Portfolio plan Global Development and International Relations

Global health

Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is recognised as one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. Unequal development in different countries in the promotion of health and control of disease, especially communicable diseases, is a common danger. Health is also seen as fundamental to the attainment of peace and security. A comprehensive approach to global health recognises the physical, psychological (or mental), and social components of health and recognises that they are inter-related. A focus on equity in global health research also involves pursuing research on these broad determinants of health. Promoting equity will also favour research that focuses on values that are linked to health equity, e.g. voice, agency, and the accountability to citizens of health systems.

Determinants of health
Health research includes research on the intersecting social, economic, political and cultural determinants of health, and access to and the provision of health services. The latter is closely connected to a range of challenges that are reflected in the other 16 SDGs, such as education, poverty, inequalities, gender equality, nutrition and food security, air pollution, conflicts, and climate change, which are generally described as the social, economic, and environmental determinants of health.

Of relevance to global health research supported by the portfolio is the influence of global-level institutions and policy processes, and global governance and financing mechanisms, which often shape the parameters for health improvement in LMICs. This includes research on public health interventions that span different sectors, including addressing health challenges through intersectoral collaboration at the nexus of human, animal and environmental health (e.g. One Health) or responding to the impacts on health and health systems of climate change.[5]

Burden of disease
Disadvantaged populations in LMICs contribute disproportionately to the global burden of disease and suffer from excessive mortality, morbidity and disability due to a range of communicable and non-communicable diseases. The specific targets set include an emphasis on vulnerable populations, including mothers and new-born babies, children under five years of age, as well as a focus on communicable diseases such as AIDS, TB and malaria, neglected tropical diseases, hepatitis, water-borne and other communicable diseases. Premature death from non-communicable diseases, mental health and wellbeing, the prevention and treatment of substance abuse, death and injury from road traffic accidents, hazardous chemicals and air, water and soil pollution are recognised and important aspects of the global burden of disease.

The portfolio will support and encompass research that can contribute to continued progress in reducing the burden from communicable diseases, maternal, new-born, and child health, non-communicable diseases (NCDs),[6] population-based public health interventions that can prevent major health risks, and all other health issues reflected in the SDG 3 targets. The spread of antimicrobial resistance (AMR) will stall progress in fighting infectious diseases, and research on all aspects of AMR in an LMIC-setting is therefore supported by the portfolio, as is vaccine development. Specific mention is also made of the need to ensure universal access to sexual and reproductive healthcare services, including family planning, information and education, and the integration of reproductive health in national strategies and programmes.

Focusing on issues that contribute to the greatest disease burden is important in order to identify areas where research can have the greatest impact. However, it is important to recognise that, in contexts and for populations where surveillance and diagnostic services are non-existent or weak, estimates of mortality and morbidity are complicated, inaccurate or even completely lacking. Research is needed that seeks to provide ‘know how’ on the development of birth and death registration and causes of death, as well as assessing documentation of morbidity, especially for ‘hard to reach’ and disadvantaged population groups.

The portfolio takes a broad approach to thematic areas covered by global health research in order to capture important parameters that effect health equity (distribution of disease burden, generating knowledge on the effectiveness, feasibility, and sustainability of interventions etc.) Thus, the portfolio covers research on the adverse interaction of diseases of all types in an LMIC-setting, referred to as the syndemic approach.[7]

Health systems
A health system is best described through its six ‘building blocks’, including health services delivery, the health workforce, medical products, vaccines and technologies, information services, leadership and governance, and financing. All six need to be in place for a health system to be able to provide the required services. Research is needed to provide information to inform health systems and strengthen the provision of high-quality health services, thereby ensuring health preparedness, promoting equity, and meeting the health needs of LMIC populations, especially those who are most vulnerable, disadvantaged and hard-to reach. One of the key targets of SDG3 is to ensure Universal Health Coverage (UHC), including financial risk protection, access to high-quality essential healthcare services and access to safe, effective, high-quality and affordable essential medicines and vaccines for all.

Emerging and re-emerging communicable diseases with epidemic or pandemic potential are a persistent threat to global health security, to public health and socioeconomic development in many LMICs. This has been underscored by the COVID-19 pandemic, which has clearly demonstrated that for one country to be safe, all countries must be safe. The goal of attaining strong health preparedness to promote global health security, as reflected in several targets in the SDGs, has the potential to accrue benefits to all countries. However, the portfolio's thematic priority of global health will only support research on this topic insofar as the focus is on health needs and health systems in LMICs.

Policy and practice
The primary objective of global health research is to conduct high quality research that will provide new knowledge and understanding of what is needed and how this can best be implemented to promote health equity and health improvements for disadvantaged populations[8] in LMICs.

The societal impact of submitted research proposals can be assessed in terms of their potential to: (1) contribute, directly or indirectly, to substantial reductions in the disease burden in LMICs; (2) promote health equity in LMICs, and (3) produce higher-level insights of relevance to policy and practice beyond the specific setting and context where studies are carried out, i.e. by closing current evidence gaps and thus informing future guidelines and policies. These three criteria will be used together to evaluate the potential for impact.

The portfolio will prioritise implementation research defined in a broad and inclusive way.[9] This reflects the significant potential of implementation research to advance sustainable and equitable health improvements in LMICs by catalysing the integration of evidence-based approaches in practice. Research on effective implementation should be understood broadly to include research on interventions with proven efficacy as well as programmes and policies with the potential to substantially reduce the disease burden and promote health equity.

The prioritisation of implementation research does not exclude funding of high-quality research, such as basic science, social sciences, epidemiological, diagnostic and clinical research, if it addresses questions that are demonstrably of high relevance to global health.

[5]Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Belesova K, Boykoff M, et al. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. Lancet. 2019 16;394(10211):1836–78.

[6]The 2018 UN Political Declaration on NCDs promotes a 5 x 5 NCD agenda, focusing on five core diseases (cardiovascular disease, chronic respiratory disease, cancer, diabetes, and mental and neurological conditions) and five core risk factors (unhealthy diet, tobacco use, harmful use of alcohol, physical inactivity, and air pollution). The inclusion of air pollution demonstrates the growing attention to environmental risk factors that contribute significantly to the burden of disease in LMICs.

[7]Syndemics involve the adverse interaction of diseases of all types (e.g. infections, chronic non communicable diseases, mental health problems, behavioral conditions, toxic exposure, and malnutrition) that, as a result of such interaction, produce an increased burden of disease in a population. Syndemics advance under health disparity, impacted by poverty, stress, structural violence or conflicts. The syndemic approach departs from the biomedical approach to diseases, which diagnostically isolates, studies and treats diseases as distinct entities separate from other diseases and independent of social contexts.

[8]Disadvantaged populations include children, and socially and economically disadvantaged groups, such as people living in poverty, rural populations and disadvantaged minorities.

[9]For a definition of implementation research, please consult the publication Implementation research: new imperatives and opportunities in global health