NIH-supported medical research and training advance health worldwide
Changing Patterns of Disease
Today, thanks to public health measures and biomedical advances worldwide, life expectancy and prosperity are generally increasing across the developing world. The major exception is sub-Saharan Africa, which continues to be heavily affected by AIDS, malaria, tuberculosis, childhood diarrhea, and respiratory diseases.
But along with getting older, people are becoming vulnerable to noncommunicable chronic diseases, including cancer, diabetes, heart disease, and the risk factors that cause them. Social and economic changes, such as migration to cities, adoption of more sedentary lifestyles, rich diets, smoking, and addictions add further risk factors to a healthy life.
For those reasons, many of the research efforts related to global health must now deal with these non-communicable and chronic diseases, in addition to the traditional infectious diseases in the developing world.
Fogarty at 40
For the past four decades, the Fogarty International Center at the National Institutes of Health has been a leader in promoting and funding international medical research and training. The benefits for everyone—including Americans—have been many. Now, health problems and priorities are changing, and Fogarty is helping to train medical researchers around the globe to meet new challenges. The idea that the United States could benefit from international research was central to the creation of the Fogarty International Center in 1968. John E. Fogarty, the Rhode Island Congressman for whom the Center is named, predicted that international studies in the health sciences would pay double dividends: the research would help build healthier, more politically and economically stable societies overseas, and U.S. citizens would reap the benefits of international discoveries.
Today, Fogarty funds approximately 400 projects awarded to both foreign and U.S. institutions. About 20 percent of Fogarty awards are made directly to highly capable research institutions in developing countries. In many of the Fogarty programs, scientists in the United States collaborate with colleagues in foreign institutions, mostly in the developing world. About one-third of Fogarty grants focus on scientific discovery; the remaining two-thirds provide support to train research scientists in global health.
Dr. Roger Glass, Director of the Fogarty International Center discusses worldwide health and NIH research and training.
Although Roger I. Glass, M.D., Ph.D., was named Director of the Fogarty International Center and NIH Associate Director for International Research just two years ago, he has been contributing to the study of global health for decades. Dr. Glass's research interests are in the prevention of gastroenteritis from rotaviruses and noroviruses through the application of novel scientific research. He has maintained field studies in India, Bangladesh, Brazil, Mexico, Israel, Russia, Vietnam, China, and elsewhere. He is fluent and often lectures in any of five different languages. MedlinePlus Managing Editor Selby Bateman shares Dr. Glass's thoughts on global health.
Why should Americans care about global health research? Do Americans also benefit?
Dr. Glass: First, from a moral standpoint, as citizens of the wealthiest country in the world, we have a responsibility to share our scientific knowledge and medical advances to benefit those less fortunate than ourselves. Second, in this increasingly "flat" world, health issues impact us all. The recent outbreak of SARS and the ongoing bird flu epidemic in Asian poultry both show that diseases don't respect borders. Globalization has increased the movement of people and products around the world, which means diseases can spread more quickly.
"Americans benefit enormously from research that has taken place elsewhere..."
Finally, Americans benefit enormously from research that has taken place elsewhere. Many parents rely on products such as Pedialyte when their children have diarrhea. This kind of oral rehydration therapy was originally developed by scientists working in Bangladesh who wanted to learn to treat cholera, which can kill quickly.
What is "implementation science" and what role does it play in global health?
Dr. Glass: There is an enormous gap between health discoveries and their delivery to communities, particularly in poor countries. For example, nearly 14,000 people in Africa and Asia die each day from HIV, malaria, and diarrheal disease, even though we can prevent, treat, and in some cases eliminate those diseases in wealthy countries like ours.
What we call "implementation science" takes proven treatments and adapts them for practical use in the field. Implementing treatments becomes very complicated when you consider the challenges of working in the developing world. We like to say "one-size-does-not-fit-all" in global health.
For instance, one of our research grantees was part of a team that recently discovered male circumcision can significantly decrease HIV transmission. That has the potential to prevent millions of deaths across Africa. But how should that knowledge be applied? What are the cultural beliefs and practices that will need to be considered in each community? These are the kinds of questions that must be studied.
How is the global health picture changing as populations in developing countries live longer and adopt a more western life style?
Dr. Glass: The good news is that—with the terrible exception of the toll HIV/AIDS is taking in Africa—life expectancy has risen substantially in many parts of the world. In China, for instance, the average person will reach 70, compared to about 40 in 1960.
As populations in the developing world age and adopt the western evils of fast food, cigarettes, and a more sedentary urban lifestyle, they show symptoms of the same conditions that plague us—obesity, diabetes, heart disease, and cancer.
If no action is taken, some 388 million people worldwide will die premature deaths from these conditions in the next decade, according to the World Bank.
Why is it important to train local researchers in the developing world?
Dr. Glass: It used to be common practice for U.S. scientists to "parachute" into a community in the developing world, gather a few samples from people who were suffering from an infection, and take them home to be studied in an American lab. But that doesn't do very much to create a long-term solution that will improve that population's health.
At Fogarty, we've made it a priority to cultivate local research expertise. Many of the scientists around the globe who were trained through Fogarty's programs have gone on to assume leadership positions in their home countries. Our vision is a world where scientific advances are implemented equally—reducing disease, promoting health, and extending the lives of all people.