(WP)EHE(T)IICPIRPD/OO J-E Report series number: RS195/GE/29fPHL) English only
REPORT MEETING OF THE SUBCOMMITTEES OF THE WPACHR ON ENVIRONMENTAL HEALTH, HEALTH PROMOTION, AND HEALTH SYSTEMS RESEARCH
Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC Manila, Philippines 30 October - 2 November 1995
Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines May 1996 WE:)j ~\/,,~,
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NOTE
The views expressed in this report are those of the participants in the Meeting of the Subcommittees of the WPACHR on Environmental Health, Health Promotion, and Health Systems Research and do not necessarily reflect the policies of the World Health Organization.
This report has been prepared by the World Health Organization Regional Office for the Western Pacific for the governments of Member States in the Region and for those who participated in the Meeting of the Subcommittees of the WPACHR on Environmental Health, Health Promotion,,,And Health Systems Research, held in Manila, Philippines, from 30 October to 2 November 1995.
CONTENTS
1.
INTRODUCTION ...................................................................................... 1 1.1 Background ......................................................•................................• 2
1.2 Objectives .......................................................................................... 3 1.3 Participants and organization ................................................................... .. 2 3. PROCEEDINGS ........................................................................................ .. CONCLUSIONS AND RECOMMENDATIONS ................................................ 6 TABLE ANNEXES: ANNEX I - LIST OF PARTICIPANTS ..................................................... IS ANNEX 2 - AGENDA .......................................................................... 17 ANNEX 3 - OPENING REMARKS BY DR S.T. HAN, REGIONAL DIRECTOR, WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC ................................. 19 - RESEARCHABLE AREAS AND PROJECTS ............................. 11
Keywords: Health services research I Environmental health I Health promotion I W..tem Pa<:ific I Philippineo
SUMMARY
The Western Pacific Region recognizes that new horizons are appearing in health. Curative care and public health have brought great gains, but alone they are not enough. We must move upstream of these measures to sustain health in holistic ways by embracing the dual concepts of health promotion and health protection. In the area of research, this implies that we must take a more integrated approach that cuts across disciplines in seeking innovative solutions to priority health problems. For this reason, it was decided to coordinate the meetings of the various WPACHR subcommittees, holding the meetings concurrently, with some joint sessions to address overlapping issues. The objectives of the meeting were: (I) to review research activities;
(2) to identify how research can further contribute to clarifying priority health development issues; and (3) to develop future directions for research in environmental health, health promotion and health systems in relation to regional health development issues of the year 2000 and beyond. General presentations were made by the Secretariat reviewing the historical situation regarding research activities under the three programme areas; and a broad framework to guide the identification of research needs was laid out along with some discussion of currently understood research issues in each of the three programme areas. Based on this initial groundwork, the three working groups for the meeting (see Annex 1 for groupings) discussed and further delineated the framework for identifying research needs, working on the development of "primary criteria for assessing fields of research as well as specific projects" and "secondary criteria for assessing research projects". In addition, these groups worked individually and then collectively on a "statement of guiding principles" for incorporation in the Region's Strategic Plan for Health Research; and further refmed the areas identified in the Strategic Plan for priority research in relation to environmental health, health promotion and health systems. In relation 10 the draft "Strategic Plan for Health Research in the Western Pacific Region, 1996-2000", the members of the Subcommittees on Environmental Health, Health Promotion and Health Systems Research recommend: (I) addition of a statement of "guiding principles" indicating that research must have a strategic and systemic focus, providing the Region with new knowledge and methodologies to apply to the process of building healthy communities and nations; (2) inclusion of primary criteria for assessing fields of research as wen as specific projects; (3) inclusion of secondary criteria for assessing research projects; (4) incorporation of information on researchable areas and projects; (5) that the WHO Regional Office for the Western Pacific should assess research capabilities in the Region; identify areas of deficiency; develop a strategy to enrich the research capabilities and skills in the Region; formulate specific research projects in consultation with countries; and develop a research-related information network.
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1. INTRODUCTION
I.l
Backgroynd
New MrWJIIS iIt 1wIlIIt The Western Pacific Region recognizes that new horizons ICe IPpearinll in bealth. Wbile health tarllets in the control of communicable diseases are beinK met, other cballeoael to bealth Ire emerlling. Some of these come in the wake of development II it diatom envOO!U!W!ll in fraaile ecosystems and negatively influences some lifestyle choices. Curative care and public bealth bave brought great gains, but alone they are not enough. We must move upstream of these meaaures to sustain health in holistic ways by embracing the dual concepts of health promotion and bealth protection. At the recent meeting of South Pacific Ministers of Health (March 1995), these idea were reinforced and put into a policy statement, the Yanuca Island Declaral/on on Health In rhe Pacific in the 21st Cenrury.
In the area of research, this implies that we must take a IIIOre intellrated approach that cuts across disciplines in seeking innovative solutions to priority health problems. For this reason, it was decided to coordinate the meetings of the various WPACHR subcommittees, holdiDll the meetings concurrently, with some joint sessions to address overlapping issues. In this way, it WII intended that a more focused health research programme be developed: a programme that addresses priority health issues in a more effective and comprehensive manner, makinll better use of limited resources. Environmental health The July 1990 meeting of the WPACHR recommended the establishment of a Subcommittee on Environmental Health Research to promote research on the impact of environmental chanlle on health. In early 1990, the WHO Commission on Health and Environment was appointed by the Director-General. One of the charges to the Commission was to identify environmental health research priorities for WHO. Wbile recognizing that somewhat different priorities millbt exist in each Region, it was concluded that the work of the Commission was important in fixinll the broad environmental health research framework within which regional priorities could be pursued. The work of the Commission was completed in 1992, and served as WHO's principal input to the 1992 United Nations Conference on Environment and Development. As a parallel initiative, a commitment was made by the environmental health programme (Regional and Headquarters) to develop new strategies for environmental health consistent with the work of the Commission and in recognition of the need to use dwindling resources in more effective ways. It was recognized that fulfilling this commitment would define priority environmental bealth issues, includinll the associated research priorities. The Regional Strategy on Health and Environment was endorsed by the Regional Committee for the Western Pacific at its forty-fourth session in September 1993. Since that time, the implementation of this Strategy has focused on the delineation of priority environmental health issues and associated plans of action. This work then forms a sound bllis for subcommittee deliberations on environmental health research priorities at the regional level.
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Health promotion Health promotion was made a priority area of work in the Western Pacific ReaioD in 1989 in response to the recognized need to influence lifestyles. A health promotion programme w. developed and strongly supported by the Regional Committee at its forty-fourth session in September 1993. It identified schools, workplaces and communities/cities/islands as settings for action. The Subcommittee on Health Promotion was established by the WPACHR at its thirteenth session in July 1990 for the purpose of receiving proposals for research and activities in health promotion which would reflect the developments in the Region with regard to structural changes with society and the environment and, consequently, with regard to living conditions, lifestyles and their impact on health. The Subcommittee on Health Promotion met in November 1991 and recommended that initially priority should be given to urban health development, with special emphasis on the urban poor. The WPACHR supported the recommendations of the Subcommittee and stressed especially the need to focus on studies of factors which contribute to buildiDa healthsupportive public policies. With the document New hori1.ons In health new research questions are emerging which need to be addressed by the Subcommittee. Health systems research Since the Subcommittee on health systems research was established in 1980, there have been five meetings. At the last meeting in 1990, priority health development issues for research were defined and recommendations were made on how to use collaborating centres more effectively. Since the last meeting, the global training materials on health systems research for managers have been used in some co.untries of the Region. There is now wide acceptance with countries that a good manager is one who is able to use and conduct health systems research activities. In addition, research continues to be conducted on those issues which were defined as being the most relevant to health development goals in the Region. At this joint meeting of the subcommittees on health research, health systems research activities and priorities were reviewed and assessed in the light of the ongoing health reform movement. 1.2 Obiectives The objectives of the meeting were: (I) to review research activities of the environmental health, health promotion, and health systems research programmes during the period 1990-1994, including achievements, problems and constraints; (2) to identify how research in environmental health, health promotion and health systems can further contribute to clarifying priority health development issues, particularly issues relating to preparation for life, protection of life and quality of life; and (3) to develop future directions for research in environmental health, health promotion and health systems in relation to regional health development issues of the year 2000 and beyond, particularly in relation to health promotion and protection.
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1.3
Participants
and organization
The total number of participants, who served as temporary advisers, at the m....iog was 16, excluding the Secretariat. The list of these participants is provided as Annex 1; the Blenda for the meeting is provided as Annex 2; and, the opening address of Dr S.T. Han, Regional Director, to the participants is provided as Annex 3.
2. PROCEEDINGS
During the first day of the meeting, general presentations were made by the Secretariat reviewing the historical situation regarding research activities under the three programme areas (i.e. environmental health, health promotion, and health systems research). A presentation was also made relating to the overall impact of the regional policy initiative New horizons In health on programme direction and research emphases. On day two, a broad framework to guide the identification of research needs was laid out along with some discussion of currently understood research issues in each of the three programme areas. Based on this initial groundwork, the three working groups for the meeting (see Annex 1 for groupings) discussed and further delineated the framework for identifying research needs, working on the development of "primary criteria for assessing fields of research as well as specific projects" and "secondary criteria for assessing research projects". In addition, these groups worked individually and then collectively on a "statement of guiding principles" for incorporation in the Region's Strategic Plan for Health Research; and further refined the areas identified in the Strategic Plan for priority research in relation to environmental health, health promotion and health systems. Attention was also paid to identifying issues that should be researched on an integrated programme basis. The work of the environmental health subgroup is reflected in the attached table, Researchable areas and projects. Building on the foundation of the Regional Strategy on Health and Environment and the policy framework New horizons in health, the subgroup focused on delineating specific researchable areas that seemed of particular interest and importance over the next five years or so. Attention was also directed at the area of nutrition and food safety where the interaction between environmental health and health promotion was seen as being particularly important. The health promotion subgroup provided some delineation of researcbable areas and projects in the attached table, but also focused on developing a broad-based outline for a health promotion strategic plan for a particular priority field of research: "Healthy lifestyles". This strategic plan outline was comprised of the following: Researchable areas: (I) Research to gain further knowledge and understanding of modifiable practices which affect health, e.g. nutrition, physical activity, sexual practices, and substance abuse (2) Epidemiological and demographic data relevant to the above
(3) Research to gain further knowledge and understanding of contextual factors which influence lifestyles and health, e.g. cultural, environmental (Physical, political, geographic, and social), biological and economic factors
-s (4) Interventions relevant to the above
Objectives: By the year 2001, to have: (I) investigated at least one modifiable practice affecting health in • mix of deveiopiDa and least developed countries, determining risk or protective significance and likely benefit from intervention;
(2) described the baseline epidemiological and demographic data relevant to the modifiable practice investigated in (1) above in Member Stales in the Region; (3) undertaken at least one project that describes and attributes risks and benefits of contextual factors which influence lifestyles and for an issue encompassed by New horlwns ill health, in a mix of developing and least developed countries; and (4) used information available for researchable areas A, B and C above, to develop, implement and evaluate a comprehensive, integrated programme at the community level to address a health issue encompassed by New horizons In health in a mix of developing and least developed countries. Domaillli to which the researchable areas and objectives can be applied: Food safety Healthy aging of the population Improvement of health potential for people living with a disability/chronic illness Infant and maternal health Mental well-being Oral health Prevention of communicable and DOncommunicable diseases Quality of life Settings, e.g. cities, schools and worksites The health systems research subgroup focused on the characteristics of desirable research activities, concluding that there should be: • • • • emphasis on community-centred approaches (i.e. approaches that are holistic and reflect effective integrating mechanisms); emphasis on interactive perspectives (i.e. among individuals, between individuals and their environment, between people and the systems that affect them, etc.); emphasis on an integrated approach (among sectors and disciplines) from the conceptualization of the project/activity; and emphasis on ensuring that there are adequate supporting mechanisms.
With these characteristics in mind, the subgroup identified three broad priority fields of research: improving quality of care in line with the concepts of New horizons in health; health financing for the disadvantaged; and partnerships in strengthening district health systems. Researchable areas were then suggested in each of these fields as follows:
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Improving quality or eare in line with the concepts or New horizoru iIIlwIIIh • improving quality of care in community health centres in terms of health promotion, disease prevention and rehabilitation based on the needs of the community; • improving conformity with good health education practices, environmental proteCtion guidelines, etc.; • evaluating the use of all relevant community resources (financial and human) in relation to improvements in the quality of care; and • developing incentives to encourage the involvement of local authorities activities to improve the quality of care, to strengthen quality of care improvement mechanisms, and to develop the infrastructures and resources necessary to enhance quality of care, Health financing for the disadvantaged • enabling the community to mobilize health care resources and use them more effectively; • developing effective mechanisms for providing policy direction and well-focused accountability; • enhancing intersectoral action and the use of multidisciplinary methodologies and approaches; and • developing local capabilities and strong support for local authorities. Partnerships in strengthening district health systems • assessing the various aspects of community need; • responding to rapidly changing socioeconomic situations and level of care needs; • coordinating various partner inputs; and • developing appropriate administrative and regulatory frameworks to support decentralized systems/mechanisms/approaches.
3. CONCLUSIONS AND RECOMMENDATIONS
In relation to the draft "Strategic Plan for Health Research in the Western Pacific Region, 1996-2000", the members of the subcommittees on environmental health, health promotion and health systems research recommend: (1) That the following statement of "guiding principles" be incorporated in section 3.0, as subsection 3.2, with the current goal statement being subsection 3.1:
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New horizons In health emphasizes the need fur health issues to be ...mined boIiatiCilly .. an integral part of public policy that is responsive to the needs of the conuDllDity and the needs of the individual. In this context. research must have a straleJic and systemic fucus, providm, the Region with new knowledge and methodologies to apply to the process of buUdm, healthy communities and nations. It should: • reflect a holistic, integrated and multidisciplinary approach to problem aolving; • enhance the integration of health considerations in decision-making at the individual, community, national and regional levels;
• be relevant to the different conditions in least developed countries, those countriel whose economies are in transition, and rapidly developm, countries; • contribute to the development and implementation of health supportive policies in different settings; • enhance human reaources development processes and the actions necessary to influence values and behaviours in positive ways; and
.• contribute to the integration of health and environmental factors in the context of an overall strategy to achieve sustainable development. (2) New subsection 5.3.1, "Primary criteria for assessing fields of research as well as specific projects": • importance to stakeholders in Least Developed Countries (LDC); • emphasizes individual responsibilities in the context of supportive environments; • amenability to collaborative research; • importance/urgency for solutions and/or planning in the area of concern; • promotes multisectoral and interdisciplinary involvement; • contributes to sustainable improvement in health in particular, and sustainable development in general; • relates to broader health and development issues; and • availability of indicators or ability to develop suitable indicators for .evaluation. (3) New subsection 5.3.3. "Secondary criteria for assessing research projects": • degree to which the project has been conceptualized from a systems perspective; • estimated health impact(s) and relevance to other priority fields of research; • quality of research methodology; • appropriate expertise and technical capabilities; • scale of project, including budgetary requirements and time-frame;
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• extent of existing effons by other agencies • potential of demonstration effects; and • transboundary implications. (4) That the information presented in the attached table (Researchable areas and projects). related to researchable areas/projects. be incorporated in the strategic plan (e.g .• in a revised version of the Table). (5) To facilitate further development of the strategic plan for health research for the WHO Regional Office for the Western Pacific should: • With respect to research capabilities. - assess research capabilities in the Region; identify areas of deficiency; and
- develop a strategy to enrich the research capabilities and skills in the Region for consideration by the Advisory Committee on Health Research at its meeting in 1996 and by the Regional Committee at its forty-seventh session. • define and formulate specific research projects in consultation with countries; and • develop a research-related information network among countries utilizing the capabilities of the "information superhighway·.
Table. Researchable areas and projects
Priority field of researcb
Researchable area
Related programme objective
Justification
Specific research objective
Research project(s)
ENVIRONMENTAL HEALTH (I) Environmental health factors (a) Accident prevention EH 7 to 11 from Regional Strategy on Health and Environment Road traffic accidents have become a leading cause of death and injury in countries undergoing rapid economic and social change. Appropriate To develop an effective strategy for minimizing road traffic accidents and injury in rapidly developing countries (a) Develop database on types and causes of accidents and injuries (b) Study the environmental and behavioural factors affecting the number of accidents and the severity of associated injuries (c) delineate mitigation measures and associated plans ofaction (b) Environmental health impact assessment (EHIA)
preventive interventions are needed.
EH 7 and 10
Current programmes in EHIA urgently require more detailed understanding of the healthenvironment interaction; and further refmement of risk assessment methodologies
To develop improved methods for the application of risk assessment principles to the evaluation of the health impacts of development activities
(a) Develop case studies of successful application of risk assessment principles (b) Field test improved methods (c) Develop guidelines for applying improved methods 10
(c) Pollution health effects, including health-related costs
EH7toil
!ndustrialization and urbanization pose severe stresses on environmental resources for sectoral development (i.e., energy, agriculture, transportation, etc.). This depletion of resources has a significant impact on health. Local epidemiological datalstudies are needed to support standard setting and preventive/control measures.
To generate epidemiological data required in formulation of air and water quality standards; to generate socio-behavioural data needed in the development of public information materials and approaches; and to support decision-making in controVprevention strategy development and implementation.
(a) Health effects studies in relation to air/water pollution, hazardous waste disposal, use of pesticides, etc. in selected areas (b) Willingness of population to pay for pollution control (c) Development and application of risk communication materials and approaches
Priority field of researcb
Researchable area (d) Integration of health and environmental factors in development planning and decisionmaking
Related programme objective EH 4, II and 12 from Regional Strategy on Health and
Justification Current knowledge of integrating mechanisms is weak. Models and information are needed to assist decisionmakers in achieving a holistic perspective and intersectoral approach to development
Spedfic research objective To delineate optimal approaches to integrating health
Research project(s) (a) Describe and evaluate approaches currently adopted by a mix of developing and least developed countries
and environment considerations in development planning and decision-making
Environment
(b) Delineate and field test new/refmed approaches
issues. (e) Human resources development for environmental health EH 2 and 6 Learning models need to be developed to enable individuals to effectively gain and apply knowledge in dealing with complex environmental health issues. To make environmental health professionals and others more effective in resolving complex environmental health problems. (a) Develop learning models appropriate to the needs of environmental health professionals in selected countries
(b) Field testing learning models
HEALTH PROMOTION AND ENVIRONMENTAL HEALTH (2) Nutrition and food safety (a) Nutrition Consistent with the National Plan of Action developed pursuant to 1992 International Conference on Nutrition (ICN)
The economic transition reflected in rapidly developing countries by a significant shift in nutrition patterns often result to problems of under-and overnutrition
To delineate these transitional problems and facilitate the development of pragmatic strategies to resolve them
(a) Develop a database on changing food consumption patterns
0
(b) Assess health risks and develop monitoring protocols (c) Develop mitigation strategies and field test
(b) Food safety
EH 7, 8, 10 and 12; and consistent with National Plan of Action developed pursuant to 19921CN
Increasing demands for agricultural food products, as well as changing food
consumption patterns, often aggravate food safety problems in developing country settings. Effective preventive and control strategies are needed.
To strengthen food monitoring/surveillance capabilities; and assess the effectiveness of various food safety intervention strategies.
(c) Develop and promote the use of standard monitoring/ surveillance protocols (b) Develop case studies of successful intervention strategies. (c) Develop guidelines for applying and promoting the use of successful strategies
Priority field of research HEALTH PROMOTION (3) Healthy lifestyles
Researchable area
Related programme objective
Justification
Specific research objective
Research project(s)
(a) Behavioural and epidemiological aspects
EH I to 3, and consistent with the Regional Strategy on Health Promotion
A major question is how to ensure that health and the environment are not damaged by the economic progress for which people have worked so hard. People should be encouraged! enabled to help themselves to avoid disease and develop lifestyles and environments that support positive health
To delineate selected modifiable practices affecting health in a mix of developing and least developed countries, determining risk or protective significance and likely benefit from intervention; to develop baseline epidemiological and demographic data relevant to the practices; to describe the associated risks and benefits; and to develop, implement and evaluate a "modifiable practice" programme at community level
(c) Investigation of smoking behaviour in school-age children in selected countries (b) Analysis of epidemiological and demographic data on "tobacco or health" in the same selected countries (c) Assess outcomes of the health-promoting schools (HPS) projects with regard to smoking behaviour (d) Develop, implement and assess HPS in a province setting
HEALTH SYSTEMS RESEARCH (4) Health care financing Health care for the disadvantaged As the financing of health care becomes more complex, and as smaller percentages of the funds come from the Develop monitoring and evaluation systems that provide information on the effective use of health care resources by type of beneficiary, particularly the most disadvantaged groups, in a community. (a) Preparation and testing of financial management packages for provinCial hospitals (b) Development of planning and management framework(s) for optimizing and tracking expenditures.
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government sector, there is a rtronger need to ensure that the needs of the disadvantaged are adequately addressed.
Priority field of researcb (5) Quality of care
Researcbable area Quality of care as a measure of health unit perfonnance
Related programme objective
Justification Costs and equity are among the issues of greatest concern in considering quality of care. Management systems need to reflect the importance of quality of care, and individuals working in the health field must see it as a priority issue. Segmentation of care leads to many inefficiencies at the district level. The traditional, vertical programme approach needs to be re-thought in many cases, and replaced with a more integrated approach to health care.
Specific research objective Develop a programme management perfonnance evaluation system which treats quality of care as a priority indicator of care effectiveness
Researcb project(s) <a) Use of comprehensive care package to derme all resources that are needed to provide good care (b)
Develop quality of care measures for district services
(6) District development
Planning and supervision of an integrated care package
Develop planning and supervision approaches which allow resources and care to be integrated, while maintaining accountability by type of care
<a) Develop supervisory practices which focus on ensuring integrated care (b) Trealment and care of the child at the health centre
'"
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LIST OF MEMBERS AND SECRETARIAT
1. MEMBERS
Subcommittee on Environmenta! Hplth Professor Ha Huy Khoi Director National Institute of Nutrition 48 Tang Bat Ho
Hm!Qi Socialist Republic of Viet Nam Professor Alejandro Herrin Professor School of Economics University of the Philippines Diliman, Ow;ron City Philippines Dr Ezekiel Nukuro Undersecretary (Health Improvement) Ministry of Health and Medical Services P.O. Box 349 Honiara Solomon Islands Mr Brent J. Powis Head of the School of Applied and Environmental Sciences University ofWcstem Sydney Hawkesbury Richmond, NSW Australia 2753 Professor Elma Torres Professor College of Public Health University of the Philippines Manila 625 Pedro Gil Street Eonita, Manila 1000
Philippines
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Annex 1 Subcnmmittee on Health Promotion Dr A. John Campbell Professor and Head Department of Medicine University of Otago Medical School P.O. Box 913, Dunedin New Zealand Dr Chen Junshi Deputy Director Institute of Nutrition and Food Hygiene Chinese Academy of Preventive Medicine 29 Nan Wei Road Beijipg People's Republic of China Dr Gillian Durham Deputy Director-General, Public Health Ministry of Health P.O. Box 5013 WelliniMn New Zealand Professor Lawrence St Leger Dean Faculty of Health and Behavioural Sciences Deakin University Burwood Campus, 221 Burwood Highway Burwood, victoria 3 125 Australia Professor Norio Shimanouchi Associate Professor Health Sociology Section Department of Health Science School of Health and Sports Science Juntendo University I-I, Hiragagakuendai Inba-mura, Inba-gun Chiba-ken 270-16 Japan
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Subrornmiftee on Health Systems 8oR'mb
Dr Shanta C. Emmanuel Assistant Director of Medical Services (Evaluation and Planning Division) Minisby of Health College of Medicine Building 16 College Road Sjnppore 03 I6 Republic of Singapore Dr Hu Shanlian Director Training Center for Health Management School of Public Health Shanghai Medical University Sbanllhaj200032 People's Republic of China
Dr Chang-Yup Kim Assistant Professor Department of Health Policy and Management College of Medicine Seoul National University 28 Yongon-dong, Chongno-gu Seo!!1 11 0-799 Republic of Korea Dr Maimunah Abdul Hamid Head Health Systems Research Division Public Health Institute Ministry of Health 1alan Bangsar Kuala Lumpur Malaysia Dr Pham Huy Dung Deputy Director Center for Human Resources for Health Minisby of Health 13RA Giang Vo
Haw!i
Socialist Republic of Viet Nam Dr Bijend P. Ram Divisional Medical Officer Northern Minisby of Health P.O. Box 104 Fiji !'ahasa
- 16Annex 1 2. SECRETARIAT Mr M. Anderson Management and Research Support Officer WHO Regional Office for the Western Pacific Manila Dr Chen Ken Medical Officer Traditional Medicine WHO Regional Office for the Western Pacific Manila OrR. Erben Regional Adviser in Health Promotion WHO Regional Office for the Western Pacific MADiia Dr A. Shirai Medical Officer Research Promotion and Development WHO Regional Office for the Western Pacific Manila Mr SA Tamplin Regional Adv iser in Environmental Health WHO Regional Office for the Western Pacific Manila
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ANNEX 2
AGENDA
1. 2. 3. 4. 5. 6. 7. 8. 9.
Opening ceremony Review of research activities New horizons in health A framework to guide identification of research needs Define priority research issues The integration of research issues Guidelines for monitoring and assessing research Plan of action for research in the Western Pacific Region Closing ceremony
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ANNEX 3
OPENING REMARKS BY THE REGIONAL DIRECTOR, WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC
LADIES AND GENTLEMEN, It is my pleasure to welcome you to this meeting of the subcommittees of the Western Pacific AdVisory Committee on Health Research on environmental health, health promotion and health systems research. As you know, new horizons are appearing in health in the Western Pacific R",ion. While health targets in the control of communicable diseases are being met, other challenges to health are emerging. Some of these come in the wake of development as it distorts environments in fragile ecosystems and negatively influences lifestyles of individuals and communities. Preventive and curative care have made great gains, but alone they are not enough. We must look beyond these measures to the future and to new directions. We must aim to sustain health in holistic ways, by embracing the dual concepts of health promotion and health protection.
These concepts are focused on the role of the individual and of the community in the regional policy framework New Horizons ill Health. At a meeting of South Pacific Ministers of Health in Fiji, in March of this year, these ideas were reinforced and put into a policy statement, the Yanuca Island Declaration on Health in the Pacific in the 21st Century. In the area of research, this implies that we must take a more integrated approach, one that cuts across disciplines in seeking innovative solutions to priority health problems. For this reason, we decided to coordinate the meetings of the various WPACHR subcommittees, holding the meetings concurrently, with joint sessions to address overlapping issues. In this way, it is intended that a more focused health research programme will be developed that addresses priority health issues in a more effective and comprehensive manner, making better use of limited resources. In August 1994, a joint meeting of the Western Pacific AdVisory Committee on Health Research and the Directors of Health Research Councils or Analogous Bodies requested that a task force be established to develop a strategic plan for health research in the Region over the next five years. This task force was convened from 29 August to 1 September 1995 here in Manila. The report of this task force meeting, a Strategic Plan for Health Research in the Western Pacific Region, 1996-2000, will constitute the foundation for your discussions at this meeting. I know that your deliberations can contribute significantly to the enhancement of this Strategic Plan, which will be presented to the full meeting of the WPACHR next year. In addition, it will also serve as the basis for our Regional input to related meetings, such as the WHO global meeting on environmental health research which will be held in Geneva in November of this year. A well-thought-out strategic plan for health research which focuses on priority problems can be tremendously helpful in bringing about the more judicious use of health-related resources.
Indeed, as we approach the 21st century, such a plan is essential if we are to successfully meet the
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Annex 3
challenges associated with New Iwrizons in health. Therefore, your work here this week should not be characterized as "business as usual". Rather, it is a significant opportunity to bring into sharper focus what has become a somewhat hazy and disparate health research framework. Again, I welcome you to Manila and the Regional Office, and thank you for your willingness to take time to contribute to this area of organizational need. I wish you every success in your deliberations and look forward to an enhanced Strategic Plan for Health Research in the Western Pacific Region. Thank you.