Where Do We Want the Health of Our Communities to Be by the Middle of this Century?

By Douglas A. Colquhoun, MB ChB, from the IARS, AUA and SOCCA 2019 Annual Meetings*

The Opening Session of the IARS 2019 Annual Meeting began with Colleen G. Koch, MD, MS, MBA, FACC, Chair of the IARS Board of Trustees, and Professor of Anesthesiology and Chair of the Department of Anesthesiology at the Johns Hopkins University School of Medicine, who highlighted the key aspects of the meeting and expressed thanks to the committee which brought this meeting together. Dr. Koch noted the international scale of the meeting, ongoing innovation in the delivery of education including the new simulation-driven learning experiences and recognized the benefits of the ongoing alignment of the IARS, AUA and SOCCA Annual meetings. She introduced the Board of Trustees, the Editor-in-Chief of Anesthesia & Analgesia and the Presidents of SOCCA and AUA. Dr. Koch briefly reviewed the 97-year history of the society including the annual meeting, journals, grants program and SmartTots program.

Davy C.H. Cheng, MD, MSc, FRCPS, FCAHS, CCPE, Distinguished University Professor in the Department of Anesthesia & Perioperative Medicine and Acting Dean at Western University, reviewed the contribution of Dr. Thomas Harry Seldon, for whom the lecture is named, to the development of modern anesthesia care and his contributions to the IARS. He then introduced a colleague from Western University, Michael J. Strong MD, FRCP(C), FANN, FCAHS, who serves now as President of the Canadian Institutes of Health Research.

Dr. Strong proceeded to explore the topic of “Health Research Funding in the 21st Century: Not for the Faint of Heart.” Dr. Strong examined Dr. Seldon’s ties to Canada and commended a number of his achievements. The core focus of the presentation was reflecting on the question “where do we want the health of our communities to be by the middle of this century?” While acknowledging that the context of his work was in Canada, he argued that this is a question every community is facing across the world.

The importance of this question is demonstrated by consideration of the demographic inversion with declining populations of young people entering the workforce and extension of life expectancy. This will lead to a substantial change in the composition of the population with increasing numbers of older adults and large populations living beyond 100 years. However, as early life risk factors are the drivers of longer-term health outcomes, the experienced late-term health events are shaped in trajectories then set in the early years. Dr. Strong remarked, “Think about our young because they are going to be the elderly.”

Into this changing landscape, the funding structure of health research was considered. Research funding is about distribution of finite resources. Dr. Strong noted that in Canada the minority of this funding emerges from federal government support, however that a substantial strategic review on its allocation is underway with plans to engage large numbers of stakeholders. But this funding should be able to act as part of a coordinated research funding environment which address the needs of a changing population.

Alongside the aging patient population are changing patterns of comorbid disease accompanying aging, but additionally this includes patients who after undergoing treatment for other conditions and have acquired diseases as the sequelae of that primary process. Collectively this may lead to very different patterns of disease burden.

Dr. Strong coordinated science to address the broad-based questions around the development of disease. He spoke against single domain approaches to understanding disease and advocated against the exclusion of consideration of socio-economic factors. He noted that culturally appropriate, community-based interventions are necessary to address the disease processes.

Collectively, he felt this would require the scientific community to move beyond short-term measures of achievement such as grant success and instead ask the fundamental question of how our work is impacting entire communities. This requires a shift towards collaboration between funders and researchers.

In his closing thoughts, Dr Strong offered two potential solutions:

Firstly, the scientific and medical community should embrace our role as healthcare communicators. Since we have the ability to drive the health status of the next generation, we need to be able to engage the community and explain why our work is necessary in delivering this outcome. This would fight against the proliferation of “junk science” and promote the true value of science. In the public sphere, concepts of valid sources of scientific knowledge have shifted away from traditional sources. To speak into this new landscape of understanding requires the engagement of the scientific community with the public. Despite its shortcomings, if the public is looking to social media then perhaps, argued Dr Strong, we as a scientific community need to be engaging via this platform too.

Secondly, we need to consider how we are working to develop the next generation of scientists. Scientific development occurs gradually via a long process of formal education, mentoring and practical experience. Using a model which focuses on the ascertainment of mastery, this may challenge us to examine the way in which this is achieved and may even occur in environments which are not classically associated with scientific development.

*Coverage from the Opening Session and T.H. Seldon Memorial Lecture: Health Research Funding in the 21st Century: Not for the Faint of Heart during the IARS 2019 Annual Meeting