A wishlist for the future of global health research

Collective Co-Director Katerini Storeng presents her top three priorities for a reinvigorated global health research system. 

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Research has played a vital role in the rise of the global health field in the past two decades. Billions have been invested to foster the research and development of new biomedical tools and to facilitate access to these technologies in poor countries. This has saved millions of lives.

However, in a world structured by deep inequalities and undergoing major transitions, a focus on technologies and quick fixes alone is not enough. Global health’s normative commitment to achieving health equity for all people worldwide cannot be fulfilled in this way. Indeed, during the pandemic, we have seen that the “scientific miracle” of developing several effective vaccines in record time could not prevent what the Director General of the WHO has called a vaccine apartheid and even a “failure of humanity”. Therefore, we urgently need to better understand the political, social, and commercial determinants that explain how such inequities arise.

To support that purpose moving forward, the global health research system must reinvent itself. And at the top of my wish list for a reinvigorated global health research system are three things: broader research scope, more research diversity and greater research independence.

Broader scope

My first wish is for broader scope. Our current system incentivises research focused on single diseases and technocratic solutions. Although it is widely recognised that the best vaccines in the world are of little use if they do not reach the people who need them, only a fraction of global health funding is allocated to health policy and systems research. Of course, we need to study the global burden of disease and the latest technological and biomedical innovations. Yet, proposed innovations in health financing and global governance arrangements deserve the same kind of critical scrutiny. We need better support for research into how power constellations, interest groups, and ideological positions affect global health, and how different political systems and cultures shape global health outcomes – not only in low-income countries but across the globe.

Research diversity

My second wish is for a more diverse and pluralistic research system. Global health has its roots in the institutes of tropical medicine that emerged in European port cities to cater to the health of colonial rulers, and, later, their subjects.  Along with American Schools of public health, these institutes lead the research in our field today. Europe and North America are also home to the largest public and private funders, and to the leading academic journals. This feeds growing concern about an unhealthy concentration of power among a small number of Western, often male-dominated institutions, who may be distorting and narrowing research priorities.

Going forward, we must address the power asymmetries that place researchers based in low- and middle-income countries at a disadvantage when it comes to shaping research priorities and agendas. This includes responding to growing calls to change the status quo, for example by providing direct funding to support researchers and research infrastructure in the countries with the greatest needs.

Shifting funding priorities in this way is important, but not sufficient. We also need to expand the envelope. More funds are necessary to make the field more pluralistic, and better equipped to realise health as a global public good. Public research funding cannot continue to come from international development budgets alone. For example, more health funding could go to address transnational concerns.

 

Independent research

Finally, my third wish is for greater research independence. Global health researchers often depend on donor agencies and philanthropic foundations for their livelihoods, and often work within, and study, complex power relations. It can be a challenge to negotiate our own position between the interests of funders, implementing agencies, governments, on the one hand, and our own research institutions and international partnerships on the other. Sometimes, the collective drive to demonstrate the success of global health investments can embroil researchers in what has been called a “success cartel.” This is a problem for independent research. Unfortunately, I am not alone in having experienced direct interference in the research process, intimidation and even censorship of unwanted findings. Too often, hasty evaluations commissioned to consultancies lacking an arm’s lengths’ distance replace in-depth critical research. Some actors’ reluctance to divulge data or information about how they operate makes the academic’s role in holding power to account frustrating at best, and impossible at worst, as my colleagues and I have experienced in studying public-private partnerships in global health.

There are certainly no quick fixes to resolve such issues of power and politics, but we must take forward the discussion. We can carefully consider the many proposals that have been made in recent years for how to improve research independence, equity, and accountability.

As we draw lessons from the COVID-19 pandemic, research is more important than ever in understanding how we got here and how to chart a pragmatic and hopeful path ahead. But to serve this purpose, we need a broader research scope that includes studying governance and finance innovation. We need greater diversity with the system, and we must hold on to the value of research independence. The future of global health may even depend on it.

 

This text was prepared for the Oslo Symposium, A world in Transitions: Implications for Priorities and Efficiencies in Global Health, Oslo, October 14, 2022. A recording of the Symposium is available here: Inviterer til internasjonalt symposium om global helse i en utfordrende tid - regjeringen.no

 

By Katerini Storeng
Published Oct. 19, 2022 3:28 PM - Last modified Oct. 21, 2022 9:32 AM
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A blog written by members of The Political Determinants of Health Collective, where they discuss how their work contributes to furthering knowledge and research in this area.