A System Approach to Prevention and Control of Diabetes, Cardiovascular Disease

September 21, 2010

Diabetes is one of the top ten non-communicable diseases worldwide with an increased risk of death.  Current treatment systems support curative medicine but they fail to include lifestyle interventions.

To reduce the risk of death in developing countries, interventional programs must be seen as a top priority in disease management. The qualities of systems using interventional programs include data measurement; decision-making, low cost options and scalability. 

By adding prevention strategies such as blood glucose screenings, symptoms of metabolic syndrome can be diagnosed.  Early treatment of metabolic syndrome reduces the risk of diabetes and other co-morbidities associated with non-communicable diseases.  

Lifestyle interventions such as screenings by local lifestyle coach’s support healthy living, are cost effective and sustainable.  Great work in being done but more evidence is needed from developing countries about the benefits and feasibility of these programs. Universities can support the development of studies that provide additional information needed to support future investments in system infrastructure and program growth.

Prepared by Anita Beninger


The Effects of Climate Change and Global Health

September 21, 2010

To get to one of the last sessions on Monday, I had to walk through a maze of hallways thinking I would end up in a room that no one could find. This was not the case. People eager to learn more about the effects of climate change on global health occupied every chair as well as every inch of carpet space. Michal Brauer was speaking on air pollution, Jenna Davis on sanitation and water, Thomas Hinckley and Joshue Tewksbury on food security, and Kristie Ebi on the general effects of climate change.

Kristie Ebi immediately grabbed the crowd’s attention with very sobering statistics — the rate of climate change that we are experiencing today is faster than over the past 10,000 years combined. There are already places in the world that we can categorize as biologically extinct. These very rapid changes are likely to have significant health impacts as well.

The biggest health challenges result from the increase in frequency and intensity of weather events. We have seen this recently with the flooding in Pakistan and the aftermath that resulted. The most notable health effects from climate change can be seen in increases in malnutrition, deaths from extreme weather conditions, cardio-respiratory deaths from air quality, and higher rates of diarrhea related diseases. Climate change can also have an effect on the MDG goals. For example, extreme weather can lead to unpredictable agricultural seasons, which increases the likelihood of malnutrition. Furthermore, when aid programs shift funding around to assist in climate change events, this may result in less assistance for already established programs on the ground.

To conclude her talk, Ebi reminded the audience that we must understand the individual dynamics of a country to address global health issues arising from climate change disasters. She showed us a picture of flooding in Mozambique in 2000. Thousands of people were rescued from trees and the entire country seemed to be covered in water. As aid groups came in, they focused on immediate rescue efforts. However, by not understanding the countries individual nature, they did not know of land mines scattered all over the country. This resulted in hundreds of deaths, mostly children, who came across these land mines after the flooding. Climate change and global health are very complicated issues that we must approach cautiously and strategically in order to achieve the greatest impact for all.

Prepared by Jori Saeger


Educational Innovation and Experiences

September 21, 2010

Anvarali Velji hosted this engaging series of presentations on ways various groups have approached global health training.

Richard Dunning started things off by presenting the results of a web-based survey used to poll trainees in medicine, public health, and nursing programs at four US universities (Johns Hopkins, UCSF, University of Pennsylvania, and the UW). The survey disclosed a high level of interest in global health, yet also identified barriers for participation in international experiences. Among the 2,090 respondents, 76% had already had an international experience, most of which had been in developing countries, and over half expressed an interest in a global health career. The importance of international experiences was highlighted by the fact that 61% attributed their interest in global health to a prior international experience. By extrapolating the data, it was estimated that at least 10% of all health sciences trainees are interested in global health, although time pressure, lack of funding, and uncertainties around how to arrange international opportunities were key barriers to participating in global health experiences.

Patricia Conrad presented an overview of the EnviroVet Summer Institute. This innovative 7-week program that represents a collaboration between UC Davis, the University of Illinois, Sokoine University of Agriculture in Tanzania, Florida Atlantic University, White Oak Conservation Center, and Tanzania’s National Parks. The institute is part of the One Health movement, which promotes an understanding of the linkages between human, animal, and environmental health. The field-based training uses a trans-disciplinary approach to inspire veterinary students to become leaders in global health. As an example, she described a situation where a local river has been drying up in a rural part of Tanzania, leading to increasing contact of humans, livestock, and wildlife as they compete for the remaining water sources. This situation has created increased potential for the spread of zoonotic diseases, including Mycobacterium bovis, and participating students have worked with local researchers to seek solutions.

Donna Denno and Suzinne Pak-Gorstein presented work that has been done to create core competencies in global health education. Using the ACGME framework, a working group of medical educators developed the first set of guidelines proposing key knowledge, skills, and behaviors that should be central to the global health training of pediatric residents. These core competencies are now being used at several universities to create and assess learning plans for global health training. They were included in the 2008 GHEC Guidebook for Developing Residency Programs in Global Health (available at http://globalhealtheducation.org/resources/Pages/default.aspx), and are currently being expanded to apply to additional residencies.

Maneesh Batra described the University of Washington’s efforts to create a sustainable and ethical international experience for pediatric residents interested in global child health. The program includes a month of didactic training, followed by an eight-week field experience during the third year of residency. The program pairs UW residents with residents from the University of Nairobi, and is focused on addressing health inequities through community health development, rather than by providing direct clinical care. Feedback from participants has been very positive, and Dr. Batra feels that this program provides a model for how a short-term global health experience can be structured to benefit both US trainees and developing country partners.

Gabrielle O’Malley discussed a collaborative effort between the University of Washington and the University of Namibia to strengthen training for MPH students. She highlighted the importance of relationship-building in ensuring programmatic success, particularly fostering mutual trust and respect and promoting good communication. She also discussed the use of distance-learning techniques as one way to address the educational challenges faced by countries with sparse and widespread populations.

The final speaker, Julie Maslowsky, described the process through which the University of Michigan developed a set of pearls to guide students engaging in international research and service-learning activities. A multidisciplinary task force, including 40 students, worked for eight months to create a resource that would be useful before, during, and after an international experience. The resulting guidelines, the Student Handbook on Global Engagement, can be accessed online at this link: www.globalhealth.umich.edu/pdf/CGH%20standards%20handbook.pdf.

During the question and answer session, the importance of mentor training, program sustainability, and defining and measuring program outcomes were discussed.

Prepared by David Roesel


Regional University Global Health Consortia

September 20, 2010

Three speakers participated in the session ‘Regional University Global Health Consortia’ on Monday to discuss ways that European, Central American and Indian regions have formed global health consortia. In forming regional organizations, these alliances hope to share resources, increase advocacy efforts, and contribute more efficiently to the global health initiative.

Andrew Haines spoke about on ‘Forging a European Collaborative Agenda on Global Health.’ Haines is a member of the London School of Hygiene and Tropical Medicine in the UK and is also working to promote the European Academic Alliance for Global Health. The Alliance created a forum for International Health, Tropical Medicine, and schools of Public Health to exchange views and ideas. The Alliance wants to interact with EU Global Health policy to strengthen the European voice in global health governance. Furthermore, the Alliance is committed to international outreach by creating sustainable partnerships in African and Asian countries.

Srinath Reddy spoke on the ‘Public Health Foundation of India Providing a Platform for Partnerships to Promote Public Health.’ Reddy is a member of the Public Health Foundation of India, which was developed in 2006. The Foundation brings the private and public sector together, promotes education in new institutions, and assists in the growth of existing institutions. Reddy believes that to successfully approach global health problems, we need to create cost effective solutions that are also scalable and politically viable. These partnerships must be forged internationally and the Foundation in India has already forged these partnerships, most notably with the Public Health Foundation in Nepal.

Lastly, Esteban Chaves Olarte spoke on ‘The Struggle of Neglected Research Groups.’ Olarte is involved with NeTropica, a Global Health alliance of Central America. He opened his session with evidence of the correlation between the amount of scientific research spent and a decrease in infant mortality. Ravaged by civil wars and a lack of resources, Central America has fallen behind in respect to scientific research. In order to increase life expectancy and lower infant mortality fates, NeTropica has invested in scientific research by promoting consortia that study similar themes. These consortia create a network of resources so that everyone in the Global Health field can learn from each other. NeTropica works by supplying grants to individuals working within these consortia. Once these groups can create regional networks, the idea is that more successfully organized partnerships can be forged internationally.

Prepared by Jori Saeger


Student Perspective: Mike Arndt, UW grad student, talks about the growth of global health on college campuses

September 20, 2010

Fogarty: Calling All Geeks for Global Health

September 20, 2010

Roger Glass, Fogarty International Center

The last several decades have witnessed the greatest prolongation of life in the history of humanity. That’s the good news.  The bad news: a growing global burden of chronic disease.  Fortunately, groups like the National Institutes of Health’s Fogarty International Center are helping to ease the pain. 

The Fogarty International Clinical Research Scholars Program gives U.S. and developing country advanced degree students in the health sciences a year of mentored clinical research training at a site in the developing world, with the intention of grooming new global health leaders from multiple disciplines. The door is open not only to “traditional” medical professionals, but also to others, from bioengineers to dentists, all “geeks for global health” are welcome to apply, said Roger Glass, Director of the Fogarty.  He cited the case of bioengineering students from a Texas university, who used a beer cooler and an old car battery to create a low-cost refrigeration for vaccines. 

Three Fogarty scholars spoke at the CUGH session.  They were: a cardiologist who worked in Kenya, an ob-gyn who worked in Zambia; and an HIV researcher who worked in Peru.

Gerald Bloomfield, MD, a cardiology fellow at Duke worked at the Moi Teaching and Referral Hospital in Eloret, Kenya, for a year.  Among his projects were: home-based screening for hypertension, which will enroll 600,000 patients over next few years; the creation of a two-year clinical research training experience in global cardiovascular disease research; and the study of atherosclerosis in sub-Saharan Africa and its relationship to HIV and cardiovascular disease.

Krista Pfaendler, MD, an ob-gyn at the University of Cincinnati, relayed her experience in Zambia. She helped to create a screening program for human papilloma virus (HPV) for women in that country. Starting from scratch in 2006, the program has now screened 50,000 women for the virus that causes cervical cancer—the leading cause of cancer-related deaths in women in Zambia. It has established 17 clinics in the country and is training and collaborating with doctors and nurses in Cameroon, Botswana, Uganda, South Africa, Nigeria, and China.

The third former Fogarty fellow, Magaly Blas, MD, is now a research professor in Cayetano Heredia Peruvian University.  Her fellowship involved training physicians and nurses in how to search for medical information on the Internet and developing online video-based interventions to increase HIV testing among men who have sex with men.

While none of the three seemed to fit the strict definition of a “Geek for Global Health,” they certainly bring new dimensions of expertise to a Global Health practice for the 21rst Century.

Prepared by Bee Wuethrich


Health of Women, Mothers and Children

September 20, 2010

State-of-the-art medicines and technologies won’t help people in poor, medically- underserved countries unless the people can gain access to those benefits, panelists said. 

Dr. Keith Martin, who is also a member of Canada’s Parliament, talked about feeling helpless in Africa while a patient “died of bloody worms, for the want of a few pennies worth of meds.”

He noted that 344,000 pregnant women die each year from preventable causes because of lack of access to the right help. Twenty times that number of pregnant women suffer life-altering injuries annually. About 8.8 million children die each year. Meanwhile, 90 percent of the world’s health research focuses on diseases affecting Western nations, Martin said.

Martin contended that a focus on primary caregivers can funnel and unify research, donations, patients and support to “one unifying place.” 

But James Kiarie, senior lecture for obstetrics and gynecology at the University of Nairobi, warned that people tackling these problems need to know that teamwork is a key, troubles must be addressed on several levels, and they should be aware that no single “silver bullet” solutions exist for any problems. Also, solutions won’t necessarily be cheap, he added.

Meanwhile, Mike English, a senior researcher for the KEMRI-Wellcome Trust Research Program in Nairobi, Kenya, said that medical research needs to take into account the complexity and context of how it will be applied in poor nations. Also, much thought must be given on how to measure starting points and progress in dealing with specific health problems in poverty-stricken countries, he said.

The nations themselves need to be involved in planning how aid should be provided to primary caregivers and their patients, said Kiarie and Jaime Sepulveda, director of special initiatives at the Bill & Melinda Gates Foundation.

In Kenya, experiences show that the nation’s universities would be good places to expand health care, Kiarie said. But primary caregivers and other medical people must buy into whatever plans are mapped out. Access, cultural appropriateness and participation by men are crucial to HIV screening and treatment, plus pregnancy care, he said.

In the Democratic Republic of Congo, war, rebellion banditry rule — with rape being widespread. No accurate statistics have been kept, but it is estimated that roughly 6 million people have died because of the conflicts in the eastern part of the country — the majority from health problems due to the violence, said Nancy Glass, an associate professor at Johns Hopkins University’s School of Nursing and an associate director of the college’s Center for Global Health. 

Rape survivors — women and a growing number of men — have limited access to health care.

Besides improving medical access, other measures include social and medical workers trying to mediate between victims and families dealing with the stigma of rape. Another health measure — economically improving lifestyles — is hampered by the fact that even a $50 loan is considered too big and scary by many eastern Congolese families, Glass said.

The answer has been Pigs for Peace. Livestock is a major money source for eastern DRC families, and is a major plank of the economy. But the culture forbids women from selling many types of animals. The exception is pigs.

Working through village associations, Pigs for Peace will provide a pig to a person with that individual to repay with two piglets from the first litter. A $14,000 investment has sent pigs to 186 families in 14 villages since December 2008. Another 700 families are on a waiting list. 

Glass noted that the people are taught how to care for their pigs, and that a danger exists of a virus potentially wiping out an entire village’s pig population.

A Washington State University veterinarian student asked how she could help with the project’s veterinary needs.

Glass replied: “Anytime you’re ready to come to the Congo.”

Prepared by John Stang.


Mobilizing Resources for Global Health and Connecting with the Academic Center

September 20, 2010

Gerald Keusch opened up this plenary session by stating that universities can play a key role in improving global health through their strength in promoting research and innovation, disseminating knowledge, and advocating for increased funding. He noted that global health is unique in that it touches on nearly all aspects of university activities, beyond just the health sciences.

Chris Murray posed the question of whether the “golden age” of global health funding is coming to an end as a result of the current economic crisis. He presented an overview of the dramatic increase in global health funding since 1990 to the present, during which development assistance for health rose from $9 billion to $27 billion. (Ravishankar (2009). The Lancet. 373:2113-24). He concludes that global health is still in an expansion phase, but that the realities of the global recession will lead to increasing pressure on governments to justify investments in global health during the next several years. In response to this, there will be increasing demand to show that money put into global health translates into improved outcomes for the world’s poor.

Nils Daulaire opened his comments by stating, “I am from the government, and I am here to help.” He pointed out that although the total percentage of the Health and Human Services budget allocated for global health is only 0.25%, that this still translates into a total dollar amount of $2.5 billion per year. He discussed the role of the Office of Global Affairs a commitment to building long-term partnerships with developing countries, helping to coordinate the activities and agendas of a wide range of federal and international agencies, and working to increase attention to the importance of chronic diseases. He also highlighted the Obama administration’s Global Health Initiative, which has allocated $60 billion dollars over six years to aims to expand upon the previous administration’s commitments to combat AIDS, TB, and malaria, and will promote increasing attention to maternal-child health and the health needs of women.

Roger Glass explained the ways in which the Fogarty International Center provides “early childhood education” in global health. He pointed out the many of the current leaders in global health had their passions for global health ignited by research experiences in low-income countries early in their training. The Fogarty Center seeks to help train the next generation of leaders by supporting similar experiences for health sciences professionals during the formative parts of their careers. He described the Fogarty Center as a “watering can” that can promote long-term, collaborative relationships between investigators and academic institutions in the US and their counterparts in developing countries.

Val Snewin discussed the ways in which the Wellcome Trust seeks to “achieve extraordinary improvements in human and animal health” by supporting global health investigators in the UK and low- and middle-income countries. With a total annual budget of 720 million pounds, the UK-based charity helps to support individual investigators, with the philosophy that they in turn will build strong teams and strengthen local research capacity.  She pointed out that although clinical trials are important, the context of global health is broadening to include things like the social sciences and water and sanitation efforts. She highlighted the African Institutions Initiative, which has donated 28 million pounds to promote equitable and sustainable South-South and North-South partnerships. Dr. Snewin stated that ultimately, health research capacity strengthening is about nurturing people, and helping create environments in which research and innovation can take place.

Victoria Marquez-Mees rounded out the session by sharing her experiences working with the Carlos Slim Health Institute in Mexico. She discussed the ways in which this NGO is working to improve health in Latin America, including maternal-child health and chronic diseases such as diabetes. She posed the question of “How do you address a series of weakest links?” referring to the need to improve capacity in multiple areas, including administrative capacity, health care delivery, and medical informatics. The Carlos Slim Health Institute has taken a number of approaches to these challenges, ranging from harnessing the power of genomic sciences and communication technology, to building educational and training capacity, to seeking locally-relevant ways to strength people’s ability to take charge of their own health. “We need to move beyond the physician-based model,” she said, to applause. “Ultimately, the target has to be the health of the people.”

Overall, it was an engaging series of talks by people representing a broad range of approaches to global-health capacity-building.

Prepared by David Roesel, Univ. of Washington


Derek Yach: Now’s the time to start thinking about chronic diseases

September 20, 2010
Derek Yach

Derek Yach, PepsiCo

Most informed people still equate “global health” almost solely with communicable diseases such as AIDS, malaria and tuberculosis as well as maternal and child health. The reality however is that non-communicable diseases (NCD), especially comprising heart disease, diabetes, cancers and chronic lung diseases are today by far the major causes of death and disability in all WHO regions with the exception of Africa. Even more concerning is that the underlying causes of these diseases including tobacco use, unhealthy diets and obesity, alcohol, and physical inactivity are increasing as risks in all developing countries.  

Today I will be moderating a session at CUGH on Prevention and Control of Chronic Diseases and am excited to see so many of the top academia and global health leaders on these issues coming together to discuss such crucial topics as the tobacco epidemic, diabetes and mental health.

These conversations will be critical as we are just one year away from the UN Summit in New York during which heads of state will address non-communicable diseases and hopefully agree on actions to prevent further increases. Having spent many years at the World Health Organization where I addressed chronic disease prevention and control, and now being at a major food company, it has been clear that the potential for innovative private public partnerships will remains an untapped and crucially needed route to successful public health impact. Over the last decade we have seen how such partnerships have spearheaded new product development for infectious diseases, new funding mechanisms that have created markets for needed vaccines for developing countries and effective ways of leveraging corporate capabilities to address micronutrient needs. We now need to apply lessons learned from partnerships such as the Global Alliance for Vaccinations and Immunizations (GAVI), Global Alliance for Improved Nutrition (GAIN), Medicines for Malaria Venture (MMV) to chronic diseases and their common risks.

So now is the time to get organized for next year’s Summit.  CUGH members and conference participants, academia and researchers, food and other industry leaders: now is the time to start thinking about what your role is so we can put the strongest data, ideas and commitments on the table and have a strong clear voice at the UN Summit next year.  New UNICEF and WHO data have shown how much progress has been made over the last decade in addressing key MDG targets.  Let’s use the extraordinary breadth and depth of committed global health leaders present in Seattle to chart a new path for NCD control that rests upon academic excellence and capability 

Dr. Derek Yach, Senior Vice President, Global Health Policy, PepsiCo, Inc. will be moderating Prevention and Control of Chronic Disease at the conference at 1:45 pm in room Kane 220. His recent summary of industry actions to address chronic diseases is available at: http://www.globalizationandhealth.com/content/pdf/1744-8603-6-10.pdf

 


Camille Webb from Lima, Peru

September 20, 2010

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