1. Knowledge for Health Development
Knowledge for Development Seminar, Center for International Development
Kennedy School of Government, Harvard University, 4 March 2004
Knowledge for Health Development
Lincoln Chen
March 4, 2004

2. Presentation How knowledge relates to health?
Oral rehydration therapy: Case
Commission health research for development
Better knowledge systems?

3. Knowledge-Health “Knowledge-based” – Multi-faceted
Technologies – drugs, vaccines
Ecological and behavioral approaches
Primary education (of girls)
Sectoral interdependencies
“Socially-driven” – Multi-systems
Health care systems
Consumer and advocacy groups
Government and national health

7. Oral Rehydration Therapy
Diarrheal diseases kill 2-3 m children/year
Virus/bacteria from water, food, hands
Deaths due depletion body salts/fluids
Oral rehydration saves lives
Replenishes body salts/fluids
Basic research – biophysics
Intestinal absorption of sugars
Sugar carries salt which carries water
Applied research - social-operational
Packet, home-mixtures
Delivery systems

12. Institutional Basis of ORT
Basic Research
NIH, Harvard Medical School
Applied Clinical Research
Cholera Research Laboratory, Dhaka
Calcutta Hopkins Research Program
Applied Field Research
Matlab, Bangladesh
Refugee Camps, West Bengal
Scientific Debate over Technology
WHO (packet) vs BRAC (home brew)
Dissemination, acceptance, use
NGOs
UNICEF Jim Grant’s Child Survival Revolution
USAID Peter McPherson
Time cycle – ORT 20 years vs smallpox 200 years

13. Commission Health Research
Independent initiative
members, secretariat, funding
Research and consultations
literature, data/analysis, consultations
1990 Report – Health Research: Essential Link to
Equity in Development
Follow-up Mechanisms
Nobel Symposium
COHRED and Global Forum

14. Major Findings Health disparities due, in part, inadequate,
imbalanced research (90/10 rule)
Key role research – generate knowledge,
apply solutions, develop new solutions
Recommendations
“Essential national health research”
International partnerships
Financing health research
International mechanism for global research

15. Lessons in Retrospect Low evidence; high politics
Biomedical/basic vs social/applied research
Research imbalances/equity gap
Funding base imperfect
Foundations, bilateral donors, NIH
Public understanding, political support
Health research-industrial complex
Efficient, effective, profitable
Somewhat inefficient, highly inequitable

17. Design Knowledge Systems
Empower end-users set priorities R&D
Location-specific knowledge for action
“User-inspired basic research”
Incorporate “tacit” and formal knowledge
Integrate public/private, needs/capabilities
Boundary spanning knowledge-action

18. Emerging Issues Scientific revolution Biology of genetics
ICT and health
Globalization WTO/IPR
Health exceptionalism – compulsory licensing
Market failure – forces for discovery (commerce, war, social)
Health knowledge as a “public good”
“Know-do gap”
3-by-5 ART for HIV/AIDS
Ethical challenges
Institutional architecture
Fissures – public/private, N/S, basic/applied
Pluralistic global system of health research
No CGIAR; WHO, ICDDRB, INCAP, BMRC, Wellcome
National/local programs
Scale boundaries in applicability of knowledge?