文章基本信息

标题：Current Priorities in Health Research Funding and Lack of Impact on the Number of Child Deaths per Year
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作者：Jef L. Leroy ; Jean-Pierre Habicht ; Gretel Pelto 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：2
页码：219-223
DOI：10.2105/AJPH.2005.083287
语种：English
出版社：American Public Health Association
摘要：We determined the proportion of research on childhood mortality directed toward better medical technology (i.e., by improving old technology or creating new technology) compared with research on technology delivery and utilization. We also estimated mortality reductions from a research-funding strategy focusing primarily on developing technology compared with one that also focused on delivery and utilization. Ninety-seven percent of grants were for developing new technologies, which could reduce child mortality by 22%. This reduction is one third of what could be achieved if existing technologies were fully utilized. There is a serious discrepancy between current research and the research needed to save children’s lives. In addition to increased research on the efficacy of treatment, there is an even greater need for increased research on delivery and use of technology. AN INVESTIGATION undertaken in 2003 for the Bellagio Conference on Child Survival showed that the vast majority of deaths of children younger than 5 years, about 10 million per year, occurred in 42 low-income countries. 1 The Bellagio Conference concluded that about two thirds of these could be prevented by interventions currently available and feasible for implementation in these countries. 1 Other articles from the conference indicated that the systems for delivering these technologies are seriously deficient 2 and that their utilization is inadequate, especially among the poor. 3 Before the Bellagio Conference, the international Commission on Health Research for Development drew attention to the imbalance in research addressing ill health in developing countries compared with research on health issues of populations in wealthy, industrialized countries. 4 The critical finding from the commission report was that 90% of all research funding for health was devoted to the health problems of industrialized countries, whereas only 10% was for research on the health issues of low-income countries. This issue has received considerable public attention, and the imbalance is now widely referred to as the “10/90 gap.” 5 The findings from the Bellagio Conference and global disparities in the allocation of research resources for health issues of populations in developing countries raise other questions about current research priorities: how much research is being directed toward breaking the bottlenecks in delivery and utilization that prevent existing technology from reducing child mortality? If, as we suspect, little such research is performed, how great a reduction in mortality can be expected from new health technologies in the future, given present conditions of utilization and delivery? We first examined the evidence for another “gap,” namely that between research investments in biological and clinical technology and research investments in delivery and utilization. Second, we estimated mortality reductions from a research funding strategy focusing primarily on the development of better health technologies compared with a strategy also focusing on delivery and utilization. These investigations were based on the premise that research leading to the development of better health technologies will not automatically have an impact on child mortality, because technologies must also be delivered to and used by the children who need them. Achieving improvements throughout this process, from basic scientific discoveries to their utilization, requires scientific research. Applied operations research in the context of health and welfare programs is generally considered to be a national responsibility, but research to obtain general knowledge through theory development and its testing in practice is a global responsibility.