Four Trinity researchers have been awarded funding from the Health Research Board, under the Health Research Fellowship Schemes, acknowledging them as emerging leading-edge health researchers currently working in the Irish health research system.
The awards are designed to support academic researchers on their journey from doctoral training to academic research leadership positions; and to support those on that same journey who are also balancing their clinical commitments.
Investigating a broader concept of what ‘well-being’ means for the funding of health technologies in Ireland
Dr Irina Kinchin, Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute (GBHI)
Project title: Measures of well-being for use in economic evaluation: valuing and assessing health outcomes in Ireland (Awarded: €244,455)
Dr Kinchin said:
“In Ireland, healthcare decisions primarily concentrate on maximising health gain. However, with more integrated social care, there is growing recognition that this perspective is too narrow. This project seeks to establish how the Irish population would value states of broader well-being. By capturing broader well-being in economic evaluations, this work provides frameworks to reconsider if, and how, to fund health technologies as most valued by the Irish population.”
In Ireland, healthcare decisions primarily concentrate on maximising health gain. However, with more integrated social care, there is growing recognition that this perspective is too narrow. Health maximisation is unlikely to be a relevant objective, particularly where demand for social care is high (e.g. in chronic diseases, palliative care) as service users have distinct priorities and needs other than just health maximisation.
A broader capability approach, defined as well-being in terms of an individual’s ability to ‘do’ and ‘be’, is warranted. The UK and the Netherlands have recently adopted the capability approach as a framework for well-being measurement to evaluating health and social care. Ireland could join them as a leader in economic valuation through this project.
This project seeks to establish how the Irish population would value states of broader well-being as captured by the ICECAP measures of well-being. The results gathered from this research are intended to directly inform the national policy makers Department of Health (DoH), Health Information and Quality Authority (HIQA), National Centre for Pharmacoeconomics (NCPE), Health Service Executive (HSE) and many other stakeholders who are seeking to allocate health resources in a manner that would not take into account not just health, but broader concept of well-being.
By capturing broader well-being in economic evaluations in Ireland, this work provides frameworks to reconsider if, and how, to fund health technologies as most valued by the Irish population.
Examining the introduction of a universal entitlement to palliative care to inform strategic planning and implementation of Slaintecare
Dr Bridget Johnston, Research Fellow, Centre for Health Policy & Management, Trinity College
Project title: Progressing Sláintecare delivery from proposal to implementation: Insights from palliative care in Ireland (Awarded: €240,598)
Dr Johnston said: “The Sláintecare Report maps out the reforms necessary to transition towards universal healthcare in Ireland. A key recommendation is universal entitlement to a health benefits package, including palliative care. Ireland would be the first country to introduce universal entitlement to palliative care and evidence is needed to inform strategic planning and implementation. This research will examine population palliative care needs and identify how the system can best adapt to provide universal access to high quality, integrated services based on need rather than location or ability to pay.”
Sláintecare, Ireland’s national ten-year healthcare reform plan recommends universal healthcare. This represents the biggest Irish health system reform since its inception. Using palliative care as an example this project examines the development of universal palliative care internationally and applies these learnings to Ireland.
Through a palliative care lens, this research explores what Ireland can learn from other countries. It then examines the supply-side factors to be addressed in meeting Sláintecare proposals. Finally, it analyses the barriers and facilitators to realising these reforms in practice. This a multi-methods design comprising; a comparative analyses of universal palliative care policy and implementation in five other countries and applying the lessons to the Irish context; modelling palliative care need between 2023 and 2040; estimating service capacity and workforce requirements in meeting policy commitments between 2023-2040; determining the applicability and acceptability of expanding the role of generalist palliative care in Ireland through stakeholder engagement.
This project is applied research in real-time evident in the multi-methods and the research team. The collaborators include the most senior national palliative and health reform leaders as well as experienced palliative care, health systems and policy researchers.
These findings will provide detailed evidence and guidance for the Sláintecare Implementation Office in delivering universal palliative care in Ireland specifically and offer wider learnings for universal healthcare implementation nationally and internationally.
Identifying the political practices of the food industry in Ireland, looking at conflicts of interest and corporations’ influence on public health
Dr Melissa Mialon, Trinity Business School, Trinity College
Project title: Industry Corporate Political Activity and its Potential Influence on Public Health Policy, Research and Practice in Ireland (Awarded: €220,824).
Dr Mialon said:
” There are solutions to protect and improve the health of the Irish population, such as restrictions of marketing of unhealthy foods to children. This could prevent premature death, suffering and disability. But, across the globe, food industry actors fight against the introduction of such solutions. My research aims to identify the political practices of the food industry in Ireland and to find solutions to deal with conflicts of interest and influence of corporations on public health, in consultation with local actors.”
In Ireland, non-communicable diseases (NCD), which include diabetes, cardio-vascular diseases and cancers, contribute to premature death and increased suffering and disability. Unhealthy diets, particularly those high in ultra-processed food products, and obesity, is one of the primary risk factors for NCD. Internationally recommended policies, such as restrictions on the marketing of unhealthy food products to children, could prevent and control NCD, but have yet to be developed and implemented in Ireland. There is evidence that the main obstacle in relation to this is the influence of the food industry, whose profits are generated from the consumption of ultra-processed products. The extent of this influence in Ireland is unknown. In parallel, there is little information, globally, about solutions to mitigate that influence.
Dr Mialon proposes to identify the influence of the food industry on public health policy, research and practice in Ireland, through one historical study, which will use internal documents from the industry, and one study of its recent practices. In addition, we will conduct interviews with key informants in Ireland. She will also identify potential solutions and provide recommendations to mitigate that influence, through a document analysis, an online questionnaire coupled with a consultation with public health experts in academia, government and civil society, and a citizen jury. This work would build on the progress that has been made in Ireland in recent years since the introduction of public health policies, particularly tobacco and alcohol control. With the results from this project, policy makers, academics and public health professionals in Ireland will be equipped to identify and counter the arguments and actions of the food industry during the development of public health policies or programmes. The second half of this project will arm them with more effective, informed solutions to counter undue influence on public health policy, research and practice.
Investigating how lung immune cells change and manipulating these changes to improve the body’s natural defense against TB
Dr Laura Gleeson, Clinical Medicine, St James Hospital, Dublin
Project title: Manipulating macrophage bioenergetics to improve patient outcomes in TB infection, Trinity College Dublin (Awarded: €523,127)
Dr Gleeson said:
“Tuberculosis is the number one infectious disease killer in the world, killing 1.5 million people per year. Through this grant, I will be building upon discoveries made through my PhD work on vital early immune responses to TB infection in the lung, developing a new strategy for improving our current approach to treatment and vaccination. I will be focussing on metabolic changes that occur in lung immune cells infected by TB and manipulating these changes to improve the body’s natural defense against infection with this deadly bug.”
Tuberculosis (TB) is the most lethal infectious disease worldwide, causing 1.8 million deaths annually. For the last four years in Ireland, we have seen a doubling of TB cases after the use of immuno-suppressants called TNF blockers, and the emergence of drug resistant TB in Irish people for the first time in this regard. Targeting and boosting the body’s natural immune response against the bacteria that causes the disease, Mycobacterium tuberculosis (Mtb), is a key strategy to develop new treatments to overcome drug resistant strains of the disease.
Central to this natural immune response is the lung macrophage, a cell that lives inside the lungs and is the first line of defence we have against infection with Mtb. There is evidence that while some lung macrophages live their whole lives in the lung, others travel to the lung from the bloodstream when an infection is present. It is likely that these two differing populations of lung macrophages – those that are always present in the lung, and those that are attracted there due to an infection – behave in different ways and have different abilities to fight infection with Mtb. Learning more about these differences and about ways to boost the infection-fighting properties of these different types of lung macrophages will lead to new treatments for TB.
Specifically, Dr Gleeson will be looking at the role of cell metabolism (the way different lung macrophages take in energy sources such as sugars and fats and uses them) in the ability of the lung macrophages to kill Mtb, and how we can manipulate this metabolism to enhance the lung macrophage’s killing ability in order to improve TB treatments.