Health research in developing countries

Despite sustained growth in spending on science and technology worldwide, financial resources for research are insufficient in many countries. In 1999, the Global Forum for Health Research (GFHR) analysed expenditure in health research throughout the world. It coined the term “10/90 gap” to summarise the worldwide imbalance in health research resources—the least amount of money is devoted to health problems that affect the most people, who are also the poorest.1 The term has since motivated a permanent international debate on health research, and funding agencies in developed countries and not for profit international organisations (such as the Wellcome Trust2 and the Bill and Melinda Gates Foundation3) have made huge investments.4 5

Given the ethically and morally unacceptable social problems in Africa, Latin America, and other parts of the developing world, it is pertinent to question whether money spent on research is justified when more urgent priorities—such as dealing with poverty, malnutrition, and illiteracy—exist. Large socioeconomic disparities in income, access to services, agency and voice, assets, and opportunities have been a characteristic of Latin American development. This has generated different meanings of citizenship between the richest and the poorest, and it has undermined institutions and generated political instability.6 Despite that, the health situation and national health systems in Latin America are improving overall, although great heterogeneity exists between and within countries. However, epidemics of dengue; a sustained increase in violence, which has important effects on health; and the difficulties the poor have in gaining access to health care are examples of the challenges that remain.7

Research should be tailored to the needs of the particular population. As a consequence, an updated research agenda for developing countries, in particular Latin America, has to look beyond the fundamental problems of disease cure and prevention and health care and focus on other important dimensions. These include health determinants (equality between socioeconomic and ethnic groups and sexual equality, fundamental human rights, and so on) and climate change. The agenda must cover health determinants accumulated during the past, present health problems, and threats expected in the future. Achieving this is essential to gaining political support for allocation of local public funds and obtaining funds from outside donors.

For research to flourish in any context, long term sustained investments in institutions and human resources are necessary. However, in most developing countries, sources of stable funding are lacking. Over recent decades, some countries in Latin America have been structuring more stable financial strategies to support research.8 9

In 2004, a US study from the National Science Foundation reported that the number of scientific articles by Latin American authors published in the world’s highest impact scientific and technical journals almost tripled between 1988 and 2001.10 The growth was concentrated in a few countries—Argentina, Brazil, Chile, and Mexico—and was greater than in emerging and developing countries in other regions. The report also found that almost half the articles were about life sciences, in particular health, whereas research on engineering and related sciences was more common in other developing regions.

How has this increase in research been possible? Despite the shortage of money and the pressure of other needs, in Latin America most of the funding has come from national public funding8 9; this is a sign of the growing importance of health research in the political agenda of several countries. In addition, a number of stakeholders have set up core strategies to foster health research, including institutional strengthening of universities and research centres and the training of research personnel. To increase the funds available for health research, taxation of industries that are responsible for increasing the incidence of diseases and deaths (tobacco, alcohol, and cars) has been proposed.11

Finally, a policy on research for health has been approved by the directing council of the Pan American Health Organization (the regional branch of the World Health Organization).12 After several years in a shy position regarding research, this organisation obtained approval from the ministries of health to have a greater role in supporting and coordinating health research in America, particularly Latin America. The experience in Latin America has shown that local political will and local investments are vital for sustained growth in health research. But the effort to develop national health systems is the biggest step towards inspiring the translation of health problems and needs into health research questions. The ongoing challenge is to show that investing in research in developing countries is not a luxury but fundamental to providing tailored, cost effective, and sustainable improvements in the population’s health.