Between 2014 and 2020, the number of research publications in the field of global health has steadily increased since the establishment of the CCUGH. Only nine papers were published in 2014, whereas this number increased to 57 in 2020. These results were consistent with previous research showing an increasing trend in publication records for global health institutions in China.10 We noticed discrepancies in the number of publications between the two studies. This is primarily due to the differences in search strategies and inclusion criteria between the two studies. One major difference was that we only included articles whose first or corresponding authors were affiliated with eligible institutions. Our rationale is that these categories, which are conventionally associated with the highest contribution and reputation,13 more accurately reflect the research capacity. Although the research output in global health has increased, the overall size of the research output and the volume of research activity is much smaller than that of public health and many other disciplines.16–18 Previous literature has documented several challenges and barriers hindering the development of global health, such as shortage of funding opportunities, lack of societal and policy support, and insufficient global experience.19 20 More efforts are needed to create a nurturing, collaborative environment for global health research to keep up the pace of China’s ambition to become a responsible and strong leader in global health.
We found imbalanced development in global health research areas among Chinese universities. Of 19 research topics considered, NCDs were the most popular, accounting for over one-third of total publications. MCH and neurological and mental disorders and diseases were the second and third popular topics, accounting for 15.5% and 11.3% of all publications, respectively. A sizeable portion of publications also focused on infectious disease, health system and policy, and trauma and injury. However, the other two-thirds of the topics were under-researched, with fewer than 10 publications. We propose several plausible explanations for the predominant focus on NCDs research. First, China has experienced an epidemiological transition from infectious diseases to NCDs over a short period.21 Deaths from infectious diseases have decreased by over 70% since 1990 in China, whereas the burden of NCDs has increased dramatically, accounting for nearly 90% of all deaths in recent years.22 Prevention and control of NCDs and their modifiable risk factors have become one of the formidable challenges facing the healthcare system. The need to address NCDs through research is enormous. Second, NCDs and their risk factors are widely available in publicly accessible databases. Massive amount of NCDs data has been collected in a wide variety of research activities, including surveys, surveillance, and registries; many of these data sources are easily accessible electronically. For example, seven papers used data from the National Health and Nutrition Examination Survey to conduct epidemiological research on NCDs.23–29 While NCDs are one of many health challenges globally, more efforts are needed to diversify the global health research portfolios among global health institutions in China. As China has been increasingly becoming an aid donor and resource provider instead of an aid and funding recipient,30 strengthening research capacity in other global health areas is a critical step for China to broaden the scope and deepen the level of its global health engagement.
Global health research is versatile in methodology. The collection of primary data from the research field and secondary data analysis are the two most used approaches in original investigations. Of the 203 papers included, over 80% analyzed existing data, while < 20% involved primary data collection. Increasing access to and sharing health data is one driving force behind this phenomenon. On the other hand, researchers in China are hindered by the system, financial, and personal barriers to implementing field-based research with primary data collection oversea.1 19 Compared to secondary data analyses, researchers are more likely to gain a deeper understanding of the research questions, design, procedures, and participants from field-based research. Field-based research provides an excellent opportunity to design and implement geopolitically and culturally relevant projects to tackle transnational health issues in real-world settings. The limited availability of funding sources is another challenge to conducting global health research outside of China. Most of the funding for global health research conducted outside of China comes from private foundations and bilateral agencies, with China Medical Board and the UK Department for International Development being the two major contributors. 19 31 It is necessary for China’s government funding agencies, such as the National Natural Science Foundation of China, to launch new funding mechanisms dedicated to global health research.
The importance of international collaborations to global health research cannot be overestimated. In this study, we found that scholars in Chinese global health institutions have collaborated with over 200 overseas institutions (i.e., primary affiliations of co-authors); a solid collaboration research network has been established. We noticed that these collaboration institutions were not evenly distributed globally, with over one-third and nearly 30% in North America and Asia, respectively. Country-specific results showed that the US had the highest number of collaboration institutions (n = 62; 28.6%). Collaborators from these US institutions mainly served as co-authors on papers analyzing secondary data. The size of research collaboration with institutions in low- and middle-income countries (LMICs) is relatively small, especially in Africa. These results suggest that profound political and economic relations with African countries do not naturally help identify research partners or establish research collaborations. Trilateral and multilateral platforms that expand from an existing collaboration between institutions in China and high-income countries to include other LMICs particularly African countries, are one feasible solution to overcome barriers to nurturing collaborations.10
We acknowledge several limitations. First, our bibliometric analyses only considered articles written in English. Although most Chinese researchers prefer writing research articles in China, they mainly submit scholarly work to English-language journals primarily due to the pressure from the institutional academic evaluation system.32 Second, authorship order and affiliation are imperfect measures of research capacity. However, the academic evaluation system in China has a long tradition of valuing primary affiliation and first/corresponding author of research publications. We, therefore, adopted a stringent criterion for selecting articles based on first/corresponding author to reflect the research contribution and capacity more accurately. Third, this study is by no means a thorough investigation of Chinese universities' research capacity in the global health field. We only considered articles published by ten founding members of the CCUGH. We might miss important trends in research conducted outside universities and emerging global health research institutions. Nevertheless, the ten founding members are the pioneers and leaders of global health research in China. They likely represent the general trends in global health research in China. Fourth, we did not include studies conducted entirely in China, which, strictly speaking, are also part of global health research. Our goal is to understand the trend and patterns of Chinese universities’ contributions to global health research (outside of China).
In summary, Chinese universities have been playing an increasingly important role in global health research as assessed by peer-reviewed publications from 2014 to 2020 of original international research studies of the ten founding members of CCUGH. We also identified important gaps in current trends. More work is needed to diversify the global health research portfolios, promote investment in field-based research, and strengthen research collaborations with institutions in LMICs. Our study, although not exhaustive, provides a practical basis for planning and evaluating priority areas in global health research for Chinese universities. More concerted efforts by multiple stakeholders, including government, private sectors, funding agencies, academic institutions, and researchers, are needed to advance the development of global health research in China.