WHO's director-general painted a grim picture at the Global Forum for Health Research in Beijing last week. Clifford Coonanreports
Spending on research into disease and health problems are growing at a phenomenal rate, but evidence is growing that the world's poorest people face being left behind when it comes to getting access to decent healthcare.
Dr Margaret Chan, director-general of the World Health Organisation (WHO), painted a grim picture for researchers and policymakers at the opening of the annual meeting of the Global Forum for Health Research, which was held in Beijing this year.
More than 10 million young children and pregnant women have their lives cut short by largely preventable causes, while life expectancy can differ by as much as 40 years between wealthy and poor countries.
"When health is concerned, equity really is a matter of life and death," Chan told the meeting, which was attended last week by 800 participants from 80 countries and included representatives of development agencies and research institutions, health ministries, NGOs and private companies.
While funding for research on communicable diseases was on the rise, this had not been matched by the power of health systems to deliver, partly because governments have failed to invest in the sector, she told the conference.
"For the first time, public health has commitment, resources, and powerful interventions. What is missing is this: the power of these interventions is not matched by the power of health systems to deliver them to those in greatest need, on an adequate scale, in time," she said.
The world will most likely fail to meet the Millennium Development Goals, a series of social and economic targets formulated by the United Nations that aim to halve extreme poverty by 2015, she said.
"We are at the mid-point in the countdown to 2015 . . . We have to face the reality. Of all the goals, those directly related to healthcare are the least likely to be met," Chan said.
"If we want healthcare to reduce poverty, we cannot allow the cost of care to drive impoverished households even deeper into poverty," she said.
The Global Forum for Health Research is a Swiss-based NGO, founded in 1998, which aims to set priorities and track resources for research on the health problems of the poor.
The forum heard how research on health systems has been badly neglected and under-funded, and more attention needed to be given to evidence, especially the collection of statistics. Less than a third of the world's population is covered by accurate data on numbers of births and deaths, and the causes of these deaths.
The forum was officially opened by Dr Chen Zhu, China's minister for health, who gave a frank analysis of the problems facing China, the world's most heavily populated country, which has pledged to provide its population with basic medical care by 2020.
As it stands, the system suffers from a woeful lack of resources and many, especially in the poor countryside, cannot afford to visit a doctor or stay in hospital.
"Big cities in the coastal regions are only part of China. If you go to the middle and particularly the Western parts of China, you may see different things," Chen said.
Globally, approximately €87 billion a year is being spent on health research, which marks a four-fold increase over the past 20 years, said Dr Stephen Matlin, the forum's executive director.
"In spite of that increase, a relatively small fraction of the total is devoted to health problems of the poor and to people living in developing countries," he said.
There has been a mushrooming of support for "neglected" diseases such as TB, HIV-Aids in the last five or 10 years. However, urban lifestyles, pollution and changing diets mean that threats such as cancer, diabetes and strokes are becoming more serious threats in poor countries, he said.
Matlin told The Irish Times that the acknowledgment by China's health minister that his country still suffered huge gaps in its ability to provide adequate healthcare to its 1.3 billion people was a sign of awareness that the problem was there.
"We had the minister of health talking frankly and openly about how it was not all Beijing and Shanghai and acknowledging there were big problems in the regions," says Matlin.
"There is a great interest from the Chinese and a recognition of the importance of research. The fact you have people in very senior positions who understand the importance of evidence is very important," he adds.
China faces an enormous challenge in rolling out healthcare systems, particularly because of the scale of the country, and research is required to make sure the investment is working, says Matlin.
Within Asia the healthcare picture is very mixed, reflecting the diverse nature of the continent.
Singapore is doing very well, but it is not really a model that would suit poorer countries, while some countries such as Sri Lanka have good data on healthcare systems which can help.
The forum is supported by a number of agencies, including the World Bank, the World Health Organisation and the Rockefeller Foundation.
"We also have support from a number of countries. The Irish Government is one of our newer contributors in the past two years. It's important because Ireland is playing an increasing role in terms of development.
"You now have the Irish Forum on Health and Irish Aid investing in funding research," he says.
Dr Pramilla Senanayake, who chairs the forum's Foundation Council, announced the completion of a mapping project of research capacities in mental health in 114 countries, which showed that while mental and neurological disorders are a growing burden of ill-health, services are woefully lacking, compounded by discrimination and stigma, which limit access to diagnosis and treatment.
"Our aspirations for this forum are that we will go far beyond asking 'what is the problem?' and that we will place emphasis on identifying solutions," says Senanayake.