Global health equity in United Kingdom university research: a landscape of current policies and practices by Gotham et al. 2016 "People's needs, rather than social privileges, [should] guide the distribution of opportunities for well-being" Braveman wrote in 1996, which is no less true now than it was then. With this definition of global health equity in mind, funding for the research & development (R&D) of new drugs should follow the distribution of the global burden of disease and seek to fill historical gaps in R&D, such as in neglected diseases, to benefit the global population rather than being skewed towards a selected few. In 2014, a group of students from Students for Global Health and Universities Allied for Essential Medicines (UAEM) got together to investigate whether the 25 top-funded higher education institutions in the UK lived up to the idea of global health equity. This project was closely based on an earlier project undertaken by UAEM North America (www.globalhealthgrades.org) and followed by a German and a Canadian Report Card last year. For these 25 UK universities, they measured the proportion of total health research funding attributable to neglected diseases (NDs) and health in low & lower-middle-income countries (hLLMIC), the universities' patenting and licensing of health-related technologies and their policies and practices in open access publishing. From these measures, they created an index (league table) to compare universities, giving us the means for evidence-based action in our own UAEM chapters. Over this academic year (2017-2018) a new group of students has been undertaking an iteration of the study, as the first version was created in 2014–2015 (published as an interactive website (www.globalhealtgrades.org.uk) and as an academic article (https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-016-0148-6). If after reading this blogpost you think you’d like to get involved in tracking the universities' progress since then, as well as exploring the inclusion of new sections such as the transparency of clinical trial results and universities' commitment to global health education, feel free to contact sarai.keestra.15@ucl.ac.uk. For now, I will give a short summary of the highlights of the last study, and explore how this can empower us as students to ensure best practices in global health equity at UK’s leading research institutions, including UCL. Research funding The global burden of NDs lies at circa 13.8% (von Philipsbron et al. (other UAEM group)) and LLMICS account for 59% of the global burden of disease. However when assessing the proportion of the health research dedicated to these diseases between 2011-2014, only 2.6% of the funding was used for research into NDs and 1.7% for health in low & low-middle-income countries (hLLMICs). For UCL, this percentage was slightly higher with 6.5% of funding dedicated to NDs and 4.4% to hLLMICs, although for the research output, measured by proportion of PubMed publications, only 1.3% focuses on NDs and 2% in hLLMICs. The top four institutions in each category were responsible for 79% of all neglected disease research and 74% of all research on health in LLMICs countries done in the UK, demonstrating an extreme siloing of the field to only elite universities. Below are figures from the study showing the proportion of total health research funding that is directed towards neglected diseases and hLLMICs at each university.
Licensing of patented technologies Only seven out of the 25 universities had a Socially Responsible Licensing (SRL) policy, which is a public commitment to make their research products affordable for developing countries. These universities were University College London, the University of Edinburgh, the University of Manchester, the University of Oxford, Imperial College London, the University of Dundee and the University of Bristol. LSHTM and the University of Liverpool indicated that they would endorse such a policy within the year after the study was conducted. However, only the first three universities mentioned above, including UCL, had specific licensing strategies to enhance access to the university's intellectual property. Although the presence of a SRL policy positively predicted the level of non-exclusive licensing and the use of access provisions in exclusive licensing, this relationship was not statistically significant. This highlights again how important it is that we as students hold our universities accountable for their policies, making sure that our universities actually put words into action and do not make false commitments. Furthermore it did not seem to be the case that higher absolute or proportional funding in NDs or hLLMIC inspired better licensing practices. Thus, even if universities did research in the areas where it is most needed, they did not necessarily consider the further steps required to enhance access to much needed health technologies.