Increase in UK and global research funding-value for money?
Last week, the UK government unveiled plans to put £775 million of extra research funding into the NHS over the next 5 years. In addition, the newly appointed Chief Medical Officer, Professor Dame Sally Davies, is also Director General of Research and Development and Chief Scientific Adviser for the Department of Health and NHS, and so has a longstanding passion for raising the profile of health research.
If we look around the world, health research funding has also grown substantially, with US$ 160.3 billion spent in 2005, up from US$ 125.8 billion in 2003. In 2005, the UK was the third largest spender on health research at US$4.2 billion, after the US and Japan. The World Health Report 2012, boldly titled “No Health Without Research” will focus on the role of research and evidence in the improvement of global health. Over the last 5 years, the World Health Organization has been making a sustained effort at the international level to encourage research initiatives in public health, including:
- The 2005 World Health Assembly Resolution 58.34, which called upon WHO member states to “establish or strengthen mechanisms to transfer knowledge in support of…. evidence-based health-related policies.”
- The Bamako Call to Action, which urged governments to allocate at least 2% of budgets of ministries of health to research and to earmark at least 5% of funding for research, including support for knowledge translation practices.
There is no doubt that more funding and resources, both in the UK and globally, will lead to more research and hopefully more evidence for clinical practice and policy, but will this lead to improvement of health or health systems? The Global Forum for Health Research found that 97% of spending on health R&D continues to be by high-income countries, with only 3% by low- and middle-income countries. Unsurprisingly, most of this money goes towards generating products, processes and services tailored to needs of the health-care markets of the richer countries. In the UK as well, there are differences of opinion over whether money in research is well spent and whether universities manage health research better than the NHS, and about the amount of resource that is wasted in the current research infrastructure.
There has been a trend towards more funding for translational research in recent years (i.e. research that actually changes practice), both globally and in the UK. Particularly since large amounts of public money are invested in research, the scientific machine must try harder to make research relevant to the health of all sectors of the population, and make the most efficient use of this research. Worldwide, ‘global health financing’ has aimed to address this issue, by channelling external finance towards the health sector of low and middle income countries in order to meet the needs of predominantly poor population groups. The increase in private funding for global health now accounts for 25% of all development aid for health. However, inadequate monitoring and tracking of resources may have complicated and fragmented health systems. This is an important lesson for UK research funding.
The next paradigm shift is the change in the manner in which research is communicated and disseminated. The usefulness of research cannot only be measured by publications because of lack of access to journals and lack of access to research institutions. Blogging, Twitter and mobile technologies are examples of media already filling a void in research communication and will play a growing role. New metrics for evaluation of health research which assess its health and broader societal impact may not be far off. The bottom line is that more funding for health research is very welcome but it must be adequately allocated, monitored and tracked to ensure that the resources are properly used and not wasted.