Thursday, April 16, 2009

Same but different: inequities in international collaborative research

When it comes to international health research and inequality, the ethical focus is usually on the relationship between the (generally well-off) researchers and the (generally poor) participants. And rightly so. But there is another relationship which has received far less attention, even though the associated ethical problems have the same basic roots. There are, namely, vast differences in socio-economic status, political power and (oftentimes) skills among researchers from industrialized nations and researchers from in resource-poor ones. The big funders of health research -- and those that set the research agenda -- are located in Atlanta, Washington, Geneva or London, and researchers from developed nations are generally in far better positions to negotate and gain research support from them. They are also likely to have received education at well-equiped, prestigious universities, to have gained mentorship in regard to publishing in the better peer-reviewed journals, and hence to have much more impressive-looking CVs. No wonder researchers in developing countries sometimes feel they are bit players in someone else's game.

This degree of inequality can lead to tensions between researchers from abroad and local researchers in developing countries. The two live in strikingly different contexts, but they have to work closely together. To bring out the contrasts and the tensions these contrasts can raise, I have sometimes asked international researchers whether they share the global budget of their research projects with local scientists. Some do, some don't. Some don't like to disclose that they are making 400% more money than their partners. Some are embarrassed by how much of the budget goes to overhead for an institution which is already quite well off.

SciDev reports that last month a conference was held in Germany focusing on North-South research partnerships and equity. A framework was proposed whose goal is to help ensure that developing country scientists have an equal role to those of developed countries in any collaborative research partnership. Capacity-building of individuals and institutions involved in health research in developing countries plays a prominent role within the framework. But then again, similar talk was aired at least a decade ago, and it is not clear how much progress has been made in the meantime. As long as the broader inequalities between countries in the 'North' and 'South' remain in place, and there is little serious commitment to combat them, the most well-meaning initiative to create equitable research partnerships faces very considerable challenges.

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Friday, April 10, 2009

Economic downturn and global health

Economic crises and economic recovery plans are dominating the news. There is news about macroeconomic indicators (such as unemployment rates) as well as how the economic downturn/recession is affecting the lives of ordinary people. Or at least, the macro- and micro effects of the crisis in America, Europe and better-off nations in Asia. With rare exceptions, there is little talk or concern about how the breakdown of the world's dominant economies is playing out in the world's poorer countries, despite estimates that the numbers of persons living on less than $2 per day will soon swell by the tens of millions.

Last week, the New York Times published an editorial about the situation that many developing countries find themselves. Currency rates are falling as is demand for whatever products those countries export in the global market. Unlike the United States and Europe, these countries don't have a few trillion dollars on hand to stimulate their own economies; they are struggling to pay back the loans taken out in years past to ... stimulate their economies. The NYT editorial claims that affluent nations should give more money to the International Monetary Fund, who in turn can extend more lines of credit to developing countries. The assumption seems to be: we need to maintain the longstanding debt and dependency relationship between developed and developing countries, i.e. prop it up with more cash injections. The editorial is silent about the very spotted history of IMF loan practices and developing countries, and about who is responsible for the culture of toxic financial products that created the global financial crisis in the first place. It has a real 'rearranging deskchairs on the Titanic' feel to it.

Another publication, quite another angle: the British Medical Journal has published a thoughtful piece on the potential effects of the financial crisis on health in developing countries, and how the crisis could be an opportunity to positively change the global financial landscape. Although there is no firm data yet, the consequences of the financial crisis on health in developing countries look very dire: if you take the 'social determinants of health' model, and reasonably assume that the economy (in terms of income) partly determines health, then people in already resource-poor countries are going to get sicker, and more are going to die of preventable and treatable conditions than before. The way out, according to the authors, is not to refill the coffers of the IMF. It would be better to first ditch the idea that the more unregulated a market is, the better off the economy will be, and the better off the health of nations will be. The de-regulation of markets seems to have faciliated the growing inequalities between the health and wealth of nations over the last decades. Moreover, at crucial points where the global market was regulated -- through trade laws and regulations -- the conditions of trade were largely set by and to the advantage of more affluent nations. We therefore need to draw radical lessons from our current predicament, by reflecting on just how we got here. As the authors write, "The financial crisis gives us the opportunity to bring social justice and environmental concerns to bear on the kind of new global economic order that must be put in place." Amazing that health professionals in the BMJ are now giving voice to these views, once the mainstay of activists at global economic forums.

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