For five days in November 2009, over 900 people from 85 countries met in Havana, Cuba, to discuss and debate “innovation for health, with a special focus on health equity and an overall objective of identifying the policies and strategies necessary to improve the global and national environments for innovation.”[1] Forum 2009 was the 13th major international event organized by the Global Forum for Health Research, an independent, international nongovernmental organization, established in Geneva as a Swiss foundation in 1998.

Since its inception, the Global Forum has focused on questions of equity, advocating for more research to address the health problems of those most in need?�essentially the poor and marginalized?�and providing evidence to support greater investments in neglected areas. It coined the term “10/90 gap” referring to the unacceptable imbalance between the percentage of resources devoted to health problems in low- and middle-income countries and the magnitude of need, originally quantified in a 1990 report by the Commission on Health Research for Development.[2,3]

Working alongside the World Health Organization (WHO), other UN bodies and numerous nongovernmental organizations, “the Global Forum has established a distinctive presence as an authoritative and independent source of reliable data, practical tools and robust arguments regarding research and innovation for the health needs of the poor.”[4]

It is the only organization that regularly tracks global resources assigned to research for health. It is also known for its development and application of tools for priority-setting and equity analysis in health research,[5-7] and for work relating to research aspects of health and the Millennium Development Goals?�poverty, equity, product-development partnerships, sexual and reproductive health, mental health, etc.

The strategies pursued by the Global Forum have made an impact in several key areas: research, analysis and synthesis work has led to a number of important publications that have influenced thinking, providing new evidence for decision-making;[8] incubation of a number of networks and initiatives has focused on critical gaps in research;[9] and annual Forum meetings have provided a unique platform for gauging and promoting progress in reducing inequities in global health research funding (See Box).

Paradigm Shift: From Health Research to Research for Health
Over the last 12 years, however, the landscape in which the Global Forum works has changed significantly with the appearance of new players (especially funders) working in new ways (such as public-private partnerships) to face new challenges (such as climate change and drug resistance).[10]

In September 2000, the UN Millennium Declaration focused world attention on the need for a global commitment to international development. All 192 United Nations member states subsequently agreed to achieve eight Millennium Development Goals (MDGs) by 2015: 1. Eradicate extreme poverty and hunger; 2. Achieve universal primary education; 3. Promote gender equality and empower women; 4. Reduce child mortality; 5. Improve maternal health; 6. Combat HIV/AIDS, malaria and other diseases; 7. Ensure environmental sustainability; and 8. Develop a global partnership for development. Organizations working in the health arena targeted particularly goals 4, 5 and 6. By 2004, however, in preparation for the Ministerial Summit on Health Research in Mexico, the Global Forum was already questioning the term “health-related MDGs”, arguing that all were important for health.

In 2005, fifteen years after the Commission on Health Research for Development report, total spending on health research globally had risen more than five-fold to over US $160 billion.[4] This overall rise included increases in R&D spending for a range of ‘neglected’ infectious diseases, including those identified in the MDGs. Sources of funding have also multiplied, along with the channels through which it is applied, and investments in research for health by some low- and middle-income countries have grown with development of systematic approaches to the creation and use of knowledge and innovation.

While the number of resources, actors and efforts to address the health problems of the poor have grown significantly in recent years, the range of health challenges faced by low- and middle-income countries has expanded considerably, demanding a more extensive research portfolio. Failure to reach the MDGs, rising rates of chronic noncommunicable diseases in low- and middle-income countries, urbanization, demographic shifts, climate change, food security, the threat of pandemics, and the global financial crisis are among these challenges.[11]

Attempts to find solutions have underlined the need for effective and equitable health systems, and major efforts toward developing and strengthening such systems are now underway. The First Global Symposium on Health Systems Research, planned for November 2010, is being organized by the WHO, the Global Forum and other partners to further these efforts.[12]

Additionally, new research on social determinants of health has emphasized the central importance of non-biomedical factors.[13] Although the Global Forum had always considered health research a broad spectrum encompassing biomedical research, health policy and systems research, social sciences and behavioral research, and operational research, the need for a new paradigm became increasingly clear. Research for health was then conceived as an expanded interdisciplinary approach involving biological, economic, environmental, political and social determinants of health.

The Global Forum defines research for health as research undertaken in any discipline or combination of disciplines that seeks to

• understand the impact on health of policies, programs, processes, actions or events originating in any sector?�including, but not limited to, the health sector itself and encompassing biological, economic, environmental, political, social and other determinants of health;
• assist in developing interventions that will help prevent or mitigate any adverse impact; and
• contribute to the achievement of health equity and better health for all.[14]

Forum 2009: Innovating for the Health of All
When the Foundation Council, the governing body of the Global Forum, met to discuss the focus of Forum 2009, the theme of innovation was chosen as an explicit attempt to find a common language to bridge gaps between researchers and implementers, and between efforts to improve health technologies and health systems.[15] The objective was to encourage governments of low- and middle-income countries in particular to invest in mechanisms to foster innovation, and the program was designed to give equal weight to technological innovation and social innovation. Special attention was paid to social entrepreneurship, the growing capacity of some developing countries for innovation to address their own health needs, linkages between the public and private sectors, global health diplomacy, and coordination and partnerships among leading organizations in the field of research for health, particularly South-South collaboration.[16]

Asselin © Global Forum of Health Research

The invitation from the Ministry of Public Health to bring the Forum to Cuba also offered the possibility to demonstrate what one developing country has been able to achieve. Cuba affords an example of economically and politically motivated innovation that has led to the achievement of a population health status comparable with that in many Organization for Economic Co-operation and Development (OECD) countries. Plenary sessions on Public Health Innovation in Cuba and New Forms of Collaboration for the Health of All highlighted key strategies of the Cuban health system and the role of innovation in sustaining them. Participants also had the opportunity to visit research centers of excellence in Havana and were able to see first-hand how technological and social innovation in Cuba work together in a complementary fashion, providing access to drugs and vaccines locally developed and manufactured; improving delivery of services at primary, secondary and tertiary levels of the healthcare system; and acting on social determinants of health outside the health sector.

Participants in Forum 2009 included senior ministers and policymakers from Brazil, China, Cuba, Denmark, Haiti, Japan, Kenya, Mexico, Nicaragua and Suriname, as well as senior representatives of the World Bank, the World Health Organization and the Pan American Health Organization; the Global Fund to Fight AIDS, TB and Malaria; the Global Alliance for Vaccines and Immunisation; bilateral development agencies and other donor organizations. The Forum provided different settings and opportunities for interaction among these leaders and researchers, heads of research institutions, social entrepreneurs, members of civil society (NGOs, People’s Health Movement and others), representatives of the private sector (pharmaceutical companies, analysts, investors), and local and international journalists.

Also presenting at the Forum were winners of the 4th annual Young Voices essay competition for authors and researchers under age 30, sponsored by the Global Forum and The Lancet. This initiative aims to identify the next generation of researchers for health, encourage them to be idealistic and provocative, and to create a network of young people working toward common goals. Over 400 entries were submitted from authors of 75 nationalities, covering a wide range of issues related to the theme of innovation for global health.[17]

The Global Forum’s emphasis on innovation as an enabler goes beyond Forum 2009 and forms a key element in its strategy?�alongside emphasis on health systems research?�for the coming years. It focuses on innovation as encompassing “the entire process from the generation of new ideas to their transformation into useful things, to their implementation.”[1] The outcome may be new products, but also new services, methods, management practices, and policies. Information and communication technologies, for example, are important not as technologies per se, but as enablers of social innovation.[18]

At the Forum meeting in Havana, the global health research community explored potential new ways of working, shifts of emphasis, developing new links between theory and action, pushing further the boundaries of better health, innovating for the health of all. In many ways, the annual Forum meetings epitomize all the Global Forum’s activities by gathering a cross-section of all those whose work influences progress towards global health equity and by providing an opportunity to exchange knowledge and opinions, share experiences and lessons learned. These events express the values that underpin the Global Forum’s work: health as a right, equity as a principle, and research as an indispensable tool.

Acknowledgments
The author is grateful to Stephen Matlin for comments on an early draft of this article, to Chad Gardner for lessons on innovation, and especially to Beverly Peterson Stearns for her insights from Forum 2009.