysis revealed a continuum of research strategies over three levels: general research strategies; research strategies including health; and public health research supported by Ministries of Health. Fifteen of the 28 countries had identifiable health research strategies, or priorities in programmes, and three for public health research. Health research strategies were not found in 13 countries, including two countries (Finland and Spain) with high health research outputs, but where funds are mainly allocated through intermediate national organizations. Comparison of national health research structures and financing is reported in an accompanying article. 16 The European Union has strong programmes for health research, in contrast to health systems where the EU member states maintain control and policy ('subsidiarity'). Health research must also have national (and local) relevance. There could be benefits in linking national health research strategies in relation to the European Union strategy. North American examples of health research strategies developed across multiple constituencies include the consultation and report (2006) by the US Centers for Disease Control, 17 and the consultation and Health Research Roadmap (2009) of the Canadian Institute for Health Research. 18 With varying levels of research capacities within individual countries, research strategies must contribute to supporting, valuing and modernizing existing research programmes and capacities, as well as exploring new approaches and disciplines for health research, including the balance of medical and social sciences. Greater involvement of ministries of health and advisers with broad policy perspectives will also help strengthen for health research.

Conclusion
Just over half of European countries have health research strategies. Fewer are led by their Ministries of Health or have specific public health research strategies. Information on national health research PHIRE: strategies for public health research strategies should be improved through collaboration between countries and coordination with the European Union's health research strategy. Further work would make comparisons of the research themes within the health research strategies, particularly those led by Ministries of Health, which have contact with health systems, in relation to policy and service needs. EUPHA can provide a framework for continued data collection, comparison and analysis.

Supplementary Data
Supplementary data are available at EURPUB online.