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Global spending on health research still skewed towards wealthy nations
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     Despite the tripling of the global spend on health research over the past decade, most research and development spending is still done by, for, and in countries with high income, a new report from the Global Forum for Health Research has found.

    The world’s annual spend on health research rose from $30bn (?6bn; €24bn) to almost $106bn between 1990 and 2001, says the report Monitoring Financial Flows for Health Research, published this week.

    Almost half the money came from the commercial sector, but the public sector contributed 44%, a sizeable chunk of which comes from the US National Institutes of Health (NIH), where the budget soared from $11.9bn in 1996 to $23.3bn in 2003.

    New substantial private, not for profit sources of funding, such as foundations and charities, have also played their part to the tune of 8%, says the report. The Bill and Melinda Gates Foundation, which was created in 2000, has donated $1bn to health projects.

    The biggest commercial players are still multinational pharmaceutical companies. But the report highlights the explosion in genomics and biotechnology research, both of which could widen global health inequities despite the undoubted potential for improving health. And research and development continues to be dominated by just a few countries, with the United States accounting for 49% of the total spend, followed by Japan at 13% and the United Kingdom at 7%.

    Most of the research often fails to consider the most pressing health issues in poorer countries or offers solutions that are too costly or that depend on developed infrastructures, says the report. "A distinctive research agenda" was needed to understand how culture, levels of development, and lifestyle influenced health in poorer countries, said executive director of the Global Forum on Health Research, Stephen Matlin.

    Professor Matlin welcomed the increased spend as evidence of the commitment to tackling global health challenges, but said that dividing the world into two halves, with the burden of infectious disease in developing countries and non-communicable disease in the developed world was now "outmoded."

    And the 32 new diseases that have surfaced since 1970, including severe acute respiratory syndrome (SARS) and HIV/AIDS, plus the escalating costs of drug development, challenged research priorities, he said.

    New approaches were needed, Professor Matlin suggested, including more public and private partnerships and possibly reform of intellectual property rights. "We need a new model for public health for the 21st century, which acknowledges disease prevention and health promotion rather than the biomedical model of a drug for everything, to enable people to be healthier for longer," he said.

    The next steps will be discussed at the annual meeting of the Global Forum, in Mexico City in mid-November. The meeting will be linked to the Ministerial Summit on Health Research, organised by the World Health Organization and the Mexican government.(London Caroline White)