Evidence, with Nancy Edwards.

Consider the structural determinants of health.

That was one of the many takeaways received by the audience who attended Nancy Edwards' plenary on Evidence.

In “Evidence for public health action: perspectives of a research funder,” Edwards, Scientific Director of the CIHR-IPPH, outlined her thoughts on using evidence to move forward the public health agenda. As she said, “we can’t keep doing things the way they have been done.”

Edwards started her talk with a brief summary of some past successes in the province; she said we'd come a long way over the past 25 years in Ontario, including: teaching health units, PHRED systematic reviews, health-evidence.ca, PHAC - National Collaborating Centres, CHNET-Works! and applied health research networks.

She said that the challenge for those of us in public health is: “How do we take this evidence that's produced and use it so that it’s not left on shelves?"

She noted new research generated in the last 25 years, including:

·    socioeconomic gradients of health,

·    effectiveness of behavioural interventions,

·    organizational interventions that support practice changes,

·    randomized controlled trials of multi-strategy and multi-level complex interventions,

·    multiple intervention trials that have yielded unexpected results,

·    lack of community engagement in design of intervention,

·    and relatively short time frames for studies reduced intervention potency study.

Edwards then challenged the audience to consider how health problems or phenomena are recurrently produced by the system.  She said the science is shifting from:

·     · understanding determinants to examining the impact of coherent, multi-level interventions and policy
      · describing socioeconomic gradients to interrogating health inequities

·     · controlling context to understanding the influence of context on interventions.

She outlined some future challenges, including addressing health inequities. She said where many calls for action exist in Canada, and, despite research and some successes, "we need to understand the pathways to health equity."

And what about those structural determinants of health? She said we don't ask about them because they are so a part of who we are, so we often overlook them. She provided the example of First Nations communities, and what was most overlooked was the structural determinant of their health: the-residential schools in which they grew up.  Edwards said, “if we're serious about working upstream, we have to get at these structural determinants of health."

Some of her further conclusions:

·    We need intersectoral action, including interprovincial and intercountry research initiatives.

·    We need to consider implementation systems. Ask the questions: “what is it that makes these interventions happen? What makes it work? and what produces failures?

·    She also touched on population and public health ethics. She said that ethics helps us to bring equity to the forefront of research and policy making.

Going forward, Edwards noted some critical issues, including:

·    linking evaluation and research

·    addressing research funding realities

·    extending research designs and methods

·    bringing together strengths of evaluation and research

·    developing priorities for data harmonization

·    determining if we are closing the equity gap and

·    shifting the structural determinants of health