The following content is a special article published in the Canadian Journal of Public Health, Vol. 107, No. 6, on March 1st 2017.
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Ottawa Statement from the Sparking Solutions Summit
on Population Health Intervention Research
Ottawa, Ontario, Canada
April 25, 2016
The Cape Town Statement was released on October 3, 2014 following the Third Global Symposium on Health Systems Research. The Statement covered a number of action themes, including health systems development, capacity development for research, cutting-edge and innovative research methods, and learning communities and knowledge translation.
Following the Cape Town Statement’s release, a call to action that included action themes and recommendations for implementation research and delivery science (IRDS) was issued. Directed at health policy-makers and managers, funding organizations, researchers and academic institutions, journal editors and publishers, and civil society organizations, it aimed to facilitate the development of responsive health systems that are effective, efficient, equitable, and people-centered.
This call to action is in keeping with the tenets of population health approaches throughout North America, much of Europe, and in many other places around the world. While the Cape Town Statement focused on health systems, the Ottawa Statement emphasizes the science of population health interventions. These include policies, programs and resource distribution approaches that are designed to have impact at the population level by changing the underlying conditions of risk and reducing health inequities. Examples of such interventions with a primary prevention orientation include organizational changes in workplace design, housing policies to reduce homelessness, immunization programs, and tax policy that discourages consumption of tobacco and other harmful products at a population level. Thus, population health intervention research (PHIR) is not clinical or laboratory-based. Rather, it is defined as research that involves the use of scientific methods to produce
knowledge about interventions that operate within or outside of the health sector and have the potential to impact the health of populations and health equity (Population Health Intervention Research Initiative for Canada [PHIRIC]).
Progress since the Cape Town Statement
The Cape Town Statement is essentially a call for action: among the various audiences it prioritized, editors and publishers have been called upon to commit to promote and advance the publication of scholarly IRDS papers through thematic issues or calls for publications of IRDS, and to showcase IRDS case studies, including both successes and failures and lessons learned from implementation. Unfortunately, on a global scale, little in terms of public statements or published work has been found to suggest that the action themes in the Cape Town Statement, or the specific calls to action regarding IRDS, have been acted upon. At this time, only three published papers can be found regarding the outcomes of the Cape Town Statement.
Since 2006, the Canadian Institutes of Health Research – Institute of Population and Public Health (CIHR-IPPH), together with a number of researchers, research funding agencies and knowledgeuser partners, have spearheaded a pan-Canadian PHIRIC with the vision of developing PHIR as a science to informpolicy and program development, implementation and scaling up, with the ultimate aim of fostering health equity and improving population health.
The CIHR-IPPH and the Canadian Journal of Public Health invited and convened the chief editors and other representatives of multiple scientific journals relevant to public and population health to discuss possible ways in which specific PHIR-related journals could better respond in an attempt to address the calls to action made in the Cape Town Statement as well as the recommendations for IRDS.
Context for Action
Participating editors acknowledged that:
- With the increasing number of predatory journals and a climate of scarce research funding, there is an opportunity to reinforce the importance of peer-reviewed scholarly work in all fields, including research on population health interventions. While most journals represented at the Sparking Solutions Summit primarily publish in English, the editors support the accessibility of published work in French, Spanish, Portuguese and other languages, as appropriate.
- In the field of public health, a science of delivery (researching how to fund, organize, manage, implement and scale up interventions that aim to improve population health and health equity) differs from a science of discovery (researching the ecologic, social, economic and other determinants and risk factors that constitute the known root causes of disease, death and disability). These differences must be acknowledged and the particular characteristics of the science of delivery should be better accommodated by relevant scientific journals.
- In recent years, most journals have made a deliberate effort to facilitate the publication of PHIR-related papers, through sponsoring calls for papers, developing new sections, and/or appointing senior editors to focus on this field of research.
- To advance the field of PHIR, scientific journals have a critical role to play; they must start publishing more population health intervention research and related case studies instead of only prevalence and/or etiological research. Examples include but are not limited to: theoretical and methodological developments in intervention study designs and related measurement; empirical studies that document the processes and/or outcomes of interventions on population health and/or health equity; and case studies of innovations in policy and practice.
- Scientific journals can also play a leadership role in sharing PHIR-related data, as called for in the recent Transparency and Openness Promotion Guidelines from the Center for Open Science (Charlottesville, VA). They may, for example, enable authors to link datasets to their published articles.
- Building reviewer capacity is also required to ensure PHIR is appropriately valued and assessed, including the need to call upon practitioner scholars.
Building the Field
The general impression is that the field is still evolving and is in the process of organizing itself. Participating editors assert, however, that further development of the field of PHIR will depend on
successfully addressing a number of outstanding scientific questions:
- How can we better address the role of replication in intervention studies? While many journals emphasize publishing novel results or approaches, it is also important to consider the importance of publishing replication studies. Increasing reliance on evidence-based practices renders virtually indispensable a number of forms of study replication, including: statistical replications, which aim to replicate existing studies with new samples and test whether the original results are due to random effects; generalizability replications, in which one aspect of the study design is altered; implementation replications, where some implementation conditions vary; theory development replications, in which variations in the intervention allow for better understanding of how the intervention works; and ad hoc replications, in which interventions may vary from
each other in multiple and usually unsystematic ways.
- Given the multiple and diverse theoretical and methodological approaches used in PHIR, how can we develop consensus within the PHIR community regarding what constitutes valid research designs and methodologies to study population health interventions, and valid tools to assess their impact?
- How should what constitutes the population health intervention under study and the relevant contextual elements that interact with the intervention be described?
- How do we reconcile language used to describe the object of study (i.e., intervention) with other ways to conceptualize it? (For example, the term “intervention” is not appropriate when working with Aboriginal communities.)
- In light of the current constraints imposed by limited manuscript word counts, what should constitute the necessary level of detail and data required to describe the intervention for purposes of interpretation of the results and potential replicability?
- We also note the opportunity to discuss novel ethical issues in this context. What are the relevant ethical issues that arise in complex intervention and implementation studies and in the use of novel population health methods? How should we resolve them?
- How can we support the publication of, and access to, more PHIR-related data sets to encourage collaboration and re-use? From a variety of perspectives, it is important to know what does not work, as well as what does, for whom and under what contextual circumstances. Without publishing negative results, we introduce significant bias into our ability to draw conclusions about intervention effectiveness, such as in systematic reviews. We encourage the publication of well-designed and executed studies, irrespective of the results.
CONCLUSIONS AND THE PATH FORWARD
Although little with regards to published work was found on whether the objectives of the Third Global Symposium on Health Systems Research and the Cape Town Statement were met, progress in response to this call to action is still possible, as was shown by two meetings of editors from PHIR-relevant journals. Participating journal editors agreed to continue supporting collective and ongoing reflection on how scientific publications in the field of public and population health can better contribute to the development of a thriving and successful PHIR field. They have committed to continue to meet on a regular basis to assess the state of this ever-changing field, and by extension contribute to the development of effective, efficient, equitable, people-centered, and responsive health systems with a population health orientation.
Editors and individuals have signed and endorsed the Ottawa Statement on behalf of the following organizations and scientific journals:
Erica Di Ruggiero, Former Deputy Scientific Director, CIHR – Institute of Population and Public Health
Louise Potvin, Editor-in-Chief, Canadian Journal of Public Health and Senior Editor, International Journal of Public Health
John P. Allegrante, Editor-in-Chief, Health Education & Behavior
Angus Dawson and Marcel Verweij, Joint Editors-in-Chief, Public Health Ethics
Evelyne De Leeuw, Editor-in-Chief, Health Promotion International
James R. Dunn, Co-Editor-in-Chief, Journal of Epidemiology and Community Health
Eduardo Franco, Editor, Preventive Medicine and Preventive Medicine Reports
Katherine L. Frohlich, Advisory Editor, Social Science & Medicine; International Editorial Board Member, Health and Place
Robert Geneau, Editor-in-Chief, Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice
Suzanne Jackson, Editor-in-Chief, Global Health Promotion
Jay S. Kaufman, Editor, Epidemiology
Alfredo Morabia, Editor-in-Chief and Kenneth R. McLeroy, Associate Editor, American Journal of Public Health
Valéry Ridde, Associate Editor for Implementation Science, BMJ Global Health
Acknowledgements: The authors would like to thank Alexander Maisonneuve, doctoral student in population health, University of Ottawa for his assistance with the journal editors meetings and the development of the Ottawa Statement.