Critical Aspects of Globalization in Medical Research
1. Introduction
There is little doubt that the promotion of global health is a noble goal. However, the methods by which research aimed at improving health in low-income countries is an area where careful consideration of the implications of globalization is required. Many of these studies are reliant upon funding from high-income country sources, whether they are public sector aid agencies or large philanthropic foundations. Global integration has made allocation of these resources to the study population easier and more efficient. However, it has also increased the competition for human and physical capital between medical research and the implementation of health programs, as well as the competition with research conducted in the public and private sectors on health issues more pertinent to high-income country populations. It is important to understand the ways in which the increased competition affects the relative margins of advantage of each research area, as well as the overall impact on population health in different countries.
The phenomenon of globalization is having an increasing effect on the medical research enterprise, and is ultimately reshaping the medical research environment. It is very vital for you to understand the impact of globalization, how it affects the research and development process. By doing so, we can attempt to constrain the potential beneficial effects, while monitoring strategies to avoid exacerbation of health disparities both within and between countries. This dissertation explores the implications of globalization in the medical research enterprise. It attempts to understand how differing global market conditions of the health and medical sector, and varying levels of research and biotechnological capacity influence the volume and allocation of medical research resources. This understanding is important, particularly in the context of the growing trend of private sector involvement in medical research, which is often linked to the development of health products designed to be sold in lucrative global markets, rather than the research and development of public health goods designed to tackle diseases that are most prevalent in low-income populations.
1.1 Background of Globalization in Medical Research
This is a result of the relationship between the private sector and state-run public health services. A decline in resources for public services has occurred, and an increasing number of abundant yet costly technological health interventions are offered. This has led to a gate opening of sorts for the involvement of private enterprise in the research and development of health interventions. The reason being that it is far more profitable to develop and market products and services than it is to provide and research cost-effective ways to deliver public health services. An indirect result of this is the increasing offshoring of research into third-world countries that have an availability of resources that is otherwise scarce due to the above reasons. This creates a complex web of relations between countries of varying socio-economic status. For the purpose of the analysis, this will be referred to as the “global health arena”.
Globalization has been a major development over the past few decades, which has affected every aspect of society. Changes have occurred in political, cultural, economic, and in more recent years, to medical research and health care. It is defined as “the process of the creation of the global marketplace.” This process has been facilitated by political changes in Eastern Europe and a general paradigm shift regarding free market economies. Fundamental to globalization is the transnational corporate system in which a large and increasingly growing proportion of health research is funded and undertaken. As a result, “public health problems of less affluent countries increasingly are being defined and addressed using criteria and interventions that have been shaped by more affluent societies. Ills are being reframed as ‘market opportunities’.
1.2 Purpose of the Dissertation
Therefore, all of the issues recurring due to globalization of medical research – be it the debate on ethics, the cost and benefit factor, the implications of intellectual property rights, or the effects on public health – can be assumed as the problems and challenges in the globalization of medical research. Hence, Chapter 1.2 defines the ‘specific aims’ of this dissertation by giving an insight into the background issues and providing an in-depth analysis and comparing and contrasting the situation in the past and now, leading to an aim of understanding the current scenario.
Chapter 1.1 has discussed the background of globalization in medical research. It has given an insight into the practice of sponsorship of clinical trials as an entry to conducting research. This has raised various issues in medical research and has stirred a debate on the practicing of clinical trials. Thus, the ethics of the conduct of clinical trials is under scrutiny. The debate on ethics has further intensified with the advent of biotechnology and the pharmaceutical industry. Chapter 1.1 has also shown the ramifications of the debate on ethics and various other issues occurring due to globalization of medical research.
1.3 Scope and Limitations
The scope of this dissertation is to examine the effects of globalization on medical research and public health. In the process of this examination, a close eye will be kept on the influence of private industry and transnational corporations on the ability of governments or supranational organizations to control medical research agendas. This study will also look at the shifting patterns of medical research, clinical trials, and new drug development, examining the new research infrastructure and how it affects levels of research and development in different countries, and the effects on public health and access to new treatments. The overall safety of globalization of research will be assessed, from the effects on research standards and integrity, to the effects on environmental health and safety, and implications on the ability to control biotechnology and its effects on public health. Finally, this study will explore the effect of increasing connections between private medical research and public health policy, how it affects the ability to set global public health research priorities and affect the use of research and development to address global public health needs. Though these are quite broad and ambitious goals to be achieved by one dissertation, it is important to be optimistic. However, there are limitations to what can be achieved with the resources available.
2. Globalization and its Impact on Medical Research
Rising global interconnectedness can be because of improved trade and diminished cultural barriers. Businesses have become more international in scope, resulting in an increase in competition, and in turn, demand for efficiency. In terms of people, there is better movement of individuals that is causing a lot more racially and ethnically diverse societies. Increased migration has brought about the transmission of diseases throughout the world. The healthcare industry is directly suffering from globalization due to the fact that its expenses have improved over the past years, stronger budget constraints are forcing several to reduce costs. Any reduced funding will have severe negative impacts on healthcare. Globalization in healthcare will have many positive effects on health and health care. To date, most of globalization’s effects on health have been harmful. On the other hand, globalization has supplied health and health care with specific benefits too. It has made an enormous amount of information available in an incredibly short timeframe. Globalization has also enhanced the quality of health care. In specific regions of the world, the latest medicine and healthcare items are not necessarily available. However, new and more powerful drugs and medical care tend to be brought to those regions when most of these signify profitable markets. Tapping into new marketplaces, health care has become one of the fastest growing sectors in the global economy.
Globalisation connects countries and brings about a mutual dependency influencing what sort of problems are addressed. Research across borders and cultures are proving invaluable. Medical research includes a lot to achieve from globalisation. By way of a closer focus on the more ambitious developing countries where most diseases tend to be prevalent, they offer a broader scope in which to have clinical trials and studies. This can have a mutual benefit for both sides. A standard trend among research sponsored by the pharmaceutical industry is to carry out such studies in countries where regulations are less stringent and wages for research staff are below those in industrialized countries. Although that is seen as exploitative, it is a logical move. Costs for such studies are astronomical and for similar results, it can be possible to free up funds for use in further research. Phase two and three trials represent the technology transfer for a developed product which may benefit the location of the research. Clinical trials work in developing countries brings in a breadth of economic activity and advances technology transfer in this sector. Published research frequently is beneficial for the sponsor and results for studies conducted in developing countries are generally relative to cost effectiveness. This could move the next product into healthcare of these countries and prove a helpful involvement for the disease being studied.
2.1 Definition of Globalization in the Medical Research Context
Globalization is a complex entity with a variety of definitions. These definitions have been set to suit a particular agenda and have been well recognized as being heavily influenced by the perspective of the authors, the organizational positions they hold, and the socio-economic contexts in which they are situated. This makes it difficult to find a definition suitable to the concept itself. However, globalization can be thought of as the process of increasing the connectivity and interdependence of the world’s markets and businesses. This process has led to an increase in the flow of ideas, culture, information, and in particular the flow of trade, investment, people, and money. Globalization can also be a system where interactions in one part of the world have profound consequences in another part of the world. This is highly plausible in the context of modern medical research due to the nature of the globalization process as previously defined and the historical and continuing linkages between health and research initiatives influenced by foreign policy. The effects of this type of globalization can contribute to inequalities in health between reaches of societies and between different countries. Such inequalities can be further accentuated by different forms of globalization mentioned above in relation to the different forms of inequality with ‘globalized’ diseases and illnesses often receiving less attention due to the altering of priorities influenced by foreign policy. In the context of a state-centric model and the inequities that it causes, this article recognizes globalization as a significant contributor to the inequalities in health across the world and will illustrate how it has impacted on medical research and the changes that this has brought to health.
2.2 Globalization’s Influence on Research Collaboration
A common tactic used by transnational corporations seeking to influence the national policy-making of other countries is to provide arguments for their preferred policy positions that are couched in terms of the best interests of the nation concerned. Such corporations often support health research in developing countries as a means to obtain access to patient populations and their data, sometimes with few or no benefits accruing to the countries or the patients in question. While such research may yield valuable information, the relationships between researchers from developed and developing countries are often characterized by a global power imbalance, with those from the developed world being in the dominant position. In such situation, there is a risk that the agenda for research conducted in the developing country is unduly influenced by the priorities of the developed world, which may not be the priorities of the host country. Globalization of the market for clinical trials is another area of health research in which transnational corporations seek to promote policy change in order to further their research interests. This has led to a situation in which it is often more expedient and less costly to conduct clinical trials in developing countries. While the growing involvement of developing countries in health research is to be encouraged, conducting trials in such countries may be to the detriment of their populations if the drugs or interventions tested are not available or affordable to them if found to be effective. This activity is often referred to as the “double standards” in research and is a clear instance of how globalization can affect the health of individual countries.
2.3 Globalization’s Effect on Access to Research Resources
There is a prevailing view that globalizing research will improve access to vital resources for curing diseases and improving healthcare worldwide. Research resources take many forms and include: government funding, access to patient populations and data, knowledge of medicinal products and their effects, and technology used to develop and test new treatments. Since research resources are not equally distributed across the world, it is often the case that the resource-rich countries will make collaborations with poorer nations in order to exploit their relative resource advantages. This can be seen as a positive sum game, since the poorer nations will be able to advance their healthcare through the acquisition of new technologies and knowledge, and the richer nations will be able to test and develop new treatments that will improve global health and possibly bring economic returns. This situation may be disconcerting for some, but in general, it is a better scenario than if each country performed its own isolated research given that it is already a reality that there are great disparities in research capabilities between different nations.
In recent years, there has been a spread of responsibilities among companies and organizations worldwide regarding medical research and discovering new alternatives to improve the world’s health situation. This concept encompasses a globalized view of medical research, which has been defined as research that is shared by scientists from different countries who work collaboratively on the same question, making use of shared methodology, technology, and data. Although this may be an ideal situation for improving healthcare outcomes for all nations of the world, this is often not the case. The move to a more globalized research environment has had profound effects on research resource allocation for both better and for worse.
3. Ethical Considerations in Globalized Medical Research
Ethical considerations are critical in globalized medical research, to protect the interests of communities and individuals involved in research, to promote high standards of scientific quality and ethical integrity, and to respect cultural diversity. Evidence of the importance of ethical considerations in international research abounds. A series of scandals involving research in the developing world, including studies of contraceptives that would be unacceptable in developed countries, studies of vertical transmission of HIV where breastfeeding was encouraged, and studies of treatments not available to subjects, have all raised concerns about exploitation of research subjects and double standards.
A high-profile public debate in the United States of America about a proposed study of short course zidovudine to prevent mother-to-infant transmission of HIV in Thailand, funded by the US National Institutes of Health, centered on different standards of care for research in different settings and whether a study that was considered acceptable in Thailand would be unacceptable in the US, for similar populations. These cases illustrate that ethical issues in global health research are not just the concern of bioethicists but are central to assuring the quality and safety of research for all involved. They also illustrate the vast diversity of relevant cultural, social, economic, and regulatory contexts in different settings that must be adequately addressed by researchers and research sponsors.
3.1 Ethical Challenges in International Collaborative Research
The biggest dilemma is to create an ethical framework for research that is uniform across developed and developing countries given the differences in the types of research conducted, the levels of scientific knowledge and infrastructure, and the vast economic disparities. The prevailing opinion among experts in the field is that a universal set of ethical standards is both necessary and possible, but there is debate on what form this should take. Some argue that a single set of international guidelines would be the best solution to providing a uniform level of protection for research subjects around the world. Others believe that the Declaration of Helsinki and the International Conference on Harmonization guidelines, which are often used as a basis for developing country research regulations, should be upheld as the international standard and applied equally to all research, whether domestic or foreign. The recent revision of the Declaration of Helsinki, which has been the backbone of ethical standards in global medical research since World War II, illustrates another approach; the changes were made in an attempt to ensure the relevance of the guidelines to the current practices and the societal changes related to medical research. This shows recognition of the need for global research ethics to evolve given the changing nature of the research.
In light of the increased international collaboration in medical research, there is a growing need to address a number of ethical considerations unique to this global context. While international research can be an efficient means of generating generalizable knowledge, it can pose challenges to implementing and ensuring ethical standards. Since ethical guidelines and standards regulating research vary across developed and developing countries, researchers, sponsors, and host country governments may exploit the double standards to circumvent obstacles in order to pursue their interests. This can compromise the implementation of effective ethics regulation, a multifaceted process involving not only the establishment of guidelines and standards, but their dissemination and knowledge among researchers and oversight and the protection of research subjects.
3.2 Ensuring Equitable Distribution of Research Benefits
Regardless of the funding source for any one study, societies and participants provide the essential resources of their own populations and individuals, time, and effort. Research undertaken in response to priorities of the providing population should address their major health problems and be of potential direct and commensurate benefit to them. Global and population health is an emerging and wide-ranging field. Progress to date has been halting and often in the form of two steps forward and one step back. But the opportunities to advance sound and collaborative global research are better now than ever before, and the need for it has never been greater. Global health issues in this era of globalization deserve to be addressed through global partnership based on mutuality, respect, and shared benefit. According to its tenet of fostering global health from the mission statement, continues to promote learning and understanding aimed toward the creation of a truly global community and the betterment of health care for the global population. The start of this new millennium offers an unprecedented opportunity to enhance the health of the global population. But, to seize this opportunity, the global community needs to act upon its shared concern of the health of people everywhere. This requires a commitment to the rights and dignity of all people and to the well-being of populations at risk. The focus must build upon the evidence demonstrating the disparities in health within and between countries and the critical interplay of health with the forces of social and economic development.
3.3 Addressing Power Imbalances in Global Research Partnerships
The net effect is that global health research is likely to be skewed, with a higher share of the research activities involving data gathering, assemblies, and training taking place in the low/middle-income country in order to facilitate its capacity building, and with the higher-income country taking the lead on the activities with greater potential to influence health (e.g., analysis of the data, clinical trials, and research on public health and medical interventions). This division of research activities is not necessarily a problem if the allocation of activities reflects the health research needs of the country hosting the fewer research activities in question. However, this is unlikely to be the case given that the research agenda in many low/middle-income countries is itself heavily influenced by the activities of foreign researchers and their domestic allies, and because there is a global agenda-setting power in defining what health problems are important and whose problems they are.
Typically, the parties engaged in a global health research project from high-income and low/middle-income countries come to the project with very different forms and levels of research capacity. Because research capacity in this context is usually tied to cash resources and a history of productivity in biomedical research, the project partners will tend to differ significantly in the ability to plan, conduct, and analyze the research, as well as to promote and translate the research findings into health policy and products that improve the health of the population.
Global research partnerships often foster a process of worldwide study that is anticipated to enhance health and advance medical science in developed and developing countries. Collaborative research is afforded on the assumption that the individuals and organizations engaged in the venture will contribute equitably towards the research effort with a fair distribution of scientific knowledge and the benefits to future patients and healthcare systems. However, numerous case studies in global health research papers owl research over the past few decades have shown that engagement in collaborative research between high-income and low/middle-income countries frequently results in benefits flowing primarily to the high-income countries and to the research institutions from the high-income countries.
3.4 Protecting Vulnerable Populations in Globalized Studies
Vulnerability is defined as a diminished ability to fully protect one’s own interests, where this may be due to a particular impairment or to the adverse influences of social, economic, or political factors. This definition brings into focus the fact that different populations may be vulnerable in different ways due to differing levels and types of impairment and because globalizing forces may affect different countries in different ways. High-income countries may have a significant number of elderly people in their population who suffer from neurodegenerative diseases such as Alzheimer’s. In contradistinction, politically marginalized indigenous peoples in low or middle-income countries may be vulnerable due to social and political factors that have adversely affected their health. These differences impact the formulation of research ethics guidelines for different vulnerable populations, and an adequate approach requires an understanding of the particular vulnerabilities and the mechanisms by which they can be exacerbated in a globalizing world.
Vulnerable populations have a heightened risk of being wronged in any setting, and this risk is intensified in globalized research where different economic and cultural environments may exist. Research involving vulnerable populations is nevertheless essential to the elucidation of the particular diseases and the best interventions for treating or preventing them. The increased potential for exploitation in global health research involving vulnerable populations requires careful attention to the formulation of research ethics guidelines. These guidelines should be based on the moral principle that research with vulnerable populations, regardless of the population location, merits special justification and carries a presumption of ethical unacceptability unless the research is intended to benefit the population in question and there is no other means of achieving this benefit.
4. Future Directions and Recommendations
Optimal global medical research will be characterized by high-quality research addressing health needs across the world and will not simply be the exploitation of research. This type of research should involve the sharing and transfer of knowledge and research resources among countries with the goal of research equity – the idea that all countries should have the opportunity to participate in research that seeks to improve their own population health. This concept of ‘global public goods in health’ was reinforced by a World Health Assembly resolution and is certainly pertinent to global health research. However, the findings from a recent study on research capacity building in poor developing countries (PCDC) noted that while global health research collaboration will often seek to address health problems common to both developed and developing countries, the research usually stems from a Northern agenda and it is not uncommon for Southern countries to become a testing ground or provide a population for the research conducted by Northern countries and/or multinational corporations. This type of research does not necessarily promote research equity and will lead to further erosion of Southern research capacity. A key part of PCDC’s strategy is to enable Southern countries to state their own health research agendas and work towards research self-reliance. This will require the transfer of technology and fostering of innovation in global health problems so that poor countries are not solely dependent on Northern research and development. The commission also advocates for greater North-South and South-South research partnerships and health research-informed policy. This may involve changes in international trade, intellectual property, and debt policies that effectively force developing countries to act as consumers of research output from developed countries, often to the detriment of their own populations’ health.
4.1 Opportunities for enhancing global research collaboration
Despite the growing volume of internationally collaborative medical research, the quality of this research is not well understood. The multilateral and multi-stakeholder nature of global health demands a broad understanding of the determinants and distribution of health. Although it is not entirely evident how optimal global health can be achieved, it is clear that it involves addressing the health needs of the whole population, in the whole world, and that global collaboration is an integral part of this process. Building and sustaining successful global research collaborations is complex and depends on contextual factors including the respective participating countries’ political and economic alignment, historical relationships, and alignment of health or research interests. A recent review of national health research systems in developing countries recommended that global health research collaboration should be aligned with national research capacity development and promote research equity. Jadhav and colleagues lay out four key considerations for international health research collaborations between high-income and low or middle-income countries: the articulation of clear and common goals; researching with and not on other countries; capacity development that includes the building of human and institutional resources; and promoting fair and equitable North-South and South-South research partnerships. An analysis of the European Union funded research collaboration with India and/or China showed that successful collaboration was dependent on good coordination mechanisms, flexibility in their implementation, and promotion of a global dimension in their focus. This mutually beneficial approach requires a concerted effort by developed countries to direct more of their research funding towards health research that will contribute to the reduction of global health disparities, improve the health of the world’s poor, and foster research capacity in those countries.
Posted date: October 06, 2009 10:17 AM
Four key areas of global medical research are associated with critical issues and are in need of future development.
4.1 Opportunities for Enhancing Global Research Collaboration
At the same time, there remain vast disparities in global health outcomes and the resources available for health. There is a danger that a globalised research “market” will prioritise research that is of greatest benefit to the wealthier nations and/or commercially viable. This, in turn, may divert resources and expertise away from health issues most pertinent to the world’s poor. The tools of globalisation such as greater access to information, increased cultural exchange, and the development of global norms and ideas provide opportunities to address this problem.
This exploration of a complex and rapidly evolving phenomenon has revealed a number of challenges to global research collaboration and a range of potential strategies to address these. Globalisation has increased the interconnectedness and complexity of the world health system. It has done this through providing new mechanisms for global health governance, increasing the role of trade and economic policy on health, better defining global and regional public goods, and providing new opportunities for public/private partnerships.
The process of globalising medical research is not something that has been forced upon the world or indeed, the medical research community. It is a reflection of how the broader global community is tackling issues of great importance to public health. Recognising the implications of global interconnectedness in this field of research as well as the broad drivers of globalisation in research will assist all involved in the practice to better focus on desired outcomes and avoid potential deleterious effects. Therefore, in conceptualising the implications of globalisation in medical research, this essay has sought to identify both positive and negative consequences as well as provide insights into how globalisation can best be harnessed to improve the health of the world community.
4.2 Strategies to Promote Ethical Conduct in Globalized Medical Research
As medical research becomes an increasingly international undertaking, it becomes ever more important to standardize the ethical guidelines and oversight mechanisms that govern research. A single global ethic for health research is an ideal to aspire to, insofar as it is essential that the same level of protection from research risks be given to all persons and communities, vulnerable or not, worldwide. While some have advocated a single international treaty on medical research like the Geneva Conventions for research in emergency situations during armed conflicts, others believe that more incremental progress can be made through the ongoing debate and discussion between various cultural and religious traditions on the common ethical principles that they share, and how these may be applied to the concrete situations of health research in different social contexts. An important starting point would be for research sponsors from developed countries to recognize that many of the same research protocols that they would approve for their own countries could be deleterious to the health of patients in developing countries and thus contradict the principle of justice in research, and to take this into account when designing and funding studies in different social contexts. Headway has already been made in the implementation of basic ethical training programs for scientists in developing countries, and the creation of educational and capacity-building programs for research ethics committees in various parts of the world. The ultimate goal, however it is reached, must be to enable all individuals and communities, regardless of their socio-economic circumstances, to be able to determine and act on their best interests in view of their own values and cultures.
Various strategies can be undertaken to ensure that the growth of global medical research enhances the well-being of research participants in developing countries. At present, many such participants are effectively subjected to a double standard of research, in that protocols that would be deemed unacceptable for use with patients in the developed world are nevertheless tried on patients in developing countries. This disparity occurs for a variety of reasons. In some cases, host country scientists are not as familiar with international standards for human subjects research and may my edu birdie for my studies in genuinely not realize that they are failing to adhere to them. In other cases, economic incentives may lead individual patients to participate in research that they would otherwise avoid. Finally, some research sponsors have simply assumed that higher risk research is acceptable in developing countries. In light of this, it is important to both increase awareness and knowledge of medical research ethics in developing countries and to improve the ethical review and oversight of research protocols.
4.3 Policy Implications for Balancing Global and Local Research Priorities
Step one for the change would be to refocus the research agenda. It would not be the case that certain research areas are ruled out, but it can be agreed upon that it is necessary to prioritize health research that has the potential to reduce, and not increase, health disparities between and within countries. This could be achieved in various ways and will take many years. One concrete step should be a greater investment into research and development of global public goods. An example of good implicit here is the recent development of affordable combination therapies for malaria. Still, it was done on terms that were unfavorable to the poorer countries, but there is potential to learn from this and repeat it in a better fashion. The research agenda is heavily influenced by who controls resources and has considerable crossover with issues of employment terms and conditions. Global health research is being funded and carried out by an array of actors, many of whom have concurrent agendas, some public and others private.
The solutions for these problems are broadly equivalent to a reformation of the entire way in which globalized medical research currently operates. Both short term and long term, the aim here would be to create a situation that is at least described by a “win-win” and at best is actually good for the poor and the rich. This might require some quite optimistic and idealistic assumptions, given the current global climate, but with patient work, it may well be obtainable. A specific and strong mechanism to drive change will be essential, although it is likely that it would need to grow something like a mass movement to become a real and lasting transformation. The best means for this might well be a set of movements toward greater regulation and aid with the overall intention of altering macro-level power relations and creating a more equal distribution of benefits and burdens in research in a way that is more sustainable and health promoting for the world as a whole. This will come into conflict with certain vested interests, so with it being a science, it would do well for it to be evidence-based, and the direction of travel would need to be constantly reviewed.
Overall, this essay has synthesized and thoroughly examined the many potential avenues through which medical research has the capability to continue successfully branching out into an increasingly globalized infrastructure. The main issue it presents is that much of modern globalized medical research could be described as exploitative. The reason for this is that the flow of money, resources, and the capacity for training tends to be from the poorer developing countries to the rich ones. The latter then get to set the research agenda, which is carried out in the former. Added to this, the research output tends to be in the form of information that benefits people in the richer developed countries. All of this means it’s “bad for the poor and good for the rich”. Globalization of this sort usually heightens health disparities between and within countries. The implications of this are all detrimental to the concept of public health, which should be there to serve those most in need of it and improve overall health while reducing inequalities.
4.4 Considerations for Strengthening Research Capacity in Developing Countries
Globalization has created various opportunities for developing countries to increase their research capacity and involvement in global research, however there are also considerable threats that certain forms of globalized research can further entrench the position of developing countries at the ‘research periphery’.
Given the importance of global research partnerships, there is much concern that the current trend of market-driven research has resulted in developing countries becoming research ‘sites’ for developed country research. It has been argued that this situation often is exploitative, and that conducting research which is beneficial to developing countries requires a genuine commitment to the health of the country in which the research is being conducted, in addition to a long-term presence and sustainable research capacity building. The WHO research policy ‘research for health: a position for the WHO’ has called for research and development which addresses the health needs of the world’s poor, and has argued for research capacity strengthening as a means to increase developing world involvement in setting the global health research agenda.
In the area of knowledge implementation for the prevention and treatment of disease, it can be said that the developing world is best served by locally conducted research, and research in which developing countries are involved in strong partnerships with developed countries. Developing countries should be enabled to take control and ownership of their health problems and solutions, and the conduct of research in partnership has potential to build local research capacity and to produce knowledge which is more relevant to local populations. Strong research partnerships have the potential to address what has been a historical and continuing global inequity in the amount of research and research funding that is focused on the health problems of developing world as compared to those of the developed world.
In the context of the thesis developed in this paper, this technology often comes in the form of pharmaceuticals and other health interventions, however the strengthening of general health systems and research into the social determinants of health are also areas of major importance. The burden of disease in the developing world is great, and much of it is due to diseases for which we already have the knowledge and technologies required to prevent and to treat. What is often lacking is that this knowledge is not implemented. Often the interventions are not implemented simply because they are not considered a priority, and decision makers of the developing world have been known to reject interventions on the grounds that they are not cost-effective because they do not understand the true burden of disease or the cost-effectiveness of the intervention.
This section has examined the numerous ways in which the globalization of medical research can influence the health of populations, and has pointed out critical considerations for how best to ensure that it can be a force to promote the health of all. It is now widely accepted that the health of populations is greatly influenced by the knowledge that is produced, and the consequent technologies.
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