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

Global Forum for Health Research 2009, Havana, Cuba

Welcome to the blog for Forum 2009, taking place this week in sunny Havana!

The theme of the meeting, innovation, is the lifeblood of research. Without it, countries never truly develop a thriving science base and are relegated to the shadow of innovative neighbours.

It’s appropriate then that scientists from around the world have gathered in Cuba to discuss scientific and technological innovation.

Political circumstances have forced Cuban researchers to innovate and develop with homegrown talent. The question now is how these lessons can be translated to the rest of Latin America – and to Africa and Asia.

Transferring knowledge isn’t the only issue of course – developing countries need to create an innovation-friendly environment for researchers to thrive in.

I’ll be writing more about how to bridge these knowledge gaps, through better knowledge translation and South-South collaboration, for example.

Another issue that I’ll write about this week is innovation in health systems research. This is an enormously tricky topic in global health. We know that developing countries need better health systems but we know very little about the science of how to improve them.

Tim Evans, assistant director-general for for information, evidence and research at the WHO and TDR scientist Shenglan Tang are leading sessions this week on health systems research as a prelude to the first global symposium on health systems research that they are hosting next November in Switzerland.

Over dinner last night, Evans maintained that innovation is most urgently needed in health systems research. It’s certainly true that while funders and big pharma fall over themselves to pump money into research for drugs and vaccines, few line up to pour money into developing an evidence-base for improving health systems.

Do you agree? We’d like to hear your thoughts on the top priorities in innovation for developing countries. Comment below to share your ideas.

Priya Shetty, SciDev.Net, priya4876@gmail.com

Reflections on a Call for Action

So after long hours of discussions and negotiations, the Bamako Call to Action has been agreed upon and officially announced to the world.

Spending three days attending various sessions on research for health as well as sitting in on the ministerial discussions left me with three distinct impressions.

First: Awareness needs to be hammered into the heads of political leaders that health is an investment, not an expense. And that no health means no development.

A fairly common sense understanding I would have thought, but perhaps one that needs to be waved vigorously, and continuously, in front of the eyes of our leaders. And maybe shoved down their throats as well, considering how similar the Bamako Call to Action is to other such previous documents.

Second: International bodies that have similar objectives need to be consolidated so that their efforts can be coordinated and programmes carried out more efficiently and without duplication.

Similarly, governments need to set national health agendas, and these really need to be carried out across several ministries and governmental departments in order to be fully effective.

Of course, I fully realise this is easier said than done. Consolidating international organisations is not impossible, but highly improbable; while getting several different governmental bodies to work together coherently and efficiently without mini turf wars erupting or plain miscommunication is as difficult as getting a stubborn donkey to move when it doesn’t want to. Not that I’m comparing government agencies to stubborn donkeys – honestly!

Third: Southern countries want to become more self-reliant in terms of conducting research. Many representatives from developing nations called for national or regional capacity building, rather than relying on the North to help provide training.

However, with the money still coming from developed nations, it is going to be quite a tricky balance satisfying everybody’s wants and needs, as well as avoiding any potential chips-on-the-shoulders, even if both sides have the very best of intentions.

At the end of the day, I believe it all boils down to individuals. If each person who attended the Forum goes away firmly believing and committed to carrying out whichever part of the Call to Action that is the most relevant to them, we might indeed see some progress in global health.

It may not be immediate, but as was said during the meeting, health is both a current and future investment.

We just need to remember the big picture, but work on our small part of it. And maybe pray for visionary leaders who think in the long term, rather than the short.

Shiow Chin Tan, SciDev.Net

Looking for concrete results

Grumblings around the conference are indicating that not all the delegates are convinced the Bamako Call to Action will result in real-world deeds. One delegate at a session on health system strengthening said yesterday that we could simply photocopy the various communiques from previous meetings, such as the Mexico Ministerial Summit on Health Research, and change the dates. “We’re not saying anything new – what is the progress we’ve made?” he questioned.

But while progress may not be revolutionary, others feel the health research community has come a long way since Mexico. The focus on research for health in this forum, rather than health research, has been highlighted by many speakers as a move towards a more inclusive research community, and one which can consider the determinants and effects of both poor and good health, rather than simply focusing on biomedical research.

And sometimes meetings such as these can have immediate effects at a country level. Aissatou Touré from the Institute Pasteur Dakar in Senegal told the same session that after the Algiers meeting, a decision was made to create a commission for research in the country’s health ministry, incorporating all the different actors involved in research for health to define the national research agenda for years to come. Let’s hope actions like these are not unusual, and the Bamako meeting will have many such legacies.

Katherine Nightingale, SciDev.Net