Does social science need rebranding?

Some would argue poor living conditions and gender inequity affect health more than the biological causes of disease. Flickr/LivingWaterInternational

As Forum 2009 closed on Friday, we were left with some thoughts on the future direction of global health research. The conference in general was heavily weighted towards the need to drive health systems research and research on the social determinants of health.

Mention these issues to many lab scientists, however, and they would argue that these fields of study are far too “soft” a science for them to engage with.

This is what really damages research into the social factors affecting health. Traditional robust methods of interrogating an issue and gathering data such as randomised controlled trials have no traction when you are thinking about how a health system functions or when you are trying to evaluate a complex health intervention.

These don’t fit into neat scientific boxes in the way that parasite counts or viral loads do.

But transforming these fields will require rigorous evidence – how else will we know what changes to make to improve health systems across the developing world?

It’s good news then that the EU announced yesterday at the meeting that its next call for grants in January 2010 would focus heavily on research into the social determinants of health.

Some would argue that poor living conditions and gender inequity affect health even more than the biological causes of disease. There is only one way to find out, of course: more research, and more robust evaluation of that research.

Priya Shetty, www.scidev.net, priya4876@gmail.com

Where there is a will…

Studying gender inequality won't fix health without the political will

Claudio Schuftan, an advocate for the right to health based in Vietnam, sounded a pessimistic note yesterday in a discussion on research into the social determinants of health.

As participants discussed the best ways to ensure that research into poor living conditions and gender inequality is treated as a rigorous science, Schuftan asked us whether we “were living in a dream world”. His point was that the scientific community talks of the need for more evidence – but what about the political will?

This is an obvious point but one worth making again amidst calls for more evidence-based policies. First, we have a lot of evidence already for what works and what doesn’t. Second, all the evidence in the world will not convince a policymaker who does not see the political will to alter health-care policies.

This was the point that Carlos Morel, director of the Center for Technological Development in Health at FIOCRUZ in Brazil, made when I spoke to him about translating innovation from Cuba to the rest of the world.

Morel said that there would be little point in Cuba transferring knowledge to countries that don’t have the capacity to use that information. Cuba’s political dictatorship – in essence, its unswerving political will – is what ensured that it first developed a robust health system on which to build more advanced scientific institutions, he said.

Africa needs to find a way now to imbue its own democracies with that strong political will for healthcare reform.

Priya Shetty, www.scidev.net, priya4876@gmail.com

Getting it out there

Given the choice, would the average scientist prefer to find a cure for tuberculosis or find a really effective way of getting it to people? It is the concentration on the former that Ok Pannenborg, a senior health advisor at the World Bank, highlighted this morning at Bamako 2008 in a plenary session on research for health challenges.

Health systems research, he said, is unsexy. Health systems are seen as “amorphous, abstract and vast”. How can anyone go about researching such things?

The key, he said, is not to see it as disease versus health systems research, or even disease research alongside health systems research – but focusing on better health systems for the treatment of disease.

Research, he said, is an indispensible tool for improving health systems, from identifying and understanding problems to developing and evaluating new ways of doing things.

But it’s not just in health systems that finding out how to best deliver things to people is key. Health is not just about healthcare, said Michael Marmot, chair of the WHO Commission on the Social Determinants of Health, in a video presentation during a later session.

Research into the social determinants of health has shown what can lead to poor health. It’s acting on this evidence which is the next step, said Marmot. We know that clean water is good for people’s health, let’s find a way of getting it to people.

Katherine Nightingale, SciDev.Net