- Split View
-
Views
-
Cite
Cite
François Alla, Challenges for prevention research, European Journal of Public Health, Volume 28, Issue 1, February 2018, Page 1, https://doi.org/10.1093/eurpub/ckx117
- Share Icon Share
Most of the burden of disease is linked to factors accessible to prevention.1 On this subject, in many European countries, there is a contrast between the quality of health systems and the weakness of prevention policies. For example, the WHO European Region has the highest rates of alcohol consumption and tobacco smoking in the world.2 It is thus satisfactory to observe that a political awareness of this issue is emerging in Europe. In France, for example, the new President and the Minister of Health have announced prevention as a priority of the new health policy.
However, prevention challenges are also research challenges: Why is smoking not declining in the most underprivileged populations? Why are population so suspicious about vaccination? Why is the use of organized screening programmes declining? What urban policies can promote physical activity among seniors? What are the most effective interventions in the fight against overweight and obesity in adolescents? What is the return on investment of nicotine replacement therapy? To what extent could smart objects and e-health applications constitute prevention tools? Answers to these examples of research questions could help to improve the efficacy and efficiency of prevention policies. Prevention research therefore needs to be reinforced to addressing three main challenges:
First challenge: explain This first challenge consists of identifying and understanding the complex causal chains, the dynamics during life, the interactions between individual biological and behavioural, environmental and social factors, and the biological mechanisms by which exposures result in pathological phenomena. In particular—beyond just a simple description—we need to explain the pathogenesis of social inequalities in health. This understanding will be based on interdisciplinary interactions associating biological sciences and population sciences—medical science and human and social sciences.
Second challenge: act In addition to a better understanding of the determinants of health, the second challenge consists of developing and evaluating innovative interventions designed to modify the current situation. In a perspective of scaling-up and transferability, intervention research must be contextualized, as the results are dependent on both the intervention and the sociocultural and organizational context with which it interacts.3 In other words, this research must consider the intervention not as an external contribution to the environment, but as an evolving system that transforms the environment in which it is conducted.
Third challenge: transmit Public health research has a cognitive objective, i.e. research, but also an interventional objective. Public health research therefore only makes any sense when it integrates the concerns of decision-makers and practitioners and when it is comprises, right from the design step, a dynamic of transfer to practice and decision-making. This integration must be thought out and encouraged. It is composed of interactions between practitioners and researchers.4 These interactions arise from interfaces organized in the two environments—research and decision-making/practice—and are essential to integration of these two environments, which have a natural tendency to remain distinct. Because this knowledge transfer is a complex process, it also constitutes a research challenge: what determines whether or not practitioners and decision-makers use the knowledge derived from research? Under what conditions is this transfer possible? To achieve what changes in policies and practices?
To address these three challenges, we need to have real prevention research strategies integrated into health policies. In this way, in France for example, the creation of a national public health research programme, with multi-annual funding, is currently proposed to implement the national ambition to invest in health prevention, to improve the efficacy and efficiency of the health system and to reduce health inequalities. It is essential that this strategy be built from an international perspective and as part of an international partnership.
Conflicts of interest: None declared.
Comments