Setting global health research priorities
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7392.722 (Published 05 April 2003) Cite this as: BMJ 2003;326:722
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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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
Re: Increased investments for health research for developing countries
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
Competing interests: No competing interests