European Partnership for Global Health

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European Partnership for Global Health
Pre-Conference Event Madrid, 31 May, 2007
Research for Health Role of European Foundations
Andres de Francisco, MD, PhD Deputy Executive
Director Global Forum for Health Research
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This presentation

• Global health challenges
• Health research for development
• Financial flows
• Potential role for European Foundations

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This presentation

• Global health challenges

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DALY Disability-Adjusted Life Year
years lost due to death Fnyears lived
with illness/disability
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Burden of disease by major cause groups and
country groups, 2002
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Trends in cause distribution of DALYs 1990 to
2002
Africa
1990
2002
Group 3
Group 3
Group 2
Group 2
Group 1
Group 1
Other LMICs
1990
1990
2002
Group 3
Group 3
Group 1
Group 1
Group 2
Group 2
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'Neglected Diseases'

• Diseases
• that are significant sources of mortality and
  morbidity
• for which there are few or no adequate
  interventions (that are relevant to large,
  affected populations)
• that attract proportionally little funding

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Many 'Neglected Diseases'

• Mortality Estimates for 2002 (World Health Report
  2004)
• Infectious and Parasitic diseases 10 904 (000)
• HIV/AIDS 2 777
• Diarrhoeal diseases 1 798
• Tuberculosis 1 566
• Malaria 1 272
• Childhood diseases 1 124
• STI (excluding HIV) 180
• Meningitis 173
• (Other) Tropical Diseases 129
• Hepatitis B 103
• Hepatitis C 54
• Dengue 19
• Japanese encephalitis 14
• Intestinal nematode 12
• Leprosy 6

African trypanosomiaisis Chagas
Disease Leishmaniasis Leprosy Lymphatic
filariasis Onchocerciasis Schistosomiasis
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Emerging and re-emerging communicable diseases

• SARS
• vCJD (Mad Cow's disease)
• H5N1 (Bird Flu)
• Pandemics in 1918 (Spanish flu)
• 1957(Asian flu)
• 1968 (Hong Kong flu)
• New communicable diseases appear in human beings
  at a rate of more than one per year (every eight
  months a new human infectious disease emerges).

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Economic impact BIRD FLU (1)

• Evolution of the virus H5N1 cannot be predicted
  but may
• lead to 1 billion cases worldwide
• lead to 2-7 million deaths
• shave Asia's GDP by 3, world economy by 0.5.
• Global Economy may suffer by USD200 billion in
  losses if epidemic lasts more than one year (WHO).

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Non communicable diseases

• Large proportion of NCD burden is related to
• demographic changes
• risk factors (tobacco, food, sedentary life)
• socioeconomic gradients
• lack of access to health systems
• As epidemics advance, the poor suffer more

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European Observatory on Health Systems and
Policies
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TANZANIA SES AND CVD RISK FACTORS
Dar Es Salaam (9,254 people 35-64 years)
SES was inversely associated with BP and Smoking
and directly with Body Mass Index -Bovet P et
al, Int J Epi, 2002
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Global health challenges

• Globalization and trade
• Demographic transition and surveillance
• Health financing - Public health spending
• Urbanization, migration and ageing
• Climate change
• Use of evidence for programme development

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Changing demographics
Global population growth, 19502050
Developing countries
Developed countries
Health Financing Revisited A Practioners Guide.
P Gottret, G Schieber, World Bank, 2006
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Urbanization

• New patterns
• Tipping point
• 2007 marks a turning point in human history the
  world's urban population for the first time
  equals the world's rural population

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'Neglected health systems'

• In many developing countries health systems are
• weak/failing
• under-resourced
• inadequately funded
• poorly managed
• lacking investment in health policy and systems
  research
• lacking in utilization of the evidence/research
  base

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World Health Report 2006 - Working together for
health
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This presentation

• Global health challenges
• Health research for development
• Financial flows
• Potential role for European Foundations

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The spectrum of health research for development
Biomedical research
Health policy and systems research
Social sciences and behavioural research
Operational research
Basic research physical and biological sciences
including chemistry, pharmacology, toxicology,
genetics, etc
Research on policy formulation, relationship to
evidence, prioritization, etc
Research on social, political, economic,
environmental determinants of health and their
relation to equity, access, lifestyle and
health-seeking behaviours, etc
Research on factors affecting functioning of
programmes, effectiveness of targeting, impact
on behaviour , disease burdens and public
health, etc
Research on health systems management, functions,
efficiency, effectiveness, system factors
affecting access scale-up, monitoring and
evaluation, etc
RD for drugs, vaccines, diagnostics, appliances,
etc
Understanding the biological nature of diseases
creating products to prevent or treat disease
states
Implementation research Understanding how to
test, scale-up and follow through the
introduction of interventions and optimise their
benefits
Innovation
Impact
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The spectrum of health research for development
Biomedical research
Health policy and systems research
Social sciences and behavioural research
Operational research
The spectrum of research for health for
development
Biological, economic, environmental,
political and social determinants of
health
Health is a state of complete physical, mental
and social well-being and not merely the absence
of disease or infirmity. The enjoyment of the
highest attainable standard of health is one of
the fundamental rights of every human being
without distinction of race, religion, political
belief, economic or social condition. WHO
Constitution 1948
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Changing Landscape of Health Research for
Development- I? ?

• Case for health as a vital driver of development
  awakening interest in role of health research in
  supporting health improvement and health equity
• Substantial increased investments in health
  research for development new money from
  traditional and new sources.
• Many new actors in landscape
• New industry interest in diseases mainly
  prevalent in LICs

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Changing Landscape of Health Research for
Development- II? ?

• Widening understanding of health attention to
  diverse determinants of health.
• WHO increased interest in health research
  developing new strategy
• Many DCs increasing commitment to investing in
  research for health developing systematic and
  equitable approaches to the creation and use of
  knowledge and innovation

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This presentation

• Global health challenges
• Health research for development
• Financial flows
• Potential role for European Foundations

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On health and research

• Global Health Spending
• 3.2 trillion USD (2002)
• 350 Billion USD in LMICs
• Global Health Research Spending
• 125 billion USD (2003)

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Global health research expenditure
45 Public 48 Private For profit 7 Not
for profit
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Health Research Expenditures(based on
bibliometric RD data)
Lewinson G, Rippon I, de Francisco A, Lipworth
S Research Evaluation, Dec. 2004
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Enough funding for research?

• Are current investments in research for health
  adequate to enhance our ability to deal with
  global health problems?
• Is our understanding of research gaps (social
  determinants, policy issues, biomedical tools)
  for health in developing countries adequate?
• What evidence is required to design and implement
  sustainable, high level impact on health
  programmes in developing countries?
• What of the current research agenda is useable in
  developing countries failing health systems?

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Fragmentation in international effort .
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Aid flows

2002 58 billion total aid flows from rich
countries to poor ones 2000 - 2002 new aid
project commitments Mozambique 1,413 India
1,339 China 1,328 Tanzania 1,371 2003 Tanzania
declared a four-month mission holiday,
receiving only the most urgent visits by donors
Source Foreign Policy, Ranking the Rich 2004
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Bilateral Donor Support to Tanzania, 2000-2002

Source Foreign Policy, Ranking the Rich 2004
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• Health research in a systems context
• Move away from project mode research
• Incorporate health research in national plans
• Put government in driving seat
• Develop coherent funding approaches

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Financing health research how to reduce the
10/90 gap

• Government financing of health research for
  development
• HICs
• - give greater priority in national research
  programmes
• - include more health research in bilateral and
  multilateral channels
• LMICs
• - give greater priority in national programmes
• - build capacity (funding and environment) for
  national health research systems innovation

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Resource Flows Data for Selected ODA Agencies,
2001
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Philanthropy

• 50 most generous philanthropists collectively
  donated over US 50 billion, 1999-2003
• Bill and Melinda Gates Foundation
• - US29.2 billion endowment
• - Warren Buffett adds over US30 billion at 5 /
  year

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Public-Private Partnerships

• PPPs now conduct 75 of all neglected disease RD
  projects (47 projects)
• PPP RD expenditure has increased dramatically
  since their creation
• direct RD has doubled between 2003 and 2004

Dr Mary Moran 2005
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This presentation

• Global health challenges
• Health research for development
• Financial flows
• Potential role for European Foundations

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Potential role for European Foundations

• Take leadership in the changing landscape of
  global health research for development
• Build upon undergoing segmented efforts
• Use the ability to commit long-term support
  instead of short-term project support
• Develop a coherent approach to research based on
  the spectrum of research for health