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ForewordGlobal Forum Update on Researchfor Health volume 4: Equitableaccess: research challenges forhealth in developing countriesForeword by Pramilla SenanayakeLife expectancy and other indicators of health have, onaverage, increased markedly across the world duringthe last century. At the same time, however, healthinequities within and between populations have persisted andin some cases worsened.Recent efforts to reduce some of the large gaps in healthstatus have been channelled through international initiativessuch as the Millennium Development Goals and a variety ofinternational health initiatives, including new public-privatepartnerships to develop products for neglected diseases andlarge pools of funds to assist disease-endemic countries topurchase drugs and vaccines. But ensuring that individualseverywhere can enjoy the right to health involves much morethan creating medicines and supporting their purchase for thepoorest countries. It requires enabling people to haveequitable access to information, health services and productsand to basic living and working conditions that give them realchoices and opportunities to maintain good health and avoiddiseases and injuries.Research has a central role to play in addressing healthinequities. It can identify the presence of major healthdisparities, help to create understanding of the underlyingcauses and provide potential solutions to be tested, verifiedand scaled up. The spectrum of research required to supportequitable access to health is therefore very broad. Itencompasses not only biomedical research to understandbiological causes of ill-health and develop medical solutions,but also research into economic, environmental, political andsocial determinants of health; and it ranges from studies ofhow policies are developed and implemented at global andnational levels to the examination of their effectiveness andimpact on the health of those who have been marginalized.This year’s edition of the Global Forum Update onResearch for Health and the annual Forum meeting of theGlobal Forum for Health Research take as their theme theissue of equitable access and the research challenges it posesin trying to improve health and reduce health disparities indeveloping countries. We are extremely grateful to the manydistinguished authors who have contributed their time andexpertise to the articles in the Update. These provide concise,expert summaries and opinions to complement the rich arrayof presentations and discussions of the many facets ofequitable access that are on the agenda of Forum 11 inBeijing this year. ❏Pramilla Senanayake is Chair of the Foundation CouncilGlobal Forum for Health ResearchAugust 2007Global Forum Update on Research for Health Volume 4 ✜ 009
IntroductionResearch contributions toimproving equitable access tohealth in developing countriesArticle by Stephen A MatlinEverywhere in the world, issues of equitable access arefundamental to improving the health of all the people 1 .Limitations of access to information, to services forprevention and treatment, or to good quality health-relatedproducts are among the many factors that create gradients inhealth status within and between societies.High levels of malnutrition, maternal and child mortalityand infections with HIV/AIDS, TB, malaria and a number ofpathogenic tropical parasites in some developing countrieshave attracted much attention and led to the establishment ofthe Millennium Development Goals 2 to reduce some of thestarkest health gradients between countries. But these do notaddress the broader health conditions that affect peoplethroughout the world, including a host of noncommunicablediseases that are becoming increasingly prevalent in low- andmiddle-income countries 3 , nor the wide range of factors anddeterminants that act as pre-conditions for people to achieveand maintain good health.Historically, some groups have experienced long-standingdiscrimination in access to health including, among others:women, people with disabilities, indigenous peoples, poorpeople, people in low-income countries, rural populations,slum dwellers, elderly people, children, adolescent and youngpeople, people of low social class or caste and peoplestigmatized by specific conditions such as HIV/AIDS.Given the wide range of health determinants andconditions that are at play, the spectrum of research requiredto address the complex range of factors associated withinequities in access is necessarily very broad. Research canhelp to identify and address barriers to access of all types(including economic, geographical, institutional, political,socio-cultural and technological barriers) and can help toidentify, test and validate measures to improve equity ofaccess for all. The range of people who need to be engagedGiven the wide range of health determinants andconditions that are at play, the spectrum of researchrequired to address the complex range of factorsassociated with inequities in access is necessarilyvery broadin such research is also extensive – encompassing not justphysical, biological, social and behavioural scientists locatedin academic research institutions but also health workers,nongovernmental organizations (NGOs), communities, civilsociety groups and individuals, including representatives ofgroups on whom the research is focused.This article considers a diverse array of factors associatedwith inequities in access to the means to achieve betterhealth in developing countries and summarizes some of theways in which research is, or could be, playing a role inremoving barriers and biases.Access to the preconditions for healthIt is increasingly appreciated 4 that a broad array of nonbiologicalfactors act as determinants of health, includingthose of economic, environmental, political and social origins(Figure 1). Improving health, especially for some of thepoorest and most marginalized in society, will require givingmuch greater attention to these “causes of the causes” of illhealth,with effort needing to be concentrated on securing thehuman rights on which many of these determinants depend.Research to examine these wider determinants of health, tounderstand the causal relationships and to demonstrate waysin which they can be used to improve health status andhealth equity is scarce and there is a need to begin byestablishing the scope of the research agenda, mapping thehuman and financial resources already available and settingpriorities for where and how the most urgent gaps are to befilled. The research agenda on determinants of health mustinclude studies of the extent to which human rights arerecognized and upheld, given that health and human rightsare inextricably connected.Among the broad range of determinants, social factors havereceived most attention recently, particularly through theestablishment of a series of Knowledge Networks by the WHOCommission on Social Determinants of Health (CSDH) 5 . TheCSDH, created in 2005 to draw attention to pragmatic waysof creating better social conditions for health, aims to promotemodels and practices that effectively address underlyingsocial inequities, human rights and the broad socialdeterminants of health; to support countries in placing healthas a shared goal to which many government departments andsectors of society contribute; and to help build a sustainableGlobal Forum Update on Research for Health Volume 4 ✜ 011
Page 3 and 4: Editorial Advisory Board:Luis Gabri
Page 5: Contents096 Child immunization: acc
Page 9 and 10: IntroductionType IType IIType IIIPr
Page 11 and 12: Introductionmaking), takes account
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Access to health“Two months ago I
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Access to healthReferences continue
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Access to healthsocio-cultural and
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Access to healthReferences continue
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Research resourcesResearch impact o
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Research resourcesBiotechnologists6
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Research resources1,61001,41,219080
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Research resources✜ A group of nu
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Decision-making148 Delivering evide
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Decision-makingChallenges in employ
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Decision-makingUsing evidence forpo
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Decision-makingsystems development.
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Decision-making✜ develop a critic
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Decision-makingGlobal and regional
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Decision-makingHigh-incomeChildrenE
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Decision-makingLow- and middle-inco
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Decision-makingLow- and middle-inco
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Decision-makingthan a quarter of th
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Decision-makingThe potentials of in
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Decision-makingGenerally, any resea
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Decision-makingReferences1.Hawes H.
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