Out of the Sectoral Box The Paradigm Shift to Research for Health

1. Out of the Sectoral Box The Paradigm Shift to Research for Health Prof A D Mbewu MBBS MD FRCP President : South African Medical Research Council Co-Chair Inter Academy Medical Panel Global Ministerial Forum on Research for Health Bamako, Mali 19, November 2008

3. Health Inequities • One of the objectives of GFHR is to ‘harness the power of research and innovation to accelerate health improvements and health equity to overcome health disparities worldwide’ • This in a world where most of the $160 billion spent annually on health research addresses primarily the needs of rich countries • Health is a public good - yet the Global Burden of Disease Report Update 2004 shows persistent huge disparities in mortality and morbidity between HIC and LIC, MIC • Huge inequities also exist within countries between rich and poor, urban and rural, educated and uneducated; with women, mothers and children often disproportionately affected • Often these inequities are growing rather than shrinking

4. '10/90 Gap' US$ bn 140 120 125.8 160 100 105.9 7.0bn/yr 10.0bn/yr 80 84.9 4.9 bn/yr 60 55.8 4.3 bn/yr 40 30 20 0 1986 1992 1998 2001 2003 US$ 1.6 bn (5%) for LMIC health needs Monitoring Financial Flows for Health Research 2006 Global Forum for Health Research, Geneva Global Health Research Expenditure 45% Public 48% Private For profit 7% Not for profit 2006

5. A Paradigm Shift to ‘Research for Health’ • Over the past 10 years GFHR and other actors have sought to shift research priorities to address health problems of poor people – with some success (PDPs, global funds for health product procurement, and to stimulate product development) • This Forum however has developed the argument further into a paradigm shift from health research to ‘Research for Health’ • This is partly due to a growing realization of the intersectoral nature of heath – that most of the determinants of health lie outside the health sector (Commission on the Social determinants of Health, 2008). • ‘Improving health outcomes therefore requires engagement across many sectors and disciplines. It is research that seeks to understand the impact on health of policies, programmes, processes, actions or events originating in any sector’. • Research for health is also multidisciplinary, multi-institutional and often participatory. • The private sector and civil society often need to be involved.

6. Health sector Other sectors Research system Health research system Innovation system National Global

7. What is Health? What is Research for Health? ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.’ WHO Constitution 1948 The spectrum of research for health for development Biological, economic, environmental, political andsocialdeterminantsof health Biomedical research Health policy and systems research Social sciences and behavioural research Operational research

8. Increased Investment in Research for Health • Research for Health will not happen unless it is funded • The first WHO Ministerial Summit on Health Research in Mexico City in 2004 made the case for increased investment in health systems research; and repeated the call, endorsed by WHO, and the African Health Ministers of the African Union; for investment of the equivalent of 2% of the national health budget on health research • Such investments would need to be closely monitored in order to ensure that they are wisely used in addressing national health priorities • In addition donors were exhorted to commit at least 5% of their health sector funds to health research

9. Making the Case for Research for Health • Policymakers need to be persuaded that health is an investment not an expense. It should be placed on the asset side of the balance sheet, not on the liabilities side • Investing in health not only improves the health status of the nation, and creates a healthy workforce who are more productive. It also directly induces economic growth through mechanisms that are still ill understood • Policy makers should be reminded that Research is central to progress in global health because Health investments alone, particularly in resource constrained environments, fail to deliver benefits unless directed and sustained by health research evidence • This is because health investments are often expensive, and the tradeoffs that are necessary even in rich countries can be grossly wasteful and ineffective unless backed up by robust evidence of efficacy and cost effectiveness. • Foolish and irrational health investments drain valuable investment dollars rands from other needed social investments such as water, housing and social welfare that in themselves can engender health, welfare and economic growth

10. Interministerial Policy Coordination and Intersectoral Collaboration • Interministerial policy coordination will be needed to ensure that wise investments are made in sectors outside the health sector that nevertheless impact upon health • A good start has been made by the attendance at this Forum of not only Ministers of Health, but also Ministers of Research, Science and Technology, and Biotechnology; Ministers of Education; Ministers of Social Services, Ministers of Food and Agriculture, Environment Ministers; as well as Pharmacists, Statisticians etc • Countries will need to ensure that all these policymakers and technocrats, in sectors that impinge upon health; continue the dialogue once they return home; and coordinate their efforts in programmes that affect health • This will mean the inclusion of a health dimension in all policies, not just those of the health sector

11. Interministerial Policy Coordination and Intersectoral Collaboration • This will require both interministerial policy coordination as well as intersectoral collaborations • Possible models include Cabinet level Sociql qnd Heqlth clusters such as exist in South Africa; and the National AIDS Councils that mobilized and coordinated activities across all sectors of society in the fight against HIV/AIDS • The various and relevant sectors will need to collaborate in implementing : * The WHO Strategy on Research for Health * The Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property * The report of the WHO Commission on Social Determinants for Health * The work of the high level Task Force on scaling-up research to strengthen health systems

12. Interministerial Policy Coordination and Intersectoral Collaboration • There will need to be dramatically expanded efforts in capacity building in research for health; and national health research systems, and regulatory systems will need to be established for medicines, ICT systems etc • Regional and global networks of health research institutions need to be set up to facilitate capacity building; and enable sharing of best practices; and establishment of common data sets in indicators of health and social determinants • Systems will need to be set up to ensure standards, ethical practice, transparency, and accountability in research for health • Stakeholders will need to ensure reliable health information and other data is used in a free and unrestricted fashion; utilizing the best and most appropriate information and communication technologies

13. Fragmentation in international effort ….

14. Interministerial Policy Coordination and Intersectoral Collaboration • Innovation and intellectual property management must ensure that social and technological innovations are used • Public private partnerships and innovative financing mechanisms such as prizes and advanced market commitments should be fostered in order to ensure health products and medical devices are developed despite ‘market failure’ • Research and development should take place in LIC and MIC as well as in HIC • Stakeholders will need to promote translation of research into evidence that can inform policy, practice and health behavior • Monitoring and evaluation of progress made in the impact of research and innovation on health is vital • Health system observatories will help countries to assess health system performance

16. Building a healthy nation through research http://www.mrc.ac.za