This entry was first posted on September 21, 2010 at 11:20 am.

With so many other actors involved in global health what is the unique contribution of the university?  Tachi Yamada said that since the renaissance people  have turned to Universities, yet in recent times, the Universities, and perhaps especially medical schools, have allowed their agendas to be driven by grantors, resources, and clinical practices rather than fundamental needs. Universities can take back the high road, he says, by focusing on global peace and security and climate change, and global health must be on the agenda also.

I sit in the audience reflecting on my work at the University of Wisconsin-Madison, and the themes resonate.  We do want to have impact on quality of life, both in our state and in our world.  Our new educational programs are preparing students to see global health in a larger multi-sectoral context.  Yet we know we have to do more and we are working to figure out what the best thing we can offer is.  Yamada says the answer is innovation, new knowledge, new insights, that can be applied to problems in a practical way. To me it sounded like the Wisconsin Idea, which is not new, that the discoveries at Wisconsin will be used to improve quality of life around the state and in our world.  This idea is always evolving, and maybe needs to become explicitly global, but it is a part of our institutional psyche that we can build on.  Meanwhile,  we and every other University in the room face the challenges of silos, turf wars, and institutional values and politics that hamper the potential of the very innovators that they want to champion!

Yamada goes on to say that innovation can be evolutionary and revolutionary….improved bed nets and creative production and distribution is evolution, while “donfusant” technologies (love that term!) that treat mosquitoes so that they can no longer smell humans is revolutionary. Innovators need supportive environments and real resources that are not at the mercy of funding cycles. The academic medical center is a very important institution with a mandate to alleviate suffering that must be honored.

Susan Desmond Hellman of UC, San Fransisco spoke next.  She began with a word of wisdom as a mentor: do something that makes you feel uncomfortable.  We should all try to take a small risk for global health today in some way…. After talking about her experience as an HIV/AIDS researcher in Uganda in the late 80s, Susan talked about the potential of the relationship between industry and Global Health.  She described both opportunities and challenges in this relationship, emphasizing the importance of industry for innovation. Industries have talent and technologies as well as development and delivery expertise and they understand regulatory environment. They do have good intentions, she asserts, and there is more emphasis on prevention and cost than ever. A big challenge is how to define the effort: is global health work a form of philanthropy or an area of product development. A second challenge is how to understand global health efforts in terms of industry priorities. A third challenge is working through inconsistent funding streams of industry.

As Chancellor of UCSF, Susan leads a growing global health sciences effort that embraces leadership, global health care, public health, education and capacity building in partner institutions. This is the way the world is going – and they are doing Global Health 4.0. They are partnering on one health, womens health, and migration health with different California system partners and there is great enthusiasm about it among faculty and students.

Jean William Pape, spoke about a the Cornell-Haiti Collaboration-(GHESKIO).  Pape began with a video about this partnership in Haiti  http://www.youtube.com/watch?v=vn6WpPtNtck established in 1982 in partnership with Cornell and they still work together today with GHESKIO serving 20,000 patients. After the quake they found and maintained treatment for nearly every patient…. and because of their presence and trust and the dire need they were transformed overnight into a refugee camp and emergency hospital.

After the film he talked about the collaboration with Cornell. Some of the Haitian nurse leaders from the 70s are still with the program! Their initial high impact success was introduction of oral re-hydration therapy, and dehydration in adults (a symptom of AIDS) led them to get involved in designing the disease, coming up with a workable care model. They are funded by NIH, PEPFAR and a number of other key players. The care model is broad, from prevention to detection and treatment and even a micro-credit program. he earthquake has resulted in three new tasks: an acute care hospital, a TB hospital, and care for 7000 refugees. They are providing training for nurse practitioners, lab techs, and public health practitioners. The biggest challenge is relocation of 1.2 million refugees…how can we make them model global health villages.

In closing he states that a successful global health center has leaders on both sides, excellent research, investigator training and focus on the poor. North and south relationships are built on institutional relationships but success depends on personal relationships in which the partners selflessly do what is the best of the country.

So there you have it:  a prescription for effective University engagement in Global Health — innovate, take a risk, work in partnerships, and selflessly do what’s right.   Should be easy, shouldn’t it?

During the opening session, Peter Piot summarized three big historical trends in how we talk about health issues that transcend national boundaries– first there was tropical medicine,then there was international health, and now, as we talk about global health, a new paradigm for global health is emerging.  This new paradigm,which he calls Global Health 4.0, will include more voices from regions outside North America, both from Europe and low-income countries. Global Health is not a region, an “over there: it is worldwide.  PI ‘s should will be from many countries, and what we now call “research sites” will become Centers of Excellence where joint learning takes place. Also, the infectious disease focus is too narrow, global health must address non-communicable disease as well.  Research will shift is focus, now leaning heavily toward randomly controlled trials, there needs to be more translation and implementation science. While we are still working on what it really means to support the health of populations and not just individuals, we need to also integrate the environment as a third focus of attention.  Finally, “Global Health 4” needs to foster a network of higher education for all.

Fitzhugh Mullan  reported on a study of medical education in Sub Saharan Africa.  They did 10 site visits and a survey of 164 schools, and realized a 72% response rate. Twenty percent of graduates migrate out of the country, and another 20% or so work in NGOs and the private sector.  Less than 10% of faculty do research.  Biggest needs that emerged were to build faculty capacity, develop  infrastructure, forge links to MOH, increase funds for  research, and promote primary care.

Lincoln Chen spoke about education for health professionals in 21st century.  In the spirit of the 1910 Flexner report which reformed medical education, he reported on the work of a consortium that focused on medicine, nursing and public health education. The identified 2400 medical schools globally, 460 schools of public health– they could not accurately assess the number of nursing schools.  Their results, to be included in a forthcoming Lancet Commission report, point toward a new kind of medical education that  links the education system and the health care system.  As the Flexner work brought medical education into the university, and problem-based reform and the rise of academic medical centers  made further improvements, now the 3rd stage should be systems-based reform.  Education must be  informative (expert) , formative (values, professionalism), and transformative (leadership for change).  To realize these goals networks and consortia are critical.

This was an inspiring start with lost of ideas and best practices within the health sciences articulated, but so far they have not mentioned any disciplines from outside the health sciences, such as engineering, agriculture, or education and how they can collaborate for global health.  It makes me feel very fortunate to be at UW-Madison where I have had the change to  work with faculty and students from the health sciences, engineering, agriculture, social work, and even astronomy.

Tomorrow morning the  plenary  meetings start at 6 am Seattle time, with the roundtable at 7 and then Melinda Gates at 8:00.  I hope some UW students will watch some of these and participate in the blog!