Reflection on the 5th RISE talk (Resilience, Innovation, Strategy and Ecosystems) given by Professor Christopher Williams, from the University of York, UK on “ Global Health Systems Strengthening and R&D: Can the Interests and Needs of Rich and Poor Countries Ever be Reconciled?”
How can R&D in health contribute to solving global inequality issues? In the 5th RISE Talk (Resilience, Innovation, Strategy and Ecosystems) on 13th January 2022, Dr. Williams who is a Professor in Strategy and International Business at the University of York explored this question with a particular focus on health system strengthening and global health R&D. A key theme he highlighted was how the concept of ‘distance’ - widely used in international business literature - can serve as a catalyst to guide our thinking on the role of health R&D in addressing global inequality.
Inequality as a social phenomenon is commonly understood as an unequal distribution of resources and opportunities, and can manifest itself in different forms. In the context of global health, inequality encompasses several indicators, including life expectancy, child mortality, infectious diseases, and maternal mortality. For example, life expectancy for Ethiopia (66.6) and France (82.9) differs by around 16 years and the infant mortality rate in Ethiopia is almost 11 times higher than that in France. Frequently, such differences between developed countries and developing countries are attributed to long-standing issues relating to poor institutional quality, poor infrastructure, corruption, political instability and even war. In terms of health R&D, this is then reflected in various problems such as a lack of trained researchers, lack of appetite by international pharmaceutical companies, social resistance, and scale up issues. WHO’s report (2019) shows that, although global health spending in real terms is growing faster than the economy, large inequalities across countries still remain. The difference concerning health spending per capita between low-income countries (e.g., $41 a person in 2017) and high-income countries (£2,937 a person in 2017) can be as high as 70 times. The report of the Commission on Health Research for Development (CHRD) also shows that 93% of the potential years of life lost in the world is in developing countries whereas 95% of research expenditure on health problems is in developed countries.
Professor Williams pointed out that, compared to the global spending on health R&D (approx.$212B in 2021), the global general spending on health systems is an order of magnitude greater, reportedly reaching $8.3 trillion in 2018. Why does inequality in global health still exist? When delving deeper into the matter, research reveals a mismatch between research effort and health needs in low-income countries (Atal et al, 2018). According to the WHO (2021), many developing countries receive Official Development Assistance (ODA) funding in health R&D, although much of this are used to strengthen health systems. This differs from the traditional pharmaceutical R&D, which focuses on knowledge exploration and creation. Instead, health systems strengthening is more about knowledge application and exploitation at a systems level. UK AID (2019) provides a comprehensive definition of health systems strengthening below:
Interventions aiming to increase/enhance service access, services coverage, service quality and safety.
Six building blocks: human resources; health finance; health governance; health information; medical products, vaccines, and technologies; service deliver.
Long-term (sustained) outcomes including improved health, equity, cost-effectiveness, responsiveness, social and financial risk protection.
Contested term but including system rather than organizational level, more than just inputs to a health system, integrated across the building blocks, and impact across diseases.
Lower income countries.
Can ODA in health R&D fill the gaps? – Equating the two sides of the same coin
Professor Williams sees the recipient component and the donor component as two sides to the ‘levelling’ coin. Both donor countries and recipient countries are equally important in ensuring the effectiveness and efficiency of health R&D funding. His recent study in Research Policy shows as life expectancy increases, the funding received from health R&D reduces. As the human burden increases, these countries attract more funding. Countries where life expectancy is low or that are going through medical emergencies see an increase in R&D funding but these countries do not necessarily have the appropriate level the provision of skilled medical researchers to utilize the funding effectively. Professor Williams study created a new construct to capture this: medical absorptive capacity. According to his study, many developing countries, however, do have a higher concentration of nurses. The implication is that health R&D ODA can only be effectively absorbed when recipient countries have the skilled medical workers able to effectively utilize these donations from donor countries. Understanding how different aspects of medical absorptive capacity effectively translate funding into successful innovations and interventions is a basis for reducing the inequality in global health. Doing this increases the ability of a recipient country to utilize funding in health R&D for the purpose of medical research and innovation to alleviate human suffering. Regarding the donor side, Professor Williams has started a new line of work examining different types of factors in rich countries that impact the distribution of funding.
Can we reconcile interests and needs between rich and poor countries as a way of closing the inequality gap?
This will be an evolutionary process rather than something that’s going to change overnight. Perhaps, we need to keep reviewing the healthcare systems to see what needs to change and where the problems lie so that we can be more resilient both nationally and globally regardless of a country’s wealth. Key factors that may need to be kept under review are
Understanding disruption time horizon (long-standing issues vs sudden global shocks such as the Covid pandemic) and locus of spending (health systems strengthening vs focused health R&D)
Understanding the factors that reduce distances between countries when they are seen in terms of disruption time horizon and locus of spending
Continual development of central coordination for innovation in global health R&D
Innovation at the interfaces: boundary spanning capabilities
Future Research Linking to RISE
What can we learn about resilience from studying global health?
How can organizational resilience knowledge be brought into the health arena?
What role do medical absorptive and disseminative capacities play in global health innovation and reconciling need and spend?
How do the sub-components of these capacities interact and influence efficient use of innovation budgets?
How can strategy for global health be developed on a collaborative/ coordinated basis to include big pharma, mission-oriented and public/ODA domains?
How can diverse mindsets amongst strategic leaders be aligned?
What are the leadership qualities needed to execute such strategy?
How can the global health ecosystem be developed, maintained, upgraded to cope with constrained funding, increased complexity, various forms of distance?
This blog expresses the author’s views and interpretation of comments made during the talk. Any errors and omissions are the author. Dr. Jacqueline You is an ESRC Postdoctoral Fellow at Durham University Business School, UK. Her interdisciplinary research focuses on organizational resilience and disruption. Prior to entering into academia, she worked for multinational corporations, primarily in the department of global supply chain networks and strategic procurement in China, the US, Canada and France and then, as an international entrepreneur based in the UK.
RISE Talk (Resilience, Innovation, Strategy and Ecosystems) is an academic initiative funded by the Economic and Social Research Council (ESRC) and hosted by the Centre for Innovation and Technology Management (CITM), Durham University Business School, in partnership with the Global Citizenship Programme, Ustinov College, Durham University.The aim is to facilitate an interdisciplinary discussion and exploration of how conventional theories inform our understanding of the phenomenon of RISE and how the role of RISE can help to address the pressing and complex issues faced by business and society, including governance and systems for sustainable development.