Centre for Behavioural Research and Program Evaluation
The Centre for Behavioural Research and Program Evaluation is a national program of the National Cancer Institute of Canada funded by the Canadian Cancer Society, and is located at the University of Waterloo.
Is Our Scientific Culture an Impediment to the Health of Canadians?
Roy Cameron and Barbara Riley
CPHA, Halifax
June 2, 2008
CBRPE Vision and Mission
Vision To transform cancer prevention and supportive care
systems to improve the lives of Canadians.
Mission To create knowledge, relationships and resources that
contribute to the continuous improvement of population level interventions.
Overview: In a nutshell
There is an urgent need to generate relevant evidence to guide population based chronic disease prevention intervention
Scientific organizations and dominant scientific culture are not oriented to support the science that must be done: if we do not support relevant science, are we not impeding the health of Canadians?
Scientific organizations and practices are starting to change in ways that enable generation and use of relevant evidence
Cancer21%
Cardiovascular Disease 18%
Injuries 12%
Mental Disorders
11%
All Others22%
Neurological &Sensory Disorders
9%
Chronic Respiratory Disease7%
BC ActNow: The Problem
Causes of Premature Mortality and Years Lived in Poor Health
•Source: Adapted from Evaluation of the Burden of Disease in British Columbia. Strategic Policy and Research Branch, B.C. Ministry of Health, January 2001.
100.0%
41.6%
53.6%
71.3%
27.0%27.0%
27.0%
-0.6%
16.6%
28.4%
-10%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 16/17 17/18
Year
Per
cent
Total
Health
Education
Other
BC ActNow: The Business Case
Revenue Growth – 3%Education Growth – 3%Health Growth – 8%Balanced BudgetOther spending reaches zero by 17/18
Conceptual Framework
Coordination and StewardshipCoordination and Stewardship
AboriginalRelations &
Reconciliation
AboriginalRelations &
Reconciliation
Public Safety& Solicitor General
Public Safety& Solicitor General
Children & Family
Develop.
Children & Family
Develop.
PremierPremier
All sectors, municipalities, Non-Governmental Organizations, Agencies, Businesses and Industry
Strategic Communications
ActNow BC provides a unifying brand for the strategic cross governmental and cross-sectoral initiative for creating a healthy BC population. Facilitates “improved alignment of cross-ministry policy”
EconomicDevelopment
EconomicDevelopment
Labour &Citizen’sServices
Labour &Citizen’sServices .Environment
.EnvironmentEmployment
& IncomeAssistance
Employment & Income
Assistance
Energy, Mines &
Petroleum Res
Energy, Mines &
Petroleum Res
Small Bus. &
Revenue
Small Bus. &
RevenueAttorneyGeneral
AttorneyGeneral
Committee on Natural Resources
& the Economy
Committee on Natural Resources
& the Economy
Committee on
Social Development
Committee on
Social Development
StrongStart BCCabinet
Committee
StrongStart BCCabinet
Committee
Agriculture& Lands
Agriculture& Lands Finance
Finance
Advanced Education
Advanced Education
Forests& Range
Forests& Range Health
Health Transportation
Transportation CommunityServices
CommunityServicesEducation
Education Tourism,Sports & Arts
Tourism,Sports & Arts
Minister of StateMinister of State
Some Practical Questions
• What is the right mix of interventions to implement?
• What is most urgent and important to do given limited resources and existing assets?
• What are residents ready for?• What will work under conditions (demographic,
physical, economic, etc) in this province?• What is feasible?• How will be know that we’ve made a difference?
Answering Practical Questions
Traditional approach: Researcher-initiated studies
Example: School Health Chronology, University of Waterloo Research GroupsRCTs of smoking prevention programs (including
questions about delivery)Began to doubt generalization through time given how
rapidly youth culture evolvesProgramming also evolves; ongoing innovation and
adaptation by practitioners
Answering Practical Questions
Alternative approach: Experimentation by social actors.
Lesson from tobacco control: “Bal laughs when asked about the role of science in guiding policy decisions… ‘where there is no science you have to go and be venturesome—you can’t use the paucity of science as an excuse to do nothing…all the scientists came in behind us and analyzed what we did’” (Sweet M & Moynihan R. 2007. Improving Population Health: The Uses of Systematic Reviews. Milbank Memorial Fund and Centers for Disease Prevention and Control.)
Answering Practical Questions
“Bal is frustrated by colleagues who wait for high-level evidence before acting…. ‘Most scientists will say you need a randomized controlled trial level of proof to do a community intervention. That’s horse feathers. We tried twenty-five things—twelve worked and we renewed those. Empirical trial and error is the oldest scientific device and we used it to distinction.’” (Sweet & Moynihan, 2007)
Proposition: The most important experiments will not be done by scientists, but by social actors.
Big Implications for the Role of Science in Population Intervention
Using existing evidence: Bring to bear any relevant evidence in formulating a policy (e.g. principles of behaviour and attitude change to inform tobacco warning labels)
Generating new evidence: Studying innovative policies as they are implemented; use evaluation methodologies to study these “natural experiments” (e.g. Charlton 2004. Natural experiment. In Lewis-Beck, Bryman, Liao (eds) The Sage Encyclopedia of Social Science Research Methods (Vol 2). Sage Publications.)
Scientific Obligation: CBRPE Position
Core obligation: Study the most important questions, in the most rigorous way possible, given the conditions
Be willing to trade off rigor for relevance (Green, Glasgow…)
Foundational assumption: the scientific community has an obligation to help find solutions to urgent problems that threaten the health and social fabric of Canada; refusing to remain “pure” by doing only studies that use the most rigorous designs is not defensible given that we are funded by taxpayers and donors who depend on us.
Scientific Impediments: Examples
Structural: e.g. grant competition timelines (e.g. annual
competitions) are impediments to studying natural experiments, which are usually fleeting opportunities
Cultural, Normative: scientist tendency to equate value with rigor, and to base
peer judgment on rigor vs. relevance, potential impact lack of urgency: “some details could be improved, let
her reapply next year” – another year is 10% of the elapsed time till BC is broke
The Good News: Science is Evolving
Example #1: Methods of defining Best Practices
Best science (strength of evidence based on internal validity)
vs Most impact (promise table: Swinburn, Gill, Kumanyika, Obesity prevention: a proposed framework for translating evidence into action. Obesity reviews, 2005, 6, 23-33.)
Impact Effectiveness
Low Medium High
Low Least promising
Very promising Most promising
Medium Less promising
Promising Very promising
High Promising Less promising Promising
The Good News: Science is Evolving
Example #2: Population Health Intervention Research Initiative for Canada (PHIRIC)
Goal is to increase the quantity, quality and use of population health intervention studies
Catalyst for aligning organizational efforts to enable a ‘new’ science of population intervention
Pan-Canadian Early days
The Centre for Behavioural Research and Program Evaluation is supported by the National Cancer Institute of Canada with
funds from the Canadian Cancer Society.
We are located at the University of Waterloo.
Centre for Behavioural Research and Program Evaluation
Top Related