Public health science and practice: from fragmentation to alignment.

The Public Health Agency of Canada (PHAC) is pleased to be part of the emerging Population Health Intervention Research Initiative for Canada (PHIRIC) and to support its ongoing development. PHIRIC is a watershed initiative. It has the potential to change fundamentally the way we think about bridging research, evaluation, policy and practice. Most importantly, it has the potential to move us from a fragmented approach to one that connects these functions within public health to strategic alignment. This alignment, in turn, will contribute substantially to health gains. There continue to be gaps between science, policy and practice in population and public health.1 Several influential reports,2,3 literature reviews4 and project-specific needs analyses have identified persistent issues and gaps in knowledge development and use with respect to informing public health decisions, especially about healthy living and chronic disease prevention. Some of these issues and gaps highlight several needs: • to develop more congruence between the needs of research users (including but not limited to policy-makers) and the research questions being formulated and addressed by investigators; • to improve linkages between databases of surveillance and research evidence (e.g., National Diabetes Surveillance System); • to develop explicit strategies, structures and partnerships to facilitate knowledge uptake into practice and policy decisionmaking (e.g., improving access to and use of systematic reviews; decision-making skills in accessing, appraising and using evidence); and • to learn from practice (e.g., generate “practice-based evidence”). To address these gaps, PHAC has placed a high premium on evidence-informed practice and provides a national focal point for knowledge development and exchange activities. Starting at home, PHAC employs senior science advisors as one strategy to create a culture of evidence-informed decision-making. PHAC supports the development of a similar culture in other organizations and among individual decision-makers. For example, PHAC's Office of Public Health Practice offers online learning modules and peer-exchange opportunities to build capacity for evidence-informed public health practice. In addition, PHAC's Canadian Best Practices Initiative includes a web-based portal designed to support evidence-informed decisions about public health policies and programs. A critical success factor for these and other knowledge development and exchange initiatives is ongoing engagement with partners, especially other national, provincial and territorial organizations. Partners must include major research funding agencies (e.g., the Canadian Institutes of Health Research), users of research evidence (e.g., the Chronic Disease Prevention Alliance of Canada and its provincial counterparts, and provincial/territorial governments) and organizations investing in capacity development to better bridge science, policy and action (e.g., the Centre for Behavioural Research and Program Evaluation, Canadian Population Health Initiative). No single organization in isolation can create capacity for population health intervention research and its use. We are the system. Collectively we need to align our efforts and resources to create a system to generate and use relevant, compelling and timely evidence to improve health policy and program interventions. The urgency to improve the effectiveness of population-level interventions for health has never been greater. The tsunami of chronic diseases cannot be treated one individual at a time. The status quo is not an option. I could not offer a more compelling business case than that delivered by Andy Hazlewood from British Columbia (Figure 1).5 If education has flat-lined and health expenses continue to grow at the current rate, there will be no resources available for any portfolios other than health and education beyond 2018. We have great reason to be alarmed. We need to translate that concern into action. We have actions on which to build in Canada. A highly relevant experience is the Canadian Heart Health Initiative (CHHI), as disPublic Health Science and Practice: From Fragmentation to Alignment