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HRP at 40: what they say. A history of scientific achievement to advance sexual and reproductive health

Source: World Health Organization (WHO) | June 2012

This report gives an overview of the last 40 years of work carried out by HRP, the Programme of Research, Development and Research Training in Human Reproduction, which was established in 1972, following a World Health Assembly resolution.

HRP aims to advance sexual and reproductive health. The organisation is the central mechanism within the United Nations system for research into human reproduction — bringing together policymakers, scientists, healthcare providers and community representatives to identify and address priorities for the sexual and reproductive health agenda.

The report highlights key achievements, including helping to prevent mother-to-child transmission of HIV; promoting human rights and gender equality in sexual and reproductive health; and widening access to family planning.

Safer, Faster, Cheaper Improving Clinical Trials and Regulatory Pathways to Fight Neglected Diseases

Source: Working Group on Clinical Trials and Regulatory Pathways | November 2011

This report provides policy recommendations to help deliver safer and cheaper medical products to people suffering from neglected diseases in developing countries, where they are needed the most.

Although more drugs and vaccines are reaching late-stage clinical development, says the report, they are held back by a lack of funding to support clinical trials, as well as clinical research and regulatory capacity in settings where neglected diseases are endemic. This undermines safety and the validity of clinical data.

The report recommends a two-pronged approach to improving the quality and regulation of clinical trials in the developing world: establishing regional regulatory pathways for the oversight of clinical trials, and building quality and cost-efficiency into trial design and implementation. It also recommends practical steps that can be taken by donors, drug and vaccine developers, and regulatory authorities to begin implementing the changes.

Playing the role of a 'boundary organisation': getting smarter with networking

Source: Health Research Policy and Systems

This paper discusses how researchers promote the use of research in policy by examining the practices of 'boundary organisations' that cross the boundary between science and politics to facilitate evidence-based policies and programmes. It identifies key lessons for organisations looking to engage policymakers and decision-makers.

The study focuses on the Regional Network on AIDS, Livelihoods and Food Security (RENEWAL), a regional 'network of networks' active in Kenya, South Africa, Uganda, and Zambia which engages government officials on programmes that could inform policies on food, nutrition and HIV/AIDS. It describes the challenges and successes of efforts to promote research in these areas; challenges include adherence to scientific principles while maintaining close relationships with political authority, and ensuring accountability to the communities within which the research is conducted.

The paper offers recommendations to strengthen efforts to get research into policy, and concludes that the concept of a boundary organisation can help researchers engage people and processes that have decision-making power.

Global status report on noncommunicable diseases 2010

Source: WHO | April 2011

This report examines the threat posed by non-communicable diseases in low- and middle-income countries, which carry nearly 80 per cent of the world's burden of cardiovascular disease; diabetes; cancer; obesity; and chronic respiratory disease. It includes tables and maps of global, regional and country-specific trends including estimated mortality rates. The data are also used to predict future trends and assess factors contributing to non-communicable disease.

Drawing on what developed countries have learned about these diseases, the report outlines options for tackling them, such as early detection and treatment. To encourage immediate action, it puts forward a series of highly cost-effective solutions that are affordable even where resources are limited. It also emphasises the need for strong health-care systems, improved surveillance and monitoring, and nongovernmental and civil society participation in efforts to reduce the burden of non-communicable disease.

Mental health and development: Targeting people with mental health conditions as a vulnerable group

Source: WHO Mental Health and Poverty Project | December 2010

This report presents evidence that people with mental health conditions meet major criteria for vulnerability and should be targeted for protection by development programmes. Mental illness such as schizophrenia, depression or bipolar disorder are common but largely neglected.

The WHO makes the case that because of their vulnerability, people with mental health problems need to be given opportunities for education and work, and to be included in decisions that affect them.

It argues that mental health should be built into sectoral and broader plans for development, with government agencies, NGOs and other stakeholders playing a key role in ensuring this. To make implementation a reality, interventions and mainstreaming efforts should be funded adequately, and recipients of development aid should be encouraged to address the needs of people with mental health conditions. The report recommends actions as a starting point towards these aims.

Vision 2030: The resilience of water supply and sanitation in the face of climate change

Source: WHO

This report presents the findings of the WHO's flagship Vision 2030 study. Comprised of a series of summary and technical papers and fact sheets, the Vision 2030 report provides a comprehensive overview of current and projected climate change and its potential impacts on drinking-water and sanitation systems. The report also points to solutions to improve the resilience of infrastructure and services to predicted changes in rainfall.

Mitigation of the impact of HIV/AIDS on rural livelihoods through low-labour input agriculture and related activities

Source: The Overseas Development Group | July 2003

This report examines the impact of HIV/AIDS on people's livelihoods in rural areas of Africa, China, Central Asia, India and Russia.

The authors consider labour economising technologies, and set out the potential policy options. They conclude that providing anti-retroviral drugs would have an immediate, and a long-term effect on food security and is the only way of ensuring continued access to labour in the rural sector.

From traditional medicine to witchcraft: why medical treatments are not always efficacious

Source: PLoS ONE | April 2009

Ensuring that traditional medicines are safe and effective is a major challenge. This study uses mathematical models to show that the treatments that become popular through communities and get passed down through generations are not necessarily the most efficacious. Often, ineffective treatments that are based on superstition can spread because, the authors say, their very ineffectiveness means that patients use the treatment for longer than medicine that actually works.

Feminization and marginalization? Women Ayurvedic doctors and modernizing health care in Nepal

Source: Medical Anthropology Quarterly | March 2010

This article argues that unless the modernisation of traditional medicine in Nepal is treated with care, it could create gender inequalities and the increased social marginalisation of women. Healthcare in Nepal is slowly being modernised to fit more with a model of Western medicine than with traditional Ayurveda. Ayurveda attracts many female practitioners since it is one of the few professions in this patriarchal society in which women are accorded high status.

National policy on traditional medicine and regulation of herbal medicines — Report of a WHO global survey

Source: WHO | May 2005

This WHO report summarises the findings of a global survey on national policy and regulation of traditional medicine in 141 countries. It presents data on existing policies for traditional medicine and regulation of herbal medicines. The report highlights common hurdles to implementing these and provides a profile of each country surveyed.

Traditional medicine: modern approach for affordable global health

Source: WHO | March 2005

This study assesses whether traditional medicine can contribute to more affordable global healthcare. It uses flowcharts to map out factors such as healthcare infrastructure and social mores that lead much of the developing world to use traditional medicine, and explains the different medicinal systems in use around the world. The author concludes that traditional medicine is a public health asset, provided it can be sufficiently standardised and verified.

How much of CAM is based on research evidence?

Source: Evidence-Based Complementary and Alternative Medicine | May 2009

According to the author of this review, only 7.4 per cent of complementary and alternative medicine (CAM) — which includes homeopathy and acupuncture — is evidence-based. The author evaluates research evidence from clinical trials and systematic reviews to reach this conclusion. By contrast, he says, more than half of all interventions in general internal medicine, and more than 65 per cent in psychiatry are based on sound evidence, including results from randomised controlled trials.

Antibiotic resistance: an ecological perspective on an old problem

Source: The American Academy of Microbiology

This report summarises current understanding of antibiotic resistance, the scope of the problem, and the methods available for detecting and preventing it. It highlights unique challenges faced by developing countries including poor research infrastructure and counterfeit antibiotics.

The authors highlight the need to build laboratory capacity, improve diagnostic tools, establish surveillance programs and implement tighter controls on antibiotic use in these countries.

Maternal and Child Undernutrition

Source: The Lancet | January 2008

This collection of articles, published by The Lancet, describes the burden of maternal and child undernutrition in the developing world and highlights proven effective interventions to reduce stunting and micronutrient deficiencies.

Undernutrition is entirely preventable yet causes more than 3.5 million child deaths. It produces stunting, wasting and intrauterine growth restriction among other problems and is particularly prevalent in Africa, Asia, the Middle East and western Pacific.

The window of opportunity for tackling undernutrition is short: from pregnancy to two years of age. After the age of two, the damage on health and brain development caused by undernutrition is irreversible.

But, as the collection shows, there are plenty of interventions that have been proved to improve child nutrition. The most effective include breastfeeding counselling, vitamin A supplementation and zinc fortification.

Nutrition and health in developing countries

Source: Springer | 2008

The author list for this collection of chapters, with names like Cesar Victora and Carine Ronsman, reads like a 'Who's Who' in nutrition and health for the developing world. The chapter topics are wide-ranging and include subjects such as the economics of nutrition programmes, the extent to which scientific data influences nutrition policies, and the challenge of providing food aid during humanitarian emergencies.

Each chapter is organised as a scientific paper. Most usefully perhaps, the authors of each chapter include both their conclusions, and a separate list of recommendations for researchers and policymakers.

FAO Right to Food methodological toolbox

Source: Food and Agriculture Organization (FAO) | 2009

This set of documents, written and published by the Food and Agriculture Organization's (FAO) Right to Food Unit, is intended as a practical guide to implementing the human right to adequate food.

This six-part guide includes background information on legislating for the right to food, as well as detailed outlines of methods to monitor the human right to adequate food.

It also includes a guide to conducting a right to food assessment, and establishing a budget for the right to food.

A common theme throughout the documents is the need to raise public awareness about these issues.

The toolbox offers policymakers background and contextual information they may not have — such as different legal options for governing the right to food — and provides practical advice on increasing access to food.

Malaria and its vectors in the Caribbean: The continuing challenge of the disease forty-five years after eradication from the islands

Source: West Indian Medical Journal | November 2008

This journal article, written by three researchers in Trinidad and Tobago, looks at malaria in the Caribbean. It asks why there are still outbreaks — including a big one in Jamaica in 2006/2007 — when the disease was allegedly eliminated in the late 1950s. The authors review malaria and vector data from across the Caribbean, summarising the pattern of imported cases as well as indigenous ones.

They identify three essential conditions for malaria transmission: presence of the vector, imported organisms and susceptible human hosts — all of which the authors show still exist across the Caribbean.

The authors suggest specific actions for regional policymakers to combat malaria. These include enhancing vector control skills, strengthening surveillance with new technologies, upgrading malaria therapy, increasing prevention strategies such as bed nets and raising public awareness of malaria. They emphasise that the role of climate change must be considered too, saying that rising temperatures could lead to new malaria vectors entering and colonising Caribbean islands and transmitting malaria on a major scale. But the authors are also careful to point out that the link to climate change is uncertain and remains contested in scientific circles.

Using climate to predict infectious disease epidemics

Source: WHO | 2005

This report from the WHO assesses the potential for creating early warning systems for vector-borne disease. It reviews the current state of research for several diseases such as dengue fever, leishmaniasis, malaria and West Nile virus.

The report includes an algorithmic framework for developing early warning systems, outlining data requirements and the different components of the system. It also contains two useful tables: one on the sensitivity of different infectious diseases to climate; and one summarising the existing research, identifying in which region the disease is most common, data availability and proposed actions.

A key problem in developing early warning systems, as highlighted by this report, is that non-climatic risk factors such as population immunity and food security strongly affect the potential for a disease outbreak. Equally challenging is the poor disease surveillance in many developing countries — the authors call on these countries to strengthen these systems, to help in the fight against climate change.

The report concludes that it will be important for researchers not to design these systems in isolation — health policymakers should be included at all stages of the design.

Global climate change and extreme weather events: Understanding the contributions to infectious disease emergence

Source: Institute of Medicine | 2008

This extensive report from the Institute of Medicine of the US National Academies takes on the considerable challenge of understanding how, and to what extent, climate change will affect infectious diseases.

The report provides detailed summaries of current knowledge on diseases such as cholera and rift valley fever. Several pages are devoted to reviewing the latest climate science to contextualise the effect on infectious disease; it also includes several maps on climate anomalies to show how they are linked to disease.

One section highlights methods to assess climate change impacts on infectious diseases. These include analyses of historical records; monitoring programs, especially those that track disease in wild animals; and comparisons of satellite-derived environmental measurements with epidemiological data.

The report concludes with an analysis of the challenges facing policymakers. In many cases, it says, the best public health measures against climate change are those that strengthen health systems in general, such as better training for professionals and better disease surveillance. Policymakers will need to move away from the traditional thinking of individual policies for individual diseases, towards a joined-up approach aimed at tackling "systemic, long-term" stresses that cause a range of effects.

Managing the health effects of climate change

Source: The Lancet | May 2009

This report provides a policy framework for assessing the impacts of climate change on health, including vector-borne disease, by considering five challenges: informational, poverty and equity-related, technological, sociopolitical and institutional.

It begins with a detailed outline of climate science so far and the financial cost of adaptation. The informational challenges relate to better monitoring and surveillance to gather urgently needed data on disease and mortality in different regions, and early warning systems to predict extreme weather events and associated disease outbreaks. Technological challenges include the development of vaccines for diseases such as malaria and dengue fever.

How do policymakers tackle such challenges? A key move will be for government and non-government agencies, academia and civil society to collaborate internationally. Surveillance and primary health information systems in developing countries must be improved and local communities need to share adaptation strategies.

Adapting to climate change also means investing in food security, clean water supplies and reforestation. Policymakers also need to stimulate industry to develop low-cost methods for recycling wastewater and desalinating sea water. Mitigating and adapting to climate change, say the authors, has become inextricable from policies to eradicate poverty or closing the gap on social inequalities and health.

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