Support for change is gaining momentum

The Global Forum for Health Research (Global Forum) agrees with the authors’ statement that health issues need to be addressed in a comprehensive way, tackling social determinants of health, for which an intersectoral approach is essential.

1. The Global Ministerial Forum on Research for Health (Bamako, Mali, 17-19 November 2008), cited by the authors, and in particular the ‘Call to Action’ and the ‘Communiqué’ that emerged from it, clearly show that support for change is gaining momentum. For instance, the Ministers and their representatives called upon all stakeholders “To implement the recommendations from the WHO Commission on the Social Determinants of Health, especially those related to health equity”. These recommendations were to: “1) Improve the conditions of daily life – the circumstances in which people are born, grow, live, work, and age; 2) Tackle the inequitable distribution of power, money, and resources – the structural drivers of those conditions of daily life – globally, nationally, and locally; 3) Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health.”
2. Even though support for this approach is increasing, the implementation of it remains more problematic. A massive task ahead, which would have a major impact on reducing health inequalities, is a change in the way research is conducted. This is indeed the reason why the Global Forum adopted the term ‘research for health’, to reflect the paradigm shift that health research needs to go beyond the health sector. The definition given by the Global Forum to ‘research for health’ is “research undertaken in any discipline or combination of disciplines that seeks: to understand the impact on health of policies, programmes, processes, actions or events originating in any sector, including but not limited to the health sector itself and encompassing biological, economic, environmental, political, social and other determinants of health; to assist in developing interventions that will help prevent or mitigate any adverse impact; and to contribute to the achievement of health equity and better health for all.” This definition draws upon inter-sectoral approaches and puts a strong emphasis on the wider determinants of health, which include, inter alias, food security, housing, education, working conditions, income distribution, social safety nets, cultural contexts, social exclusion and power relationships.The Global Forum position is fully aligned with that of the Communiqué from the Global Ministerial Forum on Research for Health, stating that the concept of ‘research for health’ signals “a long-overdue recognition that determinants of health and well-being are multi-factoral in nature. (…) Health inequities are avoidable only if policy-makers and research leaders have the political will and the scientific evidence from research across multiple sectors to address these inequities, and if inclusive processes are adopted at all stages and levels.” For this, every country should have a clear national ‘research for health’ agenda that includes the social determinants of health, evaluation of interventions and participatory action research. This recommendation emerged from a consensus during a roundtable session on health systems research at the Global Ministerial Forum. The participants added that this process should be based on consultation with communities, instead of traditional top-down national agenda processes.
3. Global health initiatives (GHIs) with disease-specific ‘vertical’ programmes are forging new relationships with health systems strengthening (HSS) initiatives as they become more aware of their influence. Some are already addressing the issue – as referred by the authors as ‘diagonal approach’ – however much remains to be done. Many recommendations emerged during the roundtable session mentioned above. Badara Samb, World Health Organization, called to urgently develop and implement a comprehensive policy framework that can guide both health systems and GHIs, to ensure that most common threats are recognized and prevented, and that positive synergies [between HSS and GHIs] are identified and built upon. Another key recommendation in that session came from the Minister of Health of Namibia, Richard Nchabi Kamwi, who stated: “We need to understand how to improve the coordination at national level to avoid or minimize the mixed messages that drives from different programmes with different funding mechanisms.” Research will therefore be essential in helping GHIs and health systems to prevent common threats and build upon positive synergies.

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