Category Archives: Sustainable Development Goals

Social determinants of health at the Global Forum on Research and Innovation for Health 2015

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SPEED READ

 – Health is heavily determined by the conditions in which people are born, grow, live, work and age, and these, in turn, are shaped by the distribution of money, power and resources at local, national and global levels. These factors are usually referred to as social determinants of health.

– The Council on Health Research for Development (COHRED) and its partners will host the Global Forum on Research and Innovation for Health (Forum 2015) in Manila, from 24-27 August 2015.

– Social determinants of health cut across many of Forum 2015 themes. In particular, they play a critical role in some of the topics that lay at the core of the programme, namely food safety and security, health in mega-cities and disaster risk reduction.

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As world leaders shift their focus to the post-2015 Sustainable Development Goals, it is important not only to understand the impact of research and innovation on health in relation to broad development objectives, but also, it is critically important to emphasize the role that research and innovation can have in reducing health inequities.

Social determinants of health (SDH) are mostly responsible for health inequities. In other words, health is heavily determined by the conditions in which people are born, grow, live, work and age, and these, in turn, are shaped by the distribution of money, power and resources at local, national and global levels. The role of research and innovation in addressing SDH and promoting health equity has been emphasized by WHO’s Commission on Social Determinants of Health, which in 2008 published the report Closing the gap in a generation: Health equity through action on the social determinants of health: “[I]t is through the democratic processes of civil society participation and public policy-making, supported at the regional and global levels, backed by the research on what works for health equity, and with the collaboration of private actors, that real action for health equity is possible” .

With this in mind, COHRED, in partnership with the Philippine Department of Health and Philippine Department of Science and Technology, will host the Global Forum on Research and Innovation for Health (Forum 2015) in Manila, from 24-27 August 2015. Forum 2015 provides a platform where low and middle-income countries take prime position in defining the global health research agenda, in presenting solutions and in creating effective partnerships for action.

HR_forum logo+dates and placeOver the course of three days, Forum 2015 will use informative and interactive discussions, workshops, networking sessions and activities to allow participants to interact, inspire, learn and partner to increase their own impact. This event will bring together all stakeholders who play a role in making research and innovation benefit health, equity and development. This includes high-level representatives from government, business, non-profits, international organizations, academic and research institutions and social entrepreneurs among others.

The programme for this event will be built around two major pillars showcasing: (1) key concepts needed to improve the efficiency and effectiveness of research and innovation for health and development, as well as (2) ways that research and innovation contribute to solutions to important global health and development challenges faced by low and middle income countries today.

Forum 2015 programme pillars and themes

I. Increasing the Effectiveness of Research and Innovation for Health:
• Social accountability
• Increasing investments
• Country-driven capacity building

II. The role of Research and Innovation:
• Food safety and security
• Health in mega-cities
• Disaster risk reduction

Clearly, social determinants of health cut across many of these themes, but in particular, they play a critical role in the second pillar of this year’s programme, under the themes of food safety and security, health in mega-cities and disaster risk reduction.

For example, the objective of food security is not only to facilitate the accessibility of nutritious and sufficient food for people, but also to provide economic and physical access to food for socially vulnerable groups. Sessions under Forum 2015’s food safety and security theme will focus on research and innovation in scientific, economic, rights-based, and commercial terms to ensure new solutions and scale up existing efforts, to ensure that food and water remain – and become – accessible and affordable to all. Social determinants in this theme reveal themselves in choices taken in agricultural production, access and distribution of food, and even dietary habits and safety standards, which all vary by region and population.

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The rise of mega-cities creates a range of health challenges, both new and old – from the rise of NCDs and return of infectious disease, to traffic related accidents and mental health issues. These issues are shaped by social determinants including housing conditions, unsafe water sources and poor air quality, to poverty, marginalization and limited access to basic healthcare.

With regards to disasters, there is wide international agreement that efforts to reduce disaster risks and increase resilience must be systematically integrated into national policies, plans and practices. As governments all over the globe are taking initiatives to reduce their risks, sessions under the disaster risk reduction theme in Forum 2015 will examine issues related to vulnerable populations who disproportionately bear the brunt of that risk, along with the range of socio-economic factors that influence the health disparities that arise between these vulnerable groups and the general population.

While it is clear that social determinants affect the disparate health outcomes of population groups in relation to food security, health in mega-cities, and vulnerability to disaster, SDH research, as well as the need for high quality research on SDH, could appear throughout the Forum 2015 programme.

Forum 2015 encourages participation by all as the meeting programme spans a wide range of topics and input is welcome in form of organized session proposals and abstracts, also on how to feature SDH more prominently in the programme this year in Manila.

Anthony Nguyen and Charlie Kent (COHRED)

Universal Health Coverage: the right path towards equity and development

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SPEED READ

– A large global coalition of more than 500 organizations from over 100 countries, has marked 12 December 2014 as the first-ever Universal Health Coverage Day, to reaffirm that health is a right, not a privilege, and that access to quality health care should never depend on where you live, how much money you have or your race, gender or age.

– Investing in health is a wise choice. Indeed, making universal health coverage a priority for all nations could be the cornerstone of the post-2015 sustainable development agenda and a powerful driver of economic growth in low- and middle-income countries.

– The Council on Health Research for Development (COHRED) proudly supports UHC Day and actively works on a number of activities at the global scale, all aimed at contributing to UHC through making the most out of the impact of research and innovation on the health and development problems of people in developing countries.

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Health is a right, not a privilege

“Health for all, everywhere”. Simple and linear as it may sound, attaining this is indeed a formidable challenge. Each year 1 billion people can’t afford a doctor, pay for medicines or access other essential care, and another 100 million fall into poverty trying to access it. In Africa and Southeast Asia, for example, nearly a third of households have to borrow money or sell assets to pay for health care.

Taking action to rapidly change this grim reality, on 12 December 2012, the United Nations unanimously endorsed Universal Health Coverage (UHC), declaring that everyone, everywhere, has the right to access the quality health services they need without facing financial hardship. Shortly after, Margaret Chan, Director General of the World Health Organization stated that, “Universal health coverage (is) the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care.”

Responding to that historic call, a global coalition of more than 500 organizations from over 100 countries is now marking 12 December 2014 as the first-ever UHC Day. Spearheaded by The Rockefeller Foundation and WHO, this coalition is stepping up to reaffirm that health is a right, not a privilege, and that access to quality health care should never depend on where you live, how much money you have or your race, gender or age.

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Looking ahead, wisely: invest in health!

Making UHC a priority for all nations is not only a matter of justice and human rights. Rather, it could be the cornerstone of the post-2015 sustainable development agenda and a powerful driver of economic growth in low- and middle-income countries (LMICs). Health improvements drove a quarter of full income growth in developing countries between 2000 and 2011. At this rate of return, every US$1 invested in health would produce US$9-US$20 of growth in full income over the next 20 years.

To revisit the case for health investment, an independent commission of 25 renowned economists and global health experts from around the world came together from December 2012 to July 2013. The commission’s report, “Global Health 2035: A World Converging within a Generation”, was published in The Lancet on December 3, 2013 and launched on the same day at events in London, Tunis, and Johannesburg. The report clearly states that there is an enormous payoff from investing in health, and specifically makes the case that:

– the returns on investing in health are even greater than previously estimated;

– within a generation—by 2035—the world could achieve a “grand convergence,” bringing preventable infectious, maternal and child deaths down to universally low levels;

– taxes and subsidies are a powerful and underused lever for curbing non-communicable diseases and injuries;

– progressive universalism, a pathway to UHC that targets the poor from the outset, is an efficient way to achieve health and financial protection. Although some might believe that UHC is costly, studies consistently show that, when well-managed to provide quality care, it delivers better health outcomes at lower costs.

Thus, there is now widespread agreement that health may transform communities, economies and nations. But to tap into such a potential for development, the way that health care is financed and delivered must change, to be more equitable and more effective. Costs must be shared among the entire population through pre-payment and risk-pooling, rather than shouldered by the sick, and access must be based on need and unrelated to ability to pay.

Benefits can be almost immediate. If out-of-pocket spending for health services is eliminated or even reduced, money that families have to spend on health can now be spent on sending a child to school, starting a business or coping with an emergency. More broadly, UHC policies create resilient health systems: in times of distress, they mitigate shocks to people’s lives and livelihoods; in times of calm, they improve a community’s social cohesion and economic productivity.

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Adding the COHRED touch

COHRED proudly supports UHC Day. Delivering sustainable solutions to the health and development problems of people living in LMICs will require more than tackling health financing. If the medicines, health workers and health facilities do not exist, for example, it will be impossible to move toward UHC. In other words, strengthening health systems will be the key to ensure health for everyone and everywhere.

COHRED’s strong belief is that research and innovation play a crucial role in speeding up progress towards sustainable solutions to the health and development problems of people in LMICs. Either through enabling developing countries to identify their own national research priorities, or by providing leadership and effective solutions to support countries to build their own research and innovation systems for health and development, COHRED works actively to deliver UHC.

Last year, the WHO’s annual World Health Report was focused on “Research for universal health coverage”, remarking that UHC, with full access to high-quality services for prevention, treatment and financial risk protection, “cannot be achieved without the evidence provided by scientific research”. In the report, several examples of COHRED’s work are cited. These include Health Research Web, a global platform for information and interaction on health research for development, and RHInnO Ethics, a platform for research ethics review management.

Reaffirming its own commitment to contributing to UHC through research and innovation, COHRED is currently seeding the future, by shaping novel groundbreaking initiatives. In April 2015, the COHRED Fairness Index (CFI) will be officially presented in London. CFI is designed to provide an assessment tool to stakeholders to measure and report vital information that reflects their performance with respect to transparency, level of engagement, accountability and equity in their collaborations. The aim is to encourage good practices in North-South health research collaborations, for the benefit of health development and innovation in LMICs. Furthermore, COHRED and its partners are gearing up for the Global Forum on Research and Innovation for Health 2015, “People at the Center of Health Research and Innovation”. Planned for August 2015 in Manila, Philippines, Forum 2015 will bring together all stakeholders who have a part in making research and innovation benefit health, equity and development. Finally on stage as leading role actors of their own future, LMICs will take prime position in defining the global health research agenda that better suits their needs, in presenting solutions and in creating effective partnerships for action.

Universal health coverage is the final destination of a journey the World cannot afford to delay. Many paths lead to that destination. COHRED is making its way with determination and optimism about the impact of its global action.

Anthony Nguyen and Carel IJsselmuiden

Making the case for research and innovation for health in the post-2015 development agenda

In this guest post, Claire Wingfield—product development policy officer at PATH—writes about a new paper exploring why research and development (R&D) of high-priority health tools for diseases and conditions affecting low- and middle-income countries (LMICs) should be a critical component of the post-2015 development agenda.

A dearth of adequate health technologies and interventions targeting poverty-related diseases—like HIV/AIDS, malaria, tuberculosis, and neglected tropical diseases—means that millions of people in LMICs continue to die each year from preventable and treatable diseases and conditions. Progress on developing new interventions targeting the health priorities of LMICs has faltered because these diseases occur almost exclusively among the world’s poorest and most marginalized populations. Thus, there is little or no perceived commercial market encouraging companies to develop products targeting LMICs. Because the health burden imposed by poverty and social vulnerability remains far too high, achieving health for all is one major goal of the post-2015 development agenda.

In a new paper—developed by the Council on Health Research for Development, the Global Health Technologies Coalition, the International AIDS Vaccine Initiative, and PATH—the authors make the case for the inclusion of research and innovation for health as a central component of the post-2015 development agenda. The paper describes the impact that increased investments in R&D and innovation for health—particularly for the world’s poorest—have had in contributing to progress toward achieving the Millennium Development Goals (MDGs)—particularly for MDGs 4 (reduce child mortality), 5 (improve maternal health), and 6 (combat HIV/AIDS, malaria, and other diseases).

Credit: PATH/Gabe Bienczycki
Credit: PATH/Gabe Bienczycki

These investments have helped to create an enabling environment for research in and for the benefit of LMICs by increasing demand for new health technologies, expanding coverage of proven interventions, and strengthening the innovation infrastructure in these countries. Building on the work of The Lancet Commission on Investing in Health—a group of renowned economists and global health experts—the paper discusses the need for increased R&D investments by all countries to achieve the dramatic health gains envisioned in the post-2015 agenda.

Adequate levels of investment, as suggested by The Lancet Commission, are critical for spurring the development of new health tools, provided they align with financing needs in R&D—notably predictability and flexibility. But even that sort of investment alone does not guarantee more products, and it does not drive innovation toward the right type of products—those that are suitable, acceptable, affordable, and accessible to populations most in need. It is essential, therefore, that indicators for R&D for health tools that primarily affect LMICs address a comprehensive set of outcomes including financing needs, infrastructure and human resources needs, enabling policies, necessary partnerships, capacity strengthening, and access requirements.

Because poor health and disability contribute substantially to poverty, research and innovation for health is linked to improving economic prosperity and is critical to eradicating poverty. Therefore, it must be continuously prioritized within the post-2015 development agenda. Ultimately, the success or failure of the post-2015 agenda relies just as much on how the goals and targets are implemented as it does on how progress will be measured. Thus any research and innovation indicators measuring progress against the goals and targets outlined in the post-2015 agenda must also increase accountability of researchers, governments, and funders, and inform research processes. Inclusion of research and innovation for health must facilitate an enabling environment for research and innovation in LMICs and encourage endemic countries to set and pursue a domestically-driven health research agenda.

Credit: PATH/Evelyn Hockstein
Credit: PATH/Evelyn Hockstein

The post-2015 development agenda is an opportunity for LMICs to set their own health agendas and research priorities and to assert their leadership in strengthening the R&D landscape focused on the needs of the poorest and most marginalized populations. Therefore, it is essential that there is broad agreement among all of the relevant stakeholders that research and innovation for health—which includes the scaling up of proven health interventions as well as the development of new and improved high-priority health technologies—is critical to meeting the ambitious goals of eradicating poverty and ensuring sustainable development for all within a generation.

In support of the inclusion of research and innovation for health in the post-2015 agenda, over 150 organizations and individuals recently signed a petition to United Nations (UN) Secretary General Ban Ki-moon and Member States urging the UN to keep the research, development, and delivery of new and improved health tools for diseases and conditions impacting LMICs at the heart of the post-2015 development agenda. It is our hope that the Members States and other UN officials shaping the agenda will head this call.

Claire Wingfield (PATH)

 

Note: From the September issue of TDR news: “We are making good progress in a number of key initiatives with partners. For example, we’ve worked with COHRED, the Council on Health Research for Development, to develop a new internet platform that lists training opportunities and other important research management information in West Africa. West Africa Health Research Web (WAHRWeb) is a database and an announcement platform for research capacity training opportunities like ethics, grant writing, and clinical trials management for the 15 countries of the West African Health Organization (WAHO).”

Research for Health must stay at the heart of the post-2015 Sustainable Development Framework

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SPEED READ

– Work on outlining the post-2015 development agenda is coming to an end. The UN 68th General Assembly will meet in New York in September to define a set of Sustainable Development Goals (SDGs).

– “Ensure healthy lives and promote well-being for all at all ages,” reads proposed SDG 3. However, where does research for health stand in the new framework’s draft?

– To make sure that research, development, and delivery of new and improved health tools are kept at the heart of the post-2015 development agenda, the Council on Health Research for Development (COHRED) teamed up with the Global Health Technologies Coalition (GHTC) and the International AIDS Vaccine Initiative (IAVI) to address an appeal to Secretary General Ban Ki-Moon and Member States of the UN.

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Looking beyond 2015

While the current Millennium Development Goals expire next year, work on outlining the post-2015 development agenda is brewing up. The UN 68th General Assembly will meet in New York in September to define a set of Sustainable Development Goals (SDGs) to focus on in the 15 years to come. The new “Sustainable Development Framework 2015-2030” is the result of a lengthy process. In particular, the proposal on SDGs was prepared by a 30-member Open Working Group (OWG), established under mandate by the Rio+20 Outcome document in June 2012. The OWG final report lays out some 169 targets spread across 17 SDGs that range from ending poverty in all its forms everywhere to strengthening the means of implementation and revitalize the global partnership for sustainable development.

Despite the considerable efforts deployed so far and the undeniable progress done in the process of arriving at this new post-2015 framework, however, many observers fear that to ensure “healthy lives at all ages”, one of the key goals currently envisioned in the development framework, a more explicit and full support to health research and related policies and capacity building will be needed in the final discussion.

To make sure that research, development, and delivery of new and improved health tools are kept at the heart of the post-2015 development agenda, COHRED teamed up with GHTC and IAVI to address an appeal to Secretary General Ban Ki-Moon and Member States of the UN.

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The appeal

We, the below signatory organizations request that the UN fully supports in the post-2015 SDG-Framework the research, development, and delivery of new and improved medicines, vaccines, and other health tools for the diseases and health conditions that predominantly affect low- and middle-income countries as well as marginalized, vulnerable populations globally.

Thanks to the leadership of the UN and investments by Member States, the current Millennium Development Goals have made major contributions to improving the health and lives of millions of people around the world. A sustained focus on some of the greatest global health challenges has led to enormous progress in many areas, including significant improvements in the development and delivery of health tools such as drugs to treat HIV/AIDS, tuberculosis (TB) and malaria. Efforts to tackle diseases have also helped underpin progress in other important areas, such as gender equality, child mortality, and maternal health. Millions of lives have been saved.

However, major challenges remain, and the health burden imposed by poverty remains far too high. In this context, it is essential that the post-2015 development agenda retains a strong focus on eliminating poverty-related diseases and conditions. The post-2015 agenda must build on previous achievements to ensure that healthy lives and access to health services can be achieved in an equitable and sustainable way, leaving no one behind. This means ensuring universal access to proven health interventions. But it also means developing and delivering new health technologies which can help address the shortcomings of existing interventions and sustainably reduce morbidity and mortality over the longer term. This will require continued support for the research, development, and delivery of new tools to combat major epidemics like HIV/AIDS, TB, and malaria, as well as other poverty-related diseases and conditions ranging from neglected tropical diseases to reproductive, maternal, and child health. Continuous investment of human and financial resources in science, technology, and innovation is essential to achieve both economic and social development for all.

We are encouraged by the current inclusion of the need to support the development of new medicines and vaccines for diseases particularly affecting developing countries in the Zero Draft document of the Sustainable Development Goals. Concern remains, however, about the omission of medical devices and diagnostics which also contribute to improving health outcomes, the lack of clarity on how this effort will be funded, and how supporting policies, incentives, capacity building, collaboration, and knowledge and technology sharing will be defined and implemented.

As organizations working to save lives and improve health, we urge you to commit explicit and full support to health research and related policies and capacity building as a core component of a new, post-2015 agenda for equitable health and sustainable development for all. We ask that you press Member States to offer similar support, and to formally assess how to measure progress towards this goal, and how to fully and sustainably finance and enable the research, development, and delivery of essential new and improved health tools.

PATHMVI

A bigger role for science

It is not only the commitment to research for health that needs to be reinforced. Apparently, the recommended SDGs contain several other science-related issues that require attention. According to a recent SciDev.Net article, “[m]any of the quantified targets based on scientific evidence that appeared in earlier documents that laid out the SDGs have been replaced by blanks or removed entirely in the final document”. In other words, science experts fear that by approving a final resolution with vaguely indicated targets will permit politicians to adjust following efforts on the basis of economic convenience rather than scientific evidence. “For example, in April, possible climate change targets included an explicit two degrees Celsius limit, and dates for when carbon emissions should be arrested and reduced. The current outcome document is silent on these issues,” continues the SciDev.Net article.

 Carel IJsselmuiden