European public health research literatures: measuring progress.

Public health research makes an important contribution to Europe and its citizens. The collaborative study SPHERE (Strengthening Public Health Research in Europe) was developed in response to a call from the European Commission’s Sixth Framework Research Programme. It includes 19 partners in 12 countries, structured around the European Public Health Association and led by the UK Faculty of Public Health. This article provides an overview to a Supplement to the European Journal of Public Health, including eight original papers making bibliometric studies on public health literatures, and two commentaries from European experts. European public health publications are similar in number to the US, if a range of databases are consulted. The majority are published in English and tend to be descriptive rather than evaluative. The integration of Europe as a political, social and economic unity will strengthen public health collaboration and funding across borders in Europe. Public health research has a strong history in Europe. It has contributed knowledge to achieve our present levels of health, and also demonstrated challenges yet to be overcome. Public health research is aimed at the organizational rather than the individual level of health—the fields of health promotion, disease control and health services. Knowledge of how diseases are caused can make it possible to control them even without detailed understanding of biological mechanisms, and evaluative research can demonstrate whether policy choices and interventions are effective across differing social contexts. Public health surveillance provides information both about health status and health needs, while analysis of health trends can demonstrate both expected and unexpected impacts of broader social forces. Public health policy and practice contribute at least as much now—and, historically, arguably more—to population disease control as medical treatment does. There are innovative methodological developments in public health research. Yet this is not reflected in the allocation of health research funds. The experimental laboratory continues to be the paradigm for medical research, in part due to a new dynamic from genetic and molecular research, with pharmaceutical ‘spin-off’ companies providing financial drive. Public health research rarely benefits from this ‘economic drive’, and its end product, of improved health through prevention, for example, is difficult to quantify in financial terms. An analysis of expenditure on ‘health’ research in the UK showed that only 2–3% of spending was on health services research, and a more recent report by a group of British research funding agencies also showed that most research funding goes to ‘underpinning’ and ‘aetiology’ research, while only 7% on ‘prevention’ and ‘health services’ together. Support for health research has been growing through the programmes of the European Commission’s Directorate for Research, first established in the 1970s. However, in the Sixth Framework Programme, covering 2002–06, public health research was separated organizationally from medical research, with a constrained budget and limited research tasks. Within this programme, the Commission put forward a call for research ‘to examine the ways and means by which research priorities in the field of public health at the European level can be identified, taking into account the interaction and needs of stakeholders—policy-makers, the scientific community and end users—and how research outcomes can be best integrated into the policy process’. SPHERE (Strengthening Public Health Research in Europe) was proposed in response to this call.