Funding Australia's health and medical research

In 1996, the National Health and Medical Research Council's research expenditure was approximately $142 million.¹ According to official estimates, this is about a quarter of Australia's total outlay on health research.² With this level of expenditure, it is reasonable to ask what we gain from this investment. In this issue of the Journal, Bourke and Butler show that in 1995 Australian research provided about 2.5% of new knowledge in medicine and the health sciences (Australian research produced 18390 publications, which were cited over 88000 times), a contribution that has strengthened in recent years.³ This is tangible evidence of our commitment to improving the health of people not only in Australia but in other countries. In one sense, this health research commitment is similar to our other international commitments, such as preserving world heritage areas or reducing emissions of gases causing ozone depletion.

Apart from this international contribution to knowledge and new discoveries to improve health, research also benefits Australia itself. For example, health care practitioners with research training are of key importance in ensuring that Australian clinical practice is effective and of high quality because they can access, sift and digest new research findings here and elsewhere. Researchers active in public health are needed to provide informed advice on the benefits and costs of proposed public health measures; for example, the detection and prevention of cancer and cardiovascular disease. The strong base of Australian medical research is also helping to build our biotechnology industry. Finally, and less tangibly, Australians derive satisfaction and pride through the achievements of their health researchers, just as they are proud of high achievers in sport and the arts.

The NHMRC now provides research funds across the spectrum of health and medical science via a single Research Committee formed in 1997 by a merger of the Medical Research Committee and the Public Health Research and Development Committee. As the largest single provider of peer-reviewed health research funds for the public good, the NHMRC has the responsibility of ensuring that Australia's health research effort is of high quality: the Research Committee provides funds on the basis of excellence (as judged by peer review), strives for fair, open and competitive processes, considers funding applications in all areas relevant to health, and attempts to ensure that research findings are translated into better health and health care delivery.

Health research is conducted mainly in universities, hospitals and medical research institutes (Box 1, above). About 30% of total NHMRC research support is provided to medical research institutes, about half of which is via block funding to five institutes. Box 2 shows the support won by institutes receiving over $1 million, those which are block funded, and the proportion of institute funding going to each State (for institutes receiving over $100 000). NHMRC funding to the major universities is shown in Box 3. The Government provides additional support for hospital and university research via salaries for researchers doing academic or clinical research as part of their teaching and clinical duties, but this does not occur for all research institutes. The institutes also play a valuable role in gaining additional support for health research from private corporations and individuals.

The report by Bourke and Butler³ shows that the medical research institutes produce some of our most highly regarded research. Ten of the 12 most cited Australian biomedical research articles are associated with institutes, and the overall citation rate for publications from institutes is impressively high: medical research institutes publish about 13% of all Australian health research articles, and these account for about 21% of the total citations of Australian health research. Underfunding the institutes would jeopardise this high quality output.

Bourke and Butler comment that their results raise issues of the efficacy of block funding,³ but stress that conclusions about funding methods require further bibliometric studies. The NHMRC's Research Committee is actively reviewing all aspects of research support, including issues in block funding, such as how best to review institutes and how to increase competition between institutes. Some will argue that the data of Bourke and Butler show that substantial, longer term research support (e.g., block funding) is required in order to achieve the highest impact research. Others will point to examples such as St Vincent's Institute for Medical Research in Melbourne to argue that institutes can achieve outstanding publication results without block funding.

The NHMRC supports a pluralistic system because the aims of health research extend well beyond quality research publication. It currently supports three-year project grants (about 48% of the current total NHMRC funding), and five-year program grants (9% of total NHMRC funding) and block grants (13% of total NHMRC funding) to provide for longer term research commitments. New researchers are supported via scholarships and postdoctoral awards (about 9% of funding), and outstanding individuals are supported by Fellowships (11% of funding, exclusive of Fellows on Programs and at block-funded institutes).

Nothing in science or medicine is immune to change. The NHMRC's research support system must accord with the ways in which research is currently conducted and be relevant to contemporary health needs. One exciting plan for the triennium 1997-1999 is the introduction of multidisciplinary Health Research Networks in important health areas. This scheme will involve researchers at different locations working collaboratively on research in areas of major health importance. Part of the aim is to capitalise on the merger of the Medical Research Committee and the Public Health Research and Development Committee by creating teams of biomedical, clinical and public health researchers. The Networks will focus on effective delivery of health care or prevention. They will thus be integrated research teams (as in the NHMRC Program Grants Scheme), but multisite and multidisciplinary. Interestingly, Bourke and Butler's article³ shows that research collaborations, both local and international, are growing strongly. The NHMRC-sponsored Networks scheme acknowledges this trend and will help to build new collaborations.

Bibliometric data are important for monitoring Australian research. We also need better indicators of the other outcomes of research (such as discoveries which benefit health or reduce health costs, better-informed medical and public health decision making, a vibrant biotechnology industry, and new generations of trained researchers in all areas) so that we can assure the Australian community that its financial investment in health and medical research is well placed.

Warwick P Anderson
Professor and Chairman, Research Committee (Public Health and Medical)
National Health and Medical Research Council, Canberra, ACT

1. National Health and Medical Research Council. 1996 Annual Report. Canberra: AGPS, 1997.
2. Australian Institute of Health and Welfare. Health Expenditure Bulletin No 13, July 1997.
3. Bourke PF, Butler L. Mapping Australia's basic research in the medical and health sciences. Med J Aust 1997; 167: 610-613.