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A new survey of the world's health-related literature has confirmed that there is a growing gap in the number of publications produced by the world's rich and poor nations. This implies an equivalent gap in their capacity to make full use of biomedical research.

The survey also reveals that, within each of four categories of economic development, publications are highly concentrated in relatively few countries.

As a result, the authors suggest "national income does not fully explain differences in the share of scientific publications on health topics".

The survey, published in the current issue of Science, has been carried out by researchers with the World Health Organization (WHO) in Geneva, Switzerland. It builds on other findings, published earlier this year, that already demonstrated that biomedical research publications are highly concentrated among the world's richest countries.

The authors of the survey, which covered almost 3.5 million articles published in more than 4,000 journals, point out that national scientific outputs reflect not only the ability to generate new knowledge but also the capacity to adapt and benefit from research conducted globally.

Their analysis focuses on all research publications concerning the operations of health systems — and not just scientific outputs addressing health and biomedical research — over a ten-year period, 1992-2001.

This allowed the survey to include publications in areas such as clinical medicine, pharmacology, public health and health systems, social sciences and social welfare, environmental sciences, and food sciences related to health.

In their conclusions, the authors point out that while the share of worldwide publications of high-income countries remained relatively constant during the period studied, 'upper-middle-income' countries increased their contribution by about 30 per cent (even though their overall share remains at 3 per cent of worldwide production).

Largely as a result of increased publications from Brazil, China, and Turkey, scientists in a third economic category, namely 'lower-middle-income' countries, increased their contribution by more than 20 per cent, reaching a total of more than six per cent share of worldwide production in 2001.

The number of publications from 'low-income' countries, which only account for less than two per cent of the total, fell by about ten per cent over the decade.

Even here, most of the research covered came from Southeast Asia, with India's proportion of the output from these 63 countries rising from 66 per cent in 1992 to 73 per cent in 2001.

The top five research producers within this group — accounting for 82 per cent of its publications — were India, Nigeria, Kenya, Pakistan, and Bangladesh. In contrast, 46 countries of Sub-Saharan Africa produced only one-fifth of the group's output.

"These results provide further evidence that the gap in scientific publications between [lower income] countries and the rest of the world has widened, " say the authors.

They argue that this trend "underlines ongoing calls to improve capacities and networks, to intensify equitable research partnerships, to increase public funding for research and innovation strategies addressing national health priorities, and to increase the visibility of research undertaken in these countries".

The authors say that China's increasing proportion of worldwide outputs addressing health topics "can be attributed to specific changes in research policies during the past two decades, including an increasing value on the assessment of research outputs".

They identify a key area for action being the need "to understand and support what pushes and pulls scientists in diverse low-income countries to contribute to worldwide publication on a broad range of health topics and to integrate them into the global science community".

Finally the authors say that they survey demonstrates that "general policies need to recognize the enormous heterogeneity that is found within countries commonly grouped together".

Reference: Science 308,959 (2005)

Link to full article in Science

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