Author: Institute of Global Health Innovation

A tidal wave of cancer

By Jeremy Laurance

Looked at in one way, the warning from the World Health Organisation of a tidal wave of cancer sweeping the globe over the next 20 years is good news. Cancer is a disease of old age – it means more of the world’s peoples are surviving long enough to get it.

But while it is good to grow old (rather than die young) no one wants to die of cancer. Many cancers still kill people before their time. And cancer imposes an immense and growing burden on families, health systems and states. Hence the WHO’s alarm call.

The organisation estimates the worldwide burden will rise by 70 per cent from 14 million cases in 2012 to 24 million in 2035, much of it borne by poorer countries. (more…)

IGHI Student Challenges Competition: Diagnosing Schistosomiasis: My Journey so Far…

Gabrielle for articleGabrielle Prager, Winner of IGHI’s 2013 Student Challenges Competition guides us through her journey throughout the contest and the next steps for her research project.

This is the problem:  In 2011, 243 million people required treatment for schistosomiasis. 28.1 million were reported to have received that treatment. Schistosomiasis is a neglected tropical disease.  What is it? It is a blood dwelling fluke. How is it treated? Mass Drug Administration with Praziquantel has been the mainstay of most treatment programmes. Uganda was the first country in Africa to initiate a national control programme coordinated by the Ministry of Health with technical and financial support from the Schistosomiasis Control Initiative (SCI). The SCI have been involved in the mapping, monitoring and evaluation of schistosomiasis.  Within two years Uganda saw a decrease in prevalence and infection intensity. As Mass Drug Administration continues, infection intensities and prevalence decreases and areas of lower infection intensities and prevalence begin to be targeted. In lower intensity areas, better diagnostic tools are required. Finding a better diagnostic tool is the beginning of my story.

Gabrielle with childDr. Charlotte Gower works closely with Dr. Poppy Lamberton in the Department of Infectious Disease Epidemiology and they have been involved in tackling this neglected tropical disease for a number of years. Dr. Gower has been investigating the identification and development of new diagnostic tools, in particular loop-mediated isothermal amplification or LAMP. LAMP is an isothermal DNA amplification technique, which allows amplification in less than an hour at a single temperature, which decreases the need for complex and expensive lab equipment. Dr. Lamberton’s fieldwork took her to Uganda to monitor infection and examine drug resistance. I had the good fortune of working with both these extraordinary women. (more…)

Next Generation: Global Health Innovators

John Chetwood, winner of  the 2012 IGHI Student Challenges Competition tells us how he has put the £2000 prize money to good use.

Detecting a Silent Cancer

DSC01559With the hepatologists at Imperial College London, I had been in rural Thailand investigating urinary biomarkers of ‘cholangiocarcinoma’ or simply put, cancer of the bile ducts. Though cholangiocarcinoma is thankfully rare in developed countries, it is showing worrying increases in incidence, and has shown little improvement in survival over the last 15 years.  There is still little hope of cure unless detected early and nearly everyone who develops this cancer will die from it. This situation is particularly bleak when you consider parts of rural South-East Asia where mainly due to parasitic infection the incidence surpasses 300/100,000, yet there are significant limitations on any kind of investigation or treatment.

IMG_0282In my final year as a medical student at Imperial College, my efforts were directed towards developing a diagnostic and screening urinary dipstick (similar to the kind currently used for pregnancy) which would lead to an accurate, cost-effective, transportable, non-perishable, and culturally permissible way to screen for this cancer in these communities. Early diagnosis of this cancer offers the only realistic chance of cure and with better understanding of how this cancer develops there was also the tangible possibility of new and better treatments. (more…)

Moving from global heath 3.0 to global health 4.0

Richard Smith of the UnitedHealth Chronic Disease Initiative and Adjunct Professor at IGHI talks about our NCD event at the Royal Society on 4th October and how we can make progress in global health as a whole.

MAF East DRCGlobal health 1.0 was called tropical medicine and was primarily concerned with keeping white men alive in the tropics. Global health 2.0 was called international health and comprised clever people in rich countries doing something to help people in poor countries. It had Cold War overtones. Global health 3.0, which is still the main manifestation of global health, is about researchers from rich countries leading research programmes in poor countries. But global health 4.0, increasingly the present and certainly the future, is research and other activities being led by researchers from low and middle income countries.

The 11 UnitedHealth/National Heart, Lung, and Blood Institute (NHLBI) centres are an example of global health 4.0 in that all the centres are led by researchers from low and middle income countries and work on programmes directly relevant to the problems in the countries. Dorairaj Prabhakaran, who is the leader of the New Delhi centre and chair of the committee of the leaders of the centres, told last week’s meeting at the Royal Society about the four phases of global health.

As Prabhakaran made clear, the concept came from Peter Piot, who is now the director of the London School of Hygiene and Tropical Medicine. Piot identified other differences between global health 3.0 and 4.0. Global health 3.0 is conducted mostly in sites and is largely biomedical and concerned mostly with infectious disease. In contrast, global health 4.0 is conducted in multidisciplinary centres and covers broader health issues, including NCD and disparities. Global health 3.0 uses predominantly the methods of epidemiology, including clinical trials, while 4.0 employs a much wider spectrum of methods through from discovery to implementation science.

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The speakers at the event from the 11 centres

The centres presenting at the Royal Society fit closely with these other aspects of global health 3.0. The research is about reducing the burden of NCD, and the work ranges from interventions to make whole communities healthier through primary care programmes to prevent NCD to projects to improve the care of those with established disease. There is also policy research, and the centres work on advise governments and help draft legislation. (more…)

Richard Smith: “I’m the minister of health in a poor country”

Richard Smith of UnitedHealth and Adjunct Professor at IGHI, writes for the BMJ about our upcoming NCD event at the Royal Society on 4th October.  

Richard_SmithI’m the minister of health in a poor country. Until last year I was a urologist. I was the president’s urologist and took out his prostate. To be honest, I don’t think it needed to come out, but he insisted. You don’t resist the president. He was delighted with the result and rewarded me by making me minister of health.

It doesn’t feel like a reward. Everybody wants something from me, but I’m very low in the hierarchy. I don’t think that the minister of finance even knows who I am. When I talk about the dangers of tobacco, he smiles at me as if I’m a child who doesn’t know what he’s talking about.

What should be my priorities? That’s my big problem.

The president, who doesn’t now have a lot of time for me, tells me to reduce deaths, but not to spend any more money. He doesn’t seem to care how I reduce deaths (or even whether I do) so long as I don’t spend more money.

Other ministers mostly ignore me, unless their prostates are playing up. The minister of finance sends an official every month to make sure I’m keeping to my ludicrously small budget. The official never smiles.

Old colleagues from medical school tell me that the teaching hospital needs a lot more money. They want to expand neurosurgery, oncology, and the dialysis programme. They also want to start transplants and cardiac surgery for children. One of the professors in the medical school is trying to start a biobank and stem cell research. He talks about the unique genetic profile of our population.

Even though I’m a urologist, I feel that achieving the MDGs should be my priority. We’re not doing badly with reducing child deaths, although I know that in the remote area that I come from deaths are just as common as they were 10 years ago. The reductions have happened elsewhere.

100015But we’re not doing well with reducing maternal deaths. All the religious leaders oppose family planning. I daren’t tell them (or anybody) that I’m an atheist. There are no obstetricians in the rural areas. They make too much money in the capital, and where would their children go to school if they were in the bush? But they won’t allow non-doctors to do Caesarean sections, and they won’t work with traditional birth attendants. They’re witchdoctors, they tell me. Whenever I try to persuade them to allow non-doctors to do Caesareans or to work with traditional birth attendants they run to the newspapers and talk about “second class care for second class people.” (more…)

Wisdom of the Crowd: 65 views of the NHS at 65

happy birthday NHSThe 5th July marked the 65th anniversary of the NHS.  To mark the occasion, the Nuffield Trust has published a new report ‘Wisdom of the Crowd: 65 views of the NHS at 65’ which invites 65 health and political leaders to give their opinion on the current state of the NHS and social care system.  They have been asked specifically to reflect on what they think needs to happen now and over the coming years to ensure the NHS and social care system is viable and fit for purpose in ten years’ time.

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Professor Lord Ara Darzi, Director of the Institute of Global Health Innovation

Contributors consisted of current and former health secretaries and ministers, senior civil servants, clinicians, managers, academics, patient representatives, journalists and other key individuals. Amongst the contributors is Lord Ara Darzi, the Director of the Institute of Global Health Innovation at Imperial College London and former Parliamentary Under-Secretary of State at the Department of Health from 2007 to 2009. Over the past 10 years, NHS funding had more than doubled and there were a series of reforms in England aimed at improving the quality and timeliness of care.  Darzi states that the injection of money did a lot of good; there was a huge amount of progress, fantastic outputs and outcomes, but he feels we could have pushed the reforms even further.

He goes on to offer four suggestions of what the NHS needs to do now to remain viable and to divert the tsunami that is about to hit.  They are: (more…)

Welcome to our blog

icon.jpgWelcome to the blog pages of the Institute of Global Health Innovation, Imperial College London.

This site provides frequent blog posts from staff and students within the College relating to the various global health topics we are working on within the institute and Imperial.  It aims to be an arena for debate and discussion and we welcome your comments and suggestions.

We are always looking for guest bloggers (internal and external to the College).  If you would like to write for our blog, contact IGHI’s Communications and Events Assistant Nikita Rathod n.rathod@imperial.ac.uk tel 0207 594 8841.