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Holding to account | E7 poorest parts of the world, and reflect a Northern look at Southern problems, proposing global solutions without sufficiently acknowledging the diversity of nations or local factors. To counter this, a stronger emphasis is needed on capacity development for ‘horizontal’ health research, so as to increase the capacity of a country to deal with its own priority health problems and to negotiate the balance between local and global priorities. Implicit in this is the need for greater efforts to improve South-South and South-North partnerships and a commitment to fund and strengthen the voice and capacity of the South. Other issues that may counter any progress are the enormous growth in private sector health research in the South, mostly from pharmaceutical companies, and the effects of intellectual property rights and trade laws on health and health research (see the more detailed discussion in chapter B2). Neither the Bangkok Conference nor the Mexico Summit adequately addressed these issues, even though the pharmaceutical industry is now the single largest contributor to health research funds in the South – by 2000, its investments were worth over US$ 3 billion. To the best of our knowledge, there has been no concise assessment of the impact on this shift in research funding on research infrastructure, training, ethics, equity and development: it is urgently required. On a more positive note, it has been increasingly recognized over the past two decades that a strong civil society is a cornerstone of democracy, progress and health (Edelman 2005), not least because of its watchdog function. The role of civil society in health research was recognized at the 2004 Mexico Summit, but was not acknowledged in the final Ministerial statement. Regular review of progress with international declarations, statements, financing, practice and other efforts will be key to the advocacy needed to make health research beneficial for everyone. This chapter has aimed to outline positive and negative trends in health research in recent years. It concludes with some suggested indicators to measure progress in future: • national health research systems – progress towards impact and self-sufficiency. • partnerships for health research – progress toward equitable partnerships, and their impact on national health priorities. • health research funding – progress towards strengthening local research capacity and addressing national health research priorities. • effects of health research funded by the private sector – understanding its benefits and harms, globally and nationally. 348
• global architecture for health research governance – progress towards better but equitable coordination. • knowledge management and sharing – progress towards increased access to and utilization of knowledge from North to South and South to North. • health systems research – progress towards developing methodologies, building capacity, and implementing research on health system performance. • effects of health research related to MDGs – understanding of potentials and limitations, globally and nationally. • impact on health – documenting and measuring the impact of health research (from any source) on health, health equity and development in the poorest countries. References Certain, E (2004). FAME: an initiative to promote local medical research publishing in Africa. Saudi Medical Journal, 25, S46. Chandiwana S, Ornberg N (2003). Review of North-South and South-South Cooperation and Conditions Necessary to Sustain Research Capability in Developing Countries. Journal of Health, Population and Nutrition, 21, 288–297. Commission on Health Research for Development (COHRED) (1990). Health research essential link to equity in development. Oxford, Oxford University Press. COHRED (2004). Health Research expenditures: essential information for rational decision-making (2004.2). Making Health Research Work for Everyone. Geneva, Council on Health Research for Development. Deangelis C et al. (2004). Registration of clinical trials: a statement from the International Committee of Medical Journal Editors. Ned Tijdschr Geneeskd, 148, 1870–1. Dickersin K, Rennie D (2003). Registering Clinical Trials. JAMA, 290, 516–523. Dwyer O (2004). WHO to unveil global clinical trials register. Bulletin of the World Health Organization, 82, 714. Edelman (2005). Sixth Annual Edelman Trust Barometer: A global study of opinion leaders (http://www.edelman.com/image/insights/content/Edelman_Trust_ Barometer-2005_final_final.pdf, accessed 14 March 2005). Farley S (2005). Support to Science, Technology, and Knowledge for Development: A snapshot of the Global Landscape. The Africa-Canada-UK Exploration: Building Science and Technology capacity with African Partners. London. Global Forum for Health Research (2004). Monitoring Financial Flows for Health Research. Geneva, Global Forum for Health Research. Horton R (2003). Medical journals: evidence of bias against the diseases of poverty. Lancet, 361, 712–3. Ijesselmuiden C, Duale S, Nchinda T (2004). Principles of Good Partnerships for Strengthening Public Health Education Capacity in Africa. Report of a Consultative Meeting, Geneva, Council on Health Research for Development. Keiser J et al. (2004). Representation of authors and editors from countries with different human development indexes in the leading literature on tropical medicine: survey of current evidence. BMJ, 328, 1229–32. Essential health research 349
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About this book Today’s global he
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Global Health Watch 2005-2006 An al
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Contents Boxes, figures and tables
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C2.1 The facts about disability 180
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Illustrations 1 Medicine cannot dea
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Acknowledgements The following indi
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London School of Hygiene and Tropic
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Victoria, Canada; Centre for Health
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Foreword New reports on different a
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Introduction Origins The Global Hea
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Child malnutrition, death and disab
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Human rights and responsibilities A
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impacting on health. The Watch hope
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part a | Health and globalization T
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Health and globalization | A1 and h
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Health and globalization | A1 in 20
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Health and globalization | A1 is gl
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Health and globalization | A1 peopl
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Health and globalization | A1 numbe
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Health and globalization | A1 and p
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Health and globalization | A1 econo
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Health and globalization | A1 Box A
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Health and globalization | A1 half
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Health and globalization | A1 appro
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table a1 Key health concerns with W
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Health and globalization | A1 Healt
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Health and globalization | A1 merci
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Health and globalization | A1 thems
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Health and globalization | A1 Even
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Health and globalization | A1 • A
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Health and globalization | A1 non-v
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Health and globalization | A1 27-28
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Health and globalization | A1 Jenki
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Health and globalization | A1 Satte
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Health and globalization | A1 WHO (
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and regulatory authorities mandated
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Health care systems | B1 4) selecti
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Health care systems | B1 • And si
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Health care systems | B1 • declin
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Health care systems | B1 user charg
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Health care systems | B1 focus on t
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Health care systems | B1 for health
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Health care systems | B1 their cont
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Health care systems | B1 health car
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Health care systems | B1 ing servic
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Health care systems | B1 Box B1.7 G
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Health care systems | B1 many of th
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Health care systems | B1 the lack o
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Macro-economic factors Impoverished
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Health care systems | B1 HALE 2000
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Health care systems | B1 But improv
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Health care systems | B1 high-incom
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Health care systems | B1 Structural
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Health care systems | B1 the high t
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Health care systems | B1 and histor
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Health care systems | B1 norms (Loe
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Health care systems | B1 Foster M,
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Health care systems | B1 Toole M et
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B2 | Medicines Introduction Essenti
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Health care systems | B2 of new med
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Health care systems | B2 chapter re
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Health care systems | B2 the fourth
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Health care systems | B2 agenda thr
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Health care systems | B2 nonetheles
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Health care systems | B2 decision o
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Health care systems | B2 for the an
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Health care systems | B2 expenditur
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Health care systems | B2 Medawar C
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Health care systems | B3 between he
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Severe shortage Low density Moderat
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Health care systems | B3 sector and
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Health care systems | B3 to the US,
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Health care systems | B3 500 400 30
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Health care systems | B3 have been
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Health care systems | B3 to underta
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B4 | Sexual and reproductive health
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Health care systems | B4 10 Policy-
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Health care systems | B4 women and
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Health care systems | B4 of funding
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Health care systems | B4 debate on
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Health care systems | B4 the sexual
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Health care systems | B4 perspectiv
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Health care systems | B5 genome res
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Health care systems | B5 drugs base
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Health care systems | B5 Complete f
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Health care systems | B5 when a tes
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Health care systems | B5 are allowi
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Health care systems | B5 of life sc
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part c | Health of vulnerable group
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Health of vulnerable groups | C1 me
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Health of vulnerable groups | C1 pr
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Health of vulnerable groups | C1 Th
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Health of vulnerable groups | C1 Ca
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Health of vulnerable groups | C1 Bo
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Health of vulnerable groups | C1 Pa
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Health of vulnerable groups | C2 DP
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Health of vulnerable groups | C2 di
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part d | The wider health context T
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D1 | Climate change Introduction En
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increasing quantities are now causi
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development, local availability foo
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14 Droughts threaten the food secur
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Protocol can meet their targets by
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15 Transport and travel are major d
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• Redesign trade rules. Governmen
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D2 | Water Access to enough clean w
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water consumption worldwide. Each p
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table d2.1 Top corporate players in
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16 Protesting against the privatiza
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Box D2.3 Regulating private water c
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The private sector overestimates th
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Box D2.7 US citizens told to boil t
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to water. Worse still, it does this
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References Barlow M, Clarke T (2002
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D3 | Food Undernutrition is by far
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Functional and Productive Capacity
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table d3.1 Corporate control of US
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keting and processing means that sm
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average Indian family of four reduc
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Bank’s US$ 93.5 million loan to C
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Avery N, Drake M, Lang T (1993). Cr
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D4 | Education Some 135 million chi
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ledge about health-care practices a
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2005, and on present trends about 4
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Box D4.3 Programmes that aim to emp
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• per capita public spending fall
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unable to recruit 9000 badly needed
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Gordon D et al. (2003). The distrib
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D5 | War War has an enormous and tr
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19 Chechnya destroyed. War has wide
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initiated a ‘war on terrorism’.
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an explosive force equivalent to ab
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the risk of their misuse and divers
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Box D5.3 An agenda for peace The Ha
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Machel G (1996). Impact of Armed Co
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part e | Holding to account: global
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E1 | World Health Organization The
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The sources consulted worldwide in
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Box E1.1 Milestones in WHO history
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aised by his attempts to revitalize
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• stronger internal focus on perf
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21 WHO - up in the clouds? Reaction
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in favour of so-called ‘vertical
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to speak openly, while bullying and
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velop a unified, purposeful health
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to medicines, and the mobilizing ro
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Recommendations WHO’s core purpos
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doctors, and more people with exper
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E2 | UNICEF In 2005, Carol Bellamy,
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In sum, for almost a decade, childr
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Page 369 and 370: part f | Conclusions Global Health
Page 371 and 372: current debt relief mechanism - the
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