Macroeconomics and Health (CMH)

MacroHealth Newsletter

No. 11, November 2004

Health needs and the global research agenda

It is estimated that 93% of the global burden of preventable mortality takes place in developing countries. However, more than 200 times more is spent on research per year of potential life lost in industrialized countries than in developing ones. As it is now widely known, only 10% of global resources in health research focuses on diseases related to 90% of the global disease burden. This has been known as the 10/90 gap. Fortunately, this worrisome situation caught the attention of a wide array of organizations, which led to the creation of the Global Forum for Health Research, an international foundation operating since January 1998. The driving force of the Global Forum is to help correct the 10/90 gap. In this sense its work is intended to promote that research efforts are targeted at diseases representing the heaviest global burden of disease, to improve the allocation of research funds, and to facilitate the cooperation among partners in both the private and public sectors.

It is a fact that global research investments do not adequately address those health issues that are most relevant to poor countries. More funding is necessary but not a sufficient condition to improve health outcomes. Additionally, there is an urgent need to develop national research agendas that address local health priorities, to build long-term national and international research capacity, and to design mechanisms to improve the coordination between research priorities and their funding.

One of the main reasons why it is of utmost importance to close the 10/90 gap is linked to the relationship between health and development. As it was extensively described by the Commission on Macroeconomics and Health (CMH), health is related to development in several ways: poor health reduces both life expectancy and educational achievement; it also reduces investment and returns from investment; it cuts down parental investment in children; it notably increases inequalities and poverty; and it has a negative impact on social and political stability. Consequently, the CMH devotes an entire chapter of its report to the promotion of global knowledge as a public good to fight against disease, stressing the importance of funding and partnerships.

Since the publication of the CMH report, an important number of countries have created their own commissions and started working on developing their own macroeconomics and health agendas. Preliminary findings from several of these countries show that work on macroeconomics and health can be a powerful mechanism to ensure that increases in health funding are effective in delivering positive health outcomes and to prioritize health policy agendas in order to reach the Millennium Development Goals. In this sense, macroeconomics and health work has supported the integration of targeted health research into national investment plans, as well as the promotion of research that is relevant to specific country’s needs, thus strengthening national research capabilities. Moreover, the fact that most of this innovative health information is generally produced by trusted national experts creates a strong foundation to influence and inform government decision-making in health policy.

This November, both the Forum 8 and the Ministerial Summit will pose an extraordinary opportunity not only to bring together academia and policy making but to deepen the dialogue on this important matter. Moreover, it will increase awareness on the relevance of macroeconomics and health work in assuring that investment in health and health research is effective and relevant. Hopefully, this occasion will also foster the idea that rather than having global research policy influencing countries health priorities, we can ensure that instead, population health needs drive the global research agenda.

Dr Julio Frenk
Secretary of Health of Mexico


Integrating health research into health planning: the role of the national commissions on Macroeconomics and Health (MH)

An increase in research in low-income countries could dramatically correct the situation of insufficient resources being invested in less than efficient and effective ways, says Louis J. Currat, MH consultant. National Commissions on Macroeconomics and Health are well-placed to support this endeavour.

The United Nations Millennium Declaration and the eight Millennium Development Goals (MDGs) are probably the best summary of the efforts undertaken by the international community over the past 40 years to find a path for sustainable development for all members of the global community, encapsulating the great achievements of this period and the great challenges confronting the world today. The fight against poverty and ill health are at the centre of the MDGs, together with education, gender and the environment.

Achieving the health MDGs by 2015 will depend, first, on a large increase in health investments. Second, it will depend on a substantial increase in efficiency and effectiveness in health investments. Indeed, not only are health budgets in some low-income countries insufficient to even maintain the present health status of the population, but they are not spent efficiently or effectively due to lack of systematic information about health actors in the country, burden of diseases, determinants of diseases, cost-effectiveness of present health strategies, and present national investments in the health sector.

This dramatic situation of insufficient resources being invested in less than efficient and effective ways could be substantially corrected with an increase in operational research and systematic gathering of information and evidence in and by low-income countries. Not only would better information lead to more efficient and effective investments in the health sector, but would go a long way to convince ministries of finance and foreign aid donors to increase their investments in health.

Following the recommendation of the 2001 CMH Report, a number of countries in the past two years created a National Commission on Macroeconomics and Health, i.e. an advisory body responsible for advising the Government on all broad policy issues in relation to investments in health and health research, so that health can make an optimal contribution to the development of the country. These National Commissions should play a crucial role in the future in operational research and gathering key information for improving the contribution of health to economic growth and fighting poverty, in particular with respect to the following eight central tasks:

  • mobilization of health and economic institutions for better health in the country
  • measurement of the country’s main health problems
  • definition of new national targets for decreasing the disease burden
  • analysis of the main determinants of diseases
  • monitoring of the Government present health strategies and programmes
  • development of improved, more cost-effective strategies and programmes for health
  • monitoring of present financial resources invested in health
  • proposals for future financial resources to be invested in health.

The benefit/cost ratio of the work of the National Commissions is likely to be very high as costs will be limited (1 to 2% of public health expenditures as order of magnitude) while benefits will be very large in terms of improved efficiency and effectiveness of total public and private health expenditures. These efforts by the National Commissions would also greatly contribute to the definition of the international health research agenda, composed of research projects which would be more efficiently and effectively undertaken at the global level as they require international collaboration.

Louis J. Currat, economist, consultant, Coordination of Macroeconomics and Health, WHO and former Executive Secretary, Global Forum for Health Research