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    Global health threats require collaboration, innovation

    New and emerging health threats, as well as the increased politicization of public health, will require global health leaders to head a coordinated response that puts equity and scientific evidence at its center.

    Michael Good, MD, CEO of University of Utah Health, facilitates a discussion of innovative models of academic health centers at the AAHCI Global Innovation Forum in Washington, D.C., April 12.
    Michael Good, MD, CEO of University of Utah Health, facilitates a discussion of innovative models of academic health centers at the AAHCI Global Innovation Forum in Washington, D.C., April 12.
    Photo credit: Richard Greenhouse

    Climate change. Staffing shortages. Health misinformation.

    The war in Ukraine. A volatile political and economic climate. The reemergence of infectious diseases including tuberculosis and poliovirus.

    These are just a few of the more pressing challenges identified by global health leaders during four days of joint meetings in Washington, D.C., April 12-16. The Alliance of Academic Health Centers International (AAHCI) Global Innovation Forum, the World Health Summit Regional Meeting, and the Consortium of Universities for Global Health brought together academic, political, and private sector leaders from across the globe for robust discourse on new and emerging health threats, as well as innovative solutions and partnerships to address them.

    “Knowledge is something that can be gained when you are by yourself or when you are with others in small or large groups,” Steven Kanter, MD, executive director of the AAHCI, told attendees at the Global Innovation Forum on April 12. “Wisdom really is best developed in the context of real experiences with other people, especially a coming together of a group of professionals like this meeting.”

    Below are a few highlights from the joint meetings, which drew hundreds of participants and speakers in person, as well as thousands more virtually, from Africa, Europe, the Middle East, North and South America, and Asia.

    Intrinsic and extrinsic factors affecting academic medicine

    Heyo Kroemer, MD, PhD, CEO of Charité Universitätsmedizin Berlin, one of the largest academic health centers in Europe, kicked off the AAHCI meeting with a discussion of three intrinsic and four extrinsic factors affecting academic medicine.

    Within medicine, scientific advances can dramatically enhance patient care, said Kroemer, pointing to Victoria Gray, a U.S. patient who suffered from debilitating sickle-cell disease until treated with CRISPR gene editing. “She’s now 37, she’s a mother of four, and she’s back to work. … This huge innovation is driven by academic medicine.”

    Still, huge populations in Africa suffer from the same painful genetic condition without similar opportunities for care. “There obviously are problems in ethics and access. This is something we really need to think about.”

    Also key to the future of global health are digitalization and the use of artificial intelligence. Patients already can be diagnosed with atrial fibrillation by a smartwatch rather than a hospital team, and other examples of the merging of the tech industry with medicine abound.

    But Kroemer raised the question of who drives the process. “We’ve seen this before. Tesla had no experience in creating cars, and now they are one of the leaders in the car industry,” he said. “Will we see a Tesla-ization of medicine?”

    Meanwhile, many of the challenges facing academic medicine stem from far beyond its walls.

    Among those challenges are massive demographic shifts. “Population aging is poised to become one of the most significant social transformations of the 21st century,” said Kroemer, quoting a United Nations document.

    All those aging individuals will need health care, and many institutions are already struggling with severe provider shortages. “Every medical institution in the world has to think about how we get the necessary human resources in the next 10 to 15 years,” he said.

    Keeping people healthy can help address such workforce shortfalls. A key way to do that is through personalized prevention that empowers people to boost their own health.

    Keeping people healthy can also mitigate another major challenge: the world’s climate crisis.

    “It’s not very well known that in industrialized nations, health care systems account for about 10% of national emissions. So we have a responsibility,” he said. “Lean service delivery … and low-carbon alternatives are a couple of things every one of us can do.”

    In addition to workforce shortages and climate concerns, academic institutions are grappling with other significant issues such as the effects of the war in Ukraine and the continuing fallout from the COVID-19 pandemic.

    During the height of the pandemic, Kroemer’s institution was responsible for treating high numbers of severely ill patients. Leaders there managed largely thanks to collaboration with other academic hospitals throughout Germany. Now, Charité and other leading hospitals across Europe are teaming up to address a range of post-COVID issues, from staffing challenges to providing clinical care.

    Kroemer emphasized the centrality of shared knowledge and expertise in addressing the world’s most significant health challenges. “I am convinced that we will survive the future of the next 20 years only in networks and collaborations,” he said.

    Innovation saves lives

    Global health leaders also discussed the need to embrace new and innovative models of providing health care.

    Harold Paz, MD, executive vice president for health sciences and CEO of Stony Brook University Medicine, noted that his institution has moved 1,400 doctors out of the hospital and into community-based centers, aiming to “drive care into the local community and do so in ways that leverage social, behavioral, and environmental determinants of health to create this curated health experience for individuals, a personalized health experience beginning in the home.”

    Steven D. Shapiro, MD, senior vice president for health affairs at Keck Medicine of the University of Southern California, remarked on the rapid growth of telemedicine during the COVID-19 pandemic, which refocused care away from the hospital and into the community — specifically, into people’s homes. “We saw that we really can do much more for our patients in their homes. But we also found that we really do need our hospitals to take care of our sickest patients.”

    University of Central Florida College of Medicine Dean Deborah German, MD, shared her institution’s innovative response to a high incidence of falls. Upon admission, each patient would undergo an assessment of their fall risk, including neurological factors and previous fall history. If a patient earned a certain score, they would be given red socks to wear instead of the more ubiquitous yellow socks, and staff were asked to provide extra assistance to those patients. “Everyone was on the lookout for the ruby slippers,” German says. “Our fall data dropped to almost zero. It was an amazing, amazing accomplishment. It’s an example of the care team using data to implement a change that drastically changed the results in our hospital.”

    Other innovative efforts involve partnering with patients themselves to improve health. “We want to move from paternalism to partnership,” said Salman Yousuf Guraya, FRCS, professor of surgery and vice dean of the College of Medicine at the University of Sharjah in the United Arab Emirates. “We have to discuss the management plan. Otherwise, it’s not going to work. It’s going to work for me but not for the patient.”

    On the research front, collaboration across institutions globally is critical for identifying new and emerging health threats, and for improving health, said Peter Kilmarx, MD, acting director of the Fogarty International Center at the National Institutes of Health (NIH). To that end, 35% of NIH-funded publications in 2017 had a non-U.S.-affiliated co-author, and every NIH agency funds international work.

    In the future, Kilmarx hopes even more research will originate in countries other than the United States. “U.S. investigators who go to foreign countries and say ‘Here’s the protocol, do you want to partner with me?’ is very different from when we can fund a foreign investigator directly and let that person be the intellectual leader.”

    Global health in a political world

    If innovation and collaboration are increasingly important to improve global health, they also become more difficult to achieve in an increasingly divided political environment.

    Trust in governments, institutions, and the value of public health interventions eroded dramatically during the COVID-19 pandemic, not just in the United States but across the globe, said Dr. Axel Radlach Pries, president of the World Health Summit. “We need something like globalization 2.0, which should be based on a vision which is shared by everyone: Healthy life on a healthy planet. And we need inclusive policies to work toward that based on mutual respect for individual approaches.”

    That focus on inclusivity should start with the recognition of the deep disparities in health and health care access that have long plagued some communities, said Loyce Pace, MPH, assistant secretary for global affairs for the U.S. Department of Health and Human Services, and “ensuring that all people, no matter who they are, have access to health and well-being.”

    Indeed, putting “equity at the heart of all policies” could help to regain society’s trust, said Dr. Hans Kluge, regional director for the World Health Organization Regional Office for Europe. “We need to stand very strong on the principles of solidarity, universality, and equity.”

    The global health community must also refocus, in a post-pandemic world, on other global health priorities, including tuberculosis, HIV, and sexually transmitted diseases, all of which have seen a resurgence in the last few years, said Kluge.

    Depoliticizing the response to these health threats, as well as to reproductive rights, will require global health leaders to focus on the scientific evidence, and to form transatlantic partnerships to bolster their work.

    “The politicization of health care … is scary but it’s also an opportunity to join forces,” said Pace, who reminded attendees of past controversies in global health, including treatment for HIV, and vaccines for measles and polio. “We do have examples where we have pushed through. We can do it again because we have done it before.”