Biomedicine and Health - Publications
Biomedical & Health Research Series: Epidemiology
The role of COMACs in the Medical and Health Research Programmes of the European Community
The EC medical and health research programmes started in 1978, growing in number of projects and number of participants from three research networks then to 140 in the Fourth Medical and Health Research Programme (MHR4, 1987-1991). The basis of the programmes is the coordination of national research activities, which means that the Member States themselves execute the actual research and development work in their participating institutes and totally finance it from national sources. The Commission of the European Communities is responsible for coordination at Community level and for the financing needed for this purpose.
Six countries outside the European Community participated in MHR4 under the 'COST' agreement (European Cooperation in Scientific and Technical Research), i.e. Austria, Finland, Norway, Sweden, Switzerland and Turkey. At that time Czechoslovakia, Hungary and Poland have become eligible to join since November 1991.
The principal aim of the programmes is to achieve a 'critical mass' of interested researchers by bringing together their cumulative expertise in a research network or 'Concerted Action' in order to find solutions to medical and health problems of major importance to Europe. Each Concerted Action has a project leader and a project management group whose members are selected from among the teams in the network. The programme funds projects which cannot be carried out in single countries or which gain an added value by being coordinated at a European scale.
In these four research programmes, the EC Commission was assisted with the implementation of the programme by a management structure consisting of:
The COMACs constituted the main operational arm of the C.G.C. and were set up on the basis of methodological disciplines, namely Epidemiology, Biology, Biomedical Engineering and Health Services Research. COMACs had to put forward proposals to the C.G.C. aimed at implementing C.G.C. strategy in their field, and they were responsible for supervising Concerted Actions. The COMACs responsibility also included regular evaluation of individual Concerted Actions and exchange of information concerning the execution of the research covered by the programme. COMACs were also active in identifying proper research teams for Concerted Actions. The COMAC members were nominated by the Member States and COST countries taking part in the programme. Particular fields of application in COMAC Epidemiology were:
- one general 'Management and Advisory Committee on Medical and Health Research' called C.G.C. (Comité de Gestion et de Coordination) and its ad hoc Working Parties giving advice to the C.G.C. for research on 'Cancer' and 'AIDS', and;
- four Concerted Action Committees called COMACs (Comité d'Actions Concertées).
Dr Manuel Hallen
- Standardisation of data collection;
- Aetiological research;
- Evaluation of the effectiveness of measures aiming at health and health care improvement.
Secretary of COMAC Epidemiology
Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this to the control of health problems. Its aim is to improve health in populations.
The practice of epidemiology - health surveillance and disease control in populations - is integral to public health practice. As a research method, epidemiology is used to evaluate hypotheses about causes of disease, to quantify health risks, and to conduct experiments to investigate the efficacy of preventive, diagnostic or therapeutic regimens or procedures.
The purposes of epidemiology are to enlarge our understanding of factors that influence health-related states or events so that the health of populations and individuals can be enhanced, protected or restored; to provide information and analyses to guide decisions affecting community health; to evaluate measures taken to enhance, protect or restore health; and to respond to community concerns regarding health.
The trends and major priorities in medicine and health for the 90's focus first and fore~ most on the medical and health problenu of the elderly: morbidity, disability, mortality. Demographic changes are significant enough to accept this priority.
Next comes the area known as 'quality of life', where our well-being is threatened by our new society and an unhealthy life-style. As health and disease contribute to the environment, this area clearly requires exploring as to its effects, positive and negative, on people.
By promoting epidemiological research in Europe on the 'major health problems and diseases of great socioeconomic impact' and their determinants, while stimulating research on health and its characteristics, answers (or the answers) may be found on how to cope with these medical and health problems. Clearly, in order to solve the majority of problems which surveys or self-assessment will eventually detect, more basic and clinical research is needed. As epidemiological research has to cover psycho-social determinants, there is an urgent need for more refined methods of high scientific quality; this is an area where research should contribute to developing and harmonising methodologies in different Member States of the European Community.
The scope of the actual priority areas in medical and health research is clearly much broader and larger than foreseen decades ago. Most medical and health problems have a multifactorial aetiology: genetic, physical, mental, and social. There is an increasing need to coordinate and integrate epidemiological research with projects proposed and realised in other disciplines.
General objective of epidemiological research as a European endeavour
As mentioned in its outline, the general goal of the Fourth Medical and Health Research Programme (MHR4, 1987~1991) is clearly to contribute to a better quality of life by improving health. The programme's distinctive feature is to strengthen European collaboration as a means of achieving this goal.
The main objectives of this collaboration are to:
- increase the efficiency of relevant research and development efforts in the Member States. Scientifically, this is done through gradual coordination at Community level after mobilisation of the available research potential of national programmes. Economically, it is achieved through sharing tasks and strengthening the joint use of available health research resources,
- improve scientific and technical knowledge in research and development areas selected for their importance to all Member States, and promote its efficient transfer into practical applications, taking particular account of potential industrial and economic developments in the areas concerned;
- optimise the capacity and cost-efficiency of health care efforts throughout the countries and regions of the European Community.
in terms of added value, the experience gained from epidemiological research within the MHR4 programme, based exclusively on Concerted Actions, has produced real results:
- the creation of networks of research teams in Europe;
- promotion of national financing of research projects relevant to European priorities in health research;
- transfer of expertise from centres of excellence to less advanced research teams;
- harmonisation of methodologies in Europe,
- standardisation of data collection and the setting up of European registers.
In the development of modern health care systems in Europe more trained epidemiologists are needed. Setting priorities for the vast number of treatment options, requires the health and disease problems to be put in the proper perspective. Preventing diseases from being results of rapidly changing social norms and environmental hazards must rest upon sound epidemiological research knowledge. Epidemiology is also needed if the populations have to make choices related to their health. All these tasks clearly indicate a need for more and better trained epidemiologists in Europe.
Professor Karel Vuylsteek
Chairman of COMAC Epidemiology
- Part I: Cancer
- Geographic Correlation of Biological Risk Factors With Gastritis and Gastric Cancer, D. Forman
- Retrospective Evaluation of Occupational Exposures in Cancer Epidemiology, D. Hémon and M. Goldberg
- Health Effects of Passive Smoking in Europe (Preliminary Results), R. Saracci
- Part II: Age-Related Health Problems
- European Registration of Congenital Anomalies (EUROCAT), M.F. Lechat
- Maternal Alcohol Consumption and Its Relation to The Outcome of Pregnancy and Child Development, C. du V Florey
- European Studies of Infertility and Subfecundity, S. Juul
- European Study on Antioxidants, Myocardial Infarction and Cancer of the Breast (EURAMIC), A.F.M. Kardinaal, F.J. Kok and P. van 't Veer
- Epidemiology of Dementia, A. Hofman and L. J. Launer
- The Epidemiology and Prevention of Diabetes, J.H. Fuller
- The Epidemiology of Vertebral Osteoporosis in Europe: Prevalence, Risk Factors and Impact, A. Silman
- Risk Factors of Parkinson's Disease, J. de Pedro Cuesta
- Diagnostic Criteria for Epidemiological Studies on Sjögren's Syndrome, S. Bombardieri
- Central Nevous System Impairment from Long-Term Exposure to Industrial Chemicals (EURONEST), R. Gilioli
- Part III: Environment and Life-Style Related Health Problems
- Asthma Prevalence and Risk Factors, P. Burney
- Importance and Interaction of Genetic and Environmental Factors in Development of Atherosclerosis, J. Shepherd
- Pre-Hospital Treatment of Acute Myocardial Infarction, J.P. Boissel
- Nutrition and Health in the European Community, J.G.A.J. Hautvast
- Homocysteinaemia and Vascular Disease, LM. Graham
- European Collaborative Study on Inflammatory Bowel Disease (ECB-IBD; Preliminary Results), M. van Blankenstein and S. Shivananda
Ethical Issues in Epidemiological Research (Guidelines Containing the Minimum Common Standards of Practice Recommended for Use by Project Leaders and Participants in the Operation of Future Concerted Actions)
- Author Index
BIOMED Publications | 08.02.2000