Academic journal article Bulletin of the World Health Organization

Open Access: A Giant Leap towards Bridging Health inequities/Acces Libre Aux Connaissances : Un Pas De Geant Vers le Comblement Des Inegalites En Matiere De sante/Acceso Libre: Un Paso De Gigante Para Resolver Las Inequidades Sanitarias

Academic journal article Bulletin of the World Health Organization

Open Access: A Giant Leap towards Bridging Health inequities/Acces Libre Aux Connaissances : Un Pas De Geant Vers le Comblement Des Inegalites En Matiere De sante/Acceso Libre: Un Paso De Gigante Para Resolver Las Inequidades Sanitarias

Article excerpt

Introduction

Health knowledge generated in the world's laboratories is passed down the information chain through publications, through its impact and application, its subsequent "translation" into appropriate contexts for different user communities, arriving finally with health workers and the general public, as the diagram of the knowledge cycle from the Canadian Institutes of Health Research has shown. (1) Studies have shown that access to published health research by the research communities in developing countries is no longer "fit for purpose". (2) As has been well documented, rising costs of subscriptions and permission barriers imposed by publishers have barred access to the extent that local health research and health care have been damaged through lack of information. (3,4) For example, Yamey (5) tells of a physician in southern Africa who could not afford full access to journals but based a decision to alter a perinatal HIV prevention programme on one single abstract. The full text article would have shown that the findings were not relevant to the country's situation.

With the advent of the internet there is little justification for continuing to create barriers to access. Richard Smith, as the former editor of the British Medical Journal, said, "Most research is publicly funded, and when the internet appeared it made no sense for research funders to allow publishers to profit from restricting access to their research". (6) This is true not only for publicly funded research but for private health charities around the world. As the Open Access Policy of the Wellcome Trust states, "We ... support unrestricted access to the published output of research as a fundamental part of its charitable mission and a public benefit to be encouraged wherever possible". (7)

Science is a collaborative process and openness is fundamental to knowledge advancement. Nowhere has this been shown more clearly than by the 2003 outbreak of SARS (severe acute respiratory syndrome) during which, at the height of the epidemic, there was unprecedented openness and willingness to share critical research information, leading to the identification and the genetic mapping of the responsible coronavirus by 13 collaborating laboratories from 10 countries. (8) The recent release of essential H1N1 data published in several toll-access journals relevant to the H1N1 influenza pandemic points to the recognition that access to health research information is critical in the containment of infectious outbreaks. (9)

It is difficult to see how the United Nations' Millennium Development Goals can be achieved without free international access to the world's publicly funded research findings or without collaborative initiatives. Goals 4 to 7 depend on the sharing of research findings for success, while Goal 8, which emphasizes the need for global partnerships for development, recognizes that sharing knowledge and capacity building establish the infrastructure for building future aid programmes.

Any solution to the inequality of access to health-care information must be based on the development of an independent and sustainable national research base. Lessons in development aid from the past few decades clearly show that mechanisms that reinforce the dependency culture are no longer appropriate. (10,11)

Solutions

The United Nation's HINARI, AGORA and OARE programmes, whereby registered libraries or qualified institutions in countries with a Gross Domestic Product (GDP) of < US$ 1250 per capita are provided free access to journals contributed by partner commercial publishers, have successfully filled information gaps for selected users. (12) However, such donor programmes have several limitations. (13) They are not driven by science (journals are donated by publishers at their own discretion rather than selected by researchers); they are only available to the poorest countries (as countries' economies improve, they no longer qualify); some low-income countries are excluded (e. …

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