Michael Wolfson, Assistant Chief Statistician, Statistics Canada and Geoff Rowe, Senior Analyst, Socioeconomic Modelling Group, Statistics Ottawa, Canada. Bulletin of the World Health Organization, June 2001, 79(6): 553-560
In a recent series of papers, Murray et al. have put forward a number of important ideas regarding the measurement of inequalities in health. In this paper we agree with some of these ideas but draw attention to one key aspect of their approach -measuring inequalities on the basis of small area data -which is flawed. A numerical example is presented to illustrate the problem. An alternative approach drawing on longitudinal data is outlined, which preserves and enhances the most desirable aspects of their proposal. These include the use of a life course perspective, and the consideration of non-fatal health outcomes as well as the more usual information on mortality patterns.
Monitoring equity and research policy
The new South African National Health Act has clarified that children may take part in ‘non-therapeutic' research (NTR) and the age at which they may provide independent consent to such research, viz. at legal majority. However, the Act will require consent from the Minister of Health for all research classed as NTR and involving minors regardless of the level of risk. This requirement is overly broad. It will require that low-risk research without direct benefits, which might be adequately reviewed by an accredited research ethics committee (REC), must also be reviewed by the Minister. As it currently stands this requirement is argued to serve no plausible ethical purpose, to cause delays and discourage essential research on the needs of children, and may inspire researchers and RECs alike to ‘foil the system'. The authors argue that in the long term there should be comprehensive law reform for child research. However, in the short term, amendments should be made to the Act to narrow the scope of this provision.
Impaired access to research information in health-related fields is not solely the preserve of developing countries but it is hugely exacerbated in poorer regions of the world. Why are such influential bodies as the Australian National Health and Medical Research Council, the Canadian Institutes of Health Research, the Centre for Disease Control and the National Institute of Health in the USA, the United Kingdom Medical Research Council and the Wellcome Trust promoting open access? Because it brings such benefits to health research including: increased visibility for research outputs; a concomitant increased usage and impact; an increase in the speed at which scientific research progresses; the facilitation of interdisciplinary research; and the enabling of new semantic computing tools to create new knowledge from existing knowledge. Open access is a key piece of the jigsaw for improving world health. All stakeholders in that vision should commit themselves to its implementation.
Online, open access (OA) medical publishing has provided new opportunities for increased transparency and innovation in clinical trial reporting, which if widely adopted can ultimately help enhance the quality and reliability of evidence, argue the authors of this article. They discuss the OA movement’s role in medical research and provide an up-to-date analysis of recent initiatives and trends. Access to original research remains the driving force behind OA, recently exemplified in the United States by a Whitehouse petition for open access publication of tax-funded research as well as the negative reaction to the controversial Research Works Act, which would restrict sharing data between researchers. Meanwhile the British government has also announced its support for OA. Improving availability of data, increasing access to research in developing countries and creating new services for easier location and reuse of clinical information are all priorities for the future and can contribute to the advancement of clinical medicine, according to the article.
In the past few years there has been an ongoing debate as to whether the proliferation of open access (OA) publishing would damage the peer review system and put the quality of scientific journal publishing at risk. The aim of this study was to inform this debate by comparing the scientific impact of OA journals with subscription journals, controlling for journal age, the country of the publisher, discipline and (for OA publishers) their business model. A total of 610 OA journals were compared with 7,609 subscription journals using Web of Science citation data, while an overlapping set of 1,327 OA journals were compared with 11,124 subscription journals using Scopus data. Results showed that average citation rates were about 30% higher for subscription journals. However, after controlling for discipline (medicine and health versus other), age of the journal and the location of the publisher (four largest publishing countries versus other countries) the differences largely disappeared in most subcategories except for journals that had been launched prior to 1996. In medicine and health, OA journals founded in the last 10 years are receiving about as many citations as subscription journals launched during the same period.
Access to health research publications is an essential requirement in securing the chain of communication from the researcher to the front-line health worker. As the diagram of the knowledge cycle from the Canadian Institutes of Health Research shows, health knowledge generated in the world’s laboratories is passed down the information chain through publications, through its impact and application, its subsequent “translation” into appropriate contexts for different user communities, arriving finally with health workers and the general public. This article focuses on the first link in the chain, from research author to reader, and the free online access to peer-reviewed published articles that are the building blocks for future health innovation developments.
Traditional, subscription-based scientific publishing has its limitations: often, articles are inaccessible to the majority of researchers in low- and middle-income countries (LMICs), where journal subscriptions or one-time access fees are cost-prohibitive. Open access (OA) publishing, in which journals provide online access to articles free of charge, breaks this barrier and allows unrestricted access to scientific and scholarly information to researchers all over the globe. At the same time, one major limitation to OA is a high publishing cost that is placed on authors. Following recent developments to OA publishing policies in the UK and even LMICs, this article highlights the current status and future challenges of OA in Africa. The authors place particular emphasis on Kenya, where multidisciplinary efforts to improve access have been established. They note that these efforts in Kenya can be further strengthened and potentially replicated in other African countries, with the goal of elevating the visibility of African research and improving access for African researchers to global research, and, ultimately, bring social and economic benefits to the region. The authors (1) offer recommendations for overcoming the challenges of implementing OA in Africa and (2) call for urgent action by African governments to follow the suit of high-income countries like the UK and Australia, mandating OA for publicly-funded research in their region and supporting future research into how OA might bring social and economic benefits to Africa
In this paper, the authors discuss open source approaches for research and development (R&D) for neglected diseases, and their potential to lower costs and R&D time frames, increase collaboration and build a knowledge commons. They describe existing initiatives and debates, and suggest how readers and the global health community might better make use of open source approaches. While most of the open source initiatives examined in the review appear to demonstrate significant potential, the authors conclude that hard evidence of impact appears to be limited thus far. They make three short-term recommendations. Governments and other stakeholders should first develop detailed profiles of open source initiatives for R&D into neglected diseases, then they should prioritise gaining more substantial and long-term investments into the area. Finally, they should start a demand-driven website incorporating a group weblog, which will act as a focal point for disparate threads of discussion as well as seeding connections and a sense of community.
Public health today enjoys commitment, resources, and powerful interventions but 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 and in time. According to this document, this arises, in part, from the fact that research on health systems has been so badly neglected and underfunded. In the absence of sound evidence, we will have no good way to compel efficient investments in health systems. Outlined in this document are a number of options for action by stakeholders to facilitate evidence-informed decision-making and the strengthening of health systems. These complementary options are intended to support the embedding of research within decision-making processes and promote a steady programme of national and global investment in HPSR. Member States of WHO may opt to pursue some or all of these actions, based on their individual context . 1. Embed research within decision-making processes. 2. Support demand-driven research. 3. Strengthen capacity for research and use of evidence. 4. Establish repositories of knowledge. 5. Improve the efficiency of investments in research. 6. Increase accountability for actions.
The current trend towards the devolution of government responsibility is usually accompanied by severe cuts in public sector budgets, forcing government departments to develop different ways of working via partnerships of various types (government and non-government) and at various levels (national, regional and local). The challenge, the authors of this paper argue, will be finding ways for these partnerships to engage all partners fully in delivering public policy whilst recognising that each partner has a different mandate and different objectives that will align to different degrees with the policy’s stated goals. They argue that devolution of government responsibility has negatively affected policymaking as Ministers tend to focus on a small number of core activities, or outputs, rather than being accountable for delivering the final outcomes that solve or ameliorate societal problems. And any further devolution of responsibility is likely to give rise to ‘messy’ partnerships as well. The authors propose that current policy-making tools based on logic and prediction will fail to deal with the complexity of partnership working, and instead they recommend techniques like outcome mapping and social frameworks, which are covered in detail in the paper.