Effective research could prevent half of the world's deaths

Health systems research has the potential to produce dramatic improvements in health worldwide and to meet some of the major development challenges in the new millennium.

Effective research could prevent half of the world's deaths with simple and cost-effective interventions, the World Health Organization (WHO) says in a new World Report on global health research.

The WHO World Report on Knowledge for Better Health: Strengthening Health Systems highlights aspects of health research that, if managed more effectively, could produce even more benefits for public health in future. It sets out the strategies that are needed to reduce global disparities in health by strengthening health systems.

Inequities in health are among the major development challenges in the new millennium and malfunctioning health systems are at the heart of the problem. Moreover, the culture and practice of health research should reach beyond academic institutions and laboratories to involve health service providers, policy-makers, the public and civil society.

The Report also argues that science must help to improve public health systems and should not be confined to producing drugs, diagnostics, vaccines and medical devices. Biomedical discoveries cannot improve people's health without research to find out how to apply them within different health systems and diverse political and social contexts, thus ensuring that they reach those who need them the most.

"There is a sense that science can do more, especially for public health," said Dr LEE Jong-wook, WHO Director-General. "There is a gap between today's scientific advances and their application - between what we know and what is actually being done. Health systems are under severe pressure and there is an urgent need to generate knowledge for strengthening and improving them."

A team of 12 internationally prominent health researchers in both developed and developing countries, coordinated by Dr Tikki Pang, WHO Director for Research Policy & Cooperation, developed the 143-page World Report on Knowledge for Better Health over 18 months. Based-on a wide-ranging consultative process and on previous reviews of global health research, the report advocates that health equity can only be achieved through better management of health research and increased investment in health systems research.

Health systems research suffers from a poor image and has been under-funded compared to biomedical research despite widespread recognition of its importance. The field attracts less than one tenth of 1% of total health expenditure in low-income countries.

The lack of attention given to this field is also reflected in the fact that only 0.7 % of scientific articles published globally in the year 2000 were in the area of health systems research.

"It is extremely important to get this report out now. The report demonstrates the enormity and complexity of the problem and outlines a way to go forward," said Eva Harris, President of the Sustainable Science Institute based at the University of California, Berkeley, USA. "It anticipates how the global community can get a handle on the problem in a constructive manner instead of lamenting a lack of action".

In Africa, for example, it is estimated that only between 2-15% of children slept under bed-nets in 2001-a simple, effective and proven method to prevent malaria. "We need to put a stronger emphasis on translating knowledge into actions - health systems research will help us to bridge this "know-do" gap". Also, that research is an investment, not a cost", said Dr Pang.

The report also illustrates how health systems research can strengthen human resources for health, health financing as well as information and delivery of health services, with some projects already yielding impressive results. Among the research projects mentioned in the report is the Tanzania Essential Health Interventions Project (TEHIP) which was set up to find new ways to plan, set priorities and allocate resources as part of a major reform of the country's health-care system. The aim was to evaluate the impact of health interventions in terms of burdens of disease and per capita cost.

Researchers found that in two Tanzanian districts, malaria alone accounted for 30% of all healthy years of life lost due to deaths in 1996-97. In response, government planners increased the budget for malaria prevention and treatment programmes from 10% to 26% by 2000-2001. Overall, the research has resulted in a better match between disease burden and health budget allocation, and the child mortality rate has been reduced by more than 40% since the late 1990's.

"Health systems should nurture a stronger culture of learning and problem-solving to tackle the major health challenges of our times," said Tim Evans, Assistant Director-General, WHO. "This could be achieved by understanding how elements within a health system interact with each other and by finding innovative ways to solve complex problems."

http://www.who.int