The Mexico Summit on Health Research 2004

The time: four days, 25 working sessions, six round tables, six joint plenaries and “networking” lunches. The people: hundreds of international delegates, 29 ministers of health, and 29 ministerial representatives. The result: three firm action points, seven vague ones. The reason: political expediency.

The Mexico Summit on Health Research was a historic gathering of health ministers—let's not quibble that only 29 bothered to turn up—and just as many ministerial representatives. The ministers spoke with passion, and surprising understanding, of challenges facing health systems research. The advocates—public health specialists, researchers, and technocrats from the World Health Organization—put their case to ministers with clarity, and surprising persuasiveness.

But what will the millions of poor people in our world make of the Mexico Agenda for Health Research, a document agreed by health representatives from 59 states? What will they make of the call for action that makes only three points that can be immediately translated into actions?

The first of these is a commitment to producing national research agendas. The world's poor could say: “Thank you, but you have been promising us these for 20 years. How do we know that this time it is different, and how do we know that research agendas will make a difference any time soon?”

What then about the commitment to supervise a network that will coordinate the various clinical trial registries and make them talk to each other and the world in a transparent manner? The world's poor could say: “Thank you, but much of the research that affects our lives is not clinical trials. Trial registration is a good start but how do we know that this good practice will spread to the majority of health systems research any time soon?”

The final concrete action is an administrative plan to revisit this issue at future meetings that will review the millennium development goals and a second ministerial summit in 2008. The world's poor could say: “Thank you, but we have heard of many meetings and learnt of many promises. Meetings are an opportunity to raise awareness and agree collective action but how do we know that these meetings will move beyond platitudes?”

The world's poor, of course, will probably say none of this because they struggle to have their voice heard. They also failed to be represented in the group that drafted the agenda for the ministers to agree, haggle over, and sign off—a glaring omission, affecting the perceived authenticity of the agenda. Much of the talk at this meeting was of demand led solutions, pull not push. In that context an agenda drafted largely by representatives of the rich, and not the poor, was a folly.

A second folly is to tie everything under the sun to achieving the millennium development goals. At this meeting we learnt that, for example, creation of a clinical trials register and national research agendas will help us achieve the millennium development goals. In that case, perhaps watching The Simpsons will too? A better solution would be to link the implementation of proved but underused interventions to the millennium development goals—for example, we know that six million child deaths could be avoided if proven strategies were properly implemented—and measure future initiatives, such as national research agendas and trial registries, by a different yardstick.

But this meeting is by no means a failure—far from it. There is a will—which will be tested at next year's World Health Assembly—and what is needed is a way of fulfilling it. Tim Evans, the assistant director general at WHO responsible for turning these fine words into firm actions, made it clear that all those gathered at Mexico are accountable to the world's poor. Performance measures must be in place to judge the success of this year's summit when the next one comes around in 2008, he said. Fine words—and now for action.