Latin America faces hurdles in health research

Global health research for America's vital interest

With rising health care costs, often health research is viewed as a major cost driver, calling to question the role and value of provincial funding of health research. Most agree that the quality of healthcare provided is directly linked to our ability to conduct quality research; however currently there is little empirical evidence supporting the link between engagement in health research and healthcare performance. In Canada this has resulted in funding for health research that varies over time and between provinces. While medical knowledge is a public good, we hypothesize there are local benefits from health research, such as the attraction of a specialized human capital workforce, which fosters a culture of innovation in clinical practice. To address this question, we look at whether health outcomes are impacted by changes in provincial research funding in Alberta compared to other provinces. Provincial funding for medical research, which varies greatly over time and among provinces, is used as a proxy for medical treatment inputs. Trend rates of reduction in mortality from potentially avoidable causes (MPAC) (comprised of mortality from preventable causes (MPC) and mortality from treatable causes (MTC)), are used as a proxy health outcome measure sensitive to the contributions of technological progress in medical treatment. Our analysis suggests that investment in health research has payback in health outcomes, with greater improvements in the province where the research occurs. The trend declines seen in age standardized MPAC rates in different Canadian provinces may be impacted by shifts in provincial research funding investment, suggesting that knowledge is not transferred without cost between provinces. Up until the mid-1980s, Alberta had the most rapid rate of decline in MPAC compared to the other provinces. This is striking given the large and unique investment in medical research funding in Alberta in the early 1980s through AHFMR, the only provincial health research funding agency at the time. However in recent years, Alberta’s rate of decrease in MPAC has occurred at a rate slower than the other provinces (British Columbia, Ontario or Quebec) with provincial medical research funding. This is striking at a population level, where Alberta’s failure to achieve a reduction in age standardized rates of MTC comparable to British Columbia, Ontario or Quebec after 1985 represents 240 unnecessary deaths in 2011 and 48,250 Potential Life Years Lost worth around $4.8 billion. The findings from our study suggest that some of the divergence in the rates of reduction in MPAC between provinces may be due to beneficial changes in institutional structure and human capital, resulting in differences across provinces in the capacity to adopt new effective healthcare innovations. While health indicators such as MPAC are the result of complex interactions between the patient, treatment and the healthcare system, as well as socioeconomic and demographic factors, this analysis suggests that a different capacity for health research within the provinces impacts health outcomes. The findings from this analysis are limited by the lack of data related to research funding and the health research workforces within provinces. This analysis has important implications for health research policy and funding allocations, suggesting that decision makers should consider the long-term impact provincial funding for health research has on health outcomes. This study also highlights the lack of longitudinal public data available for provincial health research funding. This information is critical to inform future health research policy.

With rising health care costs, often health research is viewed as a major cost driver, calling to question the role and value of provincial funding of health research. Most agree that the quality of healthcare provided is directly linked to our ability to conduct quality research; however currently there is little empirical evidence supporting the link between engagement in health research and healthcare performance. In Canada this has resulted in funding for health research that varies over time and between provinces. While medical knowledge is a public good, we hypothesize there are local benefits from health research, such as the attraction of a specialized human capital workforce, which fosters a culture of innovation in clinical practice. To address this question, we look at whether health outcomes are impacted by changes in provincial research funding in Alberta compared to other provinces. Provincial funding for medical research, which varies greatly over time and among provinces, is used as a proxy for medical treatment inputs. Trend rates of reduction in mortality from potentially avoidable causes (MPAC) (comprised of mortality from preventable causes (MPC) and mortality from treatable causes (MTC)), are used as a proxy health outcome measure sensitive to the contributions of technological progress in medical treatment. Our analysis suggests that investment in health research has payback in health outcomes, with greater improvements in the province where the research occurs. The trend declines seen in age standardized MPAC rates in different Canadian provinces may be impacted by shifts in provincial research funding investment, suggesting that knowledge is not transferred without cost between provinces. Up until the mid-1980s, Alberta had the most rapid rate of decline in MPAC compared to the other provinces. This is striking given the large and unique investment in medical research funding in Alberta in the early 1980s through AHFMR, the only provincial health research funding agency at the time. However in recent years, Alberta’s rate of decrease in MPAC has occurred at a rate slower than the other provinces (British Columbia, Ontario or Quebec) with provincial medical research funding. This is striking at a population level, where Alberta’s failure to achieve a reduction in age standardized rates of MTC comparable to British Columbia, Ontario or Quebec after 1985 represents 240 unnecessary deaths in 2011 and 48,250 Potential Life Years Lost worth around $4.8 billion. The findings from our study suggest that some of the divergence in the rates of reduction in MPAC between provinces may be due to beneficial changes in institutional structure and human capital, resulting in differences across provinces in the capacity to adopt new effective healthcare innovations. While health indicators such as MPAC are the result of complex interactions between the patient, treatment and the healthcare system, as well as socioeconomic and demographic factors, this analysis suggests that a different capacity for health research within the provinces impacts health outcomes. The findings from this analysis are limited by the lack of data related to research funding and the health research workforces within provinces. This analysis has important implications for health research policy and funding allocations, suggesting that decision makers should consider the long-term impact provincial funding for health research has on health outcomes. This study also highlights the lack of longitudinal public data available for provincial health research funding. This information is critical to inform future health research policy.

Increasingly, there is a need for national governments, public-private partnerships, private sector and other funding agencies to set priorities in health research investments in a fair and transparent way. A process of priority setting is always an activity driven by values of wide range of stakeholders, which are often conflicting. This process always occurs in a highly specific context (eg, agreed policies and targets in terms of disease burden reduction and time limit, defined geographic space, population and specific health problems).

Letter from New Zealand … and Season's greetings.

To assess the correlation between the burden of seven priority neglected tropical diseases (NTDs) included in the Brazilian National Agenda of Priorities in Health Research - tuberculosis, Chagas disease, leprosy, malaria, leishmaniasis, dengue and schistosomiasis - and their respective research funding and output. This retrospective review obtained data on disease burden from the Global Burden of Disease Study and funding data from open access sources. Publications were retrieved from Scopus and SciELO, and characterised according to the type of research conducted. Correlation between funding, research output and burden was assessed by comparing the 'expected' and 'observed' values for funding and publications relative to the proportional burden for each disease. There was an emphasis in basic biomedical research (average 30% of publications) and a shortage of health policy and systems (average 7%) and social sciences research (average 3%). Research output and funding were poorly correlated with disease burden. Tuberculosis, Chagas disease and schistosomiasis accounted for more than 75% of total NTD-related DALYs, but accounted for only 34% of publications. Leprosy, leishmaniasis and malaria, together, received 49% of NTD-related funding despite being responsible for only 9% of DALYs. The analysis evidenced a lack of correlation between disease burden, research output and government funding for priority NTDs in Brazil. Our findings highlight the importance of monitoring health needs, research investments and outputs to inform policy and optimise the uptake of evidence for action, particularly in developing countries, where resources are scarce and the research capacity is limited. The results contribute to health policy by highlighting the need for improving coordination of scientific activities and public health needs for effective impact.

BackgroundThe relationship between research funding across therapeutic areas and the burden of disease in Norway has not been investigated. Further, few studies have looked at the association between national research investments and the global disease burden. The aim of the present study was to analyze the correlation between a significant part of Norwegian investment in health research and the burden of disease across therapeutic areas, using both Norwegian and global burden of disease estimates.MethodsWe used research investment records for 2012 from the Research Council of Norway, and the investment records distributed through liaison committees between regional health authorities and universities. Both were classified by the Health Research Classification System (HRCS). Furthermore, we used the years of life lost and Disability Adjusted Life Years (DALYs) for Norway and globally from the Global Burden of Disease 2010 project. We created a matrix to match the expenditures by HRCS with the values from the Global Burden of Disease project.ResultsDisease-specific research funding increased with the Norwegian burden of disease measured as years of life lost (correlation coefficient = 0.73). Similar findings were done when the Norwegian disease burden was measured as DALYs (correlation coefficient = 0.62). The correlation between research funding and the global disease burden was low both when years of life lost (correlation coefficient = 0.11) and DALYs (correlation coefficient = 0.12) were used. Generally, when the disease burden was relatively high in Norway compared with the rest of the world, research investments were also high.ConclusionsAcross therapeutic areas, the Norwegian research investments appeared aligned with the Norwegian disease burden. The correlation between the Norwegian research investments and the global disease burden was much lower.Electronic supplementary materialThe online version of this article (doi:10.1186/1478-4505-12-64) contains supplementary material, which is available to authorized users.

Transplant Status Does Not Impact the Selection of Induction Regimens for Newly Diagnosed Multiple Myeloma (NDMM) Patients (Pts) in the Insight MM Prospective, Observational Study

Evaluation of the National Institute for Health and Care Research’s (NIHR) Global Health Research (GHR) Portfolio - Inception Report

Global health 2035: a world converging within a generation

IntroductionChild Health and Nutrition Research Initiative (CHNRI) started as an initiative of the Global Forum for Health Research in Geneva, Switzerland. Its aim was to develop a method that could assist priority setting in health research investments. The first version of the CHNRI method was published in 2007–2008. The aim of this paper was to summarize the history of the development of the CHNRI method and its key conceptual advances.MethodsThe guiding principle of the CHNRI method is to expose the potential of many competing health research ideas to reduce disease burden and inequities that exist in the population in a feasible and cost–effective way.ResultsThe CHNRI method introduced three key conceptual advances that led to its increased popularity in comparison to other priority–setting methods and processes. First, it proposed a systematic approach to listing a large number of possible research ideas, using the “4D” framework (description, delivery, development and discovery research) and a well–defined “depth” of proposed research ideas (research instruments, avenues, options and questions). Second, it proposed a systematic approach for discriminating between many proposed research ideas based on a well–defined context and criteria. The five “standard” components of the context are the population of interest, the disease burden of interest, geographic limits, time scale and the preferred style of investing with respect to risk. The five “standard” criteria proposed for prioritization between research ideas are answerability, effectiveness, deliverability, maximum potential for disease burden reduction and the effect on equity. However, both the context and the criteria can be flexibly changed to meet the specific needs of each priority–setting exercise. Third, it facilitated consensus development through measuring collective optimism on each component of each research idea among a larger group of experts using a simple scoring system. This enabled the use of the knowledge of many experts in the field, “visualising” their collective opinion and presenting the list of many research ideas with their ranks, based on an intuitive score that ranges between 0 and 100.ConclusionsTwo recent reviews showed that the CHNRI method, an approach essentially based on “crowdsourcing”, has become the dominant approach to setting health research priorities in the global biomedical literature over the past decade. With more than 50 published examples of implementation to date, it is now widely used in many international organisations for collective decision–making on health research priorities. The applications have been helpful in promoting better balance between investments in fundamental research, translation research and implementation research.

Child Health and Nutrition Research Initiative (CHNRI) started as an initiative of the Global Forum for Health Research in Geneva, Switzerland. Its aim was to develop a method that could assist priority setting in health research investments. The first version of the CHNRI method was published in 2007-2008. The aim of this paper was to summarize the history of the development of the CHNRI method and its key conceptual advances. The guiding principle of the CHNRI method is to expose the potential of many competing health research ideas to reduce disease burden and inequities that exist in the population in a feasible and cost-effective way. The CHNRI method introduced three key conceptual advances that led to its increased popularity in comparison to other priority-setting methods and processes. First, it proposed a systematic approach to listing a large number of possible research ideas, using the "4D" framework (description, delivery, development and discovery research) and a well-defined "depth" of proposed research ideas (research instruments, avenues, options and questions). Second, it proposed a systematic approach for discriminating between many proposed research ideas based on a well-defined context and criteria. The five "standard" components of the context are the population of interest, the disease burden of interest, geographic limits, time scale and the preferred style of investing with respect to risk. The five "standard" criteria proposed for prioritization between research ideas are answerability, effectiveness, deliverability, maximum potential for disease burden reduction and the effect on equity. However, both the context and the criteria can be flexibly changed to meet the specific needs of each priority-setting exercise. Third, it facilitated consensus development through measuring collective optimism on each component of each research idea among a larger group of experts using a simple scoring system. This enabled the use of the knowledge of many experts in the field, "visualising" their collective opinion and presenting the list of many research ideas with their ranks, based on an intuitive score that ranges between 0 and 100. Two recent reviews showed that the CHNRI method, an approach essentially based on "crowdsourcing", has become the dominant approach to setting health research priorities in the global biomedical literature over the past decade. With more than 50 published examples of implementation to date, it is now widely used in many international organisations for collective decision-making on health research priorities. The applications have been helpful in promoting better balance between investments in fundamental research, translation research and implementation research.

This presentation will argue that increased investment in health research is a significant public health imperative. It will use New Zealand as an illustrative case study and also draw upon international experiences. Over the last ten years New Zealand government investment allocated to health research has stood at between 0.6% and 0.8% of government health care costs. Health research advocacy organisation New Zealanders for Health Research (NZHR) argues that the level of investment should be increased to at least 2.4% in order to align with international norms, improve the population's health and well-being and save lives. New Zealand's annual amenable and non-amenable premature mortality currently stands at about 5000 and 7000 deaths respectively. Increased investment in health research holds the key to significantly impacting these figures and should be regarded as an important public health issue. NZHR is one of five similar health research advocacy organisations globally, the others being Research America, Research Canada, Research Sweden and Research Australia. All consistently demonstrate strong public support for their governments to be more actively committed to achieving increased investment in health research. New Zealand is scheduled to have a General Election in September 2020, so the results of NZHR's own polling, supported by that of our sibling organisations, are of particular relevance as NZHR seeks to make health research investment an election issue. The presentation will include comparative information from the five health research advocacy organisations globally, and will note that health researchers irrespective of where they are based are part of an international community where knowledge is shared to the benefit of all nations globally. The presentation therefore will challenge all countries, including New Zealand, to examine, and where necessary address, the adequacy of their own levels of health research investment. Key messages Health research saves lives. Health research investment is a public health issue.

IntroductionDespite recognition that health research is an imperative to progress toward universal health coverage, resources for health research are limited. Yet, especially in sub-Saharan Africa, more than 85% of the resources available for health research are spent on answering less relevant research questions. This misalignment is partially due to absence of locally determined health research priorities. In this study, we identified health research priorities which, if implemented, can inform local interventions required to accelerate progress toward universal health coverage in Somalia.MethodsWe adapted the child health and nutrition research initiative method for research priority setting and applied it in 4 major phases: (1) establishment of an exercise management team, (2) a web-based survey among 84 respondents to identify health research questions; (3) categorization of identified health research questions; and (4) a workshop with 42 participants to score and rank the identified health research questions. Ethical approval was received from ethics review committee of the London School of Hygiene and Tropical Medicine (Ref:26524) and the Somali Research and Development Institute (Ref: EA0143).ResultsTwo hundred and thirty-one unique health research questions were identified and categorized under health systems, services and social determinants (77), communicable diseases (54), non-communicable diseases (41) and reproductive, maternal, new-born, child, adolescent health and nutrition (59). A priority score ranging from 1 to 9 was assigned to each of the questions. For each category, a list of 10 questions with the highest priority scores was developed. Across the four categories, an overall list of 10 questions with the highest priority scores was also developed. These related to bottlenecks to accessing essential health services, use of evidence in decision making, antimicrobial resistance, distribution and risk factors for non-communicable diseases, post-traumatic stress disorder and factors associated with low antenatal care attendance among others.Conclusion and recommendationsThe developed priority research questions can be used to focus health research and to inform appropriation of health research resources to questions that contribute to generation of local health system knowledge which is required to accelerate progress toward universal health coverage in Somalia. The Somalia national institute of health should set up a consortium for provision of technical and financial support for research addressing the identified priority research questions, establish a mechanism to continuously monitor the extent to which new health interventions in Somalia are informed by knowledge generated through conducting prioritized health research and prioritize interventions aimed at strengthening the broader national health research system for Somalia.

A scoping review describes methods used to identify, prioritize and display gaps in health research