This report presents findings of a European-Africa consultation on the research agenda for non-communicable diseases. The workshop found that research in Africa can draw from different environmental and genetic characteristics to understand the causes of non-communicable diseases, while economic and social factors are important in developing relevant strategies for prevention and treatment. The suggested research needs include better methods for description and recording, clinical studies, understanding cultural impacts, prevention strategies, and the integrated organisation of care. Specific fields proposed for research are listed in the report. Although the European Union Seventh Framework Research Programme prioritises biomedical and clinical research, it recommends that research for Africa should also address broader social and cultural research and intervention research for greatest impact. Research policy leaders in Africa must engage national governments and international agencies as well as service providers and research communities. None can act effectively alone.
Monitoring equity and research policy
The Bill & Melinda Gates Foundation has announced 78 grants of US$100,000 each in the latest round of Grand Challenges Explorations. Grants have been awarded for the development of a low-cost cell phone microscope to diagnose malaria, the study of the strategic placement of insect-eating plants to reduce insect-borne diseases, and the investigation of nanoparticles to release vaccines when they come in contact with human sweat. The grants support research across 18 countries and six continents. This year’s European grantees are based at universities, research institutes and non-profit organisations. The winners represent groups in Germany, Sweden, Norway and the United Kingdom. Some examples of the projects funded in this round include more effective vaccines, a 'seek-and-destroy' laser vaccine, treating worm infections to improve vaccine effectiveness and new strategies to fight malaria, such as insecticide-treated traditional scarves, using carnivorous plants to control mosquitoes and using cell phone microscope to diagnose malaria. Solutions to promote family health include using ultrasound as a reversible male contraceptive and the use of vitamin A probiotics to combat diarrhoea.
In some areas of the world, one in four people with tuberculosis (TB) becomes ill with a form of the disease that can no longer be treated with standard drugs regimens, according to this report. It estimates that, worldwide, 440,000 people had multi-drug resistant tuberculosis (MDR-TB) worldwide in 2008 and that a third of them died. Of those patients receiving treatment, 60% were reported as cured, yet only an estimated 7% of all MDR-TB patients are diagnosed. These figures point to the urgent need for improvements in laboratory facilities, access to rapid diagnosis and treatment with more effective drugs and regimens shorter than the current two years. In Africa, there is a low percentage of MDR-TB reported among new TB cases, compared with regions such as Eastern Europe and Central Asia, due in part to the limited laboratory capacity to conduct drug resistance surveys. Latest estimates of WHO put the number of MDR-TB cases emerging in 2008 in Africa at 69,000. Previous reports found high levels of mortality among Africans living with HIV and infected with MDR-TB and extensively drug-resistant TB (XDR-TB).
Since 1990, the World Health Organization has used the disability-adjusted life year (DALY) statistic to quantify the burden of diseases. This indicator quantifies both morbidity and mortality due to diseases. This article notes that estimating DALYs is intrinsically problematic since, for some conditions, only limited data is available. For several tropical diseases, especially those affecting people in the poorest countries, it has been argued that DALYs are systematically underestimated. Because it is considered economically unprofitable, virtually no new drugs are being developed for this group of conditions. Being underestimated and lacking targeted drug development programmes, these conditions have been termed neglected tropical diseases (NTDs). Although there may be room for improvement in the calculation of DALYs related to NTDs, the article acknowledges that governments and policy makers use them to determine priorities in prevention and health care and therefore they cannot be ignored. It argues that research efforts targeted at a disease should ideally be in proportion to its global health impact. It considers that NTDs may be neglected twice: once by being attributed an underestimated DALY and again by limited scientific attention.
This article critiques the limitations of gross domestic product (GDP) as a measurement of a nation's success – do individuals living in countries with a high GDP really have a better life than those who don't? It discusses the work of the Stiglitz-Sen-Fitoussi Commission in attempting to find a set of indicators that better represent individuals’ circumstances today, recommending that every country should also apply other indicators to capture what is happening economically, socially and environmentally. Most criticisms of GDP fall into two distinct camps: some maintain that GDP itself needs to be fixed, while others seek to recast the criticism of GDP from an accounting debate to a philosophical one, as our reliance on such a measure suggests that we may still be equating economic growth with progress on a planet that is already overburdened by human consumption and pollution. One measure has succeeded in challenging the hegemony of growth-centric thinking – the Human Development Index (HDI), which turns 20 this year and is still used by the United Nations. The HDI incorporates a nation’s GDP and two other modifying factors: its citizens’ education, based on adult literacy and school-enrolment data, and its citizens’ health, based on life-expectancy statistics. But the HDI has plenty of critics. For example, a slight drop in literacy rates can have a disproportionate effect on a nation's HDI ranking. As a result, researchers are continuing their search for a set of indicators that will reliably measure progress for all nations.
This strategy document acknowledges that research is central to economic development and global health security and recognises that, in order to be effective, research has to be multidisciplinary and intersectoral in nature. In the face of current and emerging health threats – such as those posed by pandemics, chronic diseases, food insecurity, the impact on health of climate change, and fragile health systems – the document affirms that the Secretariat, member states and World Health Organization (WHO) partners have a joint responsibility to ensure that research and evidence help to achieve health-related development goals and improve health outcomes. It recommends an approach that involves all government departments so that health is reflected in all government policies. It identifies five interrelated goals that will help realise the draft strategy’s vision: the strengthening of research culture across WHO; the reinforcement of research that responds to priority health needs; improving capacity to strengthen national health research systems; the promotion of good practice in research, drawing on WHO’s core function of setting norms and standards; and strengthening of links between the policy, practice and products of research.
The World Health Statistics series is the World Health Organization's annual compilation of health-related data for its 193 member states, and includes a summary of the progress made towards achieving the health-related Millennium Development Goals (MDGs) and associated targets. As with previous versions, World Health Statistics 2010 has been compiled using publications and databases produced and maintained by the technical programmes and regional offices of WHO. Indicators have been included on the basis of their relevance to global public health; the availability and quality of the data; and the reliability and comparability of the resulting estimates. Taken together, these indicators provide a comprehensive summary of the current status of national health and health systems in the following nine areas: mortality and burden of disease; cause-specific mortality and morbidity; selected infectious diseases; health service coverage; risk factors; health workforce, infrastructure and essential medicines; health expenditure; health inequities; and demographic and socioeconomic statistics. With only five years remaining to 2015, the report notes that there are signs of progress in many countries in achieving the health-related MDGs. In other countries, progress has been limited because of conflict, poor governance, economic or humanitarian crises, and lack of resources. The effects of the global food, energy, financial and economic crises on health are still unfolding, and action is needed to protect the health spending of governments and external funders alike.
This article begins by acknowledging that numerous obstacles exist to improving on current development assistance indices, including: attribution across multiple donors, long time lags between aid and results with unknown lag times, the micro-macro paradox (where donor projects are deemed successful but results are not translated to macro indicators) and difficulties in aggregating across different components of 'development' such as poverty reduction, service delivery and economic growth. The article puts forward a model for measuring quality of development assistance and recommends benchmarking against specific quality indicators, based on literature, with a focus on aid processes not outcomes. It states that the index should require that large number of donors are compared to establish the 'best in class'. Quantitative indices and indices that measure change over time should also be developed and linked to changes in management decisions in aid agencies. Four indices are proposed to measure different aspects of aid effectiveness: maximising impact; reducing burden; foster institutions; and transparency.
The Commitment to Development Index (CDI) rates 22 rich countries on how much they help poor countries build prosperity, good government, and security. Each rich country gets scores in seven policy areas, which are averaged for an overall score. The policy areas include foreign aid, commerce, migration, the environment and military affairs. This website provides an interactive resource for determining scores. You can browse the charts by clicking bars, country names and policy components and explore the data maps to see results in another way. In 2009, Sweden, Denmark, the Netherlands, Norway and New Zealand ranked highest, while South Korea, Japan, Switzerland and Greece ranked lowest.
This study presents the Corrected Sibling Survival (CSS) method, which addresses both the survival and recall biases that have plagued the use of survey data to estimate adult mortality. It applies the method to generate estimates of and trends in adult mortality for 44 countries with District Health Survey sibling survival data. Findings suggest that levels of adult mortality prevailing in many developing countries are substantially higher than previously suggested by other analyses of sibling history data. Generally, estimates here show the risk of adult death between the ages of 15 and 60 to be about 20–35% for females and 25–45% for males in sub-Saharan African populations largely unaffected by HIV. In southern African countries, where the HIV epidemic has been most pronounced, as many as eight out of ten men alive at the age of fifteen will be dead by age 60, as will six out of ten women. The results of this study represent an expansion of direct knowledge of levels and trends in adult mortality in the developing world. The study recommends that governments use the CSS method for more accurate tracking of adult mortality rates.