|The eyes of others
Written by Rhonda Mullen
Suddenly global health is in, its visibility raised by high-profile gifts from people like Bill Gates and Warren Buffet and numerous network news specials. Big money is being transferred from some of the world’s wealthiest nations to some of its poorest. More students are going into the field to pursue lifelong careers. New institutes are being organized to fill voids in the global health network. And government organizations that focus on global health have taken on new cachet.
For the people and groups working in the global health trenches, all that’s good news. After all, the problems they have been trying to solve have been centuries in the making. In sub-Saharan Africa, HIV/AIDS, malaria, and tuberculosis are ravaging the adult and child populations while measles and diarrheal and respiratory diseases are disproportionately killing children. Injuries from motor vehicle accidents, drownings, and burns are taking their toll as well. Other parts of the world further along in economic development—such as Mexico, Brazil, India, and China—face not only the classic diseases of the developing world but also chronic diseases ironically brought on by adoption of a more affluent lifestyle. As Jeffrey Koplan, Emory’s vice president for global health explains it, “They have a double burden. Sometimes in the same family, you’ll have some people suffering from diabetes, heart disease, and cancer and others with some of the infectious diseases that are otherwise conquered in the West.”
With renewed attention and an infusion of funds for global health come opportunities that simply weren’t there before. Emory University launched its own university-wide effort to make a contribution to global health in January 2007 and has included global health as a priority in its strategic plan. Since that launch, global health activities have received additional significant funding from the Bill and Melinda Gates Foundation to create CDC-like institutions in low-resource countries, from national governments such as India to support vaccine collaboration in New Delhi, and from in-kind contributions from partners around the world. According to Koplan, director of Emory’s Global Health Institute (GHI) and a former director of CDC, in the first eight months of the GHI’s existence, university commitments of $3 million in funding have been matched by $3.9 million by partners. His goal is to leverage support for programs by bringing in such external support, and he sees the GHI mandate as using these resources “well and efficiently.”
Doing it “well” involves developing and supporting projects that are sustainable, ones “that can carry on well beyond our ability to support them,” Koplan says. One way the GHI is building in sustainability is through collaboration with strong partners in the developing world to leverage their breadth and depth of knowledge, human resources, and study opportunities. For example, the GHI has made a moderate investment in establishing a research laboratory in New Delhi, one that was matched with considerable funding from the Indian government to upgrade and equip laboratories for GHI researchers.
Doing it “efficiently” for Koplan means “making sure our capacity is running at full throttle, that we’re doing all we can do and that we take advantage of the resources the university has invested in us to deliver that last ounce of performance we can get.”
Part of that efficiency involves tracking progress, setting deadlines, and measuring results to make sure the institute is meeting goals. Before the institute was formally established, 18 months of planning and input from a broad crosscut of the university community already had taken place.
“When we started, we already were past jogging speed, cognizant of the pressing need to get the attention of those we wanted to work with,” Koplan says. In short order, the GHI filled out its staff, developed internal programs, assembled an advisory board of world leaders, and started making grants.
One of its first big projects to quickly become known is the International Association of National Public Health Institutes (IANPHI). Funded by the Gates Foundation and shared with the National Public Health Institute of Finland, IANPHI creates, develops, and links public health institutes at the national level with a goal of strengthening infrastructure. In its first year, IANPHI has funded 18 projects, all based on the model of sustainability and partnering.
Among its long-term projects, IANPHI is providing technical assistance to create national institutes in priority countries where currently none exist. These countries include Guinea Bissau, Malawi, and Ethiopia.
The medium-range projects, three years of duration or less, involve improving labs in Nigeria with the help of the National Public Health Institute of Japan, strengthening labs and surveillance in Mozambique with partners in Brazil, and assisting the Colombian National Institute of Public Health in broadening its role to include chronic diseases as well as measuring the extent of their burden and designing effective interventions. Short-term projects that have been funded include the design of a sustainable training program on disaster management and risk reduction in Iran, a survey of post-flood gastroenteritis in and around Dhaka, and development and execution of a strategic plan for the Uganda Viral Research Institute, including establishment of a computer-based resource center and library, among others.
To date, the GHI has distributed eight project grants at Emory University. From a drug discovery training program in South Africa to a diabetes intervention in India, read about these on the following pages.
Complementing all these projects is an effort to increase public health knowledge by publishing articles, forming new partnerships, and organizing leadership meetings focused on global health. Recent publications have appeared in the British Medical Journal, Emerging Infectious Diseases, Nature, Academic Medicine, and the South African Medical Journal. A website at www.globalhealth.emory.edu draws the information together.
Finally, to begin to make a dent in global health challenges, Koplan believes the GHI has to pay attention to underlying social determinants. Those range from poverty and environmental contributors to community support and self-determining capacity.
“You can decide, I’m going to eat better. I’m going to do that to be healthier,” says Koplan. “But if you can’t buy food that is healthy to eat, you’re living in a polluted environment, and the water is toxic, then there is a limit to what you can do behaviorally.” Additionally, people in parts of the world embroiled in civil war, such as Iraq or the Congo, think differently about their own and their families’ health than do people in areas unaffected by war.
“We are not so naïve as to think we’re going to have an immediate impact on any of those things,” Koplan says. “From our perspective, we want to see if we can make a contribution in the long haul. Our contribution is not this year, this month, this week. Our contribution is in decades. And our biggest contribution may be educating young people who go and spend their careers working on these issues. Or it might be a drug discovery or a vaccine. There are many ways to contribute and even more reasons to do so.”