Only 5.4% of the world's population was covered by comprehensive smoke-free laws in 2008, up from 3.1% in 2007, according to the World Health Organization’s (WHO) second report on the global tobacco epidemic. The report also describes countries' efforts to implement the tobacco control package called MPOWER, which WHO introduced in 2008 to help countries implement some of the demand reduction measures in the WHO Framework Convention and its guidelines. These measures are: monitor tobacco use and the policies to prevent it; protect people from tobacco smoke; offer people help to quit tobacco use; warn about the dangers of tobacco; enforce bans on tobacco advertising, promotion and sponsorship; and raise taxes on tobacco. Less than 10% of the world's population is covered by any one measure, the report states. The report tracks the global tobacco epidemic, giving governments and other stakeholders a tool to see where evidence-based demand reduction interventions have been implemented and where more progress is needed. It gives country-by-country tobacco use prevalence figures as well as data about cigarette taxation, bans on tobacco advertising, promotion and sponsorship, support for treatment of tobacco dependence, enforcement of tobacco-free laws and monitoring of the epidemic.
Monitoring equity and research policy
Coinciding with the International Day against Drug Abuse and Illicit Trafficking, the WHO launched its Global Health Observatory Database – Resources for the Prevention and Treatment of Substance Use Disorders. This global information system maps and monitors health system resources at the country level to respond to the health problems due to substance use. The system provides data for each of the assessed countries, such as funding, staff and services, and thereby complements already available information on the scope and associated harms of substance use disorders. The country profiles included in the new system cover 147 countries, which is 88 per cent of the world’s population. Current estimates indicate that worldwide, about 230 million adults aged 15-64 – or five per cent of the world’s adult population – used an illicit drug at least once in 2010, including about 27 million people with severe drug problems.
The Soul City Institute for Health and Development Communication, a non profit organisation, was started in 1992 in a bid to reduce child mortality caused by dehydration. "Children were dying unnecessarily and it was because people did not know what they were supposed to be doing," says Goldstein. Information was widely available on the process of rehydration but it did not seem to be having an impact on the desired audience. After studying the situation, Soul City decided to launch a television soap opera to capture their target audience. A radio show and newspaper series quickly followed. In trying to describe the relationship between research and mass media campaigns, Goldstein uses the phrase "simplification versus complexity." At one end stands the scientist who seeks in-depth knowledge and at the other the ordinary non-scientific individual who prefers a simple explanation. Melissa Meyer, Project Coordinator for the HIV/AIDS and the Media Project, says, "Research and entertainment need not be at odds with each other. With just a slight adjustment in perspective, they can be used very effectively to complement each other."
The WHO research strategy team has just finished its global consultations towards setting a new focus and role for WHO in health research: leadership and convening power to help other bodies set agendas, and an internal focus on ‘making a difference’ – getting care to where it’s most needed. The strategy is reported to demand impact both internally, within WHO, and externally, to give WHO a global leadership role.
An international group of prominent academics — including several Nobel prize winners — has urged WHO member states to support radically new ways to address the lack of research into diseases that affect the poor. In particular, they are seeking a sizeable increase in government support for research into these diseases through an international research and development fund, and alternatives to the financial incentives of patents.
This strategy document acknowledges that research is central to economic development and global health security and recognises that, in order to be effective, research has to be multidisciplinary and intersectoral in nature. In the face of current and emerging health threats – such as those posed by pandemics, chronic diseases, food insecurity, the impact on health of climate change, and fragile health systems – the document affirms that the Secretariat, member states and World Health Organization (WHO) partners have a joint responsibility to ensure that research and evidence help to achieve health-related development goals and improve health outcomes. It recommends an approach that involves all government departments so that health is reflected in all government policies. It identifies five interrelated goals that will help realise the draft strategy’s vision: the strengthening of research culture across WHO; the reinforcement of research that responds to priority health needs; improving capacity to strengthen national health research systems; the promotion of good practice in research, drawing on WHO’s core function of setting norms and standards; and strengthening of links between the policy, practice and products of research.
Current literature suggests that therapeutic misconception – a belief by participants in a clinical trial that they are in fact simply being given clinical care – is common, especially among illiterate populations in developing countries. In this study, most participated in research for the sake of obtaining better quality treatment made available through the clinical trials as ancillary care. Their consent to participate was not due to a belief that the actual procedures of the trial would directly benefit their health but due to government hospitals being crowded and commonly lacking drugs. In this environment, people make rational decisions to participate in research. This paper questions whether the term ‘therapeutic misconception' accurately describes participants' motivation under conditions of limited resources and discusses the issue of undue inducement in clinical trials.
Participants' refusal to take part in research is an unpleasant experience that investigators face. This paper highlights some of the reasons why people from resource-poor settings refuse to take part in health research, highlighting standards that investigators can adopt to avoid unnecessary refusals and at the same time ensure that individuals have the right to participate and freedom to refuse. The researchers conducted focus group discussions with people who had refused to take part in a number of biomedical research studies but agreed to be interviewed in this study. They found nine key factors that influence people to refuse to participate in biomedical research: failure to follow traditional customs, lack of study benefits, superstition, poor informed-consent procedures, ignorance of health research, fear of strangers, lack of cultural sensitivity, poor timing and previous bad research experiences. They recommend that researchers must embark on community engagement before implementing their studies.
Research on reproductive health in developing countries has produced a growing evidence base. But translating this evidence into appropriate health policy remains a slow process. What factors influence the use of evidence by clinicians and policymakers? And what enables or prevents them from putting research findings into practice?
This study was aimed at researching the reasons why mothers enrol their children in malaria clinical research and how family members or relatives are involved in the decision-making process. Issues related to informed consent were also a particular focus of this study. A total of 81 participants took part in eight focus group discussions, all of whom were mothers whose children had participated or were participating in Intermittent Prevention Therapy post-discharge (IPTpd) malaria research. Most of the participants reported that they chose to participate in the IPTpd research as a way of accessing better quality medical care and to benefit from the material and monetary incentives that were being given to participants for their participation. There was also a sense of trust in health workers who asked the potential participants to join the research. Most participants decide to take part in malaria research because of better medical treatment. Partners and relatives played a very small role in their decision-making process.