key: cord-0005671-3km793il
authors: Cohen, Lois K.
title: Global health research for America's vital interest
date: 2014-12-29
journal: J Am Dent Assoc
DOI: 10.14219/jada.archive.2007.0079
sha: 7311bb3d578bb1780e3bea9a20bbb3108e2d9c28
doc_id: 5671
cord_uid: 3km793il

nan

I t has been estimated that the United States invests $111 billion annually for healthrelated research, counting both the private and public sectors. 1 The Global Forum for Health Research suggests that of all investments in health research made by countries in the industrialized world, only about 10 percent is focused on the developing world, where 90 percent of the world's populations reside. 2 Research!America estimates that less than one penny of every dollar the United States spends on health research goes to improve health around the world. 3 Why are those figures important to Americans at large? Why are they important specifically to American dentists?

We know that poverty and all the problems associated with the lack of resources unfortunately characterize much of the world's populations. Malnutrition, lack of clean water supplies, poor sanitation, inadequate shelter, lack of access to health services-all of these take an enormous toll on many nations in the developing world. These realities abroad have a direct impact on America's well-being, whether those constellations of factors play out in economic terms, in social and political well-being, or in the health of our own populations living in this country.

As we read about infectious diseases that spread rapidly abroad-HIV/AIDS, severe acute respiratory syndrome, West Nile virus, avian flu or any other communicable disease-it does not take much imagination to infer potential dangers to populations on our own shores. The rise of international Dr. Cohen is a Paul G. Rogers Ambassador for Global Health Research. She also is a member of the editorial board of The Journal of the American Dental Association. Address reprint requests to Dr. Cohen via e-mail at "Lkcohen1@verizon.net".

Lois K. Cohen, PhD travel and commerce brings within our own borders disease that initially was contained outside our borders. These diseases arrive with their own costs to a person's capacity to function in the economic marketplace, to attend school or even just to maintain a minimal functional quality of life. And these conditions often present new and varying oral manifestations that have their own costs and impact on daily functioning. And it is not just communicable diseases that take a toll. Chronic diseases occur here and abroad that double the burden for the world's communities as they try to feed and educate their own and to sustain viable economies. Without health, education and economic vitality, populations become economically as well as politically unstable, leading to disorganization and dissolution of established institutions, anomic individualistic behaviors, violence and conflict and, inevitably, affecting relations between and among nations. The downward spiral of communities that weakens national cohesions is much of what we now see in the political turmoil of today's world.

Economists such as Jeffrey Sachs 4 have argued that the solution to poverty lies in helping nations and communities develop and enhance agriculture, have and maintain clean drinking water and provide basic health care. But the ability to do this will Editor's note: The Council of Science Editors has organized among science journals throughout the world a global theme issue on poverty and human development. Participating journals are simultaneously publishing articles on this topic of worldwide concern to raise awareness, provoke interest and stimulate research. This is an international collaboration among journals from developed and developing countries-more than 230 in all. The Journal of the American Dental Association is pleased to be among them and presents an editorial and four cover stories on this topic of interest to practitioners in the United States and around the world.

Copyright ©2007 American Dental Association. All rights reserved. depend on the evidence that these strategies have worked both in local communities and in scaledup demonstrations. It is the operational research capacity that often is in short supply in these deprived communities and nations. That constitutes a major barrier to moving any development agenda forward. Governments, businesses, academic institutions, philanthropies or even organized communities of advocates can move forward only with a better and stronger body of research evidence, if but to avoid the pitfalls of wasteful spending of scarce resources. We cannot risk this window of opportunity to exert credible leadership. The specific case for increasing our national investments in health research is a special responsibility of health professionals. It is not the sole responsibility of patients and other stakeholders who are necessary and critical partners involved in the development of a public policy agenda. The moral leadership must come from those with the most scientific expertise, and health professionals have that as their essential credential. If health professionals can and will organize themselves to address this issue of global health and associated health research and training, they could be effective and normative role models for others. The credibility of this unique collective across all health professions could create a powerful force for changing the downward spiral in global health and, at the same time, serve to protect the health and enhance the well-being of our own people.

One can make a special case for oral health and related research that is targeted to operational and implementation issues of effective and sustainable oral health interventions. Such research can assist in closing the gap between what we know and the reality of inadequate oral health in many parts of the developing world, as well as many parts of our own U.S. communities. Finding and testing affordable preventive and treatment strategies to deal with shortages of trained dental practitioners is a challenge for all nations.

Effectively and efficiently linking oral health interventions to more high-profile HIV/AIDS, tuberculosis or malaria initiatives is a conceptual challenge that conceivably could leverage scarce resources and serve to integrate oral health with the better-funded global health initiatives. The World Health Organization (WHO), for example, has promulgated a policy to identify the most indicative oral manifestations of HIV/AIDS; involve oral health personnel in the documentation of HIV/AIDS to ensure appropriate medical evaluation, prevention and treatment; and train other health professionals and primary health care workers in how to screen for oral lesions and extraoral manifestations-all of these being important immediate needs to address on the global scene. 5 What can American dentists do? By advocating for a greater investment in global health research and associated capacity building for research (that is, strengthening the research labor force and providing adequate research infrastructure) in a manner that is inclusive of oral health research, this nation will be able to generate and share data that will enable and drive strategic and evidence-based interventions to enhance health and oral health.

There is much to be learned from the experiences of other countries, both industrialized and developing, in that issues of health and science know no geographic borders. The United States will benefit as it does now from the research findings reported by scientists abroad or by teams of scientists that include the U.S. scientific community. Our future depends on such flexibility to work across countries and to pool expertise with others in a free and open-access environment. Only through international collaboration will dentistry achieve its highest potential. This is not a new idea; it was articulated explicitly in the American Dental Association's 2001 report "Future of Dentistry: Today's Vision, Tomorrow's Reality." 6 The ADA has made considerable progress since 2001 in recognizing and accepting a leadership role in global health and in working with government, industry and philanthropies to advocate for and implement research, education and assistance for service programs. The ADA and American

Organization.

in health research must come from those with the most scientific expertise, and health professionals have that as their essential credential.

Copyright ©2007 American Dental Association. All rights reserved. Whether joint symposia are organized, global congresses are planned or collective action is undertaken to sustain oral health expertise at global levels, the U.S. dental community already has come together and is learning from innovations occurring globally. Additionally, The Journal of the American Dental Association has demonstrated its commitment to this movement in establishing an international editorial board, as well as joining the publicprivate partnership Health InterNetwork Access to Research Initiative, which is sponsored by the WHO to distribute biomedical and related scientific information in a cost-effective way to developing countries.

Advocating for increased investments in health research domestically and internationally, including oral health research, is the smart thing to do for America's own well-being, as well as for humanitarian purposes. Global collaborations in health and health research will help other nations see us in a new light. Health care and health research are a form of diplomacy. Science is the bridge between countries that can make the difference. Science can enable people to work together effectively for common and mutual benefit, removing the barriers of inequality, moving toward social justice globally and finding new ways to prevent, diagnose and treat diseases, not only in the world's poorest countries but also in our own as well. As Michael Leavitt, secretary of the U.S. Department of Health and Human Services, testified before the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies in May, "Health holds a special place as a foreign-policy tool. It is a universal and fundamental desire of all people, and is a common concern among almost every electorate in the world." 7 Secretary Leavitt should be lauded for his leadership in helping to establish the Latin American Health Initiative, which will begin in 2008, in no small part because oral health care and oral disease prevention are among the services provided in this inaugural health services package.

Research!America-the nation's largest not-forprofit public education and advocacy alliance that works to make research to improve health a national priority-has conducted surveys of U.S. public opinion about research investments. Large majorities of Americans favor having the United States invest considerably more dollars to improve health and the quality of life worldwide, as well as at home. 3 More and more groups-and individuals from Bono to Bill and Melinda Gates to Angelina Jolie to Jeffrey Sachs-are beginning to speak out about our underinvestment in global health research. We need to step up to the challenge of this global crisis. We need to track what we now invest in. We need to develop stronger research training initiatives to enhance the quality and quantity of researchers who are culturally competent to work across international borders. We need to form even stronger alliances across the oral health and health care professions to influence the public will-and to help translate that will to decision makers who can commit needed resources for global health research and the infrastructure that supports that research. Only then can we make some strategic and credible impact on this global crisis and prevent further worsening of the burden of disease, disorders and devastation on this globe we share. ■

Health research funding losing ground

The 10/90 gap: now. Available at: "www.globalforumhealth.org/Site/003__The%2010%2090%20gap/ 001__Now.php". Accessed

America speaks: Poll data summary

Available at: "www. researchamerica.org/publications/AmericaSpeaks/AmericaSpeaksV8. pdf". Accessed

Rapid victories against extreme poverty

Policy for prevention of oral manifestations in HIV/AIDS: the approach of the WHO Global Oral Health Program

Future of dentistry: Today's vision, tomorrow's reality. Chicago: ADA Health Policy Resources Center

Statement on global health before the Senate Appropriations Subcommittee on Labor, HHS, Education, and Related Agencies