The Consortium of Universities for Global Health (CUGH) held their 8th Annual Conference in Washington DC this week. More than 1,700 people from every corner of the globe gathered for three days to explore how the world’s academic institutions can best contribute to improving global health. This year’s meeting was particularly interesting given the contrast between current prospects for financial support for global health and the trajectory of support over the last 15 years. That contrast made several of the key topics discussed at CUGH even more salient to me.
CUGH exists in its robust form in large part due to the remarkable and unprecedented increase in investments in global health made during the first decade of this century. Official development assistance for global health increased an average of 11% per year during that decade resulting in about $35 billion per year (source). HIV/AIDS investments led the way due to PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), but other notable investments came from the President’s Malaria Initiative, other bilateral donors, and the ramp up of the Bill & Melinda Gates Foundation and other foundations. These investments created demand for talented international health professionals of all types.
Universities responded with an explosive growth in new departments and schools focusing on global health. Students flocked to these new schools to acquire the skills needed to define and solve the many diverse and exotic global health challenges. As greatly expanded programs rolled out, there was a need to figure out how best to direct investments. The field of implementation science developed rapidly to fill this need. Implementation science has many definitions, but, in essence, addresses how to take what we know works (based on evidence) and apply it in the field for maximal impact. If a program has an obstacle or problem, implementation science can help find a solution.
At the CUGH meeting, there was a good deal of discussion on the proposed cuts to US-funded global health research and programs. The Fogarty International Center at the National Institutes for Health (NIH) was highlighted as a crucial program to keep, as it carries out exactly the type of effort on human capacity building for global health that the world needs now. Many participants expressed concerns about the perceived growth of anti-science and anti-data thinking, particularly in the context of the many new and remaining global challenges being studied by those in attendance.
The breadth of global health challenges is stunning: from pandemics of HIV, malaria and tuberculosis, to emerging infectious diseases like SARS, MERS, H1NI flu, Ebola and Zika, to a global surge in non-communicable diseases (NCDs) such as cardiovascular, diabetes, cancer, chronic respiratory, as well as mental illness and injuries. At CUGH, the prestigious journal Lancet launched a new journal Lancet Planetary Health that will address the interplay between health outcomes and the determinants of health in our living and physical world. Several sessions highlighted the importance of climate change on the health of human, animals and the environment, and their complicated interactions.
Infectious pandemic threats, and the sense of inevitability that there will be more in the not-too-distant future, received a good deal of attention from many quarters, including from the US Centers for Disease Control and Prevention (CDC) and NIH, as well as from other national governments, United Nations units, and academic centers and laboratories. The Global Virome Project presented on their efforts to characterize the vast number of viruses circulating in animal species that might jump or “spill over” to humans, causing new disease outbreaks. Bats, a possible reservoir for Ebola virus, were identified as a particularly important source of new viruses. The Zika epidemic underscored the importance of entomology, the study of insects, as well as the remarkable newness of birth defects related to a virus that can be transmitted by mosquitos and sex.
The presentations highlighted that, while not as exotic, NCDs will dominate the global burden of disease for the foreseeable future. While we are making progress in controlling several endemic infectious diseases, the World Health Organization projects that NCDs will be responsible for a significant increase in deaths over the next decade. In 2011, the United Nations convened a High-level Meeting on NCDs. Despite this recognition of the increasing importance of NCDs, there was no substantial new international commitment of funding to address the problem. Most countries were left to their own devices to do the best they can within the constraints of their health care systems. There is a tremendous amount to do.
As the planet’s population grows from 7.5 billion now to 9.7 billion in 2050 (half of the increase will come in Africa) there will be an ever-increasing need to have our best minds working on global heath. CUGH represents an essential component. We need to do all we can to support the institutions that help generate new evidence on global health challenges and then apply this evidence through innovative solutions.
Image credit: Rachel Bensman/used with permission