Exploring the ethics of global health research priority-setting

Bridget Pratt,Mark Sheehan,Nicola Barsdorf,Adnan A Hyder

doi:10.1186/s12910-018-0333-y

Abstract

BackgroundThus far, little work in bioethics has specifically focused on global health research priority-setting. Yet features of global health research priority-setting raise ethical considerations and concerns related to health justice. For example, such processes are often exclusively disease-driven, meaning they rely heavily on burden of disease considerations. They, therefore, tend to undervalue non-biomedical research topics, which have been identified as essential to helping reduce health disparities. In recognition of these ethical concerns and the limited scholarship and dialogue addressing them, we convened an international workshop in September 2015. The workshop aimed to initiate discussion on the appropriate relationship between global and national levels of health research priority-setting and to begin exploring what might be ethically required for priority-setting at each of those levels.Main textThis paper comprises our reflections following the workshop. Its main objective is to launch a research agenda for the ethics of global health research priority-setting. We identify three domains of global health research priority-setting—scope, underlying values and substantive requirements, and procedural considerations. For each domain, specific research questions are highlighted and why they need to be explored is explained. Some preliminary thoughts and normative arguments as to how the research questions might be answered are also offered. For example, we provide initial ideas about the appropriate relationship between different priority-setting levels and what values and substantive considerations should guide or underpin global health research priority-setting as a matter of justice.ConclusionWe anticipate that framing a new research agenda for the ethics of global health research priority-setting will spur ethicists, researchers, and policymakers to refocus their efforts on developing more rigorous and ethically sound approaches to priority-setting.

Highlights

This paper comprises our reflections following the workshop
A workshop speaker noted that empirical evidence shows nearly half of health research priority-setting processes in Low and Middle-Income Country (LMIC) are initiated by international organisations, with only a third initiated by LMIC governments and an even lower proportion (15%) commenced by LMIC researchers [25]
The ethical issues involved in setting global health research priorities are complex and under-researched

Summary

Main text

Scope In any discussion about the ethics of global health research priority-setting, the scope of the priorities to be set must first be clarified. The actors or institutions who assume or are given the responsibility to undertake a global health research priority-setting exercise gain considerable power, as they make a number of decisions that shape how the priority-setting process is conducted They determine who is included in the process and whether it is structured in a way that promotes different stakeholders having an equal opportunity to participate. Workshop speakers affirmed the potential for community engagement to play a specific and key role in global health research priority-setting—namely, capturing an “evidence of need” to inform the process They proposed community engagement could inform national priority-setting via institutional priority-setting; different research institutions could be responsible for engaging with their surrounding communities, including the disadvantaged within them, and incorporating their “evidence of need” into institutional research priorities. Where robust community engagement has occurred at the institutional level and its outputs are used to inform higher level priority-setting, it may not be necessary as part of national or global processes

Conclusion

Background

Findings

Conclusions