the health problems of people in developed countries. Of the estimated $30 billion world expenditure on health research, only 5 percent ($1.6 billion) is devoted to the health problems of people in developing countries, which account for 93 percent of the years of potential life lost in the world.

  • Of that $1.6 billion, 42 percent ($685 million) originated in the developing countries themselves; 58 percent ($950 million) originated in the developed countries. However, of the $950 million devoted to research on health problems in developing countries, only $150 million was actually transferred to those countries. Almost half of the research funding on the health problems of people in the developing countries goes to support researchers in developed countries working in their own countries.

  • Overseas development assistance (ODA) varies greatly among developed countries, from 0.2 percent of gross national product in the United States and 0.3 percent in Japan, to about 1 percent in Scandinavia. The percentage of ODA invested in health research also varies widely, but overall, it seems to have been static or declining over the past decade, because of economic recession and a decline in ODA in real terms.

  • Though some major health problems are receiving attention, others notably, the policy and social sciences, epidemiology, and management researchare relatively neglected. Biomedical and clinical research initiatives are somewhat stronger, but capacity-strengthening efforts in these fields are modest in scale and are narrowly targeted. Major gaps exist in information, monitoring, and assessment of the evolving health picture.

  • Still, the number of international research promotion programs is growing and could form the core of a worldwide health research system. Joint efforts by United Nations agencies are noteworthy, and privately sponsored efforts have been productive, though these are characterized by fragmentation and multiple, narrowly focused research initiatives.

  • Although investment in health research in developing countries is impressive, 75 percent of this investment comes from eight large or rapidly developing countries; most developing countries invest little in health research. In those countries that invest little, scientists and institutions are pursuing a range of research activities, but they face serious professional, institutional, and environmental constraints. Coherent research responses to high-priority problems at the national level are limited, and national commitment and international reinforcement for health research, specific actions to tackle constraints, and capacity building and maintenance are, at best, uneven.

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