Renewed global collaboration on health needed

January / February 2010 | Volume 9, Issue 1

PHOTO: Dr. Julio Frenk speaks at a podium, gesturing with hands, unreadable slide in background

There is an “urgent need” to strengthen
scientific capacity in developing countries,
according to Dr. Julio Frenk, who spoke
recently at NIH.

A renewed commitment to global collaboration on health - with science playing a critical role - is needed to meet the challenges and reap the benefits of an increasingly interdependent world, Mexico's former health minister Dr. Julio Frenk told an NIH audience recently.

Global health is experiencing a moment of unprecedented attention and expansion, Frenk said, but a new conceptual foundation is needed to "guide efforts to generate knowledge and lead its practical applications." He also made the case for an increased emphasis on implementation science and identified an "urgent need" to upgrade research capacity in low-and middle-income countries.

Frenk, currently dean of public health at Harvard University, recently presented a talk titled, Globalization and Health: The Role of Knowledge in an Interdependent World, as the 2009 David E. Barmes Global Health Lecturer. The annual event - co-sponsored by Fogarty and the National Institute of Dental and Craniofacial Research - honors its namesake who was a public health dentist and epidemiologist dedicated to improving health in poor countries.

New approach to global health needed

"We need a new way of thinking about global health," according to Frenk. Global health involves entire populations, he said, and encompasses all the associated cultural identities, political organizations, transnational corporations, civil society movements and academic institutions, which are charged with producing knowledge-related global public goods.

In developing a new definition, "global health" should be distinguished from the term "international health," which is largely identified with controlling epidemics across borders and dealing with the health needs of poor countries, Frenk suggested.

"Global health, however, is not 'foreign health.' Nor is 'global' the opposite of 'domestic,'" he said. "Instead, global health should be centrally concerned with the interdependence among all countries, regardless of their geographical position or stage of development, including the distribution of health challenges around the world, which gives equity a key place in the global health agenda."

Intense global health transition underway

The world is in the midst of a tense and intense health transition unlike anything seen before, which is linked to broader demographic, social and economic transformations, he said. While the average life expectancy has more than doubled since 1900, rising to 66.6 years, there are huge national differences from 82 years in Japan to scarcely 32 in Swaziland.

From a health perspective, the most fundamental change is the shift in the dominant patterns of disease, he noted. "Now, people spend substantial parts of their lives in less than perfect health, coping with a chronic condition. Illness may not always kill us, but it always accompanies us."

Most developing countries are now facing a triple burden of ill health, according to Frenk. They must simultaneously tackle the unfinished agenda of common infections, malnutrition and reproductive issues; emerging challenges of non-communicable diseases; and the health risks associated with globalization. These include pandemics such as AIDS, distribution of harmful products including tobacco and drugs, the health consequences of climate change and the dissemination of harmful lifestyles leading to obesity.

"But just like there is a global transfer of risks, there is also a global transfer of opportunities, which is powered mostly by the expansive benefits of knowledge," Frenk said. He described a cycle of knowledge involving its production through research; its re-production via education and training; and its translation into practice, which is evaluated and feeds back into the production of new knowledge.

Knowledge translation key to health

Frenk suggested the translation of knowledge is important to health by producing new drugs and treatments, informing a population's behavior and providing a scientific foundation for both health care and policy formation.

"The process of globalization can turn knowledge into an international public good that can then be brought to the domestic policy agenda in order to address a local problem."

The rollout and evaluation of Mexico's Seguro Popular, the successful universal health insurance program, is one such example, he noted. The first follow-up study showed a significant reduction in catastrophic expenditures, especially among poor households. By sharing the rigorous research design, implementation strategy and outcome data, others can benefit.

"Every country should have access to global knowledge repositories, along with the capacity not so much to adopt evidence as to adapt it to local circumstances," he said. But adequate capacity does not exist in many countries and there is an "urgent need" to strengthen it.

A coherent strategy should be developed to deploy three levels of intensity, Frenk proposed. Capacity building is needed to develop human resources where research infrastructure is weak; capacity strengthening to expand and diversify existing resources; and performance enhancement to supply catalytic investments that promote collaborative linkages between researchers in developed and developing countries.

"As we enter a new era of global health, knowledge will continue to be the key asset to sharpen our understanding of problems and to create novel solutions. In our turbulent world, still scarred all too often by intolerance and exclusion, science remains as the most powerful force for enlightened social transformation."

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