Transcript How to transfer - Tehran University of Medical Sciences

WORLD HEALTH
REPORT 2012
“NO HEALTH WITHOUT RESEARCH”
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Hamed Hosseini
MD. MPH. PhD Candidate in Epidemiology
Knowledge Utilization Research Center;
Tehran University of Medical Sciences
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Why Research?

From antibiotics to drugs for treating cancer, from the
elimination of smallpox to oral rehydration therapy, from insulin
and the birth control pill to a vaccine against bacterial meningitis
and cervical cancer, and from identifying the adverse effects of
smoking and the impact of out-of-pocket health expenditures,
medical and health research has led to dramatic advances in
health all over the world.
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Why Research?

Such advances are the result of a collective, global
effort in promoting the value of science in human
development but, ultimately, depends on the efforts
and commitments of individual countries to improve
the health of their own people while contributing to the
'global public good' and pool of scientific knowledge.
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Research improves health
Research improves health in three main ways:
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developing of new and better interventions in the form of both
medical products (e.g. drugs, vaccines, diagnostics, devices) and
improved processes to strengthen health service delivery,
ultimately contributing to universal coverage with essential health
care.
informing the development of effective health policies and
practices
empowering people and individuals to internalize knowledge and
practice healthy behaviours in their daily lives.
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Chapter 1
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Defining health research as the development and
generation of new knowledge which can be
applied to understanding health challenges and
mounting an improved response to them.
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Five types of research
for health improvement
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Different Kinds of Research
Pasteur's Quadrant sees research within the two
dimensions of a quest for fundamental
understanding and considerations of use.
 Within the quadrant, and depending on where the
research falls within 'understanding' and 'use', three
categories of research were identified:
 (1) pure basic research; (2) use-inspired basic research;
(3) pure applied research1.
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Three categories are most commonly used in
combination - the health topic of the research,
purpose of the research and methodological
perspectives.
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'traditional' approach
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Research Boundaries
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The Value of Research to
Society and the Economy
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The US government's seminal report, Science - The
Endless Frontier, authored by Vannevar Bush (7) and
published in 1945, marked the beginning of
modern science policy and ushered in a new era in
which science was seen to be vital for progress towards
national goals in health, defence and the economy.
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The Value of Research to
Society and the Economy
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Bush's report resulted in the establishment of the
National Science Foundation and a massive investment
in R&D in post WW II America in the basic and
applied sciences - it is estimated that a ten-fold increase
in funding occurred between the 1940's and the 1960's.
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It has become clear that research improves health and
adds value to society and the economy by driving
innovation for new health products and devices, but
also for improving the delivery of health services.
Importantly, knowledge coming from research also
empowers people to make individual choices towards
healthy behaviour.
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
At the same time, health research is expensive and it is
often difficult to link it directly to health, social and
economic benefits and impacts. While researchers argue
for its capacity to improve our understanding of the
world and for improving health, politicians have a more
practical view:
“research is done to make or save money”.
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The relationships between science,
innovation and health impacts is nonlinear!
'top down', largely econometric approach which
focuses on 'monetizing' improvements in life
expectancy and quality of life, and linking it to
investments in health research;
 'bottom up' or 'payback' model based on evidence
from various patient indication treatment combinations.
The general value of the 'payback' model seems to be
gaining increasing acceptance and it is being applied in
many different countries.
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On Parenthesis!!!
The advocacy organization Research America! has
claimed that, in terms of the economic returns on
research, there is a $4 return for every $1 invested in
research to develop new medical treatments for
cardiovascular diseases.
 Research to develop information to influence patients'
behaviour produced an even more dramatic economic
benefit, $30 return for every $1 invested.
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On Parenthesis!!!
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Research also plays a major role in economic
development and in wealth creation, especially in the
industrialized nations. For example, if the top 10 global
companies are ranked according to R&D spending,
four out of ten of these companies are in the
pharmaceutical sector!
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pharmaceutical companies
Much of the profits accruing to pharmaceutical
companies, and justification for its substantial spending
on R&D, are related to the utilization, and protection,
of research outputs (i.e. publications) through
intellectual property rights or patents.
 The effective combination of publications and patents
is thought to lead to innovation, which can be defined
as a "change in the thought process for doing
something, or the useful application of new inventions
or discoveries" .
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Links between publications,
patents and innovation.
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global health research'
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research which is focused primarily on the health
problems of developing countries.
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it is also important to acknowledge that 'global health
research' also refers to research on trans-national
determinants of health (e.g. health impacts of climate
change, pandemic threats, global trade, etc)
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Current Challenges in
Global Health Research
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Since the report from the CHRD in 1990, much
attention has been given to the '10/90 gap'
suggesting that less than 10% of the global
resources for research are committed to studying
90% of the global health problems, mainly those
affecting the developing world
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Investment in R&D as % of GDP
vs number of researchers, 2007
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Who are the major players
in global medical R&D?
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Approximately half of the amount spent on R&D is in the
private sector, mainly in the pharmaceutical and biotechnology
industries.
however, suggests that work done by public sector research
institutions (PSRI's) has had a more immediate effect on
improving public health than was previously thought.
Such publicly-funded research in the USA contributed to the
discovery of 9.3 to 21.2% of all drugs involved in newdrug
applications approved during the period from 1990 through
2007.
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The Gap
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The gap is illustrated by the fact that of the 1,556
new drugs developed between 1975-2004, only 21
(1.3%) were for diseases of the developing world
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Research to Improve Health Systems
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At the same time, HSR and related areas of health
services and health policy research has suffered from a
perception of a lack of scientific rigor and has thus
attracted fewer practitioners as well as resources. It is
also characterized by longer time frames for research
and the perception that it is limited to local contexts
and conditions (e.g. population and health features,
other programmes/initiatives with similar goals,
characteristics of the health system, etc), thus making it
difficult to draw generalisable conclusions.
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There has also been confusion and lack of clarity as to
what type of research is involved in strengthening
health systems. Multiple definitions of operational
research, implementation research and health
systems research define the scope of their research
very broadly with considerable overlap. The resulting
lack of clarity negatively affects the credibility and
progress of the research, and efforts to secure more
resources to support it.
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In order to improve conceptual understanding of what this type of research
consists of, and better define its scope and boundaries, an attempt has been
made to describe the three main underlying research domains relevant in
improving health systems: operational, implementation and health
systems research .
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One perspective is to consider operational and implementation research as
that which occurs at the 'micro' level while health systems research has a more
'macro', system wide view. Importantly, these domains are different, are of
value to a range of situations from local to broader dimensions, and yet
overlap. They need to more effectively interact for greater impact of the
overall, collective research effort.
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Research to improve health systems
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Thank You!
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