1. SPHERE: Gastein Health Forum Research for the Citizens of Europe Science Europe Health Mark McCarthy Professor of Public Health University College London

2. A thought experiment The European Director General for Health, a fit, handsome man, defines obesity as a key issue for European health policy --- And so …

3. SPHERE: Gastein Health Forum What evidence? Laboratory – overfeeding kills rats Laboratory – overfeeding kills rats Human – obesity reduces the lifespan Human – obesity reduces the lifespan Economic – affluence leads to indulgence Economic – affluence leads to indulgence Environment – people don’t exercise enough Environment – people don’t exercise enough Working with WHO, an expert committee concurs ‘from the evidence, this is a key health issue.’

4. SPHERE: Gastein Health Forum But what is to be done? Determinants of obesity include Determinants of obesity include food, built environment, transport, health system Impacts of obesity are: Impacts of obesity are: diseases – heart, diabetes, arthritis, health care system – surgery, utilisation, cost Politics of obesity include: Politics of obesity include: regulatory (eg labelling), economic (eg regeneration), trade & private sector (eg road lobby)

5. SPHERE: Gastein Health Forum Research questions What interventions? What interventions? Under what circumstances? Under what circumstances? Will achieve what effects? Will achieve what effects? Over what period? Over what period? At what cost? At what cost?

6. SPHERE: Gastein Health Forum Let’s use the literature Mostly from USA Mostly from USA European literature - local languages? European literature - local languages? Studies not designed as interventions Studies not designed as interventions Studies not coordinated across cultures Studies not coordinated across cultures Replication difficult and not rewarded Replication difficult and not rewarded

7. SPHERE: Gastein Health Forum Can we mobilise European research? DG Health - limited research budget DG Health - limited research budget DG Research - limited calls for health policy in FP6 DG Research - limited calls for health policy in FP6 o biomedicine directed towards ‘genomics’ o disease dominated by cancer o and environment, food, transport, informatics - all have their own agendas

8. SPHERE: Gastein Health Forum Member states … ‘Let’s leave health research to our profitable pharmaceutical industry’ ‘Let’s leave health research to our profitable pharmaceutical industry’ ‘Why pay for research if others don’t?’ ‘Why pay for research if others don’t?’ ‘Will the results conflict with domestic policies?’ ‘Will the results conflict with domestic policies?’ ‘Other European countries don’t have domestic political impact’ ‘Other European countries don’t have domestic political impact’

9. SPHERE: Gastein Health Forum Looking westwards Task Force on Obesity Task Force on Obesity DHHS pays for NIH, AHQR, CDC DHHS pays for NIH, AHQR, CDC Research linked to project interventions (both funded) Research linked to project interventions (both funded) Multidisciplinary – laboratory, environment, economics, modelling, observational, sociology, health promotion … Multidisciplinary – laboratory, environment, economics, modelling, observational, sociology, health promotion …

10. SPHERE: Gastein Health Forum Another thought experiment A bold, handsome Prime Minister decides that public services should be privatised, and health care is an excellent market opportunity A bold, handsome Prime Minister decides that public services should be privatised, and health care is an excellent market opportunity What is the evidence – ? What is the evidence – ?

11. SPHERE: Gastein Health Forum Public health research Influence policies Influence policies Knowledge from practice Knowledge from practice Good designs, strong comparisons Good designs, strong comparisons Multiple disciplines Multiple disciplines Multiple partners Multiple partners

12. SPHERE: Gastein Health Forum Public health research organisations Not disease causation – even inequalities – but interventions Not disease causation – even inequalities – but interventions Require special support to understand MS differences Require special support to understand MS differences Capable of competition but also require foundations Capable of competition but also require foundations Public sector must engage where pharma doesn’t Public sector must engage where pharma doesn’t

13. SPHERE: Gastein Health Forum SPHERE Discussion of FP6 Discussion of FP6 A call - ‘support action for FP7’ A call - ‘support action for FP7’ Engaging partners Engaging partners Creating structures - a European Research Market needs organisation and players Creating structures - a European Research Market needs organisation and players

14. SPHERE: Gastein Health Forum SPHERE Strengthening Public Health Research in Europe Science Europe Health