It’s back. At last. It’s been a year and a half since I last posted an entry on this blog and I reckon it’s time to restart it. The problem was that I didn’t know how to restart. Most of my postings were written on the plane back from somewhere, but I was finding that that time was being used up by writing meeting reports, preparing the next talk to give somewhere else, editing papers, or simply catching up with the journals. There was just no time at all. I felt I needed to offer some explanation for why I hadn’t been writing on the blog, but couldn’t find the words.
So what has changed? Well, nothing really. The volume of work remains at a completely unsustainable level, but then it’s been like that for years and I’ve managed to sustain it .... just. But just for once I’m on a plane and have no immediate deadlines – well, not quite true – I still have to prepare two lectures that I’m giving next week and the week after. But I’m not going to manage to finish them up here so I just thought – let’s do it.
I’m sorry I haven’t kept an on-line record of the last 18 months, as there was plenty to write about. Some of the highlights included:
• Speaking at the Global Ministerial Forum of Research for Health, in Bamako, Mali in November 2008. Health ministers from almost 60 countries committed to developing and funding health research strategies, including research infrastructure (ethical review procedures, clinical trials registries, and open access to data) and knowledge translation. As I argued in a BMJ editorial, this is an ambitious agenda and it will be important to hold governments to their commitments.
• Participating in the WHO global Advisory Committee on Health Research, in which I’m privileged to work with some outstanding colleagues from across the world as we develop an ambitious and exciting agenda to support research for health. In November 2009 we had a joint meeting in Panama with the PAHO regional committee, chaired by John Lavis from McMaster University, which really sets the benchmark for the other regions.
• Setting out an agenda for health research at the WHO’s European Regional Committee in September 2009, which will pave the way for action to begin to address the severe under-representation of some European countries in projects undertaking research for health.
• Starting a new EU funded (Framework 7) project, Health in Times of Transition) to study health and lifestyles in nine former Soviet countries. This builds on our earlier Lifestyles, Living Standards and Health study that provided a wealth of comparative analyses of eight countries in this region. The new project adds Azerbaijan. Field work is well under way and we should have the first results this autumn. An added strength is that, this time, we are adding community profiles, so we can understand the environments that shape the decisions that people live in. This will be the first time this has been done in this region and, at a recent meeting in Minsk there was real excitement as the different research teams worked together to address the not inconsiderable challenges.
• Making progress on the Prospective Urban and Rural Epidemiology (PURE) study. This remarkable project is led by Salim Yusuf at at McMaster and has now recruited almost 150,000 people in 17 countries worldwide. Again, we are collecting data on the circumstances in which people live and the early results presented when we met in Beijing in November 2009 indicate that it will yield some very important new findings.
• Making progress on our Rockefeller Foundation funded project updating the study on Good Health at Low Cost published 25 years ago. Their report then identified several countries and regions that were achieving much better health outcomes than would be expected given their level of economic development. They included Sri Lanka, Costa Rica, and Kerala, in India. This time, as well as seeing how the original countries have fared since that report was published, we are looking at another five that are now viewed as doing better than expected: Thailand, Bangladesh, Ethiopia, Kyrgyzstan, and Tamil Nadu. At our last team meeting in Bangkok, in April this year, provided an invaluable opportunity for the research teams from these somewhat different countries to exchange experiences.
• Preparing a report on the implications of ageing for health systems for the Czech EU Presidency, with mu colleagues Bernd Rechel, Yvonne Doyle, and Emily Grundy, subsequently published in summary form in the BMJ. This is one of the most important issues facing European governments and I hope we have been able to dispel some of the many myths.
Several projects have come to an end. The EURO-PREVOB project has provided new instruments for assessing the extent to which the environments in which people live influences their diets and levels of physical activity and the IMAGE project has succeeded in developing and publishing European evidence-based guidelines for the prevention of diabetes in those at risk.
Then there have been the papers. Early in 2009 David Stuckler, Larry King and I published a paper in the Lancet showing how the scale and speed of mass privatisation in the former communist countries correlated with the increase in mortality that occurred at the same time. We thought that this was fairly uncontroversial and saw our most important contribution (besides quantifying the relationship) as identifying the role on community support (measured as membership of organisations) in protecting people. That fitted with another study we published last year showing how measures of social capital were associated with better health in the region. We never expected the response from those who had been advocating rapid privatisation. The Economist used a leader article to dismiss our results (doesn’t everyone know that privatisation is the only thing to do....), using a graph purporting to show trends in Russian life expectancy but looking nothing like anything we’ve ever seen before. Eventually we discovered what they had done. Despite life expectancy fluctuating rapidly from year to year, they took five year averages! This had the effect of making the Russian mortality crisis disappear! Just as Stalin caused millions of deaths at the stroke of a pen, The Economist brought similar numbers back to life. And they never apologised .... Over the course of the next year, we engaged in seemingly interminable (and often frankly bizarre) exchanges, via Richard Horton, with some of the supporters of mass privatisation. The final words can be read in two letters from our critics in the Lancet, which work very hard to show that our results were wrong, along with our letter in response, in which we invoke the criteria of data torture to try to understand how they managed to get our findings to disappear. I would encourage everyone to read all three letters and make up their own minds. Unfortunately, as we have since discovered, no matter how well we rebut our critics, it has become clear that some people will never be convinced.
To coincide with renewed attention to progress in achieving the health-related Millennium Development Goals (MDGs), which focus very largely on deaths in childhood, we looked at whether adult mortality was important. Chronic diseases in adulthood have attracted much less attention than childhood illness (as we showed in an analysis of WHO expenditure prepared for the Bamako forum and published in the Lancet) yet we reckoned that the death or serious illness of a parent must be bad for their children. Our study confirmed this, showing that high rates of disease burden from non-communicable disease, such as cardiovascular disease, stroke and diabetes, were indeed associated with slower progress towards the MDGs and we were delighted when it was cited at the UN General Assembly.
And then the books… The main ones in the past year have been our two on the hospital of the future, one bringing together a series of case studies from some of the most innovative developments in Europe and the other drawing together the many issues facing hospital design in the future. These have, to our slight surprise, attracted enormous attention and have spun of a considerable number of papers as well as numerous presentations and policy dialogues.
So there we are. The blog is back. The challenge will be for me to keep it up!