Knowledge for Health Development

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Knowledge for Health Development
Knowledge for Development Seminar, Center for
International Development Kennedy School of
Government, Harvard University, 4 March 2004

• Lincoln Chen
• March 4, 2004

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Presentation

• How knowledge relates to health?
• Oral rehydration therapy Case
• Commission health research for development
• Better knowledge systems?

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Knowledge-Health

• Knowledge-based Multi-faceted
• Technologies drugs, vaccines
• Ecological and behavioral approaches
• Primary education (of girls)
• Sectoral interdependencies
• Socially-driven Multi-systems
• Health care systems
• Consumer and advocacy groups
• Government and national health

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Oral Rehydration Therapy

• Diarrheal diseases kill 2-3 m children/year
• Virus/bacteria from water, food, hands
• Deaths due depletion body salts/fluids
• Oral rehydration saves lives
• Replenishes body salts/fluids
• Basic research biophysics
• Intestinal absorption of sugars
• Sugar carries salt which carries water
• Applied research - social-operational
• Packet, home-mixtures
• Delivery systems

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Institutional Basis of ORT

• Basic Research
• NIH, Harvard Medical School
• Applied Clinical Research
• Cholera Research Laboratory, Dhaka
• Calcutta Hopkins Research Program
• Applied Field Research
• Matlab, Bangladesh
• Refugee Camps, West Bengal
• Scientific Debate over Technology
• WHO (packet) vs BRAC (home brew)
• Dissemination, acceptance, use
• NGOs
• UNICEF Jim Grants Child Survival Revolution
• USAID Peter McPherson
• Time cycle ORT 20 years vs smallpox 200 years

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Commission Health Research

• Independent initiative
• members, secretariat, funding
• Research and consultations
• literature, data/analysis, consultations
• 1990 Report Health Research Essential Link to
• Equity in Development
• Follow-up Mechanisms
• Nobel Symposium
• COHRED and Global Forum

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Major Findings

• Health disparities due, in part, inadequate,
• imbalanced research (90/10 rule)
• Key role research generate knowledge,
• apply solutions, develop new solutions
• Recommendations
• Essential national health research
• International partnerships
• Financing health research
• International mechanism for global research

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Lessons in Retrospect

• Low evidence high politics
• Biomedical/basic vs social/applied research
• Research imbalances/equity gap
• Funding base imperfect
• Foundations, bilateral donors, NIH
• Public understanding, political support
• Health research-industrial complex
• Efficient, effective, profitable
• Somewhat inefficient, highly inequitable

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Design Knowledge Systems

• Empower end-users set priorities RD
• Location-specific knowledge for action
• User-inspired basic research
• Incorporate tacit and formal knowledge
• Integrate public/private, needs/capabilities
• Boundary spanning knowledge-action

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Emerging Issues

• Scientific revolution
• Biology of genetics
• ICT and health
• Globalization WTO/IPR
• Health exceptionalism compulsory licensing
• Market failure forces for discovery
  (commerce, war, social)
• Health knowledge as a public good
• Know-do gap
• 3-by-5 ART for HIV/AIDS
• Ethical challenges
• Institutional architecture
• Fissures public/private, N/S, basic/applied
• Pluralistic global system of health research
• No CGIAR WHO, ICDDRB, INCAP, BMRC,
  Wellcome
• National/local programs
• Scale boundaries in applicability of
  knowledge?