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EDITORIALS: Jeffrey P Koplan, Courtenay Dusenbury, Pekka Jousilahti, and Pekka Puska The role of national public health institutes in health infrastructure development BMJ 2007; 335: 834-835 [Full text]

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Investing in National Public Health Institutes could help optimise the allocation of research resources

Chantal M Morel   (12 November 2007)

Public health agencies' independence is relative

Olivier Grimaud, Zoe Heritage, Luc Berghmans, John Wilkinson   (21 November 2007)

Investing in National Public Health Institutes could help optimise the allocation of research resources 12 November 2007
Chantal M Morel, Impact Assessment Adviser Save the Children, 1 Saint John's Lane, London EC1M 4AR Send response to journal: Re: Investing in National Public Health Institutes could help optimise the allocation of research resources	Koplan and colleagues rightly point out the key role of national health institutes in assembling a critical mass of skills, disciplines, experience and expertise to enhance health system development. Indeed, national health institutes can have an important role in monitoring health trends, detecting needs, signalling for proper response, and ensuring that responses are likely to meet stated ends. On these grounds the authors’ call for national health institutes to receive 10% of donor funding for health seems justified. However, there is also an important cost-effectiveness argument to be made here. Currently much of the research conducted by foreign academic institutes, non-governmental organisations, and even international organisations takes place independently of the national public health institute. This can create a breeding ground for confusion, redundant research, and wasting of limited research resources. A well supported national health institute could improve this situation by supporting communication amongst active and prospective researchers and acting as an independent repository of data for all interested stakeholders to consult. This improved coordination would result in a reduction or appropriate reallocation of research resources. A bolstered institute could also act as a strong research counterpart to donor coordinating mechanisms such as the International Health Partnership. Competing interests: None declared
Public health agencies' independence is relative 21 November 2007
Olivier Grimaud, public health teacher ENSP, Av Pr Leon Bernard, Rennes 35043, France, Zoe Heritage, Luc Berghmans, John Wilkinson Send response to journal: Re: Public health agencies' independence is relative	We agree with Koplan et al that national public health institutes require adequate funding in order to tackle health priorities(1). As suggested by the authors, a 10% toll from the budgets of vertical health programmes could be one way of achieving this. However, underlying the issue of funding is one of governance, and more specifically that of political independence. This topic was discussed during a workshop at the Helsinki EUPHA (European Public Health Association) conference, October 2007, in the context of health monitoring(2). There are variations across the EU in the way public health organisations are funded, whether they are national institutes or observatories. At one end of a theoretical spectrum, organisations can be exclusively funded from government. At the other end, funding may be provided by a single private organisation such as a private lobby or interest group. In either situation, financial dependence from a unique source may affect, at least, cast doubt on, the professional independence of the public health organisation. Government policies are inevitably value- loaded(3). Ethical dilemmas may arise from the contractual inability to communicate about problems which, although perceived as significant by the public health organisation, do not fall in the current priority list of the funding body. Public health organisations must retain their neutrality in order to be able to advocate un-fashionable issues. Participants to the workshop agreed that the aim of health monitoring is to contribute to the definition and implementation of appropriate health policies. As Koplan et al suggest, this is probably best done when the same agency, say a national public health institute, is able to deliver both diagnostic (health monitoring) and therapeutic (evidence on effectiveness of public health interventions) expertise. Furthermore, in order to achieve their aim, public health institutes must establish with funding/policy-making agencies a relationship which is close enough to enable cooperation, but also sufficiently distant to maintain their scientific objectivity. (1) Koplan J P, Dusenbury C, Jousilahti P, Puska P. The role of national public health institutes in health infrastructure development. BMJ 2007;335:834-835. (2) Grimaud O, Janzik V, Wilkinson J, Berghmans L. How can we best communicate health information to enhance the impact on decision making? 15th Annual EUPHA meeting. Helsinki. Oct 2007. (3) Lomas J. Connecting research and policy. Can J Policy Research 2000;1:140-144. Competing interests: None declared