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National Heart, Lung and Blood Institute�s Global Health Initiative: an Introductory Video

Chronic diseases are universal.  They impact entire communities and nations and they cost of millions of dollars in lost productivity and care.  Populations in developing countries are disproportionately affected, with more individuals developing these diseases at younger ages than those in higher income countries.

Chronic diseases account for around sixty percent of all deaths globally and eighty percent of these occur in low and middle income countries.

One of the things that has become increasingly clear over the last several years is that the global burden of non-communicable chronic diseases is increasing most dramatically in low and middle income countries. This has been a problem for a while in the developed world, and is becoming an increasing problem in the developing world. We see this as a huge problem for human kind and also a huge economic and community burden for the countries that are affected by this.

Believe it or not, chronic disease is killing more people than anything else in Bangladesh. So heart attack, stroke, diabetes; are bigger killers than causes of death like delivering your baby safely or childhood illnesses.

In Central America and the Dominican Republic the number one killer are chronic diseases.

Chronic disease has already become a big problem in China now, it accounts for over eighty percent of total deaths of Chinese.

Chronic disease is affecting South Africa and indeed the African continent in ever-increasing numbers. In a continent where the major diseases are tuberculosis, Malaria, and HIV, chronic diseases has been the poor relative for too many years.

In the last 20 years, chronic disease has increased very much in the southern cone.   And now, they are accounting for more than 60 percent of the causes of death and disability.

Chronic diseases are a huge burden in India. The reason why it’s a huge burden is because the numbers are huge for to begin with, and second, it afflicts Indians at a much younger age as compared to the western counterparts.

To help combat the growing burden of chronic diseases in low and middle income countries the NHLBI in partnership with UnitedHealth Group have established the Global Health Initiative, a network of eleven collaborating Centers of Excellence focused on building sustainable programs to combat chronic cardiovascular and pulmonary diseases worldwide.

What we want to do is to increase the number of people, institutions, and communities, who are equipped to fight against chronic disease. We are working with the National Heart, Lung, and Blood Institute and I think this is a very strong partnership.

Partnerships enable us to learn from and teach each other, they enable us to do more things than any of us are able to do alone, they enable us to have a bigger impact.

These Centers of Excellence are developing infrastructures for research and training to increase their capacity to conduct population based or clinical research, with an emphasis on ways to impact lifestyle factors that can decrease the risk of chronic diseases.  Each center consists of a research institution in a developing country partnered with at least one academic institution in a developed country. This helps facilitate the growth of the center’s research capabilities and opportunities.

The research we plan to do in our center is to look at a model of care that takes care from the community to the primary health care facility and back again, and incorporates all aspects, from community health workers as well as tools for the management of chronic disease.

We want to find out in the Eldoret area, what are the commonest causes of heart failure in these populations. We use a lot of firewood mainly done by women to cook and we want to find a relationship between what we find in the hospital on specific tests and finding the right heart failure, and linking these to the indoor air pollution in the home.

Our primary research focus is the implementation and evaluation of a community intervention to prevent chronic disease, and the evaluation and research aspect of it has two components. One is evaluation of intervention results, and the second component which we believe is just as important is the process evaluation.

What happens to someone when they have a heart attack or a stroke and then what happens to their family? Does having chronic disease make you poor? It’s one of the questions that we’re trying to answer.

We are conducting what is known as knowledge translation research. We are trying to find out what are the best strategies with which we can implement what we already know to counter chronic disease.

The Global Health initiative seeks to develop the next generation of global health leaders in chronic diseases.  Each center serves as a training hub for future investigators, emergent scientists, and community health workers.

Training and capacity building is one of the pillars of this program. The aim is to build capacity within the country on chronic non communicable diseases. Our ultimate goal is to create a global community from emerging investigators that really can conduct research across borders.

Our training has multiple components. We are training post-docs, or post-doctoral fellows, to learning research methods, to learning how to do prevention. We are also training junior faculty in terms of writing grants, developing prevention programs. 

We need to enlarge the number of people with the capacities to address chronic diseases and its responses at our own level. So through the center we will bring new scientists to get familiar with the tools of how to do research in-house for addressing our own problems.

In Tunisia, we are training people different ways. We are doing short term training to improve skills of young researchers to improve their ability to publish their research. We are also thinking about long term capacity building for the medical school, to increase the mass of people that can have high level degrees in public health.

This global initiative is expected to stimulate clinical epidemiologic, policy, translational and behavioral research for chronic diseases.  The Centers are collaborating with existing health care systems, raising public and political consciousness, and building institutional capacity to improve methods for the prevention and control of chronic diseases.

Each of the centers of excellence have the opportunity to conduct research at the local level with their communities, to identify factors that would put these communities at risk for the development of cardiovascular and pulmonary disease, and therefore try interventions through research questions.  What would be the most effective way of implementing prevention programs as well as modifying the risk factors? But they are also very well positioned to interact with policy makers. So as they develop this evidence, they can transmit that evidence to those policy makers so that they themselves can make decisions at the country level.

Chronic disease has got no borders.  It doesn’t differentiate between developed country or developing country.  It’s quite important that we understand the etiology of these diseases and ways and means to prevent it, so that we can learn from one culture to another culture, from one method to another method, so that collectively we will gain a better knowledge in a shorter time.

Our hope is that our global development partners will become aware that chronic disease is the biggest killer, that it is having an impact on families and on households, and on women and on children, and that this is an area that’s worth investing in globally.

We want to generate the evidence at our local settings, so then we can inform our politicians on how best to address solutions for our country.

We would also hope to develop economic models which can cost or enable governments to cost various interventions so that governments better understand what they are acquiring for a particular intervention or effort.

Community health workers are the people who are on the ground; they’re the people who come into contact first with the members of the community. And our research is going to be contributing to building that base of well-trained community health workers who are also able to do research or are also able to do evaluation. And that’s going to translate into a very direct benefit for the populations that they serve.

I think even if we reduce the burden of chronic diseases by one person over the next five years, we will have done a huge job.

If we know what the problems are, then we will apply and look for prevention and intervention strategies to prevent these diseases in the first place.

So one of the true benefits of this initiative really has been the creation of a true global community of researchers, where the flow of information knows no borders. So, a research discovery that is made in Africa, or India, or China, will undoubtedly benefit Americans here at home. This is really the nature of the global community today, that there is a dramatic sharing of information and progress on a global scale.

Last Updated: February 7, 2013

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