Turning Health Research Into Action

This article describes the difficulties found in turning health research into practices and policies that can help maintain the health of people in developing countries. Anthony refers to the high levels of child deaths throughout the world as a way to prove her point.

The October 2004 Bulletin of the World Health Organization (WHO) reports that 10.8 million children under age five die every year and that 4 million of those children die within the neonatal period—the first month of life. Some of the critical issues surrounding child mortality are the need for research to focus "on how to get appropriate interventions to the people who need them," says Cesar Victora, researcher with the epidemiology department at Brazil's Universidade Federal de Pelotas." According to Victora,"We know how to cut child mortality; we just have not been able to get these interventions to the populations most in need of them."

The article makes reference to a 2003 Report from Save the Children in which statistics show that neonatal deaths comprise 40 percent of child mortality in developing countries. In Bolivia where child mortality fell by 29 percent between 1989 and 1998, neonatal mortality declined by only 7 percent. The report suggests that low-cost interventions such as vaccines, vitamin supplements, and insecticide-treated bednets can prevent two-thirds of under-age-five mortality. The report also indicates that not enough is known about how to make these interventions more widely available to people who need them.

Anthony provides several examples that demonstrate the difficulty people have in understanding the correlation between their actions and health impacts. After babies are born they are often washed which, according to Save the Children's Elizabeth Ransom, can actually harm the baby. The first thing that should happen is that the baby should be dried and wrapped, and its first bath should be delayed. The Caribbean Mosquito Program provides another example. Residents see spraying as an effective way to kill the insects and they feel as if the government is doing something to help take care of them. The goverment officials seek votes from these residents but must deal with trying to convey the truth to their constituents that spraying is harmful in a number of ways. The Mosquito Program illustrates one example of the type of difficulties health officials are faced with worldwide.

Anthony describes health delivery systems as failing in developing countries because they do not address "childhood infections, maternal deaths, and other diseases." According to WHO's World Report on Knowledge for Better Health, countries with limited
resources struggle with "creaking infrastructure, inadequate budgets, too few doctors and nurses, and limited information on health indicators." The report states that "research on strengthening health delivery systems to make them functional and equitable could reap significant public health benefits such as health equity."

Anthony's article mentions research carried out by Ronald Labonte from the University of Ottawa's Institute of Population Health. He suggests that global health equity would require policies that support the following:

• Sufficiently funded and universally accessible health systems, with adequate numbers of health professionals;
• Equitable access to key health indicators, such as nutrition, education, water, sanitation, and housing;
• Targeted health programs to reduce the burden of specific diseases on poor populations;
• Increased research into diseases that affect the world's poor;
• Increased financing for global health and development; and
• Trade agreements that respect the "special and differential" development status of poorer nations.

Knowing how health systems function is key to understanding how to reform these systems, according to health experts. The author makes reference to Tanzania's health care system reforms as a way to demonstrate how health spending on local diseases instead of specialised, expensive hospital services can reduce mortality. Part of the reforms include giving local district health managers small funding increases to help improve healthcare delivery by focusing on local diseases. According to
Tanzania's Essential Health Interventions Project (TEHIP), after a five-year follow-up of a 54 percent reduction in infant deaths in the two districts, a 47 percent drop in under-five mortality, and an 18 percent drop in adult deaths.

The author mentions the need for health research to include impartial information. Dr. Ron Chapman, executive manager for Health Support Services at Free State's Department of Health states "Researchers will tell you the truth about what's going on, while your staff may tell you what they think you want to hear."

Public trust is essential if scientific research is able to achieve healthy outcomes for populations in developing countries. Holding technical experts, policymakers, and service providers accountable is also important. According to Anthony, "this is achieved by involving communities and civil society actors—including professional associations, religious groups, labor unions, advocacy groups, and others. "