Forum 8, Mexico 2004, Statement

Statement by the Global Forum for Health Research
at the conclusion of Forum 8
Mexico City, 16-20 November 2004

Health Research for Equity in Global Health

1. The eighth annual meeting of the Global Forum for Health Research¹, held in Mexico City, 16-20 November 2004 in conjunction with the Ministerial Summit on Health Research, brought together over 700 participants from government, intergovernmental organizations, nongovernmental organizations (NGOs), the private sector, researchers and research councils, leaders and users of health research, and representatives from civil society to consider ‘Health research to achieve the Millennium Development Goals (MDGs)’. At the end of this meeting, the Global Forum for Health Research makes the following statement, which will also serve as a contribution to the review of progress towards the MDGs in September 2005:

Health research and the MDGs

2. The vicious circle of poverty and ill health² at which the MDGs are targeted will not be broken without intensified effort to close the continuing ‘10/90 gap’.³ In many developing countries, efforts for poverty eradication have been undermined by deterioration in the population’s health. The attainment of the MDG poverty target will depend on increased research directed to the health needs of those living in absolute poverty, and to improving access to affordable products and services in a variety of settings. Health policy and systems research and social sciences, behavioural and operational research are vital to improve the functioning, reach and targeting of health services; to address aspects such as social determinants of health; and to provide a stronger evidence base to underpin health promotion strategies.

3. Achieving all the MDGs will require addressing health and its determinants in a comprehensive way and will necessitate further health research, of high quality, focused on the needs of developing countries and vulnerable populations. This research must encompass the spectrum from the biomedical sciences (such as affordable and accessible drugs, vaccines and diagnostics) to health policy and systems research, social sciences, political sciences, health economics and behavioural and operational research, and research into the relationship between health and the cultural, physical, political and social environments. It must be trans-disciplinary and inter-sectoral. It must give systematic attention to cross-cutting issues of poverty and equity, taking account of inequities based on gender, ability, ethnicity and social class/caste, among others; the needs of both the aged and the largest generation ever of young people 0-19 years; and the needs of other specifically disadvantaged groups such as migrants, refugees and those exposed to violent conflict.

4. More research is also required into the determinants of child health; into new tools to avert the childhood mortality that results from a handful of diseases; and into scaling up improved delivery and utilization of existing methods which could already avert two thirds of child deaths. Research is also needed on nutrition, pregnancy care and skilled care during and after delivery, to improve maternal and neonatal health and decrease maternal and neonatal mortality and morbidity; and to develop female controlled methods of protection, including microbicides and vaccines, for the prevention of HIV infection. Given the interrelationships between sexual and reproductive health and rights and the conditions that are addressed by the MDGs, it is apparent that the MDGs will not be achieved without much greater attention to sexual and reproductive health, including research in the biomedical, health systems, and social sciences domains and the translation of that research into policies and programmes.

5. Increases are being seen in developing countries in morbidity and mortality, due not only to HIV/AIDS, malaria and tuberculosis but also emerging and re-emerging infectious diseases. There are rapidly growing levels of injuries and noncommunicable diseases, including cardiovascular disease and diabetes, as well as increasing challenges in mental and neurological health. Thus, narrow targeting of a few specific preventive and curative interventions is unlikely to deliver all the desired outcomes. An approach is needed that encompasses all these areas, not just the specific MDG targets. Targeted programmes and efforts to make general improvements in health systems should be mutually supportive and synergistic. This requires research into areas such as scaling up, providing access to and increased utilization of health systems and services, and addressing inequities. Methods of measurement need to be developed to adequately capture the impacts of ill health on individuals, families, communities and societies.

Necessary actions

6. The exercise of political commitment and power is the necessary pre-requisite to ensure the implementation of the health research agenda required to support the achievement of the MDGs. The public and private sectors, governments of developed and developing countries, research institutions, multilateral agencies, NGOs and civil society must commit themselves to the shared responsibility of advancing the volume and pace of health research that is focused on improving the lifespan and health of people everywhere. Research is needed to better understand the uneven distribution of power in the global health system and the changing role of different actors, to ensure increased equity and accountability in global health.

7. To provide the resources necessary for essential research within developing countries, we urge governments of these countries to spend at least 2% of their national health budgets on health research, as recommended by the 1990 Commission on Health Research for Development. These funds should be used locally for health research and research capacity strengthening. Also in line with the Commission recommendation, donors are urged to allocate 5% of their funding for the health sector to health research and research capacity strengthening in developing countries. Monitoring the use of funds for capacity development is a vital complementary activity.

8. Civil society, NGOs and communities must be involved in the governance, definition, generation and conduct of health research; in the application of the knowledge and technologies it provides; in monitoring progress and in maintaining the public debate about resources and priorities. Ethical and technical reviews of research must assess the likely contribution of the research to policy making and to equitable health outcomes, in particular to redress major inequalities such as sex and gender differentials.

9. Innovative research should be supported by the public and private sectors and by academic institutions. Priority should be given to research and development to create technologies and products directed to meeting developing country needs and to ensuring their delivery. The private sector and governments should more intensively explore avenues to ensure sustainable and equitable access to products, services and treatment. The not-for-profit private sector should continue its commendable contributions to health and health research. Research is needed into the roles of both intellectual property systems and public-private partnerships in creating health products and widening equitable access to them.

The Global Forum for Health Research

10. The Global Forum for Health Research commits itself to work with the World Health Organization, Council on Health Research for Development and other agencies to close the gaps in health research for the needs of developing countries. It will promote increased attention to strengthening evidence-based approaches to health, through the application of both existing and new knowledge and through the active diffusion of knowledge to civil society with the participation of civil society organizations. The Global Forum will also work in partnership with research councils, national institutes of health, researchers, NGOs and community-based organizations, fostering systematic collaborations to improve global health and support the attainment of the MDGs. It will conduct and promote research to identify and document what works, to help build the evidence base for health research that supports effective health interventions. It will encourage better use of priority-setting tools and processes to help focus research on vital, neglected areas, and to strengthen research capacities. The Global Forum will continue and intensify its tracking of resource flows for health research, to better understand and call attention to the gaps in resources.

11. The Global Forum for Health Research welcomes the statement issued by health ministers at the conclusion of their Mexico Summit, and looks forward to further, periodic conferences to maintain the discourse at a high political level.

12. The Global Forum for Health Research will intensify its own efforts to work, in collaboration with international and national partners, to help achieve the MDG targets of better health for all.

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The Global Forum for Health Research is an independent international foundation based in Switzerland .
Health is defined as a state of complete physical, mental, social and spiritual wellbeing and not merely the absence of disease or infirmity.
The expression ‘10/90 gap’ was coined to describe the imbalance in how resources for research were being allocated, following the estimate made in 1990 that less than 10% of global health research resources were then being applied to the health problems of developing countries, which accounted for over 90% of the world’s health problems. The expression continues to serve as a symbol of imbalance in the allocation of global health research resources.