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5 Health Research Agendas and Funding David E. Nelson Abstract There is a large range of national public funding support for health research across countries. By contrast, allocations for overall funding for health literacy and related research areas are limited. Health research agendas and resource allocation are policy decisions that involve the use of power. There are strong incentives to maintain the status quo, especially in the face of level or declining funding. Many macro- and microlevel factors influence research agendas and funding support. These range from broader societal values and health care delivery systems, to the individuals themselves who make decisions. There is a great need for more research in areas such as implementation of simple interventions in “real-world” settings and the effects of communication technologies on receipt, processing, and seeking of health information by the public. There is some reason for optimism: awareness and support for more transdisciplinary and applied research relevant to health literacy is increasing, and some countries have adopted effective approaches to assess new health technology and treatment prior to introduction into clinical and public health practice. Introduction There is increasing concern that the results from health research do not lend themselves to information that is practical and understandable by patients and other members of the public, clinicians, policy makers, and journalists. In other words, there is a gap between what health researchers study and communicate among themselves, and what lay audiences and clinicians want and need to know. Regardless of whether one looks at levels of funding for health literacy itself, or of funding for related topics such as health services research, health technology assessment, or dissemination and implementation, there are currently few resources being devoted to conduct research on these critical topics. Before examining some of the more specific issues regarding research and practices to improve health literacy, we need to examine critically what type 62 D. E. Nelson of health research gets conducted and funded. In other words, how, what, and why do some health issues and items become included on research agendas and receive funding, and what are the implications for increasing research needed to improve health literacy? In this chapter, I provide a broad review of the extent to which financial resources are currently allocated for health research across different countries. I then examine how health research funds are distributed, and the content of national health research agendas. Thereafter I consider the major factors that influence the development and funding of research agendas, and their implications for health literacy and related research. To conclude, I consider potentially fruitful issues or topics directly relevant to improving health literacy for which more research is needed. First, however, I offer a few caveats: There is not much empiric research on health research agenda development or on how such funding decisions are made (CIHR 2004; Shaw and Greenhalgh 2008; Tetroe et al. 2008). Definitions and categorizations of research agendas and funding areas across countries or in the scientific literature are inconsistent (e.g., what is considered to be applied , clinical, translational, prevention, or public health research). This review was conducted using resources available in the English language. Finally, more information was identified and used from the United States (particularly the National Institutes of Health [NIH]), Australia, Canada, and the United Kingdom than from other countries or sources. Overall Health Research Funding Levels A useful starting point is to consider international funding estimates of health research, sometimes referred to as research and development (R&D), from a 2008 report published by the Global Forum for Health Research based on 2005 data (Burke and Matlin 2008). Health R&D investments accounted for 21.6% of R&D funding across all economic sectors, compared with 11.5% in 1986. In 2005, an estimated $160 billion (U.S. dollars) was spent on health R&D worldwide, and this amount has grown considerably since 1986 (Figure 5.1). A total of 51% of health R&D funding in 2005 came from the private sector, 41% from public funds, and 8% from not-for-profit organizations. Of the total funding, $155.3 billion (97%) came from high income countries. The United States accounted for 50% of health R&D funding; the combined amount from Japan, the United Kingdom, Germany, and France accounted for another 27% (Table 5.1). For the 6% of funding from the category “all other countries” in Table 5.1, most of it was from the so-called innovative developing countries of Argentina, Brazil, India, and Mexico. However, a different picture...

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