Important steps to improve translation from medical research to health policy
© Jiang et al.; licensee BioMed Central Ltd. 2013
Received: 26 January 2013
Accepted: 27 January 2013
Published: 8 February 2013
Translational medicine entails not only “from-bench-to-bedside” but also preventive medicine. The present article proposes a conceptual framework of translational research from scientific research to health care policy and public health policy. We highlight the importance of translational medicine to bridge between research and policy and share our experience of translating medical research to public health policy in China as well as obstacles and challenges we are facing in the translation process.
Translational Medicine (TM) has become a fashionable term in medical society and seems important to almost everyone despite that the term is variably defined by different stakeholders. It was described as a “from bench to bedside” pathway in early 1990s when the concept of TM had just emerged. More specifically, it referred to “the transfer of new understandings of disease mechanisms gained in the laboratory into the development of new methods for diagnosis, therapy, and prevention”. Such a definition was commonly accepted and even adapted to categorize types of life-science researchers[2, 3].
However, it is being increasingly recognized that this definition is incomplete within the overall TM concept and neglects the importance of health policy. The disconnection between research and health policy was described as “Sound of one hand clapping”, which may have contributed to the scarcity of TM studies on health policy. For instance, we reviewed articles published in two specialty journals in TM: Journal of Translational Medicine from January, 2007 to June, 2012 and Science Translational Medicine from October, 2009 to June, 2012. Among the 833 published articles, only one focused on government implementation of public policies.
Several TM frameworks have been proposed in recent years[5–7]. T3 activities of the policy making in the road map of TM proposed by Dougherty and Conway address “how” health care is delivered. Others emphasized that public health policy should be included into TM framework[6, 7]. However, the role of health policy in the TM model has not been clearly illustrated. We emphasize the importance of health policy in achieving the ultimate goal of improving population health here using two examples from China, and discuss obstacles and challenges that we are facing in the translation from medical research to health policy, an integral part of translational medicine.
Child lead poisoning
Childhood lead poisoning used to be considered as a problem in industrialized countries but not in China. However, a series of well designed, comprehensive epidemiological and clinical studies on child lead poisoning in Shanghai, China, between 1988 and 1996, demonstrated that lead poisoning was a real threat to Chinese children. Leaded gasoline was found to be the major source of lead. These findings were confirmed by other studies in different locations of the country[8, 9], indicating that childhood lead poisoning in China should be prevented.
Sleep insufficiency in school-aged children
An adequate amount of sleep in high quality is important to maintain the health and functioning in the optimal condition. Sleep insufficiency in children and adolescents has been associated with cognitive deficits, mood disturbance and weight gain. Previous studies demonstrated that adolescents could not reliably introspect on the actual level of sleepiness after chronic mild sleep restriction, as compared with young adults, even when the impairment in reaction time was noticed during working memory tasks.
Policy-makers were persuaded to pay close and immediate attention to the sleep insufficiency in children on basis of our epidemiological studies. Shanghai Municipal Education Commission subsequently issued two regulations regarding the sleep intervention which was proposed to adjust school start time. School start time was then changed from 7:15 to 8:15 o’clock for elementary schools and from 7:00 to 8:00 o’clock for middle schools since 2007. We furthermore conducted a validation study in 10 elementary schools in Shanghai that participated in the national sleep survey between 2005 and 2009 to evaluate the effectiveness of the intervention. Our results showed that a 30-minute delay of school start time increased the average sleep duration by 23.4 minutes and decreased the prevalence of daytime sleepiness by 9%. It is worth noting that our studies were conducted in collaboration with Shanghai Education Research Institute affiliated to Shanghai Municipal Education Commission, which facilitated the translation from research to the local government.
Challenges and opportunities
A number of obstacles and challenges still remain even though some successes in translating medical research into public health policy have been achieved. There are substantial differences in value, need, and culture between research community and policy makers. Researchers, mostly from academic settings, are less motivated to translate medical research into public health policy, since academic promotion and tenure decisions are mainly based on the quantity and quality of publications in scientific journals and the number of funded research grants. Translating clinical and epidemiological studies into public health policy is often neglected, though it is understandable that scientists are expected to do highly sophisticated, cutting-edge studies and to get funding and good publications. China established one of the national highest awards called National Award of Advances in Science and Technology that honors successful translational research with great public health impacts, to encourage more scientists to translate medical research to public health policy.
Another obstacle in translational research is the barrier of communication between researchers and policy makers, as described by Mirvis. It may be difficult for policy makers to understand and have the access to research findings, to meet researchers and discuss the feasibility of translating results of medical research into public health policy, due to different educational and cultural backgrounds. It is our experience that it will be more beneficial if policy makers can be engaged as early as possible and provided with clear and simple messages, which has been proved by our experience. The success of our translational process was attributed to the fact that the staff in the governmental agencies could be involved in the project at the early stage during which they discussed the study at each step of progress. Those research results could be better understood and an appropriate action could be then taken by policy makers accordingly. Public health advocacy is a skill that requires education, training, and practice. Scientific researchers should be highly encouraged to have such skills breaking through one of major barriers, hesitation to approach policy makers. Direct communication between researchers and policy makers will benefit the process of translational medicine from research with the high quality to public health policies.
In conclusion, translational medicine is more than “from bench to beside”. The process from medical research to public health policy is an integral part of translational medicine. An effective mechanism is needed to encourage scientists to conduct studies with high public health impact, engage policy makers as early as possible, and improve public advocacy skills. Hopefully, those efforts will make a great impact in improving population health.
The work was supported by Chinese National Natural Science Foundation (81172685); Ministry of Science and Technology of China (2010CB535000); Shanghai Municipal Committee of Education (11SG19,HJTY-2010-A09).
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