Scientific challenges

One of the purposes of public health research is to provide decision-makers and the healthcare system (Ministry of Health, health authorities, operators of the healthcare system, health insurance policies, professionals and patients’ associations for example) with all of the factual and theoretical elements that are likely to facilitate their choices.

Following up children with growth problems, reading a growth curve. Clinical investigation center 9202

Following up children with growth problems, reading a growth curve. Clinical investigation center 9202 "Physiology and physiopathology of development", Robert-Debré Hospital, Paris

This requires carrying out different types of research enabling three levels of analysis of the health determining factors:

  • personal dimensions (influence of personal characteristics generally coded in the biological substrate and the behavior of people on their health);
  • environmental dimensions (influence of rare or common industrial products, dietary products, pollution, drugs and so on);
  • organizational and institutional dimensions (with direct regard to the healthcare system itself, its strategic choices and its use by the population).

Some of these analyses call for studies on a number of the population (statistically representative of what we want to analyze), known as cohort studies. For example, the cohort ELFE, representative at national level, will take account of 20,000 children born in 2010 who will be followed up from birth to adulthood in a multidisciplinary approach. Eventually, it will therefore constitute an irreplaceable source of data shedding light on the development of a child in his/her environment, with focus on studying the different factors in interaction throughout childhood and teenage to adulthood (biological, family, social, environmental, school, behavioral, health and nutritional factors) and on the impact of situations gone through as a child on the health and physical, psychological, social and professional development of people.

It is easy to see the importance of epidemiological surveys and public health analyses of this type. Without them, we would not have the information we need for making life and society choices - information that is becoming ever more vital as we progress in a rapidly changing complex environment. For example, it was not until 1956 that the statistical link between smoking and lung cancer was made thanks to an epidemiological survey protocol on a large number of participants, despite tobacco consumption having been around for several centuries already in Europe! Citizens today show a great deal of concern in their health, in understanding all of its determining factors and in effective public choices in this field.

Which scientific strategy should be followed?

Through its analysis of the research potential over the last few months, the Institute of Public Health has revealed a certain number of French public health and clinical research strengths, including multidisciplinary development in many teams and close interface between production of knowledge and intervention, which places clinical research and public health research at the heart of clinical decisions and the drawing up of health policies – undeniable qualities of expertise in the teams.

By contrast, this analysis has also highlighted those weaknesses that are now clearly identified as they are encountered on a daily basis by all researchers in the field as well as users of public health research: the relative dispersion of teams which is hampering not just the national and international visibility of their research findings but also their capacity to take action on emerging health risks and still not enough interaction between fundamental and clinical approaches in human and social sciences and public health, despite its necessity for an integrated understanding of the different factors involved in the population’s health.

Doppler ultrasound of the brachial artery for studying endothelial function. Laboratory of cardiovascular diseases of clinical investigation center 9501, Jeanne d'Arc Hospital, Nancy.

Doppler ultrasound of the brachial artery for studying endothelial function. Laboratory of cardiovascular diseases of clinical investigation center 9501, Jeanne d'Arc Hospital, Nancy.

In view of these observations, the Institute of Public Health has made supporting the development of what we now call “large research infrastructures" its first priority in the field of public health research and clinical practice. In practical terms, these infrastructures are large-scale observational study initiatives, such as the aforementioned ELFE cohort, and which are equivalent - in public health and clinical research - to the large astronomy telescopes. They are therefore long-term “observatories” of health trends in a given population, by uniting all of the factors that are likely to explain these developments. These infrastructures are a powerful incentive for research teams to group together. Indeed, they generate a huge amount of high-quality data requiring a variety of in-depth analyses that a single research group cannot conduct alone. They are also an incentive for interdisciplinary approaches to be developed, particularly between fundamentalists, clinicians, epidemiologists and teams in social and human sciences, given the multidimensional nature of the data collected over time.

In thematic terms, the Institute of Public Health would like to facilitate the development of research in fields where knowledge needs to be increased and expanded as regards the underlying health challenges. This is the case for relations between health and the environment, linked to the increasing use of industrial projects in our daily environment and the global deterioration of our ecosystems. It is also the case for disability which can only become more common as the population ages and more chronic diseases generating diverse disabilities arise.

Moreover, not enough research is being carried out in France on the functioning and management of the healthcare system or public policies, not to mention prevention, compared with current practices abroad. The Institute of Public Health is therefore responsible for stimulating the development of research in these different areas by fostering interdisciplinary approaches to the subjects addressed.

Functioning of the healthcare system

This research field (dubbed “Health Services Research” in English-speaking countries) compares the functioning of healthcare services with health production. It deals with requirements, healthcare supply and demand, as well as the facilities, people involved, procedures and evaluation of the healthcare system in the areas of prevention, diagnosis and treatment of diseases.

In global terms, this research field concerns the organization of the healthcare system and the definition of the strategy (health policies, programs, development and implementation conditions and so on). At a local level, it involves understanding the methods for organizing the healthcare system and access for users, arbitration procedures and the question of how those involved behave. One of the objectives of this research movement is to provide health planning managers with useful evaluation tools in the allocation of resources.

Health and public policies

All public policies, even if they do not directly concern health themes, can have direct or indirect health effects. We must therefore question the way in which public policies and the resulting institutions and social organization methods are likely to have an impact (positive or negative) on populations. Drawing on our knowledge of the population’s health, we can also question the extent to which existing public policies are sufficient.

Prevention and prevention policies

Given the continuing high level of avoidable premature death in France (death before the age of 65), the Institute of Public Health would like to encourage clinical and public health research to be carried out in two areas where the health risks are closely related to individual and group behaviors: prevention of narcotic abuse and dependence (tobacco, alcohol and cannabis mainly) and nutrition and nutritional education in view of the continued increase in the prevalence of overweight and obesity in the French population and of its foreseeable consequences on disease and death rates.

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