Saturday, April 18, 2009

Promoting physical activity and healthful diets: should we pursue more practice-based evidence in order to get to more evidence-based practice?

The obesity epidemic, sedentary lifestyles and lack of fitness, and the burden of disease related to vascular problems, asks for effective promotion of physical activity and healthful nutrition. I spite of the growing and very substantial number of behavioural nutrition and physical activity interventions that are being implemented in the Netherlands, only very few of these are evidence-based. Today, the Netherlands Organisation for Health Research and Development (ZonMW) hosted a workshop on this gap between practice and research, that I was asked to chair. On the one hand, quite a few interventions are being tested, initiated by academic researchers, while on the other hand schools, municipal health services, and national health promotion institutes are developing and implementing a range of interventions that have not been tested. Academia seems to fail to study the interventions that policy makers and practioners like, while policy and practice appear to fail to adopt the interventions that academia have tested and approved.
Prof. Larry Green, Adjunct Professor of Epidemiology and Biostatistics at the University of California at San Francisco, and, I believe, the godfather of planned health promotion, and author of the text book on this topic (Health promotion planning: an educational and ecological approach), gave an introductory lecture on the issues, after which two example projects were presented. The first one, the Krachtvoer (power food) project, initiated in academia, developed and tested according to the text books, but taking very long to get into the hearts and minds of practice. The second one, BigMove, developed and initiated in practice settings, but failing to get any funding for formal evaluation.
These presentations were followed by a general discussion and two workshops. The results and conclusions will help ZonMW to further improve their grant allocation procedures, to put what is being done in practice more in the lead to define what needs to be researched, and hopefully giving scientists the responsibility to define and develop the right methods and designs to do that. We should move from finding the appropriate research questions to the well-controlled research designs that the scientific community prefers, to finding and developing the right research designs to the research questions derived from what is going on in health promotion practice.

Physical activity promotion among the elderly

On Thursday April 16, Marijke Hopman-Rock held her inaugural address to accept her endowed chair in physical activity among the elderly, at the VU University Medical Center. Her professorship is embedded in the EMGO Institute for Health and Care Research. Prof. Hopman-Rock is also co-director of the Body@Work research program on promoting physical activity and prevention of musculoskeletal disorders.

Dr. Hopman-Rock gave a very lively and and stimulating talk on why physical activity should and can be pursued among the elderly, and what kind of research is necessary to bring this field forward in the years to come. This endowed chair is a further enrichment of EMGO’s research on healthy aging that has such a strong foundation in the Longitudinal Aging Study Amsterdam (LASA), with Dorly Deeg as its director and professor of epidemiology of the elderly, and Marjolein Visser as professor of Healthy Aging.

Sunday, April 12, 2009

The Netherlands National Public Health Conference

On April 8 and 9 the annual national conference on public health was held in Rotterdam. This year’s theme was ’building bridges’ in health promotion between research, policy and practice. I attended the first day of the conference. In the opening session the Inspector General Gerrit van der Wal, of the Netherlands Health Care Inspectorate, gave a presentation that clearly showed that the inspection takes health promotion seriously, which includes that health promotion and public health practice should strive towards evidence-based practice. The director of the municipal health service of Amsterdam held the second short keynote. He argued that he strongly prefers evidence-based practice in public health, but in lack of availability of evidence-based interventions for many problems that his organisation faces, he argued that he could not wait for the evidence, and thus relies on professional experience and creativity. This opening session, as well as a debate session at the end of the day that I participated in, focussed, I believe, too much on the gap between science and practice in health promotion, in stead of the bridges that have been build in recent years. One strong example of bridges that are under construction are the so-called academic workplaces , or academic collaborative centers for public health in which public health academic research works closely together with practice organisations such as municipal health services, primary care organisations, or occupational health services, to plan and conduct research based on problems that these practice organisations face, to combine practice innovation with evaluation research, and to implement outcomes of scientific research in public health practice.
In another session during the day I gave a short introductory presentation in a workshop on the basic values and goals of public health practice: should we aim for health promotion as our most important goals, is it autonomy in making healthful or unhealthy choices that we should strive for, or is it social justice that public health practice should help to realise?