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Gerald T. Keusch, M.D. Associate Provost and Associate Dean for Global Health, Boston University.

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Presentation on theme: "Gerald T. Keusch, M.D. Associate Provost and Associate Dean for Global Health, Boston University."— Presentation transcript:

1 Gerald T. Keusch, M.D. Associate Provost and Associate Dean for Global Health, Boston University

2  Health disparities - scene setting  Where have we come from?  Where are we now?  Where are we going  Partnerships  Intended and unintended consequences


4 Populations with Equal Access to Health Care SOURCE: Gomes and McGuire Unequal Treatment, Confronting Ethnic and Racial Disparities in Health Care National Academy of Sciences, 2001

5 Life expectancy at birth by world region, 2001 AreaTotalMalesFemales World676569 Developed countries757279 Less developed countries646366 Africa545255 Asia676568 Latin America and Caribbean716874 Europe747078 North America (U.S. and Canada)777480 SOURCE: Population Reference Bureau. 2001 World Population Data Sheet. Washington, DC: Population Reference Bureau, 2001.

6 80 70 60 50 40 30 05,00010,00015,00020,00025,000 About 1900 About 1930 1960 1990 Life Expectancy (Years) Income Per Capita, 1991 International Dollars


8 Population 1997-9 (Millions) Ave. Annual Income per Capita ($) Life Expectancy (y) Infant Mortality /1000 Births Least Developed Countries (38) 643 $ 29649103 Other Low Income Countries (23) 1,777 $ 5386160 High Income Countries 858 $23,335776 WHO Macroeconomics Report, 2001

9 Its why its called a fortune cookie!


11 Imaging, X-ray to MRI Immunology, a new science New vaccines, from polio to HPV Eradication of an ancient pathogen Behavioral risk factors – tobacco, diet Pathology to molecular/cellular biology Receptors, signaling, molecular cross-talk Genetic sciences and the human genome Omics, systems biology, bionics, designer meds

12 Increasing disparities in health Failure to use available technology Increasing disparities in health research Knowledge doesn’t equal problem solving More people affected by neglected diseases Rise of a for profit pharmaceutical industry that must focus R&D on the business bottom line Impact on access, availability, affordability, appropriateness, acceptability Excessive attention to life-style drugs Inattention to neglected tropical diseases

13  Public health is the art and science of making sure nothing happens  When nothing happens, nobody notices  Politicians worry when nothing happens – “nothing” is a political vacuum  When asked to pay for nothing they balk  When they pay and nothing happens they get mad  When they balk or they get mad the public health system suffers…until something happens  When something happens, everybody is blamed, especially the public health system and its “failed” leadership who “mislead” the politicians

14 <5%


16 Poverty: billions live on less than $2/day; health expenditures are woefully inadequate. Population: > 6 billion and growing. Environment: Continuing degradation, climate change, pollution and disease spread. Civil Society: Civil and foreign wars, genocide, displaced persons, refugees and migration, failed states. Health: 95% of global disease burden is in the developing countries and local expenditures are grossly inadequate. Research: > 90% of $$ is for first world diseases so little is spent on disease affecting the majority – too much oriented to highly technical, expensive drugs, diagnostics or devices.

17  Globalism as the 21 st century theme The response to a changing world The social conscience of students  Health as a key global concern Health is the basis for development Health as a human right Health as a security issue  Centrality of health to international policy Core aspiration of all nations Role of health in “soft” diplomacy

18 The Essential Premise: There are many sectors but just one, health, is central to all others ECONOMICSPOLITICS BUSINESSHEALTH CIVIL SOCIETY AGRICULTURE ARTS AND CULTURE

19 Global health is a field of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasizes transnational health issues, determinants and/or solutions; involves multiple disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population-based prevention with individual level clinical care.


21 More old, more young More poor, more hungry More crowding, more pollution More degradation of environment More discrepancy in access to resources More resentment, political instability, violence More social disruption, failed states, terrorism

22  Figure out what the problems are Applied as well as basic and translational research Can involve students as well as faculty Get into the field, in facilities and the community  Identify potential solutions Facility or community based Be sure they are culturally appropriate  Implement interventions Funding/staffing Capacity building


24 Increased scientific knowledge has accounted for much of the dramatic improvement in health that has occurred in this century—by providing information that forms the basis of household and government action and by underpinning the development of preventive, curative, and diagnostic technologies… Because the fruits of science benefit all countries, internationally collaborative efforts, of which there are several excellent examples, will often be the right way to proceed.

25 Universities have four critical roles Education – (including education of the public at large), but this may be relegated to 2 nd place in some research intensive institutions Research – generation of new knowledge Service – translation and application of knowledge in society Policy – inform the political sector, influence decision making

26 Teach global literacy – business students need to understand the magnitude of disparities in health, science students need to understand the practical value of their work, all students need to know about the real world Make global studies a required part of the core curriculum Contribute to improvement of K-12 education in science and technology Promote public access to the health literature Encourage publication in open access journals Find venues to publish work that doesn’t work Speak in plain language to the public

27 Embrace a global culture of science with high ethical standards, open and free communication, concern for global public goods Reduce barriers between academic faculties and promote interdisciplinary research Connect basic and applied research within the research culture Reward applied research productivity by faculty through recognition, support, academic promotions Establish thoughtful socially relevant intellectual property policies and licensing terms: knowledge as a global public good

28 Contribute to capacity building in science, clinical medicine, and public health Support training of developing country health workers in a manner that does not lead to emigration Work more directly with international agencies to improve health and health capacity in developing countries Promote the good side of globalization, correct the bad Enter national policy decision making process to insure that evidence is used effectively University Consortium for Global Health National Academy of Science/Institute of Medicine Advocacy



31 Traditional Business model Innovative PH model

32 From “layer cake” (tasks taken on separately by different sectors) to “marble cake” (cross sectoral partnerships). In research we call it interdisciplinarity There are three key questions:  What’s in it for me (my institution)?  What will my partner contribute?  What will it cost me?


34 1. Trust 2. Trust 3. Trust

35 1. Respect 2. Respect 3. Respect

36 1. Relationships 2. Relationships 3. Relationships Who your “ambassadors” are does really matter.

37 Improve access to information, globally – publish in open access journals Develop sustained collaborations with developing country scientists for training, research, and improving clinical services Advocate for “better” (more enlightened) tech transfer policies – understand IP and TT Organize and become vocal advocates for appropriate assistance to developing countries for capacity building and service Canadian version of the newly announced Obama initiative in Global Health Work with IRDC – an inherently good agency Science for Humanity

38 Value applied research in career development, e.g. work on rapid low-tech low-cost diagnostics


40  Progression to integrative partnership model  Capacity improvements  Managerial competence  Good governance – transparent, fair, ethical  Meaningful health benefits  Learning lessons become bidirectional

41  Neocolonialism – control issues  Introduction of inappropriate technology  Displaced concern – e.g. from local problems to hosting international students  Cultural clashes  Facility based focus  Research dominance – leadership roles, authorship/presentation of data

42 “I think I can make you very happy if I can get funded.” McGill Partner



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