Duke

University Engagement in Global Health

May 11, 2011 Duke Global Health Institute Michael Merson, Director

Global Health is a Hot Topic!

• Recent Google search returned 2,300,000 hits!

• More than 70 US universities have established formal global health programs in the past 5 years • More than 270 universities in the US and Canada report some kind of GH activity or initiative • Strong interest among students of all levels in conducting overseas fieldwork (research and service)

What is Global Health?

Global Health is an area for

study, research ,

and

practice

that places a priority on improving health and achieving

equity in health

worldwide. Global health emphasizes

transnational

approach, involves

many disciplines population

based and is a synthesis of

prevention

with individual-level

clinical care

.

Koplan et al., 2009. Lancet. 373: 1993-95.

Hans Rosling's 200 Countries, 200 Years, 4 Minutes

What is the scope of the challenge?

  • HIV, TB, malaria, zoonotic diseases  •

Chronic Diseases

CVD, diabetes, cancer, mental health

Environmental threats

• Water & air pollution, climate change 

Infectious Diseases Social Determinants

• Gender, poverty, education, culture 

Health Systems Strengthening

• Health delivery systems, human resources for health

Why take

action in Global Health?

Security

 Threats of disease globalization; emerging infectious diseases

Diplomacy

 Citizens, civil society, and corporations can perform when politics fail; serve as ambassadors of good will

Science

 Build knowledge of global value and conduct research that is critical to scientific advancement

Sustainable Development

 Health is central to economic development and good health is directly linked to both higher life expectancy and economic improvement Source: Health is global: a UK Government strategy 2008-13. UK Government, 2008.

Why take action in Global Health?

Commodity

 Global health care industry is worth over $3.5 trillion annually; health commodities are important part of national economies and imports/exports are subject to international trade regulations

Global Public Goods

 Benefits society; international community has common interest in global health (ex; smallpox eradication, WHO Framework on Tobacco Control)

Human Rights

 The right to health has been enshrined in numerous international and regional human rights treaties as well as national constitutions Source: Health is global: a UK Government strategy 2008-13. UK Government, 2008.

      

Why has GH become so popular on university campuses?

Response to 9/11 and Iraq conflict  Pandemics in the news: SARS, AIDS, Avian Flu, etc.

Information technology boom Philanthropy: Gates and other foundations Influence of media and “rock stars”: Bono et al.

Social justice: Access to medications Involvement of faculty from many disciplines A young generation with “unconsummated desire for sacrifice and service”

Why has Duke made such a strong commitment to global health?

 Consistent with the strategic plan for Duke University: “Making a Difference”   Service to society ethos Commitment to interdisciplinary scholarship across the university  Student enthusiasm and support from leadership of the university

Duke-GMS in Singapore:

Transporting Duke’s medical curriculum to Asia and potentially impacting the health of 400 million persons

Duke in Kunshan

• Undergraduate Focus Cluster • GH Certificate • M.Sc. in Global Health • Postdoctoral Program • MD 3 rd Year GH Study Program • GH Residency Program • Student Fieldwork Grants • International Programs • School of Medicine Clinical Core

DGHI in Action

Education Service DGHI Research Policy

• Signature Research Initiatives: – Cardiovascular Disease – Global Aging – Global Environmental Health – Gender, Poverty and Health – Emerging Infectious Diseases – Health Systems Strengthening • Domestic and international fieldwork opportunities for students and faculty • International sites for research and education • GH P.L.U.S. program (surplus medical equipment) • Access to information on GH • Center for Health Policy • Monitoring & Evaluation Unit • Policy Unit to support decision making related to GH

Where DGHI Works

• • • • •

Global Health Research at Duke

(As of January 20, 2011)

120

active global health research projects in

28

countries 6 Signature Research Initiatives (SRIs) Research grants:    Cumulative: 72 grants totaling $32 million Active grants in FY11: 40 grants totaling $6.2 million New grants awarded in FY11: 16 grants totaling $9.9 million 24 DGHI-funded projects (cumulative since 2008) including pilot projects, third yr medical student research awards, travel grants, transition and targeted awards, and buy-outs More than 200 faculty academic publications in 2010, including nearly 30 with a co-author from a low-income country

Center of Excellence in Cardiovascular Disease in China and Obesity Research in U.S.

Positive Outcomes for Orphans (POFO) Research Project Key findings:

-

One in seven orphaned and abandoned children (OAC) in low- and middle-income countries is engaged in child labor

-

Female children are twice as likely as male children to be engaged in child labor

KNOWLEDGE = CLEAN WATER

Study conducted in India to test the logic that empowering people with knowledge about the E. coli contamination of their drinking water would lead to improved household hygiene and water-handling.

Medical Education Partnership Initiative (MEPI)

DCRI Global Reach Trials conducted in 64 countries

DHVI: CHAVI and Haynes VDC Member Sites

DHVI: IQAC (Denny)Proficiency Testing Sites

Duke Global Surgery

Challenges for Research Administrators

• • • • • •

Knowing the context Diversity of funding agencies IRB clearance Increased scrutiny and compliance Communications PIs working globally