The University of Massachusetts Institute for Global Health began in 1998, set up as a tangible symbol of the university’s long-term institutional commitment to support the development of the first School of Public Health in South Africa, a project conducted in collaboration with the Medical University of South Africa (MEDUNSA) and funded by USAID. The mission of the Institute for Global Health today is to protect and promote the health of people across the globe. Founded on a commitment to building non-exploitative partnerships, the IGH seeks to reduce health disparities and improve quality of life in international settings. To achieve these goals, the IGH serves as a catalyst for initiating large-scale multi-disciplinary programs of public health health research and education.
Both self-interest and the demands of justice call for concerted action to reduce threats to population health, ranging from emerging infectious disease epidemics to the aftermath of natural disasters to the social unrest caused by hunger and the inequitable burden of disease. To this end, the IGH conducts collaborative research projects designed to develop effective programs and policies to alleviate pressing global health problems and it provides a range of educational opportunities for US and international personnel seeking advanced training in the global health issues. In an increasingly interdependent world, the IGH places special emphasis on finding integrated system solutions to health problems associated with post-colonial, post-conflict social conditions.
For more than a decade, the IGH has designed, implemented, and evaluated programs of global health research and education in Africa, China, Southeast Asia, Russia, the Middle East, the circumpolar region and South America. The IGH has been awarded funding from many sources, including USAID, UNICEF, UNFPA, ASEAN, the US Department of Education, the US National Institutes of Health, national governments, and private foundations. Currently, three research arenas in which the IGH is making distinctive contributions are in food systems, health and the environment; the epidemiological transition and chronic disease prevention; and ethnic relations in post-colonial, post-conflict societies.
Highlighting its interdisciplinary nature, the IGH is not housed within a single School or College at UMass, but reports directly to the Vice-Chancellor for Research. The IGH has 47 faculty affiliates and faculty expertise comes from all nine Schools and Colleges on campus. The IGH is also fortunate to be able to draw on a network of over 300 international alumni of the UMass School of Public Health, a fully accredited School since 1970. Our alumni provide a rich reserve of expertise and contacts in carrying forward our mission.
Health Research and Sustainable Development
As a Research One university, our faculty are primarily interested in forming international partnerships to conduct well-designed and meaningful research. The IGH focuses on addressing major problems to achieving global health equity, such as the rise of chronic, non-communicable diseases and the need for systemic interventions consistent with sustainable development. As the global burden of disease increasingly shifts towards the risks associated lifestyle behaviors, the traditional tools of medicine are no longer effective or appropriate in protecting and promoting population health. Health care systems designed to control infectious diseases are ill-equipped to implement programs and policies aimed at changing the socio-political environment and reducing risky behaviors such as smoking, excessive drinking, illicit drug use, unprotected sex, unhealthy diets and sedentary lifestyles. Promoting changes in the way people live is an inextricably moral and political issue. As such, the IGH is dedicated to promoting community-based participatory research methods that seek to maximize the participation of those affected by a problem in determining its solution. In addition, health problems cannot be resolved in isolation. While poverty and hunger continue to have the greatest impact on the lives of the world’s bottom billion, the accelerating pace of land and water depletion must be reversed to ensure the protection of the environment for future generations. The IGH specializes in research on developing food systems that promote health and protect the environment.
Program Development and Implementation
The IGH is actively involved in designing and implementing public health prevention projects across the globe, especially in building capacity to produce innovations in the delivery of health care services. In the face of the growing challenges posed by the epidemiological transition and the rise of chronic, non-communicable diseases, the IGH is a global leader in promoting the use of community-based participatory methods for tailoring programs to the local context. To develop effective prevention programs, we provide many forms of training and technical assistance, including partnerships with institutes of higher education and local NGOs; long-term technical assistance; short-term consulting services; institutional capacity building; staff training; and program planning and evaluation.
The IGH has extensive experience and capacity in conducting program evaluation, including formative, process, outcome and impact evaluation designs. We are committed to conducting rigorous evaluations that will improve project performance and provide accountability in demonstrating the effective use of limited resources. The IGH employs a range of best practices for engaging local stakeholders to ensure that all measures are appropriately adapted to local conditions.
The IGH has made significant contributions to establishing schools of public health in institutions of higher education internationally. Public health is distinct from medicine in its emphasis on developing programs and policies that address the needs of the community as a whole (in contrast to treating individual patients one-by-one) and by its primary orientation towards prevention, rather than disease treatment. While the UMass School of Public Health offers international students many opportunities to attend, the IGH takes educational programs to the field. We provide educational training programs in a variety of formats, from short courses, to full semester courses, to 2-4 week multi-course institutes, to co-teaching to distance learning.
The IGH is dedicated to engaging local academic and practice partners in co-developing curricula, appropriately adapted to priority health conditions and resources while maintaining international standards in quality of education. The IGH stresses the introduction and integration of public health programs under the broad umbrella of sustainable development, highlighting the inter-dependence of the health sector with economic development, literacy and education, nutrition and food production, and environmental protection. Faculty and staff affiliated with the Institute recognize that a curriculum is more than a list of courses and seek to introduce innovations in teaching methodologies through experiential short courses, dual degree programs, on-line courses, workshops, symposia, and other types of trainings.
Community-Based Participatory Research: CBPR is a philosophical orientation to research that aims at maximum feasible participation of community members in all phases of the research. CBPR thus builds community capacity to design and implement comprehensive, community-based public health prevention programs. In addition, the use of community-based participatory research aims to strengthen civil society by engaging members of various public institutions (e.g., universities and hospitals) and private non-profit organizations (e.g., Women’s Groups, chambers of commerce, religious groups) in advocating for better health policies and programs. The CBPR methodology thus fulfills three key purposes: (1) it demonstrates respect for community autonomy, by assuring that community members approve of the project goals and find the methods acceptable; (2) it elicits ideas from community members for more effective health interventions; and, (3) it strengthens the capacities of participants to gain control over the conditions that affect their health (e.g., by making the policy development process more transparent). These purposes operate simultaneously in a mutually reinforcing process.
Research Ethics: Since the conduct of the controversial HIV-perinatal transmission trials in the early 1990s, debates have raged about the ethics of international health studies. That research raised serious questions about the potential for exploitation and the adequacy of present protections for participants in international health research. In response to these controversies, calls have been issued to mandate community involvement in decision-making about the conduct of health research. One key issue left unresolved by these calls is practical strategies for instituting a community oversight process with legitimate authority. Since justice demands that resources be allocated fairly, communities must have a say in determining whether scarce resources are being diverted from more pressing priorities or result in other potentially important opportunities being lost. Given the enormous power of the pharmaceutical industry and academic health research enterprise, it is critically important to establish a body with sufficient standing to set fair terms of participation and protect against the potential for exploitation. The IGH offers trainings that provide both the ethical justification for Community Advisory Boards and practical advice for forming partnerships between host communities and researchers. Steps covered include involving community partners in determining the importance of the health problem; assessing the research value; planning and overseeing the research; and integrating the study findings into the health care system.
Global Health Leadership: The start of the 21st century has brought renewed calls for health equity in confronting the disproportionate burden of disease falling on low income countries, especially Africa. Analysts point to four major challenges that must be addressed to make progress in achieving health for all: (1) chronic disease reduction; (2) HIV/AIDS; (3) emerging infectious diseases; and (4) access to proven cost-effective prevention interventions. Faced with these enormous challenges, there is growing recognition of the need for global health leadership training institutes across the globe. The IGH offers an intensive year-long training institute that includes a 17-module global health leadership curriculum structured around three central themes: (1) globalization, or the effect of the global economy on health and development; (2) health for all/reducing health disparities; and (3) the threat of rapid global spread of infectious disease.
Conflict resolution: In collaboration with the UMass Center for Peace and Violence Studies, the IGH conducts basic research on the origins of violence among ethnic groups and has developed a range of intervention programs designed to reduce ethnic tensions associated with violent eruptions. This work aims to understand why group relations become hostile and how to promote peaceful relations between groups. This program of research draws on various theoretical approaches, research methodologies, and practices to understand the factors (e.g., poverty and unequal access to resources across groups) that lead to ethnic tensions, as well as the consequences of ethnic tensions and violence for health. These investigations employ a variety of quantitative and qualitative research methodologies at different levels of analysis ranging from the individual, to cultural, to societal structures and institutions. Intervention programs focus on preventing destructive conflict and violence and addressing their negative impact on populations. Such programs range from conflict resolution workshops for leaders, to grassroots programs and school-based intervention programs, to the growing use “edutainment” in mass media programming in conflict-prone societies.
Food systems, health & the environment: The world is witnessing an unprecedented breakdown and degradation of critical ecological elements such as food systems, agriculture, water systems and energy systems resulting in an array of inter-related global challenges. Solutions to these inter-related challenges have to be integrated due to their interdependency and have to be addressed from a foundation of common scientific concepts to derive technology strategies and solutions. Some of these critical challenges include:
- Agricultural Sustainability & Soil Biology
- Food Security – Hunger & Malnutrition
- Infectious Diseases from Caloric Deficiencies
- Obesity & Metabolic Diseases from Refined Calories
- Environment & Eco-Restoration Challenges
- Sanitation & Water Challenges
- Energy Dependence on Hydrocarbons
Solutions to global agriculture, food security, health, environmental, energy and water resource challenges must be interconnected and there is an need urgent attention for overall economic and sustainable development. The most serious critical challenges in the context of development is the need to solve food security. Solutions lie in adopting concurrent and integrated approaches to develop food technology strategies for environmental sustainability of food crops and animals and preventive diet design to combat infectious and chronic diseases. Such advancement in agro food systems solutions can only emerge from concurrent innovations in education and training.
Alternatives to antibiotic resistance: Alarms over growing antibiotic resistance and the role of antimicrobials in animal husbandry have sounded for more than a decade. Both the WHO and CDC have issued reports proclaiming the need to prevent antibiotic resistance in agriculture and veterinary medicine and they have published guidelines seeking to reduce the use of antibiotics in animal husbandry. In North America and Europe, 50% of all antimicrobial administration (by weight) is used on food-producing animals and poultry. In 2000, 17.8 million pounds of antimicrobials were administered to animals in the US alone. According to a 1999 report by the National Academy of Sciences, nearly 100% of chickens and turkeys in the US were fed rations medicated with antimicrobials. To slow the development of resistance, some countries, notably Sweden in 1986 and Denmark in 1999, have restricted antimicrobial use in feed. Several experiments have demonstrated that prevention of Salmonella colonization in chickens can be achieved by feeding them phytochemicals. These effects may be achieved by direct antimicrobial activity or by selectively stimulating the growth of one or more bacterial species already resident in the colon, thus improving host immunity. For many years now, the IGH has been conducting a line of research designed to demonstrate the health benefits and economic value of select botanicals used in traditional medicines as a substitute for use in animal husbandry to reduce the over-reliance on antibiotics in feed supplementation.
Select Current Projects
Russia: Comprehensive Community-Based Public Health Prevention Project in Pskov, Russia. The goals of the Comprehensive Community-Based Public Health Prevention Project in Pskov, Russia are: (1) to improve reproductive health outcomes, by reducing high rates of abortion and STIs, by increasing use of protective contraceptive methods; and (2) to increase life expectancy and improve quality of life, by reducing high rates of diabetes and stroke, by implementing community-based health promotion activities focusing on improving dietary and physical activities and reducing smoking and alcohol consumption, in Pskov, Russia.
China: Reducing exposure to antibiotics and synthetic hormones in the food supply by use of Traditional Chinese Medicines in animal husbandry. The goal of this project is to identify botanicals used in Traditional Chinese Medicine (TCM) that can replace or reduce the overuse of antibiotics and synthetic hormones as feed supplements in animal husbandry. The results of this research are intended to address growing concerns about antibiotic resistance in livestock, and to benefit human health by reducing the presence of antibiotics and hormones in the global food supply and replacing them with potentially more beneficial botanical products. This research also seeks to demonstrate the economic viability of protecting small farms from development and to promote the protection of bio-diverse environments. Another research objective is to advance the science of standardization of TCM preparations through the use of powdering technologies. The research is being conducted in collaboration with Tsinghua University in Beijing and Shandong Agricultural University in Tai’an, China.
Iran: Collaborations in Health Promotion in Tabriz, Iran. The goal of this project is to foster collaborative ties between health researchers in Iran and the US. The project has four components. The first component focuses on developing and evaluating community-based approaches to outpatient diabetes management. The second project focuses on abating arsenic contamination in local water supplies. The third project addresses issues in women’s health, focusing in particular on community-based approaches to improving quality of life for women going through menopause. The fourth component provides trainings in global health leadership and conflict resolution to staff at the National Public Health Management Center. This research is being conducted in collaboration with Tabriz University of Medical Sciences (TUMS).
South Africa: South African AIDS Vaccine Initiative (SAAVI): Research on Community Readiness and the Role of Community Advisory Boards. The goals of this research are: to assess the extent to which community members are adequately prepared to make informed decisions about whether they want to participate in new experimental HIV vaccine prevention trials; and to examine the role of Community Advisory in insuring that adequate protection are in place. Since the conduct of the controversial HIV-perinatal transmission trials in the early 1990s, debates have raged about the ethics of international health studies. In response to these controversies, a number of bioethicists have recently issued calls to mandate community involvement in decision-making about the conduct of health research. One major concern raised by these analyses is whether Research Ethics Committee (REC) reviews and individual informed consent provide sufficient ethical safeguards in all contexts. To advance the development of sound context-appropriate ethical standards, the purpose of this research is to develop a principled justification for the ethical assessment of international health research protocols by community representatives and to make practical recommendations regarding a feasible process for achieving community oversight. This research is being conducted in collaboration with the Medical Research Council in South Africa.
Afghanistan: In collaboration with the UMass Center for International Education, the UMass Institute for Global Health is participating in a $5.4 million project funded by US AID to improve the quality of medical education and establish the first School of Public Health in Afghanistan. The Higher Education Project – Medical Education (HEP-ME) was initiated in July 2009. Project partners include the Institute for Global Health; the University of Nebraska Medical Center; Indiana University; the Academy for Educational Development; and the UMass Center for International Education. The HEP-ME project has six major components: (1) creating a new MPH degree program; (2) revising existing public health courses in the undergraduate medical education program; (3) improving clinical rotations for medical students; (4) building capacity in English as a Second Language; (5) building capacity in informational technologies, and (6) institutional development.