Five members of the Global IDEA Scientific Advisory Committee respond to Dr. Moore and colleagues: Global IDEA Scientific Advisory Committee. Health and economic benefits of an accelerated program of research to combat global infectious diseases

Buxton, MJ

Hanney, S

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S. R. Hanney

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Global IDEA

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technology: access to safe drinking wa-ter, effective sanitation, safe housing,adequate nutrition (especially forwomen and children) and universal ed-ucation. Furthermore, local health ser-vice research in low-income countrieswould greatly assist these countries toexpand application of their current ar-senal of effective health care interven-tions. Yes, developing countries havebeen neglected in terms of biomedicaland clinical research into infectious dis-eases, but the technical knowledgeneeded to improved population healthin developing countries already exists.David MooreRobert HoggBC Centre for Excellence in HIV/AIDSJerry SpiegelCentre for International HealthUniversity of British ColumbiaVancouver, BCReferences1. Global IDEA Scientific Advisory Committee.Health and economic benefits of an acceleratedprogram of research to combat global infectiousdiseases [editorial]. CMAJ 2004;171(10):1203-8. 2. Jha P, Lavery J. Evidence for global health [edi-torial]. CMAJ 2004;170(11):1687-8. 3. Easterlin R. How beneficial is the market? Alook at the modern history of mortality. Eur RevEcon Hist 1999;3:257-94. 4. McKeown T. The role of medicine: dream, mirageor nemesis. Princeton (NJ): Princeton UniversityPress; 1979. 5. Moore D, Castillo E, Richardson C, Reid RJ.Determinants of health status and the influenceof primary health care services in Latin America,1990-98. Int J Health Plann Manage 2003;18:279-92. 6. Black JA. The population Doomsday forecast:lessons from Kerala. J R Soc Med 1993;86:704-6. 7. Caldwell J. Routes to low mortality in develop-ing countries. In: Caldwell J, Santow G, editors.Selected readings in the cultural, social and behav-ioural determinants of health. Canberra, Australia:Highland Press; 1989.DOI:10.1503/cmaj.1041727We applaud the recent informal as-sessment of the potential healthand economic benefits that might flowfrom an accelerated program of researchto combat global infectious diseases.1The policies adopted for the organiza-tion and prioritization of health re-search should themselves, wherever pos-sible, be evidence-based.2 However,many conceptual and empirical obsta-cles face those attempting retrospectiveanalyses of economic benefits from spe-cific programs of health research; inparticular, it is necessary to take full ac-count of the cost of the contributing re-search and of its application, and to thenassess the value of the incrementalhealth and other benefits that follow.3The proposal from the Global Infec-tious Disease Evidence and Analyses(Global IDEA) network1 refers to workfrom the United States on the economicbenefits of health research4 that isrightly receiving considerable attention.In assessing returns in the context of theglobal debate about infectious diseases,however, one obvious problem is thevalue placed on the health gain. The USstudy valued the life of a US citizen atabout $3 million but even if that is theappropriate value to use in the US con-text, it is improbable that such a figurewould be applied rationally by decision-makers in other countries.The Global IDEA Scientific Ad-visory Committee also argues that if$2 billion is spent over 10 years for re-search on new tools that lead to a 5%increase in lives saved, this could, usingfigures from the important report fromthe Commission on Macroeconomicsand Health,5 result in annual returns ofabout $9 billion. We suggest that, in es-timating the real return, it is essential toallow for the (possibly very substantial)costs of applying any new tools or tech-nologies that result from the research.3More work is needed to refine themethods for analyzing the paybackfrom investments in health research.Initiatives such as the program pro-posed by Global IDEA might then besupported with firmer evidence of theirpossible benefit. Stephen R. HanneyMartin J. BuxtonHealth Economics Research GroupBrunel UniversityUxbridge, UK References1. Global IDEA Scientific Advisory Committee.Health and economic benefits of an acceleratedprogram of research to combat global infectiousdiseases [editorial]. CMAJ 2004;171(10):1203-8. 2. Hanney SR, Grant J, Wooding S, Buxton MJ. Pro-posed methods for reviewing the outcomes ofhealth research: the impact of funding by the UK’s‘Arthritis Research Campaign’. Health Res Policy Syst2004;2:4. Available: www.health-policy-systems.com/content/pdf/1478-4505-2-4.pdf (accessed2005 Jan 19). 3. Buxton M, Hanney S, Jones T. Estimating theeconomic value to societies of the impact ofhealth research: a critical review. Bull WorldHealth Organ 2004;82(10):733-9. 4. Murphy KM, Topel RH, editors. Measuring thegains from medical research: an economic approach.Chicago: University of Chicago Press; 2002. 5. World Health Organization. Macroeconomics andhealth: investing in health for economic development.Report of the Commission on Macroeconomicsand Health. Geneva: The Organization; 2002. DOI:10.1503/cmaj.1041726[Five members of the Global IDEAScientific Advisory Committeerespond to Dr. Moore and colleagues:]Health determinants are not neces-sarily health interventions. Inter-ventions need to be practicable (i.e.,widespread use is possible) and afford-able. We agree with David Moore andhis colleagues that universal primaryeducation has social returns beyond itsimpact on child and maternal survival.However, safe housing, sanitation andfood subsidies are more costly and lesspracticable than are public health inter-ventions.1As we have recently reviewed,2 re-search and the diffusion of knowledgehave improved public health interven-tions (which differ from the more nar-rowly defined “medical” interventions),making them more efficacious andcheaper, which means that they are morecost-effective. Thus, mortality fell morerapidly in the 20th century than it fell inthe 19th century. Access to vaccinationand treatment of respiratory infectionsand diarrhea explain more of the declinein child mortality in India since 1975than do differences in income growth oreducation.3,4 In rural Senegal, recentmortality decline can be traced to specificinterventions, even in the absence of uni-versal safe water, sanitation or housing.5Smoking controls and changes in satu-rated fat intake have decreased adultmortality in Poland.6 (Declines in mortal-ity due to tuberculosis before 1950 are ariddle. Although these declines were notdue to antimicrobials, it is unclear if bet-ter living standards were responsible.Less well studied cofactors for tuberculo-sis may well have played a role.7) Interventions based on “egalitarianCorrespondance1538 JAMC • 7 JUIN 2005; 172 (12)

5. World Health Organization. Macroeconomics and health: investing in health for economic development.

Estimating the economic value to societies of the impact of health research: a critical review.

Global IDEA Scientific Advisory Committee. Health and economic benefits of an accelerated program of research to combat global infectious diseases [editorial].

Proposed methods for reviewing the outcomes of health research: the impact of funding by the UK’s ‘Arthritis Research Campaign’. Health Res Policy Syst 2004;2:4. Available: www.health-policy-systems .com/content/pdf/1478-4505-2-4.pdf (accessed

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