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Aquest article pretén contribuir al debat sobre l'objectivitat de la ciència, la independència i la llibertat acadèmica dels qui investiguen. A partir d'una breu panoràmica sobre els factors que modelen la recerca en salut pública, es pretén iniciar una reflexió des de la perspectiva ètica sobre la llibertat dels i les investigadores a l'hora de realitzar la seva recerca —les forces externes i internes que la modelen— i el propòsit social de la seva labor investigadora, que ha de ser el progrés del coneixement a fi d’augmentar el benestar social i la salut de les poblacions., This article aims to contribute to the debate on the objectivity of science, independence and academic freedom of researchers. Based on a brief overview of the factors that shape public health research, we intend to initiate a reflection from the ethical perspective on the freedom of researchers when conducting their research —the external and internal forces that shape it— and the social purpose of their research work, which should be the advancement of knowledge to increase social welfare and the health of populations., Este artículo pretende contribuir al debate sobre la objetividad de la ciencia, la independencia y la libertad académica de quienes investigan. A partir de una breve panorámica sobre los factores que moldean la investigación en salud pública, se pretende iniciar una reflexión desde la perspectiva ética sobre la libertad de los y las investigadoras a la hora de realizar su investigación —las fuerzas externas e internas que la moldean— y el propósito social de su labor investigadora, que debe ser el avance del conocimiento para aumentar el bienestar social y la salud de las poblaciones.

Diabetes is a major public health problem, increasingly affecting low- and middle-income countries. The project CEAD (Contextualizing Evidence for Action in Diabetes in low-resource settings) aims to evaluate the implementation of comprehensive diabetes care in two low-resource settings in Ecuador and to stimulate context-led health systems innovations to improve diabetes care and reduce inequity. The mixed-methods approach includes a 24-month retrospective study to assess the current level of implementation of comprehensive diabetes care and participants will be followed up prospectively for two years to assess changes in healthcare and clinical outcomes from the outset of the research. We will include individuals diagnosed with type-2 diabetes aged over 18 years, who are accessing diabetes care in health facilities in the study districts. Varied stakeholders (patients and family members, community members, healthcare workers and decision-makers) will interpret the underlying causes of the observed weaknesses and propose solutions to strengthen diabetes-related healthcare in focus group discussions (FG). A second set of FG will analyze perceived improvements in healthcare based on prospective cohort findings and consider the success/failure of any context-led innovations occurring throughout the research. Our study will demonstrate how evidence can be contextualized to stimulate local innovations and overcome weaknesses of diabetes-related healthcare in low resource settings.

Challenges remain for policy adoption and implementation to tackle the unprecedented and relentless increase in obesity, diabetes and other non-communicable diseases (NCDs), especially in low- and middle-income countries. The aim of this mixed-methods study is to analyse the contextual relevance and applicability to low-resource settings of a sample of evidence-based healthy public policies, using local knowledge, perceptions and pertinent epidemiological data. Firstly, we will identify and prioritise policies that have the potential to reduce the burden of diabetes in low-resource settings with a scoping review and modified Delphi method. In parallel, we will undertake two cross-sectional population surveys on diabetes risk and morbidity in two low-resource settings in Ecuador. Patients, community members, health workers and policy makers will analyse the contextual relevance and applicability of the policy actions and discuss their potential for the reduction in inequities in diabetes risk and morbidity in their population. This study tackles one of the greatest challenges in global health today: how to drive the implementation of population-wide preventative measures to fight NCDs in low resource settings. The findings will demonstrate how local knowledge, perceptions and pertinent epidemiological data can be used to analyse the contextual relevance and applicability of potential policy actions.