“Pneumonia, diarrheal diseases, tuberculosis and malaria, when combined, have been estimated to account for more than 20% of the disease burden in the world (mostly in developing countries), yet they receive less than 1% of the total public and private funds which are devoted to health research.”(1)
Though developing countries bear 90% of the global disease burden, only 10% of all health research funding is used to address these diseases.(2) As such, there exists a need to bolster the research capacity in developing countries through international and national collaboration. Today, various governmental bodies, in partnership with organizations like the World Health Organization, Canadian Coalition for Global Health and Commission on Health Research for Development, are working to address this global health research inequity, commonly known as the 10/90 gap. These institutions develop solutions to overcome various difficulties, such as lack of financial and intellectual resources, which hamper efforts to build a solid research community.(3) Also, they have begun to draw attention to the neglected research needs of the developing world. Already there is evidence of success; new drugs and vaccines are increasingly being developed to treat neglected tropical diseases.(4)
Global health research should not only generate knowledge; more importantly, it should lead to action. In particular, research outcomes must guide policy and program development as well as the delivery of health services. Healthcare interventions should be evidence-based and grounded in solid research.
Consider the case study of antiretroviral therapy (ARVT), which is widely used to treat HIV-positive patients in developed countries. While ARVT is in high demand in the developing world, transferring this first world technology to a developing country is not easy. Due to lack of health infrastructure in much of the world, the widespread use of ARVT may introduce new risks such as viral resistance. Thus, research must first be conducted to help create structured ARVT programs that can avoid these unintended consequences.(5)
Moreover, scaling up ARVT in developing countries is a tremendous project in which success is ultimately dependent on sound research. For instance, the availability of ARVT may encourage unsafe sexual practices in a particular community. To address this concern, researchers must first try to anticipate the potential social impact of ARVT. Furthermore, unanticipated logistical issues may arise. For example, it may prove difficult to keep track of a large number of patients and ensure that they make their follow-up visits. “One study of patients lost to follow-up in Malawi demonstrated that half the patients who had been lost had died, and of those, 58% had died in the 3 months following their last clinic visit.”(6) Yet another unforeseen problem could occur when expanding ARVT treatment to children. Because children’s immune systems are still developing, they may respond differently to ARVT.(7) In such instances, research is essential in order to foresee negative outcomes and to ultimately ensure the successful implementation of health programs.
“Although the particular negative attributes a society ascribes to a [medical] condition may vary widely with the culture, there is a common thread of implied moral wrong. The stigmatized individual is seen as an affront to the moral order, one who violates the norm, becoming a public enemy who evokes fear, even fear for one’s life, and hence someone who must be put down – or put out – literally isolated.”(8)
Perceptions of disease and healthcare vary with culture. In the developing world, different stigmas may be attached to disease, which in turn may be attributed to a variety of beliefs not commonly held by those in the Western world. Oftentimes, the stigma that accompanies disease is so great that people are unwilling to seek treatment. Therefore, stigma is a barrier to effective healthcare delivery, and represents one kind of cultural barrier that research seeks to eliminate. When a cross-cultural medical or public health intervention is to be implemented, research should be conducted to examine the social factors that may impede the delivery of care.(9)
Without a sound understanding of a community’s cultural psyche, many health workers find that programs fail despite their best efforts and advanced technologies. To avoid such pitfalls, health workers must conduct research to understand the cultural perceptions of disease in the communities where they serve, and develop culturally-sound approaches to healthcare delivery.
It is important to take an interdisciplinary approach to global health problems, which are often multi-faceted in nature. Health is a broad concept; it is not simply a biological phenomenon but is also influenced by various social, economic and political determinants. Diseases, as much as they are caused by microorganisms, are also linked to certain “inherently global health issues,”(10) such as water shortages, deforestation, greenhouse gas emissions, increasing poverty, financial instability, trade in health damaging products, war and conflict etc. For instance, a singular focus on HIV/AIDS ignores the many other dimensions of the disease:
“For example, the HIV/AIDS pandemic, particularly in Africa, affects several vulnerable groups, particularly women. Poverty, war and conflict, and ecological degradation are all important co-factors. Liberalization, structural adjustment programs, and the aid policies of wealthy nations, which constrain taxation revenue and equitable access to health services, are also determinants. Trade agreements underpinning the HIV/AIDS pandemic relate to intellectual property rights (patents) and accessibility of drugs, as well as the decline in “special and differential” exemptions that poorer countries can invoke to protect their still developing domestic economies to ensure greater growth and fairer distribution of its benefits. No single research project on HIV/AIDS should be expected to incorporate all of these elements. A singular focus on HIV/AIDS, however, obscures the important role of these and other co-factors of inherently global health issues.”(11)
Due to the diverse determinants of health, there are many ways for students to be involved in global health research. Students from different academic disciplines can bring their knowledge and skills to bear on the various social, economic, biological and political dimensions of disease. Global health research is a collaborative process; each researcher contributes a piece to solving the puzzle of disease and morbidity. Multi-disciplinary research findings are used to tackle key health problems.
For instance, Unite For Sight's Global Impact Fellows carry out research projects in order to enhance knowledge about global eye care needs and solutions. Global Impact Fellow Abraar Karan developed a research study that identified the advantage of using visual aids to improve patient understanding about cataract and its treatment, thereby prompting Unite For Sight to implement visual aids at outreach programs. Another Global Impact Fellow, Bradford Lee, researched glaucoma and suggested improvements for follow-up and disease management. His research has been published in a peer-reviewed journal.
Global health research is necessary to remove the various social, cultural, and logistical barriers that confound the well-intentioned efforts of many global health programs. Therefore, research must focus on concerns raised by developing countries, closing not only the gap in health disparities within countries, but also the gap in knowledge between the developed and developing world.(12) Furthermore, research must be sensitive to the culture of a particular community. As the field of global health research continues to grow, student researchers have the potential to make very important contributions.
(3) Lee, Kelley and Anne Mills. "Strengthening governance for global health research: The countries that most need health research should decide what should be funded." British Medical Journal 30 Sept 2000 775-776. Web.24 July 2009.
(4) Norris, Jeremiah. "Global health research: don't ignore achievements so far ." The Lancet Vol. 317, Issue 961506 Mar 2008 810-811. Web.24 Jul 2009.
(5) Boulle, A and N Ford. " Scaling up antiretroviral therapy in developing countries: what are the benefits and challenges?" British Medical Journal 19 Nov 2007 Web.24 Jul 2009.
(6) Boulle, A and N Ford. " Scaling up antiretroviral therapy in developing countries: what are the benefits and challenges?" British Medical Journal 19 Nov 2007 Web.24 Jul 2009.
(7) "Trial Summary." Arrow: Anti-retroviral Research for Watoto. UK Department for International Development & Medical Research Council of UK. 24 Jul 2009 <http://www.arrowtrial.org/ts_overview.asp>.
(8) Keusch, Gerald T, Joan Wilentz, and Arthur Kleinman. "Stigma and global health: developing a research agenda." The Lancet Feb 2006 525-527. Web.24 Jul 2009.
(10) Labonte, Ronald and Jerry Spiegel. "Setting global health research priorities Burden of disease and inherently global health issues should both be considered." British Medical Journal 05 Apr 2003 722-723. Web.24 July 2009.