Collaboration Workshop for Global Health System Strengthening Triangle Global Health Consortium 02 December 2009 Sally S. Tinkle Senior Science Advisor, Office of the Director National Institute of Environmental Health Sciences Strengthening Global Health Systems: An NIEHS – WHO Collaboration that Translates Bench Research to Public Health

NIEHS Mission …to reduce the burden of human illness and disability by understanding how the environment influences the development and progression of human disease. Exposure- Disease Relationships Epidemiology Exposure Assessment Genetic Susceptibility Public Education and Involvement Prevention Research Policy and Regulation Fundamental Research in Mechanistic Toxicology Prevention and Improved Public Health

Program Description and History UN Conference on the Human Environment established need t o limit adverse environmental health impact of environmental chemicals globally Initial Goals: To address environmental health issues Promote scientific exchange among experts from developed and developing countries International Programme on Chemical Safety (IPCS) established by WHO, UNEP, ILO to coordinate a science-based response to global health concerns posed by environmental chemicals; housed at WHO NIEHS, through MOU with WHO/IPCS, established the first Interregional Research Unit (IPCS/IRRU), housed at NIEHS (in kind support and staff), as nexus for scientific exchange among regional environmental health scientists and IPCS staff. NIEHS-WHO Cooperative agreement to support and play key role in IPCS Evolving emphasis: Continue to address global environmental health issues Promote scientific exchange among experts from developed and developing countries

Program Products Collaborator-oriented ( ) Develop workshops on critical global EHS topics, focus on susceptible populations. Promote global collaborations through flexible, science-based frameworks of researchers, leverage investments and infrastrucures Harmonize methodologies to improve the scientific basis for risk assessment. Product-oriented ( ) Established and staffed IRRU on NIEHS campus that is directed by WHO/Geneva Produced 207 Environmental Health Criteria documents: peer-reviewed scientific evaluations of health/environmental risks posed by chemicals (EHCs). NIEHS/IPCS/IRRU authored 11 and participated in development of the others Actively participated in other IPCS products Concise International Chemical Assessment Documents (12), Health and Safety Guides (107), International Chemical Safety Cards (1308), numerous workshops

Example Product Environmental Health Criteria Document 237 (2006) Principles for Evaluating Health Risks in Children Associated with Exposure to Chemicals unique biological characteristics of children developmental stage-specific susceptibilities and outcomes exposure assessment methodologies to assess health outcomes in children implications and strategies for risk assessment for children

Collaborators Founding organizations ( ): NIEHS, WHO, UNEP, ILO Current collaborators: Determined by the research topic and mission of the agency/organization or the research interests of the Principle Investigators

Major Achievements Brings together developing nations and developed nations, regions of the world Provides mechanism for leveraging resources –workshop international working group network Significant documents: Bangkok Statement (2002), Human and Ecological Risk Assessment document (EHC 237, 2003), Libreville Declaration (2008) Health professionals training modules: e.g., reproductive health and the environment, evaluating childhood health risks associated with environmental exposures Provides NIEHS/NIH opportunities to demonstrate its scientific strengths and exert significant leadership and influence on global environmental health issues –Identify principle investigators and trainees (ITROEH) to bring into the networks Advances the central role of NIH and the US in promoting global public health to ensure viability and sustainability of the people and the planet

Current NIEHS-WHO Activities Vulnerable Populations: Children’s Environmental Health Network Mechanistic Research Topics: Gene-environment Interactions, Toxicogenomics/Biomarkers of Environmental Exposure, Toxicogenomics of Risk Assessment Environmental Chemicals: Endocrine Disruptors, Benzene, Persistent Toxic Substances, POPs Harmonized Risk Assessment Methods: Development of Improved Methodologies on Risk Assessment, Integrated Risk Assessment, Mixtures

Benefits for Global Health Systems Early example of translating bench research to public health Identify critical global environmental health issues; coalescence of mutual interest in environmental health Across nations: Compare data Transfer knowledge and technologies; need for harmonized documents, methods and approaches Share resources Provide a large cohort on "rare" diseases or specific environmental exposures prevention of exposure & promotion of safer environmentsWork more effectively towards prevention of exposure & promotion of safer environments

Differences between science-based approach and public health approach to problem solving WHO regional divisions of the world create stovepipes and environmental issues are cross-cutting and need a horizontal, integrated solution. Different areas of world need different collaborative mechanisms Cultural and national perspectives on science, health, and collaboration Developing nations lack infrastructure and 7% indirect costs in many developing nations hampers infrastructure development Rising cost of travel Harder to document translation products than documents Challenges to Strengthening Global Health Systems

NIEHS Global Environmental Health Website NIEHS Next Steps Develop an NIEHS WHO Environmental Health Science Collaborating Center Strengthen trans-NIEHS participation in WHO and other international collaborations Trans agency collaborations, e.g., Climate Change and Health White Paper