Intro
Health research has contributed tremendously to advancing health and welfare throughout the world. Gains in health have already been attained, and health research continues to have great potential to contribute to the well-being of persons in both low-income and high-income countries. The "10/90" reports of the Global Forum on Health Research (GFHR) have helped highlight that, although the burden of disease attributable to morbidity and mortality is greatest in developing countries, most health research has focused on the needs of developed countries and relatively little on the needs of lower-income countries (GFHR 2003). Despite the relative dearth of health research focused specifically on their most important health problems, lower-income countries have also benefited from health research, often as much from research originally motivated to serve high-income countries as from research specifically designed to address the needs of low-income countries.
In the future, health research aimed primarily at addressing the needs of affluent countries is likely to continue to produce benefits for lower-income countries, even in the absence of efforts to manage scientific research in the interest of lower-income nations. Indeed, as lower-income countries increase in income, their health problems will likely come to resemble more closely the health problems of higher-income countries. However, "trickle-down" approaches are not an efficient way of producing knowledge to advance the health and well-being of the populations of lower-income nations. Instead, a rational approach is needed that appreciates both the value of health in lower-income nations and the potential for rational scientific management to efficiently allocate resources for scientific research. The work of the GFHR and other organizations in this regard is an important step in this direction. Moreover, recent advances in understanding about the value of improvements in health and in approaches to the value and priorities of health research provide powerful theoretical tools to address these issues.
Although the application of these principles is still in its infancy, these tools provide a valuable framework for determining the value of health research relevant to low-income countries and for maximizing the value of research that aims to promote health in those countries. In the following section, recent innovations in determining the value of health research at an aggregate level are reviewed. The conclusion is that the value of health research has been immense and is likely to increase dramatically in coming years, especially in lower-income countries. In deriving these conclusions, not only health-oriented measures of improved health, such as life years, disability-adjusted life years (DALYs), or quality-adjusted life years (QALYs), were considered, but also how increases in income may increase the value of such improvements. In a later section, recent methods that can be used to estimate the value of specific research projects are reviewed. The application of such methods promises to better identify the value of health research in specific instances, which can enhance the case for research spending to improve health in developing countries and can increase the efficiency with which available research funds are spent.
