The contemporary public health effort sees much debate about the concepts of “evidence” and “the evidence base”, and the usefulness and relevance of such terms to both policymaking and practice. A key challenge to public health is to better contextualize evidence for more effective policymaking and practice. Theory on the translation of research findings into policy and practice, and on knowledge utilization, offers only part of the solution to this complex task. The policymaking context is highly political and rapidly changing, and depends on a variety of factors, inputs, and relationships.
Monitoring equity and research policy
To achieve universal access to HIV prevention and treatment, the scientific and public health community must respond quickly to developments on the ground to narrow the gap between discovery and intervention. Dr Charlie Gilks, head of treatment, prevention and scale up at the World Health Organization's (WHO) HIV/AIDS Department, stressed the need to "learn by doing" at the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment, a biennial scientific meeting, in Rio de Jeneiro, Brazil. Gilks emphasized the importance of research on HIV prevention in addition to more effective ways to deliver treatment. "While we work to keep people alive and healthy with the tools we have now, we also need to ensure that future generations will have access to better prevention technologies," said Gilks, referring to the importance of vaccine and microbicide research.
The first report published by the Global Forum on an annual meeting, Health Research for the Millennium Development Goals, summarizes the main themes of Forum 8 from plenary presentations and includes a CD-ROM with all the presentations, media and final documentation of the meeting. The report clearly demonstrates that a great deal is known about the kinds of research that are urgently required to accelerate and intensify the efforts necessary to achieve the Millennium Development Goals (MDGs). The Global Forum for Health Research is an independent international foundation based in Geneva. The report and CD-ROM can be ordered or downloaded from the organization's website: http://www.globalforumhealth.org
This second Global Forum assessment responds to widespread interest on the part of those who fund research, manage and set priorities in different institutions and use our results to try to improve the health of populations around the world. The study presents a new estimate of global spending on health R&D for 2001 but also exposes major gaps in the availability of good quality data from all sectors, disease-specific information and the measure of complex determinants such as poverty, inequity, and gender.
Health policy and systems research (HPSR) is an international public good with potential to orient investments and performance at national level. Identifying research trends and priorities at international level is therefore important. This paper offers a conceptual framework and defines the HPSR portfolio as a set of research projects under implementation. The research portfolio is influenced by factors external to the research system as well as internal to it. These last include the capacity of research institutions, the momentum of research programs, funding opportunities and the influence of stakeholder priorities and public opinion. These dimensions can vary in their degree of coordination, leading to a complementary or a fragmented research portfolio.
Many countries in Africa are planning to provide highly active antiretroviral therapy (HAART) to millions of people with acquired immune deficiency syndrome. This will be a highly complex therapy programme. Physician-based models of care adapted from industrialized countries will not succeed in providing treatment to the majority of those who need it in resource-constrained settings. Many current ART support programmes are making little or no investment in research, but answering important questions on delivery of HAART will be essential if HAART programmes are to be successful in African nations with a high burden of human immunodeficiency virus infection.
Biomedical science and technology are developing at a more rapid pace than ever. Investments in health research and development (R&D) have never been higher—global spending on health research increased from US$30 billion in 1990 to US$105.9 billion in 2001. But despite advances in technology and unparalleled research spending, the medical needs of many of the world's population go unmet. For example, only 1% of new drugs approved between 1975 and 1999 were specifically developed for tropical diseases and tuberculosis—diseases that account for over 10% of the global disease burden. There is a growing demand from many quarters for a new international policy framework. A new international treaty on essential health R&D could provide a binding framework to redirect today's knowledge and scientific expertise to priority health needs. The treaty could help to cement new political commitments and coordinate complementary partnerships aimed at generating and rewarding health innovation as a global public good. This is according to a paper produced by the The Neglected Diseases Group.
Global health research is essential for development. A major issue is the inequitable distribution of research efforts and funds directed towards populations suffering the world's greatest health problems. This imbalance is fostering major attempts at redirecting research to the health problems of low and middle income countries. This article concludes that there is a need to more effectively include NGOs in all aspects of health research in order to maximize the potential benefits of research. NGOs, moreover, can and should play an instrumental role in coalitions for global health research.
"Research is a widely applied instrument for harnessing knowledge and providing insight into complex development issues. It helps in generating options for policy, management and action, and in empowering people and organizations in developing and transition countries, as well as industrialised countries. Ultimately this should make it easier to cope with the challenges of sustainable development under increasingly difficult circumstances. Research for development is therefore frequently placed in an application oriented context, in which concepts like inter and transdisciplinary research, equity, ownership, participation, etc. are widely accepted, but are not always put into practice. Research partnerships of various types and intensities, involving research institutions in industrialised and developing or transition countries, are important means for contributing to knowledge generation and capacity building."
"While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers. Recognizing the importance of theory calls for new expectations in the practice of health services research. These include: the formation of interdisciplinary research teams; broadening the training for those who will practice health services research; and supportive organizational conditions that promote collaboration between researchers and decision makers. Further, funding bodies can provide a significant role in guiding and supporting the use of theory in the practice of health services research."