Mexico summit calls for greater commitment to health research
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《英国医生杂志》
Governments should fund the necessary health research to ensure vibrant health systems and to reduce inequity and social injustice, health ministers urged at the conclusion of the summit on health research held in Mexico last week.
No specific level of funding was agreed, despite an initial suggestion that governments in developing countries might invest 2% of national health expenditure in research and capacity building and that development agencies could earmark at least 5% of their financing of the health sector for the same purpose, proposals first made by the international Commission on Health Research for Development in 1990.
Fifty eight ministries of health were represented, half by ministers, at the four day summit, which was designed to build momentum for a global initiative to strengthen health systems through research and in the process to help achieve the United Nations' millennium development goals.
A 10 point call for action was agreed by the ministerial representatives. The annual meeting of the Global Forum for Health Research, held in parallel, also issued a statement calling for research to be used to improve equity in global health.
Dr Julio Frenk, Mexico's minister of health and the summit's host, described the event as a landmark gathering. "The mere fact that this is the largest ever gathering of ministers of health is a triumph," he said.
"We have shown we can meet round a table with the producers, translators, implementers, and users of research, which is a key force in health improvement. This gathering is a powerful signal that we believe in the value of research.
"Several interesting messages came out. First, the need for a comprehensive approach to health research, which moved away from the divisive discussions at previous meetings that tended to pitch biomedical research against pubic health and social science research. This was very positive.
"Second, we recognised that the most neglected area has been health systems, and we need to concentrate on that. We need better solutions to meet the needs of all people throughout the world. We also need to make existing health system solutions available to all.
Dr Julio Frenk, Mexico's minister of health, told the summit: "We have better informed the demanders of research—in other words, the ministers of health. The challenge is to make sure the interaction between demanders and suppliers of research works."
Credit: WHO
"Third, we went over the supply side solutions comprehensively, but what is new is that we focused on the demand side of the equation. Before now we have had a push strategy with knowledge, and we have now started discussing pull strategies. At this summit we have better informed the demanders of research—in other words, the ministers of health.
"The challenge is to make sure the interaction between demanders and suppliers of research works. This does not occur spontaneously, and you need mechanisms to make this happen. For example, we need to embed research, by training a new kind of professional, knowledgeable enough about research to act as a translator of research in local settings."
The call for action places the onus on national governments to strengthen health systems research and includes establishment and implementation of national research policies, support of evidence based policy making, and increased collaboration among governments, funders, the international community, and WHO.
The summit also called for the creation of a mechanism for linking international registers of clinical trials to ensure a single point of access and the unambiguous identification of trials, and it recognised that research results must be published, documented in internationally accessible registers and archives, and synthesised through systematic reviews.
Dr Lee Jong-wook, WHO's director general, said, "Globally we have surpassed $100bn annually in health research spending. Despite this absolute increase we are still not much further ahead in reducing the 10:90 gap .
"On a national level, I am encouraged that four countries have met the 1990 recommendation of the Council on Health Research for Development of spending 2% of health budget on research. Our host country's achievement in this regard is seen in the many health achievements and the thriving culture of evidence and research."
Some delegates, however, expressed concern that the ministerial call for action was short on concrete steps. Dr Tim Evans, head of WHO's Evidence and Information for Policy Department and responsible for the initiative, acknowledged this concern and warned against complacency ahead of the next ministerial summit, planned for 2008.
"We have to be accountable and develop some specific criteria about how we will know if we have been successful by 2008," he said. "We have to be tough on ourselves—these agendas are urgent—and we need to commit ourselves to efforts to translate these well intentioned words into specific actions."
The joint summit and forum were the culmination of lengthy preparation and included regional meetings. "Mexico is part of a process that now spans at least 14 years," said Dr Frenk.
"It started with the landmark report in 1990 in Stockholm that spawned a number of valuable initiatives and increased the awareness of the importance of research and development. The next milestone was Bangkok in 2000. Mexico brings all that activity to a new height, which bodes well for further development of the process and for more funding of research."
The call for action will be further refined and presented to the next executive board meeting of WHO and then put forward for agreement at next year's World Health Assembly. (See p 1249.)(Kamran Abbasi)
No specific level of funding was agreed, despite an initial suggestion that governments in developing countries might invest 2% of national health expenditure in research and capacity building and that development agencies could earmark at least 5% of their financing of the health sector for the same purpose, proposals first made by the international Commission on Health Research for Development in 1990.
Fifty eight ministries of health were represented, half by ministers, at the four day summit, which was designed to build momentum for a global initiative to strengthen health systems through research and in the process to help achieve the United Nations' millennium development goals.
A 10 point call for action was agreed by the ministerial representatives. The annual meeting of the Global Forum for Health Research, held in parallel, also issued a statement calling for research to be used to improve equity in global health.
Dr Julio Frenk, Mexico's minister of health and the summit's host, described the event as a landmark gathering. "The mere fact that this is the largest ever gathering of ministers of health is a triumph," he said.
"We have shown we can meet round a table with the producers, translators, implementers, and users of research, which is a key force in health improvement. This gathering is a powerful signal that we believe in the value of research.
"Several interesting messages came out. First, the need for a comprehensive approach to health research, which moved away from the divisive discussions at previous meetings that tended to pitch biomedical research against pubic health and social science research. This was very positive.
"Second, we recognised that the most neglected area has been health systems, and we need to concentrate on that. We need better solutions to meet the needs of all people throughout the world. We also need to make existing health system solutions available to all.
Dr Julio Frenk, Mexico's minister of health, told the summit: "We have better informed the demanders of research—in other words, the ministers of health. The challenge is to make sure the interaction between demanders and suppliers of research works."
Credit: WHO
"Third, we went over the supply side solutions comprehensively, but what is new is that we focused on the demand side of the equation. Before now we have had a push strategy with knowledge, and we have now started discussing pull strategies. At this summit we have better informed the demanders of research—in other words, the ministers of health.
"The challenge is to make sure the interaction between demanders and suppliers of research works. This does not occur spontaneously, and you need mechanisms to make this happen. For example, we need to embed research, by training a new kind of professional, knowledgeable enough about research to act as a translator of research in local settings."
The call for action places the onus on national governments to strengthen health systems research and includes establishment and implementation of national research policies, support of evidence based policy making, and increased collaboration among governments, funders, the international community, and WHO.
The summit also called for the creation of a mechanism for linking international registers of clinical trials to ensure a single point of access and the unambiguous identification of trials, and it recognised that research results must be published, documented in internationally accessible registers and archives, and synthesised through systematic reviews.
Dr Lee Jong-wook, WHO's director general, said, "Globally we have surpassed $100bn annually in health research spending. Despite this absolute increase we are still not much further ahead in reducing the 10:90 gap .
"On a national level, I am encouraged that four countries have met the 1990 recommendation of the Council on Health Research for Development of spending 2% of health budget on research. Our host country's achievement in this regard is seen in the many health achievements and the thriving culture of evidence and research."
Some delegates, however, expressed concern that the ministerial call for action was short on concrete steps. Dr Tim Evans, head of WHO's Evidence and Information for Policy Department and responsible for the initiative, acknowledged this concern and warned against complacency ahead of the next ministerial summit, planned for 2008.
"We have to be accountable and develop some specific criteria about how we will know if we have been successful by 2008," he said. "We have to be tough on ourselves—these agendas are urgent—and we need to commit ourselves to efforts to translate these well intentioned words into specific actions."
The joint summit and forum were the culmination of lengthy preparation and included regional meetings. "Mexico is part of a process that now spans at least 14 years," said Dr Frenk.
"It started with the landmark report in 1990 in Stockholm that spawned a number of valuable initiatives and increased the awareness of the importance of research and development. The next milestone was Bangkok in 2000. Mexico brings all that activity to a new height, which bodes well for further development of the process and for more funding of research."
The call for action will be further refined and presented to the next executive board meeting of WHO and then put forward for agreement at next year's World Health Assembly. (See p 1249.)(Kamran Abbasi)