Reflections after Mexico
Authors: Lalit Dandona
Journal: The Lancet (2005)

Your Editorial on the Mexico Statement1The Lancet The Mexico Statement: strengthening health systems.Lancet. 2004; 364: 1911-1912Summary Full Text Full Text PDF PubMed Scopus (25) Google Scholar refers to the dominance of basic science over public health, and the relatively mild approach to dealing with this imbalance preferred by the health ministers at the Mexico Summit. If health ministers and other policy makers were provided with specific details of this imbalance in their respective countries through objective documentation and analysis of health research output, it would serve two major functions. First, the policy makers themselves would have less doubt about the imbalance and the harm it causes, and second, objective evidence would give them the teeth to push for action from resistant stakeholders. For example, analysis of health research output from India2Dandona L Sivan YS Jyothi MN Bhasker VSU Dandona R The lack of public health research output from India.BMC Public Health. 2004; 4: 55http://www.biomedcentral.com/1471-2458/4/55Crossref PubMed Scopus (58) Google Scholar highlights several stark imbalances. First, of the health research output in 2002 available in the public domain, only 3–4% was in public health, with the remaining almost equally divided between basic and clinical sciences. Second, within the meagre public health research output, human resources, health policy, health economics, and impact assessment of public health interventions were particularly poorly represented. Third, there was a low proportional research output in several major diseases or conditions that contribute substantially to morbidity—ie, injuries, cardiovascular diseases, respiratory infections, diarrhoeal diseases, perinatal disorders, childhood cluster diseases, unipolar major depression, and HIV/AIDS. Fourth, India produced 20 times less quality-adjusted health research output than Australia per unit gross domestic product adjusted for purchasing power parity, and this ratio for public health research output was even higher at 31 times. This is an example of how objective evidence can help inform policy makers and other stakeholders about the specific deficiencies in health research output that must be corrected. The availability of such specific evidence would not only assist policy makers in setting priorities and in funding decisions, but would also shake the scientific and academic community out of its acceptance of the current dominance of basic sciences over public health sciences. This latter supply-side correction is as important as encouraging the demand for relevant research by policy makers.2Dandona L Sivan YS Jyothi MN Bhasker VSU Dandona R The lack of public health research output from India.BMC Public Health. 2004; 4: 55http://www.biomedcentral.com/1471-2458/4/55Crossref PubMed Scopus (58) Google Scholar, 3Horton R Reasons to be cheerful, part three.BMJ. Nov 26, 2004; http://bmj.bmjjournals.com/cgi/eletters/329/7477/1249#87177PubMed Google Scholar The science community has to arrive at a balanced view of health research that is driven primarily by the need to improve population health. Only then can the science community provide appropriate guidance to policy makers on priorities in health research. To accomplish this, the quantity and quality of health research output from less developed countries must be objectively tracked with regard to its balance between basic science, clinical research, and public health and its relation to the major contributors to ill-health. Without generating such specific evidence in less developed countries, the articulation of and advocacy for better linkage of health research with population health improvements may remain too generic and, therefore, less effective. I declare that I have no conflict of interest.