WORLD HEALTH REPORT 2012 “NO HEALTH WITHOUT RESEARCH” Copyright: Knowledge Utilization Research Center1

Copyright: Knowledge Utilization Research Center 1

WORLD HEALTH REPORT 2012

“NO HEALTH WITHOUT RESEARCH”


Hamed Hosseini

MD. MPH. PhD Candidate in Epidemiology

Knowledge Utilization Research Center;

Tehran University of Medical Sciences


Why Research?

From antibiotics to drugs for treating cancer, from the elimination of smallpox to oral rehydration therapy, from insulin and the birth control pill to a vaccine against bacterial meningitis and cervical cancer, and from identifying the adverse effects of smoking and the impact of out-of-pocket health expenditures, medical and health research has led to dramatic advances in health all over the world.


Why Research?

Such advances are the result of a collective, global effort in promoting the value of science in human development but, ultimately, depends on the efforts and commitments of individual countries to improve the health of their own people while contributing to the 'global public good' and pool of scientific knowledge.


Research improves health

Research improves health in three main ways:

developing of new and better interventions in the form of both medical products (e.g. drugs, vaccines, diagnostics, devices) and improved processes to strengthen health service delivery, ultimately contributing to universal coverage with essential health care.

informing the development of effective health policies and practices

empowering people and individuals to internalize knowledge and practice healthy behaviours in their daily lives.


Chapter 1 Defining health research as the

development and generation of new knowledge which can be applied to understanding health challenges and mounting an improved response to them.


Five types of research for health improvement


Different Kinds of Research

Pasteur's Quadrant sees research within the two dimensions of a quest for fundamental understanding and considerations of use.

Within the quadrant, and depending on where the research falls within 'understanding' and 'use', three categories of research were identified:

(1) pure basic research; (2) use-inspired basic research; (3) pure applied research1.


Three categories are most commonly used in combination - the health topic of the research, purpose of the research and methodological perspectives.


'traditional' approach


Research Boundaries


The Value of Research to Society and the Economy

The US government's seminal report, Science - The Endless Frontier, authored by Vannevar Bush (7) and published in 1945, marked the beginning of modern science policy and ushered in a new era in which science was seen to be vital for progress towards national goals in health, defence and the economy.


The Value of Research to Society and the Economy Bush's report resulted in the

establishment of the National Science Foundation and a massive investment in R&D in post WW II America in the basic and applied sciences - it is estimated that a ten-fold increase in funding occurred between the 1940's and the 1960's.


It has become clear that research improves health and adds value to society and the economy by driving innovation for new health products and devices, but also for improving the delivery of health services. Importantly, knowledge coming from research also empowers people to make individual choices towards healthy behaviour.


At the same time, health research is expensive and it is often difficult to link it directly to health, social and economic benefits and impacts. While researchers argue for its capacity to improve our understanding of the world and for improving health, politicians have a more practical view:

“research is done to make or save money”.


The relationships between science, innovation and health impacts is

nonlinear!

'top down', largely econometric approach which focuses on 'monetizing' improvements in life expectancy and quality of life, and linking it to investments in health research;

'bottom up' or 'payback' model based on evidence from various patient indication treatment combinations. The general value of the 'payback' model seems to be gaining increasing acceptance and it is being applied in many different countries.


On Parenthesis!!! The advocacy organization Research

America! has claimed that, in terms of the economic returns on research, there is a $4 return for every $1 invested in research to develop new medical treatments for cardiovascular diseases.

Research to develop information to influence patients' behaviour produced an even more dramatic economic benefit, $30 return for every $1 invested.


On Parenthesis!!! Research also plays a major role in

economic development and in wealth creation, especially in the industrialized nations. For example, if the top 10 global companies are ranked according to R&D spending, four out of ten of these companies are in the pharmaceutical sector!


pharmaceutical companies

Much of the profits accruing to pharmaceutical companies, and justification for its substantial spending on R&D, are related to the utilization, and protection, of research outputs (i.e. publications) through intellectual property rights or patents.

The effective combination of publications and patents is thought to lead to innovation, which can be defined as a "change in the thought process for doing something, or the useful application of new inventions or discoveries" .


Links between publications, patents

and innovation.


global health research'

research which is focused primarily on the health problems of developing countries.

it is also important to acknowledge that 'global health research' also refers to research on trans-national determinants of health (e.g. health impacts of climate change, pandemic threats, global trade, etc)


Current Challenges in Global Health Research

Since the report from the CHRD in 1990, much attention has been given to the '10/90 gap' suggesting that less than 10% of the global resources for research are committed to studying 90% of the global health problems, mainly those affecting the developing world


Investment in R&D as % of GDP

vs number of researchers, 2007


Who are the major players in global medical R&D?

Approximately half of the amount spent on R&D is in the private sector, mainly in the pharmaceutical and biotechnology industries.

however, suggests that work done by public sector research institutions (PSRI's) has had a more immediate effect on improving public health than was previously thought.

Such publicly-funded research in the USA contributed to the discovery of 9.3 to 21.2% of all drugs involved in newdrug applications approved during the period from 1990 through 2007.


The Gap

The gap is illustrated by the fact that of the 1,556 new drugs developed between 1975-2004, only 21 (1.3%) were for diseases of the developing world


Research to Improve Health Systems

At the same time, HSR and related areas of health services and health policy research has suffered from a perception of a lack of scientific rigor and has thus attracted fewer practitioners as well as resources. It is also characterized by longer time frames for research and the perception that it is limited to local contexts and conditions (e.g. population and health features, other programmes/initiatives with similar goals, characteristics of the health system, etc), thus making it difficult to draw generalisable conclusions.


There has also been confusion and lack of clarity as to what type of research is involved in strengthening health systems. Multiple definitions of operational research, implementation research and health systems research define the scope of their research very broadly with considerable overlap. The resulting lack of clarity negatively affects the credibility and progress of the research, and efforts to secure more resources to support it.


In order to improve conceptual understanding of what this type of research consists of, and better define its scope and boundaries, an attempt has been made to describe the three main underlying research domains relevant in improving health systems: operational, implementation and health systems research .

One perspective is to consider operational and implementation research as that which occurs at the 'micro' level while health systems research has a more 'macro', system wide view. Importantly, these domains are different, are of value to a range of situations from local to broader dimensions, and yet overlap. They need to more effectively interact for greater impact of the overall, collective research effort.


Research to improve health systems



Thank You!

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WORLD HEALTH REPORT 2012 “NO HEALTH WITHOUT RESEARCH” Copyright: Knowledge Utilization Research Center1