Translational global health: from shortage to science to service
Authors: Mahiben Maruthappu, Nigel Crisp, Raghib Ali, Alexander Finlayson
Journal: The Lancet Global Health (2013)

The translational pipeline in biomedicine (from bench to bedside) focused the attention of the global research community on delivery of results to patients.1Zerhouni EA Translational and clinical science—time for a new vision.N Engl J Med. 2005; 353: 1621-1623Crossref PubMed Scopus (534) Google Scholar The notion was rapidly accepted, as shown by the training of researchers in translational approaches, the establishment of translational research institutes, and the development of performance frameworks assessing research output according to effect. In the broad and burgeoning discipline of global health, no such pipeline exists. Rather, social science research, analyses of the burden of disease, policy frameworks, generation of low-cost health solutions, and the provision of care in resource-limited settings are fragmented.2Samb B Evans T Dybul M et al.for the World Health Organization Maximizing Positive Synergies Collaborative GroupAn assessment of interactions between global health initiatives and country health systems.Lancet. 2009; 373: 2137-2169Summary Full Text Full Text PDF PubMed Scopus (414) Google Scholar Activity exists in both geographical and disciplinary siloes. Funding sources, research groups, health centres, and non-governmental organisations are each divided by location and interest.2Samb B Evans T Dybul M et al.for the World Health Organization Maximizing Positive Synergies Collaborative GroupAn assessment of interactions between global health initiatives and country health systems.Lancet. 2009; 373: 2137-2169Summary Full Text Full Text PDF PubMed Scopus (414) Google Scholar Global health is hampered by political fences, an absence of global coordination, and insufficient communication. However, with recent honing of political will, galvanisation of the academic community, and development of global communication methods, barriers are being circumvented. We believe that within this emerging globalised health architecture, the time is right for the formulation of a framework that will translate human suffering into global health equity. Such a framework, if appropriately communicated, could unify the complex global effort, ensuring health and wellbeing for all. The prospect of the integration of research, pharmaceutical, political, and non-governmental organisation interests in a multistakeholder network, sharing a common goal, is now more feasible than before.3Kim JY Farmer PE Porter ME Redefining global health-care delivery.Lancet. 2013; (published online May 17.)http://dx.doi.org/10.1016/S0140-6736(13)61047-48Google Scholar On the basis of this platform, we propose that a translational lens is applied to global health. Such a process would integrate basic, social, and political sciences with epidemiology, health partnerships, and on-site services (figure). This partnership will form a science-to-service continuum that is evidence-based and focused on the global population and sustainability. Although ambitious, we believe that such a pipeline is both a realistic and valuable aim. Findings from studies have already shown that integration of health system components improves quality, enhances coordination between services, and reduces costs.4Singh P Sachs JD 1 million community health workers in sub-Saharan Africa by 2015.Lancet. 2013; (published online March 28.)http://dx.doi.org/10.1016/S0140-6736(12)62002-09Google Scholar, 5Hotez PJ Mistry N Rubinstein J Sachs JD Integrating neglected tropical diseases into AIDS, tuberculosis, and malaria control.N Engl J Med. 2011; 364: 2086-2089Crossref PubMed Scopus (46) Google Scholar Although our proposal does not need to be the definitive and broadly accepted translational framework, we present it here to encourage debate. If such a framework is to be introduced, it needs to be widely consulted, broadly agreed on, and then disseminated to all levels of the global health community. Challenges lie both in the model's appropriateness, and in the feasibility of focus and maintenance of global attention. We hope that this will initiate discussion and culminate in a widely accepted conceptual framework for translational global health, which will enhance the efficiency and effectiveness with which we move from shortage to science to service. We declare that we have no conflicts of interest.