AJPH First Look, published online ahead of print Dec 28, 2006
February 2007, Vol 97, No. 2 | American Journal of Public Health 203
© 2007 American Public Health Association
DOI: 10.2105/AJPH.2006.107060
Addressing International Child Health Priorities
Cesar Victora, MD, PhD
This issue of the Journal focuses on international child health priorities. As is increasingly becoming the case for the Journal, we are publishing a mixture of international and US-based work. Our editors are actively and constantly seeking high-quality articles written by authors from low- and middle-income countries, an effort made evident by this issue.
It is widely known that 10% of the world’s expenditure in health research is for the conditions accounting for 90% of the global burden of disease (10/90 Report on Health Research 2003–2004. Geneva, Switzerland: Global Forum for Health Research; 2004). These are diseases primarily affecting poor countries and particularly the poorest individuals in these countries. The Journal is making a concrete effort to promote a more equitable balance regarding this unacceptable 10/90 gap in funding.
In this issue, Leroy et al., in "Current Priorities in Health Research Funding and Lack of Impact on the Number of Child Deaths per Year," build upon the notion of the 10/90 gap to show that, of the scarce research funds aimed at reducing child mortality, 97% were directed at the development of new technologies, such as drugs, vaccines, or laboratory diagnostics. Only 3% were spent on operational research to determine how to best deliver existing interventions to mothers and children who need them most. This percentage is in stark contrast to the recommendations a group of scientists and policymakers made in 2003, of which I was a part. On that occasion, we gathered detailed information on the distribution of causes of death and on the efficacy of existing interventions, concluding that two thirds of the more than 10 million annual deaths of children could be prevented by universal coverage with off-the-shelf, low-cost interventions. We argued that research on how to deliver these interventions is as important as, if not more important than, studies aimed at developing new biological tools.
If simple antibiotics for pneumonia, oral rehydration and zinc supplementation for diarrhea, and insecticide-treated mosquito nets for malaria were effectively reaching all children in the world, more than 6 million deaths would be prevented each year (Jones et al. How many child deaths can we prevent this year?
Lancet. 2003;362:65–71[CrossRef][Web of Science][Medline]
). Yet there is considerable need for further research on the best channels for reaching mothers and children. Should antibiotics for pneumonia be prescribed by doctors, community health workers, or small pharmacists in the private sector? Should mosquito nets be sold at low cost in the market or should they be provided free of cost? How can policymakers ensure a continued supply of oral rehydration salts with zinc in the most remote parts of Africa? At the health systems level, how can one stop the cruel migration of qualified health workers from poor to rich countries? How can one effectively deploy and maintain health workers in rural areas? These are important research questions that must be answered in order to reduce global child mortality on a sustainable basis. Leroy et al. make an important contribution by showing how little is currently spent on research on intervention delivery and health systems.
With this Editor’s Choice I conclude my tenure as international associate editor for the Journal. It has been a great honor to collaborate with the Journal, its editors, and its staff over the past 5 years. My move is related to an increased role in global child health research and program evaluation, particularly in Africa and Asia, where the difficult challenges described in this issue affect the everyday lives of mothers and children.
Copyright © 2007 by the American Public Health Association
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