July 2009

Meet Our Featured Guest Columnist:
Dr. Roger Glass

is director of the Fogarty International Center at the National Institutes of Health.

Q: How/why did you become involved in global health issues?

A: First, from a moral standpoint, as citizens of the wealthiest country in the world, we have a responsibility to share our scientific knowledge and medical advances to benefit those less fortunate than ourselves. Second, in this increasingly "flat" world, health issues impact us all. The recent outbreak of SARS and the ongoing bird flu epidemic in Asian poultry both show that diseases don't respect borders. Globalization has increased the movement of people and products around the world, which means diseases can spread more quickly. Finally, Americans benefit enormously from research that has taken place elsewhere. Many parents rely on products such as Pedialyte when their children have diarrhea. This kind of oral rehydration therapy was originally developed by scientists working in Bangladesh who wanted to learn to treat cholera, which can kill quickly.

Q: Describe some of the successes you have seen in your work.

A: The good news is that--with the terrible exception of the toll HIV/AIDS is taking in Africa--life expectancy has risen substantially in many parts of the world. In China, for instance, the average person will reach 70, compared to about 40 in 1960. As populations in the developing world age and adopt the western evils of fast food, cigarettes, and a more sedentary urban lifestyle, they show symptoms of the same conditions that plague us--obesity, diabetes, heart disease, and cancer. If no action is taken, some 388 million people worldwide will die premature deaths from these conditions in the next decade, according to the World Bank.

Q: What were some of the challenges?

A: There is an enormous gap between health discoveries and their delivery to communities, particularly in poor countries. For example, nearly 14,000 people in Africa and Asia die each day from HIV, malaria, and diarrheal disease, even though we can prevent, treat, and in some cases eliminate those diseases in wealthy countries like ours. What we call "implementation science" takes proven treatments and adapts them for practical use in the field. Implementing treatments becomes very complicated when you consider the challenges of working in the developing world. We like to say "one-size-does-not-fit-all" in global health. For instance, one of our research grantees was part of a team that recently discovered male circumcision can significantly decrease HIV transmission. That has the potential to prevent millions of deaths across Africa. But how should that knowledge be applied? What are the cultural beliefs and practices that will need to be considered in each community? These are the kinds of questions that must be studied.

Q: How can people make a difference?

A: It used to be common practice for U.S. scientists to "parachute" into a community in the developing world, gather a few samples from people who were suffering from an infection, and take them home to be studied in an American lab. But that doesn't do very much to create a long-term solution that will improve that population's health. At Fogarty, we've made it a priority to cultivate local research expertise. Many of the scientists around the globe who were trained through Fogarty's programs have gone on to assume leadership positions in their home countries. Our vision is a world where scientific advances are implemented equally--reducing disease, promoting health, and extending the lives of all people.