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Health Serv Res. 2006 April; 41(2): 303–309.
PMCID: PMC1702514

Increasing the Global Exchange of Evidence-Based Research

Mary A Pittman, Dr.P.H., President, HRET and Per-Gunnar Svensson, Ph.D., Director General, IHF

Recent headlines about the avian flu pandemic highlight our need for a common understanding of the epidemiology and treatment of diseases and their impact on international systems of care. Diseases that have crossed international borders include severe acute respiratory syndrome (SARS), human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), multidrug-resistant tuberculosis (MDR-TB), and malaria. Enhanced efforts for front line personnel to work together on limiting the spread of infectious disease have stimulated greater understanding of the systems for surveillance and care delivery across nations. Although our field has some outstanding examples of cross-cultural, cross-national research (Anthony and Lurie 2004; Peabody et al. 2004; Yoo et al. 2004), many of the leading health care journals are just beginning to encourage and facilitate greater sharing of research methods and findings across geopolitical boundaries.

The Health Research and Educational Trust (HRET), an affiliate of the American Hospital Association (AHA) and publisher of the journal Health Services Research (HSR), along with the International Hospital Federation (IHF), publisher of World Hospitals and Health Services (WH&HS), are collaborating to advance and facilitate the sharing of health services research across the globe. This collaboration aims to foster greater international access to evidence-based research in health care and, in particular, to encourage more cross-national and cross-cultural research. In joining IHF, HSR, also the official journal of AcademyHealth, will offer greater access to an international perspective in health services research—a goal consistent with the increased attention given by the Journal in recent years to international issues and authors.

New technologies and a growing awareness of common interests provide an opportunity to rise above challenges to global exchange. These challenges include language barriers, limited knowledge of the policies, financing and organization of different health systems, limited uniformity in data available for research, and lack of opportunities to collaborate with international researchers with common interests. Facilitating greater global exchange are electronic channels and Web-based publishing that improve ease of communication and a greater interest by multinational corporations in health and health care issues as it affects their workforce and products. New communication technologies benefit researchers by offering greater speed and access to journals and research findings across the globe. Researchers in developing countries no longer have to bear the added expense or delay for the mail to bring a printed journal.

In The World is Flat, Thomas Friedman (2005) explores in new ways the rationale for all sectors to pay greater attention to globalization and its impact on the way we think about business. He points out that “flattening” the world will disrupt both traditional and developing societies in ways that are bound to be surprising and swift. For example, a new health care industry has emerged in India and Australia where computed axial tomography (CAT) scans are read for small and medium sized hospitals in the United States. Compressing the digital images allows more rapid reading of scans, provides lower costs and greater access to skilled radiology services in smaller and rural organizations, and efficiently deploys limited resources. This is one of the many examples of “disruptive” technologies and solutions that combine technology and the ready sources of skilled labor to lower costs for providing the same quality of services in other nations. Similar disruptive technologies will aid our monitoring of global diseases and treatments.

In addition to diagnosing and treating deadly infectious diseases, health care leaders across the globe are dealing with issues such as quality and safety, emerging technological solutions to address specific diseases, access to and cost of care, and workforce shortages. Evidence-based solutions are emerging to address issues such as quality and safety; technological solutions, to address access and cost and workforce shortages. While many specific solutions to these issues depend upon the structure of the particular health care system and the resources available for health and health care issues, there are many common issues that need sound research to promote promising policies and practices. For example, to facilitate safety and quality collaboration across their two nations, the Institute for Healthcare Improvement (IHI), a U.S. organization focused on patient safety, has worked closely with The Health Foundation in the United Kingdom to carry out the Safer Patients Initiative (SPI).

A shortage of health care workers is another issue that crosses international boundaries and has become particularly acute in developed nations where the population is aging. Workforce shortages have spurred increased migration of workers from developing countries (Bhorat, Meyer and Mlatsheni 2002; Findlay and Lowell 2002; Stillwell et al. 2003; Dovlo 2004) to developed countries. English-speaking countries in Africa and Asia are losing a significant number of health care professionals, mainly nurses and doctors, to wealthier English-speaking countries. Nearly 30 percent of every graduating class of newly examined physicians in Ghana migrate each year. Migration has implications for both the nations that “export” and “import” these health care workers and has led to worldwide attempts to redress the consequences. For example, the 57th World Health Assembly passed a resolution in May 2004 calling for mechanisms to compensate poor countries that lose health care workers to wealthy countries.

In 2007, HSR will publish a special issue on international nurse migration, sponsored by AcademyHealth. This special issue will serve as the centerpiece of an international meeting on health care workforce migration set for March 2007 in Geneva, Switzerland and sponsored by HRET, IHF, and AcademyHealth, in collaboration with a number of other key/strategic professional organizations, both United States based and international. The meeting will spotlight the global workforce shortages, also the focus of the 2006 World Health Day on April 7, as well as identify ways to further research collaboration on health care workforce issues with a balanced perspective between developed and developing nations. The meeting objectives include:

  1. Summarizing and building the knowledge and awareness of health care workforce issues from other meetings and publications as well as raising new issues.
  2. Creating a network of researchers interested in this topic.
  3. Identifying gaps in current research for future research.
  4. Stimulating new ideas and innovative solutions for addressing long-term policy issues related to workforce.

In conjunction with this international effort to facilitate a global exchange on evidence-based and policy-relevant research, HRET and IHF are offering discount subscriptions to both HSR and WH&HS. For more information on subscriptions and the call for papers for the March 2007 international meeting on workforce migration, visit and


  • Anthony C, Lurie N. “Global Health Services Research: Challenging the Future.” Health Services Research. 2004;39((6, part 2)):1923–6. [PMC free article] [PubMed]
  • Bhorat H, Meyer J, Mlatsheni C. Skilled Labour Migration from Developing Countries: Study on South and Southern Africa. Geneva, Switzerland: International Labour Organisation; 2002.
  • Dovlo D. “Using Mid-Level Cadres as Substitutes for Internationally Mobile Health Professionals in Africa: A Desk Review.” Human Resources for Health. 2004;2((7))
  • Findlay A, Lowell L. Migration of Highly Skilled Persons from Developing Countries: Impact and Policy Responses. Geneva, Switzerland: International Labour Office; 2002. ILO Migration Paper No. 43.
  • Friedman TL. The World is Flat: A Brief History of the Twenty-First Century. New York: Farrar, Straus and Giroux; 2005.
  • Peabody J, Tozija F, Muñoz J, Nordyke R, Luck J. “Using Vignettes to Compare the Quality of Clinical Care Variation in Economically Divergent Countries.” Health Services Research. 2004;39((6, part 2)):1951–70. [PMC free article] [PubMed]
  • Stillwell B, Diallo K, Zurn P, Dal Poz MR, Adams O, Buchan J. “Developing Evidence Based Ethical Policies on the Migration of Health Workers: Conceptual and Practical Challenges.” Human Resources for Health. 2003;1((8))
  • Yoo BK, Bhattacharya J, McDonald K, Garber A. “Impacts of Informal Caregiver Availability on Long-Term Care Expenditures in OECD Countries.” Health Services Research. 2004;39((6, part 2)):1971–92. [PMC free article] [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust