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HIGH FLYERS THINK TANK
National Research Priorities Strategic Forum
26–27 June 2002
Priority
setting: The NHMRC experience
by Alan Pettigrew
| Alan Pettigrew is the inaugural Chief Executive Officer of the National Health and Medical Research Council (NHMRC). He has had a long association with the NHMRC, including as a member of the Research Committee, Chair of the Grants Committee and the Grants Access and Awards Committee, and as a member of the Medical Research Committee and its Executive. His former positions include Deputy Vice-Chancellor (Academic Planning and Resources) at the University of New South Wales and Executive Dean (Faculty of Biological and Chemical Science) and Pro Vice-Chancellor (Biological Sciences) at the University of Queensland. He has served as a Board member of UniQuest Ltd and as a member of the Mater Medical Research Institute Development Council. |
It is a pleasure to be here and I am certainly learning a lot as we pass through this particular phase of the priority setting process.
To give you a flavour of how the NHMRC is approaching this issue and has approached it in the past, I need to first draw upon the fact that the NHMRC is established as a statutory organisation according to its Act. In the Act it says that the NHMRC is charged with the responsibility of raising the standard of individual and public health throughout Australia. It is charged with doing that through three different ways:
- fostering the development of consistent health standards between the States and the Territories;
- supporting medical and public health research and training throughout Australia; and
- giving consideration to ethical issues relating to health.
So we are there to provide advice, we are there to support research and we are there also to consider and advise on ethical issues relating to health. That sets the environment in which NHMRC has to work.
In order to do that, the National Health and Medical Research Council has two principal committees established in the 1992 Act. They are the Australian Health Ethics Committee, whose membership is prescribed in the Act, and the Research Committee, with details of its composition also prescribed in the Act. But the Council has also established, under ministerial approval, the Health Advisory Committee and the Strategic Research Development Committee.
So this is the organisation which has to look at national priorities in a research sense but also in the context of its Act and its overall responsibilities across the board.
The other contextual issue which faces the NHMRC is, of course, that there is data available on what NHMRC research should be supporting, in terms of improving health for all Australians. This is some data published by the Australian Institute for Health and Welfare, from their Health 2000 report, which shows the Australian burden of disease across major disease groups as they were in this country in 1996. For each disease area, there are two columns. Basically, the darker blue column relates to disability of the population, and the lighter blue column refers to lives lost. You can see that for cardiovascular disease there is a lower level of disability relative to the burden of disease causing death in the country. But just go down a couple, down to mental illness, and you will see that the disability line there far outweighs the death line. That is, not many people die of mental illness, apart from the suicides et cetera, but the disability burden in the country of people who are alive is very high in that particular area. So there are contextual differences, even within different disease areas, that we have to pay attention to in directing our efforts to improve outcomes in these areas.
So then the priority contexts for the NHMRC are the national burden of disease, and out of that has emerged the national health priority areas. These are constructed by the National Health Priority Action Council, and the formula which is used basically aggregates data across the sort of graphs shown above. We can account for 70 per cent of the burden of disease in Australia across the six national health priority areas:
- cardiovascular disease
- cancer
- injury
- mental health
- diabetes
- asthma
Each of these disease areas, each of those diseases, in addition to just being a major problem for the country in terms of health, is multifactorial. There are many, many factors which impinge and lead to that burden of disease, and each of those factors needs some attention.
So how is the NHMRC approaching this? First of all let me just describe for you what is happening with the Research Committee at the present time. The Research Committee’s overall funding strategy supports and underpins the activities of the Research Committee.
We are responsible for improving the health of Australians, through research, across all disease areas in the Health portfolio. We are there to fund excellence, and the choices between what research to fund and what not to fund are really through the Research Committee, based on selecting on the basis of excellence: the best and the most creative people and the best and most creative research. We like to fund as a major player globally so Australians can participate on the international stage, such that they can bring information back to the Australian scene and implement change in the Australian health care sector. We are providing sustained mechanisms to develop and to maintain excellence – that is, trying to underpin national capacity, not only through supporting people in our Fellowship scheme and our medical research force but also through supporting facilities in whatever way we can. Another key strategy in the Research Committee’s activity is to consult with the people who apply for the money.
It is an interesting observation, when you look at the research that is funded by the Research Committee based on excellence, to see where the funding goes. Across the broad health areas listed above, the ones in grey are the ones which I listed previously as being those areas which make up 70 per cent of the burden of disease in this country. That is, there is a natural accretion of researchers into the areas of most importance in health care in the country. This is not a guided thing; this is actually just happening out of the research community itself. And 49 per cent of the total number of project grants in 2002 are directed towards those six key areas of health care.
Back in 1999, the Wills review was released and the government accepted all but one of the recommendations of that review. The outcome of that has been an impact on the NHMRC in terms of changing the direction of how we go about supporting health and medical research in the country. We were asked to provide an effective health and medical research sector, to look at the issue of priority-driven research in a particular area of concern to the Wills review, we needed to link better with industry, and we needed to get a better public investment in a well-managed research sector. So the strategic directions which emerged out of that review in ’99 are going on at the present time and we are couple of years into the process of change.
That change of strategic directions has included changes in the shape of research funding, so that there is an increased emphasis on longer and larger grants, giving our best researchers a more secure base upon which they can develop their ideas and bring through their results, and at the same time to improve national capacity. National capacity is referred to most often in NHMRC circles as being the national capacity in terms of people with skills to do the research. In order to lift our game in certain areas, we have had to facilitate support, clearly, in the clinical research, population health research and, more recently, health services research.
We are tasked with improving awareness and capitalisation of IP as it applies to our sector, and with facilitating appropriate commercialisation of research. We have