The Commission on Social Determinants for Health has recommended assessment of health equity effects of public policy decisions, and this study provides guidance on assessing equity for users and authors of systematic reviews of interventions. Particular challenges occur in seven components of such reviews: developing a logic model; defining disadvantage and for whom interventions are intended; deciding on appropriate study design(s); identifying outcomes of interest; process evaluation and understanding context; analysing and presenting data; and judging applicability of results. The study concludes that greater focus on health equity in systematic reviews may improve their relevance for both clinical practice and public policy making.
Monitoring equity and research policy
Assessing equity in systematic reviews: Realising the recommendations of the Commission on Social Determinants of Health
Tugwell P, Petticrew M, Kristjansson E, Welch V, Ueffing E and Waters E et al: British Medical Journal 341(c4739), 13 September 2010
Casebook on ethical issues in international health research
Cash R, Wikler D, Saxena A and Capron A (eds): World Health Organization, 2009
This compilation of case studies in research ethics is designed for use by course instructors and workshop leaders. The editors argue that the use of case studies in workshops and formal courses is an especially valuable teaching tool, as students and workshop participants can grapple with ethical dilemmas and uncertainties in concrete situations. The editors have collected 64 case studies, based on episodes that have occurred in global health research throughout the world. Eight chapters comprise the cases un¬der the following titles: Defining research; Issues in study design; Harm and benefit; Voluntary informed consent; Standard of care; Obligations to participants and communities; Privacy and confidential¬ity; and Professional ethics. Each chapter begins with an introduction that outlines the issues and provides some guidance for the topics addressed in the cases, and ends with a brief annotated list of suggested readings. Questions for discussion follow each case. In each chapter there is cross-referencing to cases in other chapters.
Does South Africa need a national clinical trials support unit?
Siegfried N, Volmink J and Dhansay A: South African Medical Journal 100(9): 521–524, August 2010
No national South African institution provides a coherent suite of support, available skills and training for clinicians wishing to conduct randomised controlled trials (RCTs) in the public sector. This study assesses the need for establishing a national South African Clinical Trials Support Unit. Key informant interviews were conducted with senior decision-makers at institutions with a stake in the South African public sector clinical trials research environment. The study found that trial conduct in South Africa faces many challenges, including lack of dedicated funding, the burden on clinical load, and lengthy approval processes. Strengths include the high burden of disease and the prevalence of treatment-naïve patients. Participants expressed a significant need for a national initiative to support and enhance the conduct of public sector RCTs. Research methods training and statistical support were viewed as key. There was a broad range of views regarding the structure and focus of such an initiative, but there was agreement that the national government should provide specific funding for this purpose. In conclusion, stakeholders generally support the establishment of a national clinical trials support initiative. Consideration must be given to the sustainability of such an initiative, in terms of funding, staffing, expected research outputs and permanence of location.
Levels and trends in child mortality, 1990-2009
You D, Jones G, Hill K, Wardlaw T and Chopra M: The Lancet 376(9745): 931–933, 18 September 2010
According to this article, the latest estimates of under-five mortality from the United Nations Inter-agency Group for Child Mortality Estimation (IGME) show a one-third decline at the global level of under-five mortality rates from 89 deaths per 1000 livebirths in 1990 to 60 in 2009. Over the same period, the total number of under-five deaths has decreased from 12.4 million in 1990 to 8.1 million in 2009. The article argues that this constitutes evidence that progress on child mortality is being made across all regions of the world, with many regions having reduced the under-five mortality rate by 50% or more. With only five years left until the 2015 deadline to achieve the Millennium Development Goals (MDGs), progress needs to be accelerated. These IGME estimates are the latest available information on child mortality to provide a basis for assessing progress and reaching consensus for action.
Overview of research activities associated with the World Health Organization: Results of a survey covering 2006/07
Terry RF and Rijt TV: Health Research Policy and Systems 8(25), 6 September 2010
This paper presents the first comprehensive effort to provide an overview of the research associated with the World Health Organization (WHO) headquarters in 2006/07. Information was obtained by questionnaire and interviews with senior staff operating at WHO headquarters in Geneva. The paper found that 45% of WHO permanent staff are involved with health research and the WHO's approach to research is predominantly focused on policy, advocacy, health systems and population based research. The Organization principally undertakes secondary research using published data and commissions others to conduct this work through contracts or research grants. This approach is broadly in line with the stated strategy of the Organization. The researchers note that the difficulty in undertaking this survey highlights the complexity of obtaining an organisation-wide assessment of WHO’s research activity in the absence of common standards for research classification, methods for priority setting and a mechanism across WHO, or within the governance of global health research more generally, for managing a research portfolio. As the rollout of the WHO strategy on research for health proceeds, the researchers expressed hope that similar exercises will be undertaken at the WHO Regional Offices and in support of capacity building of national health research systems within Member States.
Access to Medicine Index 2010
Access to Medicine Foundation: 2010
The Access to Medicine Index independently assesses how individual pharmaceutical companies perform in promoting universal access to essential medicines, and may be used as a tool in improving performance. The 2010 ranking reveals important progress, if only because companies have shown far greater willingness to open up. The Index unveils improvements research and development, and pricing, but also shows that the industry as a whole still has a long way to go, according to Wim Leereveld, the Index's founder. The Access to Medicine Index ranks 20 of the world's largest pharmaceutical companies on their efforts to make sure that medicines are made for, and reach, people in developing countries. The Index encourages drug companies to compete and offers investors and others a way to compare their social responsibility records.
Global Forum for Health Research, Forum 2009: Innovating for the Health of All
Jupp S: MEDICC Review 12(3): 5–7, July 2010
This article discuss the work of the Global Forum, a global body of health decision-makers that focuses on questions of equity, advocating for more research to address the health problems of those most in need – essentially the poor and marginalised –and providing evidence to support greater investments in neglected areas. Since the Forum’s previous conference in 2009, the article notes that a paradigm shift has taken place from ‘health research’ to ‘research for health’. This new approach promotes greater understanding among all stakeholders of the impact on health of policies, programmes, processes, actions or events originating from other sectors. It also is intended to assist in developing interventions that will help prevent or mitigate any adverse impact on health and contribute to the achievement of health equity. While the number of resources, actors and efforts to address the health problems of the poor have grown signifi cantly in recent years, the range of health challenges faced by low- and middle-income countries has expanded considerably, demanding a more extensive research portfolio. Challenges include countries that are not on track to reaching the Millennium Development Goals, rising rates of chronic non-communicable diseases in low- and middle-income countries, urbanisation, demographic shifts, climate change, food security, the threat of pandemics, and the global financial crisis.
Making the web work for scientific research
Science Online London, 16 August 2009
In preparation for the Science Online London 2010 Conference, which will be held from 3-4 September 2010 in London, United Kingdom, this video provides information on how the web is changing the way researchers conduct, communicate, share, and evaluate their work. The video is a panel discussion with Jimmy Watson, Stephen Friend and John Wilbanks, which is moderated by Tim O’Reilly. Some of the topics they talk about will also be discussed at Science Online London, such as new platforms for collaboration, networking and sharing research.
Overcoming barriers to improved research on the social determinants of health
Baum F: MEDICC Review 12(3): 36–38, July 2010
This paper examines the recommendations of the World Health Organization's Commission on the Social Determinants of Health regarding the need for improved research on determinants of health inequity and discusses the following barriers to implementation of those recommendations: the power of the biomedical imagination in health and medical research; emphasis on vertical health programming; ideological biases outweighing evidence in policy decisions; and academic reward systems, including the inherent conservatism of peer review. The paper concludes with suggestions for changing research funding and assessment systems to overcome these barriers, for example by setting the agenda for social determinants research in consultation with researchers, policy actors and, wherever possible, relevant affected communities.
Research for health equity: Knowing is not enough
Editorial: MEDICC Review 12(3): 3, July 2010
In 1990, a report from the Commission on Health Research for Development pointed to the gross imbalance between the magnitude of diseases affecting the world’s poor majority and the meager funds spent on research to fight them. Responding to growing momentum, in 1997 the Global Forum for Health Research was founded to address this skewed research agenda. In the editorial, the editors of MEDICC Review reviews progress made since 1997 in terms of the Global Forum’s agenda. They refer to the contributions of Cuba and other developing nations to the evidence suggesting that only through simultaneous development of technologies and public health strategies can disease be effectively tackled and prevented. In turn, this requires the political will to consciously develop health research capacities and a health research system with lines of investigation well-matched to disease burden and national public health priorities. Since 1997, when lack of financing for biomedical research on diseases of the poor was the main health equity concern, over time the health equity lens has revealed other, more complex dimensions of the factors influencing research priorities and the eventual application of their findings. The editors argue that this requires an approach that moves the debate from issues of biomedical and technological research to introduce tough questions about implementation, bringing in discussion of health systems, social innovation, and ways for equity-guided research to become more influential in policy decisions.