First People's World Health Report: Measure research impact on poor
Scientists should open their eyes to the politics and economics of health, and measure the impact of their work on the poorest, says the first peoples’ world health report.
By Prakash Khanal (September 05)
“You have failed in your human rights obligations… and we are watching you.”
These were core messages that David McCoy, managing editor of the first people’s report on health, the 378-page Global Health Watch 2005-2006, aimed at Western leaders and all institutions, health professionals, and scientists having an impact on world health.
McCoy was speaking at the launch of the report, or the “Watch” as he called it, in London this July. The Watch is a “people’s” alternative to the annual WHO World Health Report, and was written by over 120 individuals, including health professionals, from 70 non-governmental organisations. It represents a civil society perspective on global health, and will become a biennial series.
The report focuses on the neglected political and economic factors affecting health, but it doesn’t forget health research. In a chapter devoted to the subject, it takes the lead from the Commission on Health Research for Development’s 1990 report connecting research to equity, and the Global Forum’s 2004 study on financial flows.
It concludes that the real impact of health research on the poorest needs monitoring, and makes nine recommendations on what needs measurement:
• national health research systems – progress towards impact and self-sufficiency.
• partnerships in health research – progress toward equitable partnerships, and their impact on national health priorities.
• health research funding – progress towards strengthening local research capacity and addressing national health research priorities.
• the effects of health research funded by the private sector – understanding its benefits and harms, globally and nationally.
• global architecture for health research governance – progress towards better but equitable coordination.
• knowledge management and sharing – progress towards increased access to and utilization of knowledge from North to South and South to North.
• health systems research – progress towards developing methodologies, building capacity, and implementing research on health system performance.
• effects of health research related to the Millennium Development Goals – understanding potentials and limitations, globally and nationally.
• impact on health – documenting and measuring the impact of health research (from any source) on health, health equity and development in the poorest countries.
The Watch was launched simultaneously in Cuenca, Ecuador, at the Second People’s Health Assembly, where 2 000 people from across the five continents were gathered to debate national and global health priorities. It was also to be launched in several other countries, including in India, by the People’s Health Movement, and will be presented in November in the United States at the annual meeting of American Public Health Association.
At the London launch, McCoy called on world leaders, health professionals and international institutions to stop ignoring the fact that exploitation is at the root of the plight of many poor and marginalized communities, rather than a lack of aid or charity.
“We need people - particularly from within the health community - to understand the whole range of political, institutional and policy failings that impact on health”, said McCoy. “To some extent, the Watch suggests that the health community as a whole is failing to promote a public health agenda to inform globalisation, or to shape the way intellectual property rights are being reformed”.
The report strongly but politely argues that WHO needs to assert itself more strongly as the key multilateral health agency. It calls for a wide-ranging debate to address the weaknesses and constraints of WHO, including its inadequate funding and internal management problems.
“We need WHO, and this report fulfils the role of a critical friend”, said Gill Walt, head of international health policy at London School of Hygiene and Tropical Medicine, speaking to RealHealthNews. “As we might expect, they also need to improve their relationship with civil society”.
“This report says that the health community needs to look at morbidity and mortality more widely”, said Walt. “You have to look at employment, at water and all the other things that affect health of the people. The report talks about World Trade Organisation, the patenting of medicines and privatisation. It puts health in a much broader context, not just looking at the health sector.”
According to Walt, “The other important thing about this report is that it is a collective product that represents voice of many many people… In a way, the Global Health Watch is a collective representation of less powerful people pushing their voices to the more powerful”.
“The Watch itself is not an organisation” explained McCoy. “It provides a platform for existing NGOs, campaigns and health professional associations to act and lobby for change”.
Amongst its recommendations, the Watch offers a ten-point agenda for the repair and development of health care systems. Points include promoting community empowerment to improve accountability, emphasising trust and ethical behaviour in the face of “corrosive” commercialization, focusing health care systems on the district level, and adopting broad health systems indicators rather than indicators for individual diseases.
And of course there’s also finance. The Watch calls for abolishing user fees, “adequate” funding for health care systems and staff, ending the commercialisation of health care - and improving the quality of donor assistance.
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