With limited resources in our health care system, difficult choices must be made in how health authorities prioritize services and allocate resources. Recent research has shown that decision-makers in health authorities face two sets of impediments in this task: a lack of skills in these processes, and an organizational culture in health administration that implicitly supports allocation based on historical patterns. Program budgeting and marginal analysis (PBMA) is a framework designed to assist decision-makers in weighing evidence from numerous sources to determine how resources might be allocated to improve health gain or to better meet other relevant criteria. To facilitate organizational adoption of PBMA as an alternative decision-making process, further research is required to develop strategies for implementation, as well as to drive key methodological aspects of the process. Craig Mitton is addressing these issues by applying PBMA across service areas in the Vancouver Island Health Authority (VIHA). While advancing key aspects of priority setting through the introduction of PBMA within VIHA, he is also facilitating skill-building among stakeholders in the application of the new decision-making process. He is also evaluating its implementation, which will not only refine the process for VIHA, but also contribute to the literature on priority setting in health organizations.
Program: Scholar
Priority setting methods for cancer control and care
Priority setting is the focus of health economics—a branch of economics concerned with issues related to the scarcity of health care resources. With cancer expected to be Canada’s primary cause of death by 2010, priority setting in cancer control and care is imperative. An aging population, rising health care costs and increasing demand have resulted in the need for identifying effective and cost-effective ways to improve cancer patient outcomes. Basing his work on an internationally-recognized economic framework for priority setting (called Program Budgeting and Marginal Analysis), Dr. Stuart Peacock is developing new evidence-based methods to help health care decision-makers determine the most effective cancer interventions to fund. His research will develop three significant innovations within this framework: methods to address improvements in life expectancy and quality of life from health programs; methods to address community preferences and equity concerns; and measures to evaluate priority setting and evidence-based decision-making. Dr. Peacock’s goal is to develop an evidence-based framework for decision-making in cancer services that is transparent, explicit and accountable.
Improving access to necessary care of older adults in British Columbia and Canada
By 2031, one-quarter of the Canadian population is expected to consist of adults aged 65 years and older. While many seniors lead healthy and active lives, a significant number live with multiple chronic health issues that require a broad spectrum of social and health services. In order to understand the health needs of seniors and the ability of the health system to meet them, high quality evidence about health and health care delivery is required to answer the many questions that still remain regarding seniors’ access to health services. Dr. Adrian Levy’s research encompasses four inter-related projects focused on generating knowledge about health services required for older adults in BC, including the impacts of changing health services and future health services requirements. These projects include: describing process flows for seniors from independent living to long-term care in the Vancouver Coastal Health Authority; examining the impact of closing residential care beds in BC; comparing wait times to long-term care in BC with those in Ontario; and determining the number of seniors who are institutionalized within in the community in which they live. Dr. Levy’s research findings regarding the health care needs and challenges facing older adults in BC will inform policy and program decision-making related to long-term care in the Vancouver Coastal Health Authority.
An interventional HIV research program to reduce transmission and enhance antiretroviral treatment outcomes among highly marginalized populations
The prevalence of HIV infection among injection drug users and other highly marginalized groups is a significant health issue in Canada. Vancouver’s Downtown Eastside (DTES) is particularly hard hit, with HIV prevalence rates estimated at 25 per cent. These high rates of HIV infection persist in spite of efforts to reduce HIV transmission through various prevention programs, harm reduction strategies, treatment facilities and community law enforcement. HIV prevention strategies and treatment therapies that are effective among other populations have not had the same success in the most vulnerable and marginalized members of society. As an HIV clinician and researcher in the DTES, Dr. Mark Tyndall’s research takes three streams: Observational Cohort Studies: Identifying trends in risk behaviors, drug use patterns, HlV/Hepatitis C rates, social changes, law enforcement initiatives, and the impact of harm reduction interventions on key health indicators; Antiretroviral Therapy: Developing and evaluating strategies and programs that enhance the uptake, delivery and sustainability of antiretroviral therapy to marginalized groups; and Clinical trials research: Advancing Vancouver as a centre for clinical trials research for the evaluation of candidate HIV vaccines and other novel therapies among marginalized groups. Together, Dr. Tyndall’s studies will allow for evidence-based decision-making and improved health outcomes for marginalized groups living with HIV in the DTES and other urban areas in BC.
The exploration of genetic conditions affecting the health of aboriginal people
Canadian aboriginal people have shorter life spans and an increased burden of disease compared to their non-native Canadian counterparts. As in all populations, complex disease—both genetically and environmentally determined—plays a significant role. For example, among the Inuit of Baffin Island, the prevalence of one type of congenital heart defect is four times as high as in other populations.
Dr. Laura Arbour is exploring the genetic and environmental determinants of heart defects among the Inuit of Baffin Island. She will determine the contributing factors of genetics, intake of nutrients that are important in heart development (such as folate and vitamin A) and environmental exposures during pregnancy. She will also assess whether current public health efforts to reduce birth defects by fortifying flour with folic acid are sufficient for people in a northern environment. The goal of her research is to inform public health efforts aimed at prevention, early recognition of symptoms and timely treatment.
Psychosocial determinants of adolescent health behaviour
There are numerous segments of the Canadian population who experience a disproportionate burden of ill health. A key issue in addressing this disparity is the early identification of those groups of people who are vulnerable to poor health outcomes over the course of their lifespan. Identification of these groups, and the factors leading to this vulnerability, is a priority for researchers. One area of interest is in identifying the early childhood determinants of health behaviours, such as a child’s health, stress in the family, economic conditions or neighbourhood safety. Dr. Stefania Maggi studies the extent to which early influences can predict which children will follow trajectories of health vulnerability throughout the lifespan. Her research uses a combination of administrative databases, national surveys, and longitudinal data collection to follow up on the same individuals over a number of years, spanning developmental phases from early childhood to adolescence and young adulthood. By identifying what factors in childhood increase the likelihood of unhealthy behaviours and/or poor educational outcomes during adolescence her research will inform early prevention efforts aimed at the social determinants of health.
The role of Prostate cancer support groups (PCSGs) in health promotion
There is a significant body of research that describes the psychosocial, rehabilitation and health needs of men diagnosed with prostate cancer. These needs cannot always be met by professional health care services, particularly in the case of health promotion programs intended to help men with prostate cancer maintain and optimize their health and well being. While more and more men are accessing community-based support services such as Prostate Cancer Support Groups, little is known about whom these groups serve, what services they offer, and how they are funded.
Dr. John Oliffe is exploring the role of Prostate Cancer Support Groups in health promotion, and determining how men’s health and illness behaviours are informed and influenced through attending these support groups. Through a better understanding of how these groups operate, he hopes to develop recommendations about how best to support this type of resource, and identify potential ways to integrate the groups with professional health care services. This work will help inform future content, design and implementation of prostate cancer health promotion programs.
Impact of nutrition and physical education school policies on childhood obesity: Understanding the implementation process and its impact on behavioural and weight outcomes
The prevalence of childhood obesity is rapidly increasing in Canada, increasing fivefold for both boys and girls from 1981-99. As the genetic characteristics of the human population have not changed in the past 30 years, childhood obesity is thought to be caused by behavioural and environmental factors that predispose children to consume more calories than they expend. Obesity is also linked to a number of diseases, including cardiovascular disease, type 2 diabetes, and some cancers. Schools provide an ideal setting to intervene on children’s behaviours. Recently, policy strategies have been proposed to change the school environment to limit access to unhealthy food and to increase opportunities for children to be more physically active. However, these changes are taking place without the scientific evidence necessary to support these strategies. Louise Mâsse is examining the impact of school-based policies on changing nutrition and physical activity behaviours among children. In addition, she is identifying the factors that prevent from implementing healthy school policies and creating healthier environments. The results of her study will provide insightful information for policy-makers to improve the health of BC children
Social class and health: Innovative theoretical exploration and empirical confirmation
Two broadly-defined approaches to conceptualizing social class can be applied to the empirical study of health inequalities. In the first, social class is equated with the socioeconomic status of individuals, i.e., with individual-level measures of wealth, educational credentials and/or occupational prestige. Explanations for empirical relationships between health and this particular conception of social class generally address material, behavioural or psychosocial phenomena, such as housing conditions, lifestyle choices or perceptions of relative standing. In the second, social classes are social groups, defined by the nature of their relationships to the economic mode of production and forms of control wielded in the workplace (the perspective of the neo-Marxist theorist Erik Olin Wright), or defined relationally in social space by their possession and utilization of various economic, educational, social and cultural capitals (the perspective of the French social theorist Pierre Bourdieu). In this tradition, explanations for class-health associations attempt to simultaneously address individual-level and group-level factors in a complex mix of agency and structure. Dr. Gerry Veenstra is investigating relationships between social class and health and well-being in Canada, integrating individual-level models founded upon material, lifestyle and psychosocial explanatory factors with social-structural theoretical frameworks inspired by theorists like Bourdieu and Wright. Building upon his previous work in BC, Dr. Veenstra will engage in an ethnographic exploration of different class positions and then administer a questionnaire survey to randomly-selected Canadian adults, assessing possession of various manifestations of control and capital. He will apply linear-causal statistical techniques such as regression analysis and relational techniques such as multiple correspondence analysis to this survey data in an attempt to identify and explain factors underlying social class and health inequalities in Canada.
Roles of the cilium, a sensory organelle, in health and disease
Cilia are slender appendages that protrude from most cells and tissues in humans. The motile forms produce whip-like motions, while the non-motile (known as “primary”) forms act as antennae, detecting chemical and physical changes in their environment. Both forms of cilia are critical to human health. For example, motile cilia propel sperm in males, and move debris in respiratory airways. Primary cilia are implicated in sensory processes such as vision, sense of smell and hearing. Defects in the forms or functions of cilia can cause a wide range of human ailments, including kidney and heart disease, obesity and diabetes, and sensory impairments such as blindness. Using bioinformatics, genetics, cell biology, biochemistry and genomics approaches, Dr. Michel Leroux is studying previously unknown components of cilia and characterizing them in the nematode C. Elegans and in human tissue culture cells. He is also working to identifying genes associated with the many ciliary disorders in humans, including some associated with obesity and cystic kidney disorders. By providing fundamental insights into the form and functions of cilia, Dr. Leroux’s studies may uncover new potential targets for therapy in a wide range of human diseases.