Alignment, alignment and alignment

27 januari 2016

Research and development are the conditional drivers for innovation that are indispensable for the sustainability of our welfare and wellbeing. Innovation is the generation and application of new knowledge, and both need our utmost investments. The most important obstruction for continuous and smooth innovation is fragmentation, in funding, managing, execution and utilization of Research and Development (R&D). Alignment is the new concept to fight fragmentation, both on a national and international level. Although valid for all sciences, this concept of alignment holds specific meanings for health research.

In 2011 we changed the definition of health (Huber. M, British Medical Journal, Vol. 343, 235 - 237). Health is no longer the absence of disease or disability, nor a complete physical, mental and social wellbeing. Nowadays health is seen as the empowerment of individual humans to cope and adapt even in the presence of disease or disability in order to independently manage daily life including its physical, social and mental challenges. We tend to shift from thinking in disease and therapy towards health and behavior. In this concept, health encompasses much more than medical sciences alone and crosses with technical and social sciences and humanities. Here our first level of alignment pops up, crossing the classical boundaries between separate scientific disciplines.

In order to enable the scientific alignment, politics and governance need to align as well. Challenges related to health cut across the classical boundaries of our administrative system. By the above definition, ministries dealing with health, science, education, social affairs and welfare, labor, economic affairs and others are all committed to complement the health research and development agenda. In consequence, the respective funding agencies need to align as well in their program portfolio’s. The latter requires also a firm policy towards mutual public and patient involvement, in public-private partnering (industry, charities, insurers, pension funds), and inclusion of the health care system. In our programs we pay equal attention to performing evaluation and impact assessments.

In The Netherlands we made important progress, first by establishing University Medical Centers (UMC’s) bringing medical faculty and academic hospital under one governance roof, and by establishing ZonMw as an integrated full-scope funding organization for health research and health care innovation. In close collaboration we are working on a common health research agenda. In 2011 we established national top sectors aiming at an integrated approach on public-private partnerships within nine sectors that are of crucial societal and economic importance, including Life Sciences and Health. And last year, a national research agenda was developed by an unprecedented process of grand-scale public consultation. Furthermore, 2016 is the year of transition for NWO (Netherlands Organization of Scientific Research) to re-organize its nine scientific areas into four more comprehensive and integrated domains, with a strong emphasis on trans-domain collaboration. In this way we trust that on a national level we will be much better aligned to meet with the grand challenges calling on an interdisciplinary approach.

Last but not least we need to remember that on the European level Horizon 2020 was designed to meet the grand societal challenges (including health, demographic change and wellbeing) that call for a transnational approach. Within the frame of Horizon 2020 the European Commission supports activities that are initiated by Member States themselves, through instruments like CSA’s, ERA-NET’s, Joint Programming Initiatives (JPI’s), and Research Infrastructures (RI’s). As a result of these instruments a level of alignment between national R&D policies and between national and EC policies is at stake. Also here partnerships are key, between governments, funding bodies, and public, patient, private and professional parties. Working along these lines the leverage of your own funding input is manifold.

To avoid new fragmentation on a higher level, we need to align the agenda setting for the various instruments as well, in order to make them complementary and supportive to each other. Since this has not be done so in the design phase, we need to restore this alignment in the implementation phase. And also here we need evaluation and impact assessment.

Alignment was the buzz word for 2015, and it will no doubt be the buzz word for 2016. However, in this column I aim to emphasize that alignment is more than an easy buzz word. It holds a concept of unprecedented collaboration on all levels, scientific, policy, professional and education, both nationally and internationally. It sounds complex, but once you start to work on it appears to be doable. And not only doable, it becomes highly profitable as well. It seems that the original ideas about an European Research Area are working after all. I feel privileged to be able to contribute.

Edvard Beem
Co-director ZonMw
The Netherlands Organisation for Health Research and Development

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