Latin America faces hurdles in health research

Abstract

Latin American countries face many obstacles to ramping up their capacity for health research, including lack of funds, human resources, and ill-defined goals. Anastasia Moloney reports. A recent drive by the Colombian Government to promote post-graduate degrees in a bid to boost research in health and increase the numbers of trained scientists in the country has thrown into the spotlight the overall poor state of health research in Latin America and the challenges the region faces. With few postgraduate degrees and scholarships on offer, only 1·8 in 1 000 000 Colombians graduate from university every year with a doctorate compared with 50 per 1 000 000 people in Brazil. The government initiative aims to increase the number of post-graduate students in Colombia by 3000 over the next decade, particularly in the social sciences, by offering over 500 more scholarships a year. The case of Colombia illustrates some of the common challenges in health research facing most countries in the region, including a lack of government funding for research, ill-defined health research priorities, and problems retaining researchers. Over the decades, health research in Latin America has been traditionally underfunded and has not been a health reform priority. Few countries in Latin America manage to spend at least 1% of the country's gross domestic product (GDP) on research for health. Peru and Ecuador fall markedly short of the regional average (0·54% of GDP), investing just 0·10% of their country's GDP on health research. Across Latin America, there are huge disparities in development. Around 16% of Chile's population lives in poverty, while in Haiti this figure rises to 60%. Such variations account for the vast differences governments in the region allocate to health research and the priority it is given. In Latin America, research in health is concentrated in a handful of countries and in the region's largest economies—Mexico, Chile, Brazil, and Argentina—which account for roughly no more than 2% of the world's production. These countries contribute around 90% of the total investment in research and development in the region. Over the past decade, Brazil, Mexico, Chile, and to a lesser extent Argentina, have increased their investment in health research. These countries are near to spending the recommended 2% of the national public health budget on research and allocating 5% of international aid for the health sector on research and strengthening research infrastructure, as recommended by the Commission on Health Research for Development in 1990. Most of the region's renowned centres of excellence are also found in Latin America's leading economies. Brazil's Oswaldo Cruz Institute is esteemed for its research on infectious diseases, while the country's Ludwig Institute for Cancer Research is involved in the Human Cancer Genome project. Mexico's research institutes are known for their long standing experience in the areas of cardiovascular diseases, cancer, nutrition, paediatrics, and respiratory diseases. Earlier this month, Chile, acclaimed for its research in nutrition, opened five new science and technology centres of excellence as part of the government's push to boost research and development. Brazil has arguably the most dynamic health research sector in the region, especially in the fields of public health, biotechnology, and pharmacy, backed by a defined government policy on science and technology and clear health research priorities. During the past decade, steps have been taken to improve the state of health research in Latin America. Across the region, there is growing interest and debate in promoting research in health and developing systems for health research, as part of achieving the Millennium Development Goals (MDGs). The current focus on reducing poverty, child and maternal mortality, and combating HIV/AIDS, malaria, and other diseases, as set out in the MDGs, has given impetus to improving health care provision and investment. In turn, this has prompted some regional policy makers to look at how health research and local scientists can play a pivotal part in meeting these goals. But reaching the MDGs remains “an ambitious target”, and “many countries have not yet taken steps towards research for health that will advance them to meeting the goals by 2015”, concluded a report from the Global Ministerial Forum on Research for Health in Bamako, Mali, last year. The report adds: “Faced with the financial crisis on top of the other challenges, many participants commented that innovation and collaboration would probably offer the best hope for solutions”. There is a growing consensus, though, that health research can provide solutions to the region's health problems, offer better health services to the poor, and help reduce the gap between rich and poor. Furthermore, the idea that health research goes beyond seeking solutions to diseases but plays a crucial part in driving a country's economic and social development is gaining ground in Latin America. Perhaps this has been the most important trend in changing attitudes to health research in the region during the past decade. The premise that health research can drive development has been embraced be some regional governments, notably Chile, Mexico, and Brazil, and is beginning to shape, albeit tentatively, the public health policy agenda. These countries also boost the region's most developed and sophisticated health research systems. According to the Council on Health Research for Development (CORED), Argentina, Costa Rica, Chile, Mexico, and Brazil stand out as having the most integrated systems for health research in Latin America. This policy framework includes a clear figurehead who drives health research (usually a health ministry official), separate allocation of funding and resources for health research, defined health research priorities based on local needs, and established partnerships with the science and technology sectors. Venezuela, Panama, and Colombia have “semi-structured” health research systems, while Bolivia, Honduras, Paraguay, and Uruguay are “developing” their frameworks, notes CORED. Research in Latin America has traditionally focused on the region's three neglected diseases: malaria, leishmaniasis, and Chagas disease. Latin America has produced medical milestones, from the discovery of Chagas disease by Brazilian scientist Carlos Chagas in 1901, to Cuba developing the first meningitis B vaccine, and Chile leading the development of the copper intrauterine contraceptive device. But over the decades, research has been less common in non-communicable diseases, such as diabetes, obesity, and cardiovascular diseases, which are increasingly killing more people in Latin America. Other gaps in health research remain, and there are few comparative regional studies. Challenges common to the region such as ageing and high levels of drug-related and criminal violence, mental health issues brought on by war, post-conflict trauma and youth violence, occupational health, and sexual and reproductive health have so far received little attention from researchers. Also, research focusing on the new challenges facing Latin America, such as the health effects of urbanisation, climate change, and environmental health is still incipient. Perhaps more importantly, little research has been done on how these new challenges are affecting the region's poor and its Indigenous groups. Latin America's health research agenda, like it is in Africa, is still largely dictated by foreign donors and sponsors who tend to channel funds to find drugs for diseases more common in Europe and the USA, such as cancer. Such dependence on outside funding makes it difficult for Latin American countries to influence the health research agenda and get funding to focus on regional priorities, such as Chagas disease and dengue. During the past two decades, there has been a five-fold increase in expenditure for health research and development, reaching US$160 billion in 2005. But as Stephen Matlin, executive director of the Global Forum for Health Research, noted during the 2008 Global Ministerial Forum on Research for Health in Bamako: “97% of this comes from high-income countries and most of it ($155·2 billion) is spent by high-income countries on products and services tailored to their own health-care markets.” Faced with dwindling funds for research in health, researchers in Latin America are focusing on strengthening communication between researchers and policy makers, and forming research partnerships in and outside the region. Another constant challenge for research institutes and universities across Latin America is to secure funding at a time of a global downturn, train researchers, and improve general research infrastructure and equipment, and retain senior researchers. “Overall, funding for research from government funds has generally decreased in most countries, partly because of the global economic slow-down”, said Emma Fernàndez-Repollet vice president of research and technology at the University of Puerto Rico. “Research from private sources, such as pharmaceutical companies has also decreased.” Despite funding issues, there is growing optimism that research for health will become a more urgent priority among Latin American governments ahead of the MDGs in 2015, while integrated systems for health research already established by some countries in the region will help boost the amount and quality of health research produced in Latin America. Department of ErrorMoloney A. Latin America faces hurdles in health research. Lancet 2009; 374: 1053–54—In this World Report, the abbreviation for the Council on Health Research for Development (p 1054) should have been “COHRED”. Full-Text PDF