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Rapid Responses: Rapid Responses published:
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Ethics should also guide global health research
- Tikki Pang (4 April 2003)
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Global or Local?
- Richard L. Newell (6 April 2003)
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Application research is needed
- James A Dickinson (6 April 2003)
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Establishing Global Health Studies
- Ilona Kickbusch (10 April 2003)
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Increased investments for health research for developing countries
- Mohammad Abdur Rab (10 April 2003)
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Re: Increased investments for health research for developing countries
- Meenakshi Sharma (7 March 2006)
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Tikki Pang, Director, Research Policy & Cooperation World Health Organization, Ave Appia, 1211 Geneva 27, Switzerland
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I applaud Labonte and Spiegel's thoughtful piece on the setting of global health research priorities. They rightly point out that the setting of such priorities must be seen not only in the context of disease burden but also in terms of broader global issues pertaining to the environment and the prevailing social, political and economic conditions. They suggest several important principles by which global health research might be prioritised. I would like to suggest that they add another key principle, i.e. "Research that is based on sound ethical principles and which avoids exploitation of vulnerable populations". In the post-genomic era, the promotion and upholding of sound ethics is key to ensuring that developing countries benefit fully from the unprecedented knowledge advances of the past decade. Competing interests: None declared |
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Richard L. Newell, Cruise ship's doctor In the Caribbean
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I am sure that there is a place for global health research, but feel that perhaps this would serve the interests of the researcher and his/her sponsor more. Local research ios more likely to produce results that are relevant to local people. However, before global research is undertaken, we must not forget that much is already known about the preventable causes of morbidity and mortality around the world. I would suggest that the G8 nations focus first on two things. One that would have an immediate beneficial impact is the establishment of secure potable water for all. This is on the agenda and it will be interesting to see what actually gets done. Secondly, once again in this kind of article, the word education is missing. Education in resource conservation, personal hygiene and waste disposal, safe food preparation and eventually education in fertility control would have a major contributor to world health. And aside from these obvious matters is the question of despotism. The individual despotism of a man over a woman (one of the main reasons for the spread of HIV in sub-Saharan Africa and elsewhere); the local despotism of the chief or landlord over his clan and tenants, keeping the lower orders down to ensure his own enrichment; and finally the large- scale despotism of dictators and governments (such as Mugabe and Saddam) who systematically rape their countries and steal the wealth from their people, pursue wars of self-aggrandisement and destabilise whole regions of the world to the detriment of everybody's health and wealth. Only once these have been addressed can we get excited about vaccination programmes and formularies, and research into the priorities for global health. Competing interests: None declared |
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James A Dickinson, Professor of Family Medicine University of Calgary, Dept of Family Medicine, UCMC North Hill, 1632-14th Ave Calgary Ab canada T2N
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Labonte and Spiegel give a thought-provoking priority list for research that will really make a differnce. However, so much research has been performed, but remains unused, because we do not know the best ways to disseminate and apply it. Those of us at the front line have difficulty obtaining the right information and using it under the limitations of the systems we work under. Until more work is done on dissemination, including how to change systems, and effective incentives for managers and front-line professionals, much of the useful research they advocate will make little difference to the population. Competing interests: None declared |
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Ilona Kickbusch, Professor, Head Division of Global Health Yale University, new Haven, CT 06520-8034
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As the leader of a one year Fulbright New Century Scholars (NCS) Initiative on "Health in a borderless world" I would like to draw the attention to the statement of the 30 Fulbright scholars from 19 countries which summarized a new approach to scholarly collaboration in global health. The full statement can be found on: http://www.cies.org/NCS/presentations.htm The NCS scholars found it important to qualify that global health research is not only about health impacts but also the study of local resilience and resistance and of public policy responses at various levels of governance. Indeed the study of the political determinants of global health emerged as being as important as the economic and social factors. The Fulbright NCS scholars have proposed to establish Centers of Excellence in Global Health Studies and to develop Masters programs in Global Health Studies at universities in the developed and the developing world. The challenge is to enable the development of a new body of knowledge and skills that fully recognize the need to develop new kinds of transnational comptence in health research and policy making. This also means thinking beyond traditional disciplinary and methodological boundaries and developing a new ethics of global health research. Competing interests: None declared |
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Mohammad Abdur Rab, Regional Advisor, Research Policy and Cooperation Cairo, Egypt
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I would like to start by acknowledging the views expressed by Drs Labonte and Spiegal in their paper, for aptly highlighting the key global health issues and for keeping this important issue on the front burner, if you like, of the global arena. The authors have very rightly referred to the need for recognizing priorities in health research, the commitments by rich G8 group and the emerging new programmes for disease control and prevention. Clearly, these have strong influences and impact on global health one way or another. It is however, equally important to pause ponder and ascertain, as to how much and to what degree, these efforts have been translated into real term action with respect to health research. It has been over 12 years that the International Commission on Health Research and Development in its report "Essential link to equity and development" recommended to the (developing) countries to invest at least 2 % of national health expenditures to support essential national health research and strategies to build sustainable research capacity. Similarly, the international development agencies were advised to invest at least 5 % of their project / programme aid for the same purpose in developing countries. Despite this plea been echoed on several occasions over time (Investing in Health Research and Development, Report of the adhoc committee on health research relating to future intervention options, 1996; International Conference on Health research and development, Bangkok, Thailand 2000), sadly, few have heeded this call. Evidence suggests that investments in health research are still paltry, more so, where the need is most. The national processes of setting priorities for health research have to be coupled closely with matching efforts to develop and strengthen capacities for undertaking such research, and the ability to translate the research into action. In the absence of capabilities for carrying out research, the exercise of priority setting unfortunately remains at best academic. The advent of the genomic era, the ensuing advances in genetics and biotechnology and the promise and hope therein, for improving health of mankind, simply means that the World has little choice but to invest in this field to utilize its benefits. It however remains to be seen how the rapidly emerging knowledge and technologies will impact on global equity in health care. Thus far we see no evidence of the gap narrowing, in fact the contrary appears to be true. In view of the scarcity of resource allocations to health in general in the developing countries, a key challenge will always be "how to prioritize the (health research) priorities?" Competing interests: None declared |
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Meenakshi Sharma, Senior Research Officer Indian council of Medical Research, New Delhi, India -110029
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Despite the plea to International Development Agencies to invest at least 5% of their aid to support essential research in developing countries, investments in this area have been paltry. It must also be mentioned that the onus for this poor response may also lie with developing countries who either lack or have poorly defined national health research priorities. The idea of setting these national goals remains more or less confined to front line runners in health sciences in these countries. In this ladder of hierarchy, the capacity of an innovative young mind is lost. Similarly the involvement of community in making such decisions is to the best minimal in these countries. It must be remembered that only through advocacy of their needs, projections of their scientific capabilities and showing these as potentially beneficial projects for developed world, from economic as well as global security angle, a new era for investments in health research in developing countries can be ushered in. Competing interests: None declared |
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