NIH Center Makes Strides in Global Health Initiatives

Efforts to reduce health disparities around the globe are yielding more research and training opportunities for behavioral scientists. Known for its work in studying the nature and prevention of disease outside the United States, the Fogarty International Center, the international arm of the National Institutes of Health (NIH), takes a multidisciplinary approach to addressing global health issues such as HIV/AIDS and other emerging infectious diseases, population growth, mental illness, and tobacco-related illness by supporting behavioral, clinical, epidemiological, and basic research and research training.

Gerald T. Keusch
Keusch

According to the Center’s director, Gerald T. Keusch, MD, who also serves as NIH Associate Director for International Research, research opportunities will continue to increase for behavioral scientists. For example, Keusch said the spread of HIV and other communicable diseases internationally prompted NIH to identify behavioral research as an important research area in the search for potential new prevention methods.

“We began to think strategically about how to provide support to not only understand how the disease takes hold and spreads, but, importantly, how to prevent future infection,” he said.

Keusch also noted that the next two decades will bring substantial changes in the health needs of the world’s population, as demographic changes and aging occur in developed and developing countries. By 2020, noncommunicable diseases, including mental illness, are expected to account for as much as 60 percent of the global burden of disease and disability.

The Fogarty International Center supports collaborative research and training projects at more than 120 institutions throughout the US and in more than 100 countries. The projects support training of U.S. and foreign scientists, as well as research to increase knowledge on diseases and conditions that affect people throughout the world.

Keusch believes that it is in the US’s self-interest to address global health concerns as international travel and trade become increasingly more commonplace and worldwide immigration continues. “Diseases don’t understand immigration. These issues don’t end at the border,” he said. “In addition, as NIH works to advance research for the health of everyone, we must identify the best scientific ideas and opportunities, wherever they are.”

To complement its own extramural research and training programs, the Fogarty International Center works on behalf of the NIH through diplomatic, intergovernmental, and informal channels to identify opportunities and enhance international cooperation. It partners with U.S. agencies, foreign funding agencies, non-governmental organizations, and others to tackle priority health and health research concerns.

SMOKE-FREE WORLD

Among the universal health issues the Fogarty Center is tackling are non-communicable disease such as smoking-related diseases and deaths. According to the World Health Organization (WHO), tobacco is fast becoming a greater cause of death and disability than any single disease throughout the world. Each year, approximately 4 million people worldwide die from tobacco-related causes. If current smoking patterns persist, the number of tobacco-related deaths will rise to 10 million annually by the year 2025, surpassing the death toll from AIDS, tuberculosis, automobile accidents, homicide, suicide, and childbirth combined. Seventy percent of this increase will occur in the developing world, where health care systems are inadequate to address current needs and will be strained to the brink by the burdens imposed by the expected magnitude of tobacco-related illness.

In June 2001, together with partners from within the NIH, and in cooperation with the WHO’s Tobacco Free Initiative, the Fogarty International Center launched a five-year, $17 million program to address the growing incidence of tobacco-related illnesses and death in developing countries. The International Tobacco and Health Research and Capacity Building Program will support studies of research methods for reducing tobacco consumption in low- and middle-income countries. The program seeks researchers who will be able to link behavioral, social, and basic science with clinical and operational aspects of health care research.

Keusch said he hopes that the tobacco studies supported by this program will deliver information about why and when youngsters in low- and middle-income countries begin smoking. The research is also expected to consider the influences on young people that contribute to the initiation of smoking, including the messages young people receive through the media.

Keusch said the Fogarty International Center may sponsor future research studies to take a look at the broader issue of youth involvement with other risk-taking behaviors, such as drug use, sex, and high-speed driving. The International Tobacco and Health Research and Capacity Building Program awards will be announced in early 2002.

AIDS: A GLOBAL THREAT

Thirty percent of FIC’s $50.5 million budget is devoted to HIV-related research; a significant portion of it is focused on behavioral issues. Since 1988, the Fogarty Center has funded HIV/AIDS research and training programs through its AIDS International Training and Research Program (AITRP), which supports HIV/AIDS and related tuberculosis research and training for foreign health scientists, clinicians, and allied health workers from developing countries and emerging democracies.

Currently, the AITRP is helping its scholars in Brazil study the effect of the HIV/AIDS treatment post-exposure prophylaxis on sexual disinhibition. In Peru, AITRP scientists are conducting a study on compensated sex and finding alternative ways for young women to earn money in a depressed economy; and in Mumbai, India, AITRP scientists are sponsoring day-long workshops to reduce the transmission of HIV/AIDS using culturally relevant information gained in pilot studies.

Psychologist Tom Coates, professor of medicine at the University of California at San Francisco (UCSF), is director of UCSF’s AITRP-funded program. Coates said that the funding provided by the Fogarty International Center helps bring the brightest social and behavioral research scholars from developing countries, including Zimbabwe, Brazil, Peru, India, Thailand, and Vietnam, to the United States to train in all aspects of HIV prevention.

Coates believes the FIC and other NIH institutes recognize the role of behavior in HIV/AIDS transmission and, as a result, the AITRP has received strong support for its research and training programs from across the NIH. Since it started 13 years ago, the AITRP has provided research and training opportunities at the Master’s, PhD, and post-doctoral levels for more than 2,000 scientists from developing countries and emerging democracies. In addition, over 50,000 AITRP-supported scientists have been trained in advanced short courses in their home countries.

“The supply for behavioral science research has been very strong at the NIH,” Coates said. “Though it’s unfortunate, HIV is certainly advancing behavioral science in a very important way.”

AITRP programs broaden the scientists’ expertise while establishing a long-term behavioral research and biomedical presence in each scientist’s home country and facilitating new prevention efforts. In addition, the AITRP staff at each U.S. institution teaches the foreign scientists how to apply for NIH funds and maintains ongoing relationships even after they return to their home countries.

Coates believes AITRP also helps scientists who have excelled in the program to receive further education by allowing them to obtain an advanced degree in public health and then helping them to establish research centers of excellence in their home countries to sustain ongoing research. Much of what the US and foreign AITRP-supported scientists have learned about HIV/AIDS interventions can also be applied in the United States, Coates said.

“The program is a really important two-way communication tool,” Coates said. “AIDS is a disease that points its finger at everything that is wrong in society and the issues that society and individuals have to deal with.”

COMMON GROUND, SHARED SOLUTIONS

As the Fogarty International Center works to advance global health, it partners extensively with groups around the world and seeks input to identify areas of concern. For example, since 1999, the Center has served as the Secretariat of the Multilateral Initiative on Malaria (MIM), an alliance of research and public health agencies and African scientists. MIM stimulates collaborative research to answer the needs of public health programs in malaria-endemic countries, to modernize communication systems used by the malaria research community, and to strengthen behavioral and biomedical research related to malaria prevention and control.

In addition, in September 2001 the Center-in partnership with other NIH institutes and offices and US agencies as well as domestic and international organizations-sponsored an international conference to examine the social and cultural determinants of stigma, explore how stigma prevents people from seeking or getting treatment for disease, and determine future research opportunities.

The conference, “Stigma and Global Health: Developing a Research Agenda,” was oriented toward developing a research agenda that will lead to the mitigation of the impact of stigma on individuals and societies. The Fogarty International Center expects to announce a new stigma and global health research program in the next year to meet the challenges identified at the international conference.

Another initiative that the Center led on behalf of global partners was the establishment of the Global Forum on Bioethics. First held at NIH in 1999, the Global Forum brings together individuals from the developing world who are responsible for the ethical conduct of research in their countries to engage in dialogue about how these issues might be approached in their own countries and in international collaborative research. In February 2002, the Fogarty International Center will co-sponsor the third Global Forum for Bioethics in Research.

Announcements of new Fogarty International Center initiatives and opportunities and a full list of programs and contacts are available on the Center’s web site at www.nih.gov/fic.

Observer Vol.14, No.10 December, 2001

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