International Group Brings Inequities Of Health Research To World's Attention

At first glance the mandate set before the Commission on Health Research for Development when it was formed in 1987 may have read like an assignment from Mission Impossible: "to survey current health research worldwide, identify strengths and weaknesses, and propose improvements." But the independent international commission, headquartered in Cambridge, Mass., completed its task (the first of its kind) and recently published its findings in a 136-page report entitled "Health Research: Essential Link To Equity In Development." The report contains the results of a two-year survey that focused on health research activities, research capacity, and research support in 10 developing countries. In essence, what the commission found is that the life span of those living in developing countries is one third shorter than that of people living in industrialized countries. Shorter life spans coupled with other health issues hinder economic, political, and social development. The commission also found a gross mismatch" between the burden of illness (prevalent in developing countries) and money invested in health research (primarily in industrialized countries). To bring about health equity, more scientists and stronger research programs are sorely needed in the Third World. Several years ago, Joseph A. Cook, director of the Tropical Disease Research program at the New York-based Edna McConnell Clark Foundation (The Scientist, May 28, 1990, page 26), saw the need for an international assessment of the state of world health and health research. "Back in 1985," says John R. Evans, chairman of the commission, "Joe Cook brought a group of people together. He felt that there was no organization looking at health research overall as there is in agriculture. . . There was no way of looking at priorities, looking at what was neglected, and so on." Evans, who is also chairman and chief executive officer of the Toronto-based biotechnology firm Allelix Inc. and chairman of the Rockefeller Foundation, worked with 11 other commission members from as many countries (see table on page 19) to organize, oversee, and evaluate the survey. The commission members, who come from industrialized as well as developing countries, have a variety of backgrounds that include biomedicine, nutrition, law, economics, and cell biology. Two thirds of the commission members are scientists. John R. Evans (Canada): Chairman and chief executive officer of the biotechnology firm Allelix Inc., Toronto; chairman of the Rockefeller Foundation. Gelia T. Castillo (the Philippines): Professor of rural sociology at the University of the Philippines, Los Ba¤os. Fazle Hasan Abed (Bang-ladesh): Founder and executive director of the Bangladesh Rural Advancement Committee; chairman of South Asia Partnership. Sune D. Bergstrom (Sweden): Professor emeritus of biochemistry at the Karolinska Institute of Stockholm; recipient of the 1982 Nobel Prize in Physiology or Medicine. Doris Howes Calloway (United States): Professor of nutrition at the University of California, Berkeley; member of the World Health Organization's Expert Advisory Panel on Nutrition. Essmat S. Ezza t (Egypt): Co-founder of the medical school, dean of the faculty of medicine, and professor of internal medicine at the Suez Canal University, Ismailia. Demissie Habte (Ethiopia): Professor of pediatrics and child health at Addis Ababa University; director of the International Center for Diarrheal Disease Research, Bangladesh. Walter J. Kamba (Zimbabwe): Vice chancellor and professor of law at the University of Zimbabwe; member of the executive committee on the International Development Research Center, Canada. Adetokunbo O. Lucas (Nigeria): Chair of the Carnegie Corp.'s Strengthening Human Resources in Developing Countries Program. Adolfo Martinez-Palomo (Mexico): Professor of cell biology at the National Polytechnical Institute, Mexico City; winner of the 1988 Third World Academy of Sciences award in biology. Saburo Okita (Japan): Former foreign minister of Japan; chairman of the advisory committee on international development cooperation to the prime minister of Japan; chairman of the World Institute for Development Economics Research of the United Nations University. V. Ramalingaswami (India): Special adviser to the executive director of UNICEF; former director of the All India Institute of Medical Sciences. The commission recommends in its report that each country perform a self-evaluation. This assessment will provide a means of identifying crucial health issues that pertain specifically to that country. Once each country does this, the next step is for developing countries to form partnerships with - not dependencies on - industrialized countries. "Developing countries, says Evans, "should have a greater voice based on the evaluation of their needs." And once these needs are evaluated, each country has a chance of getting its needs on "the world's scientific agenda," Evans says. These nations, he says, should not simply function as "doormats" for outside groups to walk on as they come in to run the research system. "Each country should act as a partner with the development assistance groups," he says. "This will strengthen each country's sovereignty over how health research is developed." Self-interest and a sense of control, in turn, could lead to an increased interest in health research. Piquing the interest of people in developing countries for research, says Evans, is one way of obtaining funds for that research. Indeed, among the most striking findings in the report are those that pertain to funding. According to the commission, 93 percent of all preventable deaths occur in developing countries. Yet, of the $30 billion invested worldwide in health research in 1986, only $1.6 billion, or 5 percent, was spent on health problems of the developing world. Of that $1.6 billion, 42 percent ($685 million) originated from the coffers of agencies in developing countries. The other 58 percent ($950 million) of the money came from various organizations in industrialized countries (see chart). But of that $950 million, only $150 million actually made its way over to scientists and health policy researchers in developing countries. The bulk of the money stayed within the industrialized countries, funding scientists working on Third World health problems. The question of whether the $30 billion spent worldwide or the $1.6 billion spent on developing countries is enough, says Evans, is hard to answer. What is important, he says, is the "rational application of funds" - funds that need to be used effectively in order to achieve each country's priorities. The effective use of funds, says Evans, would "generate more respect for and interest in investment in health research." Getting the people of each country to demand (and thus fund) more research, however, is critical and will involve invoking changes in attitude. "Research is not some kind of luxury," says Evans. "It's what you do to use limited resources more effectively. When policymakers realize that research will let them do their jobs more easily, then they will help to set research priorities." To help get developing countries started, the commission sent a copy of the report to health ministers in each country. In addition, the United Nations Development Program (UNDP) has sent a copy to each of its representatives throughout the world. The United Nations Children's Fund (UNICEF) has also sent copies to each of its regional representatives. Also, the report was distributed at the World Health Assembly Technical Discussions held in Geneva, Switzerland, last month, where it was received very well. Despite the favorable publicity, Evans says that the realization of the commission's recommendations will still require hard work. "Essential national health research is quite weak in most countries. And it's not linked to policymakers and industry," he says. To further the move toward global equity in health, the commission recommended that an international body be established to monitor progress and promote financial and technical support for health research. "At first," says Evans, "we thought that maybe what was needed was an organization like a CGIAR [Consultative Group on International Agricultural Research]. But we found that this is not a model for health research." CGIAR, headquartered in Washington, D.C., supports a number of agricultural research centers around the world with the purpose of improving the quality and quantity of food production in developing countries. Although this group has been successful in conducting research and drumming up financial support, Evans says that it hasn't always been successful in transferring the knowledge gained to the people who would best benefit from it. Instead of a collection of international centers, Evans believes that global health research would best benefit from a "network of national centers." As each country solves its own health problems, it can then share its knowledge with other countries facing similar problems. The role of the international mechanism for health research, then, would be not so much to conduct research, but to promote interest and support for research. So as not to be "self-perpetuating," upon forming, the commission had decided that it would dissolve shortly after its report had been published, either by late summer or by year's end. This was purposely decided, says Evans, to ensure that the commission would not serve as the monitoring mechanism. Evans says that the International Development Research Center of Canada (IDRC) and the Swedish Agency for Research Corporation with Developing Countries (SAREC) "should take the leadership" before the commission formally dissolves. But even when that happens, Evans doesn't see his work as having come to an end. "As commissioners, we have the responsibility to act as advocates." Members of the scientific community, too, can help. "Scientists need to realize that health is really a global affair," he says. "Some portion of the scientific community needs to be given to the problems of the developing world." For more information about the commission, write Commission on Health Research for Development, 22 Plympton St., Cambridge, Mass. 02138; (617) 495-8498.

International Group Brings Inequities Of Health Research To World's Attention

Become a Member of

Meet the Author

Angela Martello

Published In

June 1990

Related Research Resources

Bunsen Burners and Bad Hair Days

Research Resources

Podcasts

Webinars

Videos

Infographics

eBooks

Taking the Guesswork Out of Quality Control Standards

PFAS: The Forever Chemicals

Unlocking the Unattainable in Gene Construction

Comparing Analytical Solutions for High-Throughput Drug Discovery

Products

Product News

Thermo Scientific™ Centrifuges with GreenCool Technology

Singleron Biotechnologies and Hamilton Bonaduz AG Announce the Launch of Tensor to Advance Single Cell Sequencing Automation

Zymo Research Launches Research Grant to Empower Mapping the RNome

Cytosurge Appoints Magid Haddouchi as Chief Commercial Officer