The Best of Both Worlds

By Pam Auchmutey

HIV specialist Carlos del Rio bridges patients and populations as chair of the Hubert Department of Global Health


Picture of Global Health

At the Ready

China’s Environmental Black Box

Clinic of Hope

Activist at Heart

Leaders in the Making

A Cross-fertilization of Ideas

The world shifted last April for Carlos del Rio. The Emory infectious disease expert and medical faculty member was named Hubert Professor and Chair of the Hubert Department of Global Health. Later that month, he boarded a plane for Mexico to assist colleagues there with the H1N1 influenza outbreak.

The shift was not as dramatic as it might seem. "I've been doing global health work for a long time," says del Rio, a native of Mexico and former chief of medicine at Grady Memorial Hospital. "Two of my main areas of interest are health disparities and global health. The work I was doing at Grady was related to global health here in Atlanta.

"What is different is that I've moved from an environment in the medical school that primarily focuses on the patient to an environment in the school of public health that primarily focuses on populations."

The chair that del Rio holds was made possible by a gift from the Hubert Foundation. To date, the foundation has given and pledged more than $13 million to the RSPH. The foundation was created to honor the wishes of the late O.C. Hubert, who asked that his estate be used to help people who were hungry and sick. Thanks to the guidance of William Foege, currently Presidential Distinguished Scholar and professor emeritus of global health, the Hubert Foundation chose to focus on improving health globally through the RSPH. In 2006, the school named its global health department for the Hubert family in appreciation of their support.

"It thrills me through and through to think of what we've been able to do," says Atlanta attorney Richard Hubert, who is O.C.'s son. "Dr. del Rio has the right talent to carry out my father's wishes to change lives."

Del Rio's curiosity about health and a world without borders emerged early on. He is the son of a Mexico Supreme Court chief justice and diplomat and the grandson of a physician turned diplomat. In junior high school, del Rio read Microbe Hunters, Paul de Kruif's classic about Louis Pasteur and other microbiology heroes. "That book clearly made a difference to me," he says. "That's the kind of book you read and think, ‘That's what I want to do.' "

After earning his medical degree in Mexico, del Rio completed his residency and fellowship training at Emory. His views on health disparities deepened through daily contact with underserved patients at Grady. Later, he went on to serve as executive director of the National AIDS Council of Mexico, where he developed programs to control spread of the disease. "I learned about public health and global health through HIV," he says.

It was through the National AIDS Council that del Rio came to know RSPH Dean James Curran, then chair of the CDC's Task Force on AIDS. Through the council's collaborations with WHO, del Rio saw a global catastrophe in the making. In 1996, he returned to Emory to help ramp up its efforts in HIV/AIDS prevention and treatment.

Thus he began doing what some jokingly describe as the work of three people. He taught students, residents, and fellows in the School of Medicine. He served on the adjunct faculty in the RSPH. He conducted research on HIV/AIDS, TB, hepatitis, influenza, and other infectious diseases. He treated patients with the same diseases at Grady Hospital and at the Ponce de Leon Center, Grady's outpatient clinic for patients with HIV. And more.

One day, Curran and David Stephens—the infectious disease expert who mentored del Rio during his fellowship—asked for his help on an nih grant application to create a Center for AIDS Research (CFAR) based at Emory. Today, the Emory CFAR, led by Curran, del Rio, and pathologist and vaccine development specialist Eric Hunter, includes more than 100 scientists and clinicians who have garnered $59 million for research.

This past summer, del Rio became the Emory site leader for the NIH-sponsored HIV Prevention Trials Network (HPTN). The worldwide collaborative develops and tests non-vaccine interventions designed to prevent HIV transmission. For the next three years, CFAR investigators will conduct clinical trials at the Ponce Center and at the Hope Clinic, part of the Emory Vaccine Center.

"Antiretroviral therapy has saved countless lives over the past decade, and intensive research is under way to discover an HIV vaccine," notes del Rio. "But the biggest impact on the disease comes from preventing transmission."

Remember the "P" word

Developing effective HIV prevention and intervention programs in the most affected communities is a challenge globally as well as locally. "­Every time a patient comes to Grady with severe pneumonia and you find that they're infected with HIV and already have AIDS, there has been a failure of public health to prevent them from getting infected and from being diagnosed to prevent them from getting sick," says del Rio. "If we were successful at prevention, we wouldn't see these patients coming to the hospital. That's the challenge that public health faces in this country. There ought to be incentives for people to stay healthy instead of barriers to staying healthy."

More daunting is preventing disease on a global scale, much of which rests on changing unhealthy behaviors related to diet, exercise, smoking, and sex. "We know very little about how to implement population-wide behavior change," he says, "and we need to learn more."

Growing human capital to strengthen research capacity in resource-constrained countries is also key. Since 1998, the NIH/Fogarty International Center has funded the Emory Aids Training and Research Program (AITRP) to build capacity in Armenia, the Republic of Georgia, Ethiopia, Mexico, Rwanda, Vietnam, and Zambia. Led by del Rio, AITRP brings a select group of young scientists to Emory each year for advanced training. Emory faculty also train and mentor scientists in these countries.

The training program has opened avenues to improving health. In Ethiopia, del Rio helped expand HIV testing among the police force and bring antiretroviral therapy into the community for people living with HIV. In the Republic of Georgia, the Emory AITRP and the Emory-Georgia Tuberculosis Research Training Program, another NIH/Fogarty program led by RSPH adjunct faculty member Henry Blumberg, has helped build research capacity in HIV, hepatitis, and tuberculosis research.

Their efforts have made a difference. Del Rio was among four U.S. university researchers honored by Republic of Georgia First Lady Sandra Roelofs for a decade of work to combat AIDS. That level of political engagement, del Rio notes, is critical to halting AIDS and other diseases. "To be effective, we need strong partners."

Del Rio intends to expand partnerships and resources to benefit the global health department in multiple ways: Growing the number of new faculty. Increasing research. Expanding collaborations with the School of Medicine and other partners in ­Atlanta and around the world. And meeting students' rising expectations. Over the past two years, global health spurred 80% of the increase in school enrollment.

"The growing interest in global health among students and trainees is amazing," says del Rio. "This is a generation of people who think globally, who continuously think about addressing diseases in other countries. The challenge is how to use that energy effectively for meaningful change in the community and in the world."

  Reynaldo Martorell  

Building Global Health Capital

Reynaldo Martorell has never strayed far from his roots. He grew up in Honduras, one of the poorest countries in the Americas. His family was more fortunate than most. His father worked for a multinational banana company, which provided a steady income, food to eat, running water, a place to live. But Martorell remembers how poverty and poor diet affected the lives of other families, especially their children.

His concern for their health led him to study nutritional problems in developing countries. For the past 12 years, he also chaired the Hubert Department of Global Health, a role he relinquished last spring to focus more on research.

When he first arrived at the school, the "department" he joined was called the Center for International Health. As the department evolved, so did its name—from "center" to the Department of International Health, the Department of Global Health, and now the Hubert Department of Global Health.

The only endowed department at Emory and the only named department at a U.S. school of public health, the Hubert Department of Global Health has earned a reputation as one of the best in the world. Teaching and research strengths include infectious and chronic diseases, population and reproductive health, community health, and nutrition.

As his departmental responsibilities grew, Martorell maintained an active research portfolio and partnered with several foundations and agencies. He continues to collaborate on a landmark longitudinal study in Guatemala to assess how childhood nutrition affects health and quality of life in adulthood. In an article published last year in The Lancet, Martorell and his colleagues showed a direct link between nutrition intervention during early childhood and income. Among other findings, the team showed that improving childhood nutrition during the first two years of life increased the wages of adult men by 46%. Martorell regards the paper as the most influential of the study, ongoing since 1969.

In earlier articles on the study, "We showed that childhood nutrition influenced adult body size and health, and that it was also related to cognitive development and schooling," he says. "In the Lancet paper, there was a direct link to income. We've been pursuing the argument that investing in early childhood nutrition is a long-term economic investment because it builds human capital. It produces people with greater potential to be economically productive."

More studies are pending, such as one examining the long-term effects of the 1959 to 1961 famine in China on adult health and human capital. A study currently in the planning stage will analyze the implementation of maternal nutrition intervention programs in Ethiopia, Nigeria, and India.

"I'm very happy to have been chair of the department, but it's time to put more effort into research, " says Martorell. "It's a great time because so many opportunities in global health await." — Pam Auchmutey


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