In November 2004, health ministers and delegates from 58 countries gathered in Mexico City to address the urgent need for robust national health systems and equitable health services. Organized with the World Health Organization (WHO), this landmark event culminated in the Mexico Statement on Health Research, which called on governments, funders, and the international research community to strengthen health research systems and advance equity in health.
Almost exactly two decades later, at the Eighth Global Symposium on Health Systems Research in Nagasaki, Japan, the Alliance for Health Policy and Systems Research and the Asian Development Bank brought together participants to reflect on the Summit’s enduring legacy and address the pressing challenges facing global health systems today.
The evening reception in Nagasaki featured a series of high-level speakers, including Dr. Jeanette Vega, the former Minister for Social Development and Family in Chile and Vice-Chair of the Board of the Alliance. Offering a historical perspective, she underscored the Summit’s significance: “While the Summit might not be widely known by everyone here in Nagasaki, it was pivotal in bringing us together today.”
She explained that, just months after the Summit, at the 58th World Health Assembly in Geneva, ministers endorsed key principles such as greater transparency in clinical trials, supporting evidence-informed policy-making, and focusing on health systems research. “That call to action ignited a global movement,” she said, “fostering collaboration among researchers, policy-makers, funders and communities. It laid the groundwork for milestones like the Bamako Summit in 2008 – whose statement called for donors to direct 5% of health aid on research and governments to spend 2% of health funding on it – and the first Health Systems Research Symposium held in Montreux, Switzerland, in 2010.”
Julio Frenk, who served as Mexico’s Minister of Health during the Summit and was a key organizer of the event, reflected on the progress made since then. “The Alliance has helped drive health systems research to new heights, increasing its volume, improving its quality, and enhancing its visibility and translation,” he said. However, he cautioned that sustaining these gains in today’s rapidly changing global landscape “punctuated by the rise of populism and geopolitical polarization, challenges that have only deepened in the aftermath of the COVID-19 pandemic” remains a challenge.
John-Arne Røttingen, Chief Executive of the Wellcome Trust and a delegate from Norway at the Summit, echoed this sentiment, emphasizing the need for actionable research. “We need to continue to work together to […] catalyse evidence-based shifts in financing, in policy and in organizational practice and care, and ensure health systems are appropriate to the context,” he said.
Ending the evening on an optimistic note, Richard Horton, Editor-in-Chief of The Lancet, highlighted the transformative potential of research. “The spirit of Mexico 20 years ago was about achieving a parity of esteem between health systems research and biomedical research,” he remarked. “Perhaps the spirit of Nagasaki today is about the intentional application of research to protect and strengthen our communities and the natural systems on which they depend – a prize that I think is certainly worth striving for together.”
As participants reflected on two decades of progress and the challenges that lie ahead, the reception served as a reminder of the critical role that collaboration and research play in building equitable health systems – an enduring legacy.