www.ucl.ac.uk/global-health
LONDON’S GLOBAL UNIVERSITY
global-health@ucl.ac.uk
@UCLGlobalHealth on twitter
THE GRAND
CHALLENGE OF
GLOBAL HEALTH
10 /11
THE UCL
GRAND CHALLENGES
UCL – London’s global university – has the opportunity
and the obligation to address the major problems
facing the world.
Across the breadth of academic disciplines – from
neuroscience to urban planning, from security to health
informatics and environmental law – our world-leading
researchers apply their insight, creativity and daring
to the planet’s major intellectual, cultural, scientific,
economic, environmental and medical challenges.
We can only address major challenges by harnessing
our collective expertise, by working across and beyond
traditional disciplines. Profound outcomes result from
great minds acting in combination. Bringing together
differing perspectives, understandings and procedures
generates novel solutions.
The world’s most pressing problems are complex
and systemic. Their resolution requires partnership
transcending the boundaries between disciplines.
WHY UCL?
We have identified areas in which new interdisciplinary
partnerships can thrive, and where UCL’s critical
mass will deliver novel achievements. We call these
the Grand Challenges. They are global in significance
and will draw on the complete scope of our expertise.
Our initial Grand Challenges are:
Global Health
Sustainable Cities
Intercultural Interaction
Human Wellbeing.
We are positioning ourselves to build on our
contribution to these objectives. We are forming
alliances and collaborations, across multiple
disciplines, focused on issues of global significance.
We are removing internal barriers to interdisciplinary
collaboration. We are establishing mechanisms
whereby our expertise and analysis of these
challenges can be brought into forums to engage
funding agencies, opinion formers, legislators
and the public.
External engagement is central to our vision. We invite
you to deploy your own expertise and objectives in
partnership with ours; simply because together we
can transform the world.
UCL is London’s leading multidisciplinary
university, with 8,000 staff and 22,000 students
from more than 140 countries.
UCL is one of the world’s leading universities
(rated fourth in the QS World University Rankings
2010), is the best UK university for health research
(according to the Department of Health) and 11th
in the world for medicine (according to the
Shanghai Jiao Tong University Rankings 2010).
Focused on the translation of research into
solutions to the world’s major problems, UCL works
across the disciplines and with partners all over
the world. Current activities include leading the
search for an HIV vaccine to developing the clinical
use of stem cells in heart disease, blindness and
spinal cord repair.
UCL is Europe’s second most productive
partnership for biomedical science research
(according to the Partnership for Science &
Technology Studies), which accounts for 65%
of all university activity.
Design studiospecial.com
Professor David Price
UCL Vice-Provost (Research)
In the 2008 Research Assessment Exercise, UCL
was rated the best research university in London,
and third in the UK overall, for the number of its
submissions which were of ‘world-leading quality’.
A study sponsored by the Department of Health into
health research found that, between 1995 and 2001,
UCL produced more highly cited papers than any
other university in the UK – over 1,000 more than
the university in second place, Oxford.
21 Nobel Prize winners have worked or studied at
UCL. These include Professor Francis Crick, who
co-determined the structure of DNA, and more recently
Sir Martin Evans in 2007, for discovering the principles
for introducing specific gene modifications in mice
through embryonic stem cells.
UCL Partners – the new academic health science
partnership comprising UCL, Great Ormond Street
Hospital for Children NHS Trust, Moorfields Eye
Hospital NHS Foundation Trust, the Royal Free
Hampstead NHS Trust and University College London
Hospitals NHS Foundation Trust – forms the largest
centre for biomedical research in Europe.
INSIDE
GLOBAL HEALTH
02
THE GRAND CHALLENGE
OF GLOBAL HEALTH
03 – 05
THE UCL INSTITUTE
FOR GLOBAL HEALTH
06 – 25
GLOBAL HEALTH AT UCL
06 – 08 / Climate Change & Health
09 – 11 / Vulnerable Populations
12 – 13 / Social Determinants of Health
14 – 15 / Non-Communicable Diseases
16 – 18 / Infectious Diseases
19 – 20 / Governance, Rights & Justice
21 – 23 / Education, Engagement & Capacity-Building
24 – 25 / Student Activity
26
INDIVIDUAL ACHIEVEMENT
27 – 31
EVENTS
32
DIRECTORS, STAFF,
THEME LEADERS AND
ADVISORY BOARD
01
THE GRAND
CHALLENGE OF
GLOBAL HEALTH
UCL’s Research Strategy defines Grand Challenges:
those areas in which we facilitate cross-disciplinary
interaction – within and beyond UCL – and apply
our collective strengths to overcome problems of
global significance.
Billions of us lack access to adequate food, water,
sanitation, medicine and education. Unnecessary
suffering prevails, despite the breakthroughs in
medical sciences that have made it possible to
prevent, contain, manage and eliminate much disease.
Solutions to a range of health problems around the
world are within our grasp, yet societal and natural
forces conspire to prolong and extend the disease
burdens of huge numbers of our fellow humans.
Applied through the Grand Challenge of Global
Health, UCL’s intellectual resources – the
understanding of these societal and natural forces,
in partnership with biomedical expertise – provide
both our opportunity and our obligation to contribute
to the achievement of equity in global health.
Our potential
Transcendent partnerships
UCL has a strong international profile in the major
disciplines that are key to addressing barriers to
sustainable improvement of global health. These
include anthropology, development planning, political
science, built environment, law, climatology, human
rights, economics and biomedicine.
Significant outcomes result from these great minds
acting in combination. Bringing together differing
perspectives, understandings and procedures
produces novel solutions.
Within and beyond those disciplines perceived
as central to the issue of global health are many
thousands of expert individuals, working at the
very forefront of their disciplines – from philosophy
to transport studies, computer science to gender
studies, environmental engineering to security science.
Much of this work is not explicitly ‘global’ or ‘health’ in
nature. It all, however, has a role to play in addressing
the Grand Challenge of Global Health.
02
Global health problems are complex and systemic.
Their resolution requires partnership transcending the
boundaries between disciplines. The UCL Institute for
Global Health is the mechanism through which such
partnerships are being achieved.
THE UCL INSTITUTE
FOR GLOBAL HEALTH
The cross-fertilisation of our expertise in global health
is coordinated through the UCL Institute for Global
Health, directed by Professor Anthony Costello
(UCL Centre for International Health & Development)
and Professor Anne Johnson (UCL Population Health),
and coordinated by Sarah Ball and Susan Crane.
The institute is developing a university-wide agenda
leading to strategies, programmes, research and
teaching to bring our combined expertise to bear
on global-health challenges.
Our activities
Within our university, the UCL Institute for Global Health is:
•initiating and enhancing discipline- and departmentspecific programmes, research and teaching
•stimulating cross-disciplinary discourse and intellectual
debate across the university
•enabling the development of activity to make possible
effective large-scale cross-disciplinary approaches
and interventions.
Image: Teddy Tun Win Hla, UCLU Photo Society
If you would like to get involved, find out more or
contact us, please visit the UCL Institute for Global
Health website (www.ucl.ac.uk/global-health).
Beyond UCL, we are:
•creating real and virtual spaces for academic
discourse, in the public-policy arena and global
political processes
•exploring partnerships with a wide variety of
stakeholders, including representatives of state and
non-state agencies, funding bodies, civil society
and others with whom we work to achieve common
goals for research, education, advocacy and
public-policy initiatives
•positioning UCL as a key informant to governments,
business and the community about matters relating
to global health
•developing the provision of UCL’s intellectual capital
through consultancy and project portfolios.
03
Image: Teddy Tun Win Hla, UCLU Photo Society
Our research
Our research aims to overcome the barriers to
achieving health for everyone in the world. To do so,
we believe that it must be conducted according to
the following principles.
Our method is holistic. We unite our broad range of
academic disciplines to focus on global health, from
basic science and the development of novel
interventions, through clinical evaluation to technology
transfer and implementation at scale.
Our efforts are evidence-based. Our research
programmes measure key outcomes to demonstrate
improvements in health and reductions of
mortality rates.
Our approach is collaborative. We build on networks
with leading overseas institutions, policymakers and
practitioners, and with local teams in resource-poor
settings, in order to foster innovative, relevant solutions
to partner countries’ particular experiences of global
health problems.
Our work is action-oriented. Good research leads
to the identification and development of effective
technological, educational and structural interventions.
We collect evidence in the real world, evaluate
interventions in communities and put our research into
practice so that it can provide practical solutions for
policymakers to implement on a large scale.
Our programmes are empowering. We support locally
led actions developed in poor communities,
strengthening their capabilities and facilitating their
engagement with governments. We aim to build global
networks of academics to promote research and
teaching capacity in the developing world.
Our activities promote equity and security. We are
responsive to the social and economic determinants
of health and recognise that the reduction of social
inequities and insecurity are essential to achieving
healthier and more harmonious populations.
Our education programmes
Our education programmes aim to enable people to
reflect on their own experience, to enhance it through
exposure to cutting-edge teaching and research, and
to apply it as part of a collaborative effort to achieve
global health for all.
As a research-led teaching university, we provide a
first-rate learning experience based upon high-quality
teaching informed by groundbreaking research with a
global perspective.
Our teaching, therefore, is conducted in accordance
with the principles underlying our research: our method
04
Professor Anthony Costello, Co-Director of the UCL Institute for Global Health
is holistic; our efforts are evidence-based; our
approach is collaborative; our work is action-oriented;
our programmes are empowering; and our activities
promote equity and security.
Global citizenship
UCL’s commitment to infuse its teaching and learning
with the theme of global citizenship is particularly
relevant to global health education.
We seek to prepare our students to respond to the
intellectual, social and personal challenges that they
will encounter throughout their lives and careers. We
wish them to engage with global citizenship, social
justice and environmental responsibility, working
seamlessly with and within a wide range of countries
and cultures.
At undergraduate level UCL offers a pioneering
intercalated BSc in International Health, which attracts
medical and other students from around the world.
Medical students may also take second- and fifth-year
elective exchanges in international public health issues.
Opportunities for graduate students include:
the MSc/Diploma in Global Health & Development;
the MSc/Diploma/Certificate in International Child
Health; the European MSc in International Health, with
more than 200 modules provided through a network of
28 European partner institutions; the University of
Image: Matt Clayton
Image: Teddy Tun Win Hla, UCLU Photo Society
London MSc/Diploma/Certificate in International
Primary Health Care; the MSc/Diploma in Health &
Society: Social Epidemiology; and a variety of taster
and short courses.
UCL graduates include students from almost
140 countries and from a variety of professional
backgrounds, including healthcare workers, health
managers, medical doctors, nurses, researchers and
non-governmental organisation workers. This increases
the capacity for students to learn from each other’s
skills, experiences and perspectives.
Beyond biomedicine
Beyond the biomedical sciences our taught and
research degree programmes impact on global health.
They include:
•medical anthropology (UCL Anthropology)
Professor Anne Johnson, Co-Director of the UCL Institute for Global Health
•biochemical engineering (UCL Biochemical
Engineering)
•earthquake engineering with disaster management
(UCL Civil, Environmental & Geomatic Engineering)
•environmental systems engineering (UCL Civil,
Environmental & Geomatic Engineering)
•environmental and sustainable development
(UCL Development Planning Unit)
•social development practice (UCL Development
Planning Unit)
•economics of development (UCL Economics)
•global migration (UCL Geography)
•globalisation (UCL Geography)
•history, 1500 AD – present (UCL History)
In education, as in research, major developments
can occur when the expertise and perspectives of
different academic disciplines are brought together.
One exemplary initiative is the UCL MSc in Global
Health & Development, which brings together
UCL education relating to global health. In doing so,
it offers a unique, cross-disciplinary perspective on
global health – drawing on partnerships between
biomedicine, the social sciences and the humanities.
•gender studies (UCL Centre for Intercultural Studies)
The programme aims to empower students to affect
change, through the combination of theoretical
insight with practical relevance. It equips them
with an advanced analytical ‘tool kit’ to conduct
independent applied research. They are able to
criticise the main theories, approaches, research,
policy and practice in global health.
•environmental law and policy (UCL Laws)
To find out more, see our website (www.ucl.ac.uk/ghd).
•science, technology, medicine and society
(UCL/Imperial College London Centre for the History
of Science, Medicine & Technology)
•archives and records management (UCL
Information Studies)
•global justice and health (UCL Philosophy)
•human rights (UCL Political Science)
•international public policy (UCL Political Science)
•urban studies (UCL Urban Laboratory).
Our public engagement
Our public engagement programmes include the
annual UCL–Lancet Lecture, coordinated by the
UCL Centre for International Health & Development,
the UCL Institute for Global Health Symposia series
and many other global health events (see page 27).
05
Reducing the adverse effects of climate change
requires three levels of action: policies must be
adopted to reduce carbon emissions; it is vital to
act on pathways that connect climate change and
adverse health; and it is necessary to put in place
appropriate systems of public health to deal with
adverse outcomes.
Examples of our engagement with the health effects
of climate change during 2010:
Evidence The UK’s first International Policy
Symposium dedicated to analysing the links
into
between population dynamics and climate
Policy
change was held. It was convened by the
UK-based Population & Sustainability Network, the
British Medical Association, the Africa office of Partners
in Population & Development and the Commonwealth
Medical Association Trust, co-sponsored by UCL,
the London School of Hygiene & Tropical Medicine,
Marie Stopes International, the International Planned
Parenthood Federation, US-based Population Action
International and the UK All-Party Parliamentary Group
on Population, Reproductive Health & Development.
This event brought together climate change and sexual
and reproductive health and rights advocates,
scientists and opinion leaders from throughout the
world, together with UK political leaders, to assess
commonalities and take forward the Copenhagen
agenda in ways which include academically rigorous
strategies for linking population with climate change
in the policies and programmes that will shape the
21st century’s response to climate change. Speakers
included Professor Anthony Costello (UCL Institute
for Global Health).
06
Professor Judith Stephenson (UCL Institute for
Women’s Health) collaborated with colleagues at the
London School of Hygiene & Tropical Medicine and
the Population & Sustainability Network to highlight
and review the links between population dynamics
and climate change in the Journal of Public Health.
Population dynamics have not been integrated
systematically into climate change science, and
the contribution of population growth, migration,
urbanisation, ageing and household composition to
climate change mitigation and adaptation programmes
needs urgent investigation. World population is
projected to reach 9.1 billion by 2050, with most of
this growth taking place in developing countries.
While the principal cause of climate change is high
consumption in developed countries, its impact will
be greatest on people in the developing world.
Evidence On Health Day at COP16 – the United
Nations Climate Change Conference
into
in Cancún, Mexico – delegates and
Policy
negotiators were briefed by Professor
Hugh Montgomery (UCL Medicine). A paper based
on the report of the 2009 UCL–Lancet Commission on
Managing the Health Effects of Climate Change – and
endorsed by the Climate & Health Council, Health Care
Without Harm and the Health & Environment Alliance
– was distributed by members of the International
Federation of Medical Students’ Associations.
Image: World Bank / Yuri Kozyrev
Climate change is the most significant global-health
threat of the 21st century. The scale and complexity
of the problem demands an urgent, integrated and
multidisciplinary approach.
Image: Mr Antonio Silva, UCL Anthropology
CLIMATE CHANGE
& HEALTH
Image: World Bank / Yuri Kozyrev
Professor Mike Davies (UCL Bartlett School of Graduate
Studies) and colleagues highlighted that during a hot
period in London, more than 40% of monitored
bedrooms failed the recommended overheating criteria
during the night time. There was some indication that
purpose-built flats were more prone to overheating.
There is potential to use such data as the basis of
a heat-related health-risk epidemiological model for
London, to help health policymakers to target the most
vulnerable building types and areas. Climate change
presents potential increased threats to the comfort and
health of urban populations as a result of higher
summer temperatures.
A two-day workshop was held on dry sanitation,
convened by Dr Barbara Penner (UCL Bartlett School
of Architecture) and Dr Sarah Bell (UCL Civil,
Environmental & Geomatic Engineering), the civil
society organisation Umphilo waManzi, the University
of KwaZulu-Natal, eThekwini Water & Sanitation
and other South African bodies. It examined
eThekwini’s experience of installing more than 90,000
urine-diverting toilets as part of a strategy to improve
sanitation provision in peri-urban and rural areas,
with the aim of informing future engagements with
sanitation issues.
Image: Mr Antonio Silva, UCL Anthropology
Since the 19th century the export of the West’s public
health engineering model has led to a global preference
for water-borne sanitation, even in situations where it
is not economically or ecologically viable or culturally
appropriate. Given climate change’s stress on the
world’s water resources, there is considerable potential
that in future this dry sanitation technology will be
transferred to other African municipalities, other
developing countries and even developed countries.
A farmer and her herd
Evidence As part of the World Health Organization
(WHO) Global Health Histories Seminar
into
series, Dr Colin Summerhayes (Executive
Policy
Director of the Scientific Committee on
Antarctic Research) and Dr Maria Neira (WHO Director
of Public Health & Environment) presented Climate
Change & Health: The evidence, at WHO headquarters
and to a large online audience. Co-organised by the
Wellcome Trust Centre for the History of Medicine at
UCL and the Department of Knowledge Management
& Sharing at WHO headquarters, this series continues
the now established goal of bringing policy designers,
managers and academics involved in health research
on to the same platform.
07
A discussion meeting, Communicating Climate Risk and
the Implications for Food Security – Looking to COP16
and beyond, marked the run-up to the 2010 United
Nations Climate Change Conference (COP16) in
Cancún, Mexico, and was hosted by the UCL Institute
for Risk & Disaster Reduction, the UCL Institute for
Global Health and the UCL Environment Institute, in
collaboration with the Humanitarian Futures Programme
at King’s College London and the Advisory Committee
on Protection of the Sea. Presentations and a debate
were led by a panel of experts including Professor Lord
Julian Hunt (UCL Earth Sciences), Professor Anthony
Costello (UCL Institute for Global Health), Emma Visman
(King’s College London) and Elsie Owusu (JustGhana).
UCL co-hosted a two-day climate change conference
in Hong Kong, which brought together academics and
practitioners from around the world, including India,
China, Australia and Singapore. The keynote speech
was delivered by Edward Yau, Hong Kong’s Secretary
of State for the Environment, and four speakers from
UCL contributed: Ian Havercroft (UCL Centre for Law
& the Environment) on the law and science interface in
relation to carbon capture and storage; Professor
Catherine Redgwell (UCL Laws) on geo-engineering;
Professor Joanne Scott (UCL Centre for Law &
Governance in Europe) on multi-level governance of
climate change, with a focus on the European Union;
and Professor Mark Tewdwr-Jones (UCL Bartlett School
of Planning) on sustainable development in London and
Hong Kong. The conference will lead to the publication
of a special issue of Carbon and Climate Law Review.
08
Image: World Bank / Julio Etchart
Evidence Dr Richard Taylor (UCL Geography) was
awarded UK Department for International
into
Development funding to improve
Policy
understanding of the resilience of African
groundwater to climate change and links to livelihoods.
The project will develop policy recommendations for
assessing how groundwater can support adaptation
and build resilience to climate change. Groundwater
provides most of the domestic water in rural Africa and
supports poverty reduction through irrigation. Reliance
on groundwater is likely to increase as rainfall becomes
more variable and demand for water becomes greater.
Image: World Bank / Julio Etchart
VULNERABLE
POPULATIONS
Our key concerns are to generate knowledge about
at-risk communities and individuals, and to ensure
that interventions have a measurable impact on the
health and wellbeing of populations.
In countless areas – from maternal and child health
to disability, and from family planning to malnutrition
– we are intent on identifying workable solutions and
rolling out those with impact.
Examples of our engagement with the health of
vulnerable populations during 2010:
Evidence Professor Nora Groce (Leonard Cheshire
Disability & Inclusive Development Centre
into
at UCL) spoke at two major panel
Policy
discussions to mark the International Day
of Persons with Disabilities. The first was at the United
Nations (UN), co-sponsored by UNAIDS (the joint UN
Programme on HIV/AIDS) and the UN Department of
Social & Economic Affairs. The second, at the US State
Department, focused on disability and AIDS.
UCL hosted an exhibition of photographs chronicling
the university’s involvement in a project to improve
mother and child health in rural Africa. The UCL Centre
for International Health & Development established
the MaiMwana Project in Malawi in 2002. It aims to
reduce mother and child mortality and morbidity by
mobilising women’s groups in local communities to take
control of their own health issues. Through a UCL
Beacon Bursary, awarded to Mikey Rosato (UCL Centre
for International Health & Development), these groups
have used disposable cameras to document the impact
the project is having on their lives.
Evidence Dr Maria Kett (Leonard Cheshire Disability
& Inclusive Development Centre at UCL)
into
worked with the United Nations Mission in
Policy
Liberia to provide technical expertise on
disability and inclusive development to the Disability
& Human Rights Task Force, comprising government
ministries, NGOs, disabled people’s organisations and
UN agencies – with the aim of developing a National
Disability Strategy for the country, which is slowly
recovering from decades of violent conflict.
The inaugural five-year review of the UCL Elizabeth
Garrett Anderson Institute for Women’s Health (IfWH),
conducted by an international panel of experts, found
that the IfWH is starting to rival the best European
institutions of its kind. The independent reviewing
panel praised the institute as unique in the UK, and
for producing research of international standing.
During its first five years, the IfWH has been at the
heart of a number of groundbreaking projects, such
as: trialling the first-ever ovarian cancer screening
programme in the UK; finding new evidence to suggest
that cancer is a stem cell disease; research into cooling
to prevent adverse outcomes from asphyxia in babies
and rolling out a global health programme, which
includes the Ugandan Women’s Health Initiative.
09
Professor Nora Groce (Leonard Cheshire Disability
& Inclusive Development Centre at UCL) was awarded
a grant from the International Labour Organization to
conduct a pilot study into the status of persons with
disability who make their living in whole, or in part,
by begging in Ethiopia. Professor Groce’s research
addresses the current gaps in knowledge about this
large – and largely marginalised – population. The next
phase of this work will be a larger multi-country study
of disabled street beggars.
Evidence Sugar given to newborn babies as a routine
form of pain relief does not work, according
into
to a UCL study published in The Lancet.
Policy
Instead, sucrose changes the facial
expressions of some babies giving the impression that
pain is being relieved. The finding could lead to future
changes in healthcare policy as oral sucrose is
frequently given to relieve procedural pain in newborn
babies who must undergo invasive procedures.
Dr Rebeccah Slater (UCL Neuroscience, Physiology
& Pharmacology), who led the study, said: “This is
especially important in view of the increasing evidence
that pain causes short and long-term adverse effects
of infant neurodevelopment.”
A survey of 22,000 households in Nepal was planned
to understand better the services that may be available
to disabled pregnant women, as well as identify where
there may be barriers to equal access to such services
for disabled women. The study is a collaboration
between researchers at the Leonard Cheshire Disability
& Inclusive Development Centre at UCL and the UCL
Institute of Child Health, in partnership with the
Nepalese NGO Mother & Infant Research Activities.
10
Dr Isabeau Walker (UCL Institute of Child Health) led
a cross-sectional survey of all 72 hospitals performing
major surgery in south-western Uganda, in order to
study paediatric surgery rates and determine if existing
surgical facilities and workforce met World Health
Organization (WHO) standards. The results highlight
that although 29 hospitals were performing major
surgery, none met WHO standards. Access to all
surgery, including paediatric surgery, is poor and
investment in basic healthcare facilities, the surgical
workforce and training is urgently needed.
Dr Walker is collaborating with staff in Mbarara
University Teaching Hospital to improve care of the
mothers in the obstetric unit. The focus of the project
is routine assessment and triage of mothers admitted
to the obstetric unit, the use of an early warning score
and development of a pictorial early warning score for
lay attendants. The WHO Surgical Safety Checklist and
routine handovers have been introduced for mothers
undergoing caesarean section.
A UCL Global Disability Research Group Seminar,
Humanitarian Disaster Relief: Disability and the new
Sphere guidelines was held; see page 28.
The UCL Institute for Global Health held its 12th
symposium, Sex Workers: Stigma and barriers
to health; see page 27.
Image: © David Constantine / Science Photo Library
Image: © Fabio Concetta / Dreamstime
Evidence Dr Maria Kett (Leonard Cheshire Disability
& Inclusive Development Centre at UCL)
into
has been the Global Focal Point for
Policy
Disability for the revision of the Sphere
Handbook on Minimum Standards in Disaster
Response. Disability is recognised as a cross-cutting
issue in disaster response and Dr Kett has been
working across all the sectors to ensure that the
handbook’s aims – of improving the quality of
assistance to people affected by disaster and
improving the accountability of states and humanitarian
agencies to their constituents, donors and the affected
populations – are accessible and inclusive of persons
with disabilities.
Image: © Fabio Concetta / Dreamstime
Dr Zelee Hill (UCL Centre for International Health
& Development) was awarded funding by the
Bill & Melinda Gates Foundation – as part of
collaborative research with the Malaria Consortium
and the London School of Hygiene & Tropical Medicine
– to increase access to treatment for sick children
where health services are geographically and
financially inaccessible. The inSCALE project aims
to rapidly increase the impact and reach of integrated
Community Case Management in Mozambique
and Uganda by testing innovations for improved
motivation, retention and performance of community
health workers.
Evidence The World Health Organization’s
Community-Based Rehabilitation (CBR)
into
Guidelines were launched globally at
Policy
a CBR conference in Abuja, Nigeria.
Researchers in the UCL Centre for International Health
& Development contributed to the editing of this guide
to the conceptualisation and implementation of CBR
particularly in low income, remote or underserved
regions. It promotes a model of rehabilitation which
moves away from medical models of rehabilitation and
uses instead a human rights and social development
framework.
Image: © David Constantine / Science Photo Library
Dr Mary Wickenden (UCL Institute of Child Health)
is helping to develop and trial innovative monitoring
and evaluation methods to track the success of this
approach to improving the lives of disabled people.
Focus: Effectiveness of women’s community groups
Women’s community groups have had a dramatic effect
on reducing neonatal mortality rates in some of the
poorest areas in India, according to UCL research
published in The Lancet. The groups provide a
cost-effective intervention with added benefits such
as significantly reducing maternal depression and
improving decision-making among the women.
The study was subsequently named Trial of the
Year by the Society for Clinical Trials.
A previous study conducted in Nepal and published
by The Lancet in 2004 suggested that participatory
women’s groups could achieve a significant impact
on neonatal health in poorer countries, far more than
one-to-one contact with a health worker. To see if these
findings could be applied in other countries, the
researchers repeated the exercise in Jharkhand and
Orissa, two of the poorest states in eastern India.
A team led by Professor Anthony Costello and
Dr Audrey Prost (UCL Centre for International Health
& Development), and Dr Prasanta Tripathy from the
Indian voluntary organisation Ekjut, evaluated how
women’s groups affected neonatal mortality and
maternal depression in intervention areas as compared
to areas where no participatory groups were set up.
The cluster-randomised controlled trial was funded
by the Health Foundation, the UK Department for
International Development, the Wellcome Trust and
the UK Big Lottery Fund.
The effects of the interventions were dramatic: by
the second and third years of the trial, the neonatal
mortality rate in the areas where the participatory
women’s groups existed had fallen by 45%. These
areas also saw a fall of 57% in moderate depression
among mothers by the third year of the trial.
The researchers believe that improved social capital
– the access the group gave women to a wider support
network of peers – was potentially the most valuable
aspect of the groups and would have contributed
towards the improved childbirth and childcare
practices and the reduction in maternal depression.
It may also explain why such groups have had much
greater success than direct – even one-to-one –
interventions with healthcare workers.
11
SOCIAL
DETERMINANTS
OF HEALTH
The gross inequalities in health that we see within
and between countries present a challenge to the
world. The conditions in which people are born, grow,
live, work and age are at the root of much of these
inequalities in health, and these social determinants
are relevant to infectious and non-communicable
diseases alike.
Examples of our engagement with the social
determinants of health during 2010:
Dr Christopher Gerry (UCL School of Slavonic & East
European Studies) described to more than 100 UCL
alumni the important role that alcohol plays in the
cultures and societies of eastern Europe. Recalling
the richness of toasting rituals, Dr Gerry explained
the myriad complexities that make drinking and
drunkenness powerful and unavoidable aspects of
social life across the region. He explained the darker
side of the elevated position alcohol holds in eastern
Europe, citing alarming statistics that indicate that the
substance lies at the heart of the health crisis in
Russia. Alcohol misuse may be responsible for up to
one-third of all deaths occurring in the country.
Dr Jennifer Mindell (UCL Health & Social Surveys
Research Group) became the UK collaborator in an
European Union-funded European Health Examination
Survey Pilot. Building on an earlier feasibility study,
this pilot has developed standardised methods for
sampling, data collection, measurement protocols,
sample collection and analysis and data handling,
to ensure comparability of findings.
12
Image: Wellcome Photo Library / Wellcome Images
UCL’s approach to research on global health
and society is uniquely cross-disciplinary and
includes world-leading work in this area by the
UCL International Institute for Society & Health.
The prevalence of negative health and social factors in
developed nations is highest where wealth is
distributed unequally. That pattern was demonstrated
by worldwide epidemiological data presented by
Professor Richard Wilkinson (Nottingham), co-author
of The Spirit Level and co-founder of the Equality Trust.
At an event organised by the UCL Grand Challenge
of Human Wellbeing, he argued that, in contrast to less
equal rich countries, more equal rich countries have
lower levels of physical and mental ill health, less
obesity, less violence and fewer teenage births.
Image: Wellcome Photo Library / Wellcome Images
Elected as President of the British Medical Association,
Professor Sir Michael Marmot (UCL Epidemiology
& Public Health) issued a rallying cry to doctors to lead
the fight against health inequalities and social injustice.
He said: “My year as president will have real meaning
if I can help encourage other doctors to be active in the
challenge to reduce avoidable inequalities in health,
not just here within Britain, but globally between
countries.” Professor Marmot told the audience that
the international community had the knowledge and
the means to address health inequalities and social
injustice, but not always the political will.
Evidence Urban water poverty has its roots not in
water scarcity but in social inequity,
into
panellists argued at Glass Half Empty?
Policy
Urban water poverty in 2010, a panel
discussion marking the mid-point of the International
Decade of Water for Life and the start of the last five
years of the Millennium Development Goals (MDGs).
Between 1990 and 2009, there had been a reduction in
the proportion of the world’s population without access
to safe water (from 23% to 13%) and sanitation (from
51% to 37%), yet 884 million people still lack access to
improved water supply and 2.5 billion people still lack
access to improved sanitation.
Urban Water Poverty, a project developed by the UCL
Grand Challenge of Sustainable Cities, will publish a
range of perspectives in a special issue of the Journal
of Urban Sustainable Development. The project was
led by Adriana Allen (UCL Development Planning Unit),
Co-Director of the UCL Urban Laboratory, and Dr Sarah
Bell (UCL Civil, Geomatic & Environmental Engineering),
Co-Director of the UCL Environment Institute.
Professor Russell Viner (UCL Institute of Child Health)
highlighted the social determinants of health in
adolescents at a joint seminar held by the UCL
International Institute for Society & Health and the UCL
Institute for Global Health. Major changes in health are
underway in many low- and middle-income countries
that are likely to bring greater focus on adolescents.
Unlike younger children, adolescents appear to have
benefitted little from the epidemiological transition.
While adolescence was previously seen as the
healthiest time of life, young people transitioning into
employment and marriage may be particularly
vulnerable to the effects of globalisation and social
and economic change.
Focus: European health inequalities
Evidence The World Health Organization European
Region (WHO EURO) published the interim
into
report of the first phase of the two-year
Policy
European Review of Social Determinants
and the Health Divide across Europe. The review’s first
phase assessed levels of inequalities in health across
the WHO EURO and identified the barriers to and
opportunities for reducing these. The review is chaired
by Professor Sir Michael Marmot (UCL Epidemiology
& Public Health).
Professor Marmot’s 2010 independent report, Fair
Society, Healthy Lives, found that although health
inequalities are normally associated with the poor,
premature illness and death affects everyone below
the wealthiest tier of English society. The review –
commissioned by the government – proposed new
ways to improve everyone’s health and reduce
inequalities that it describes as ‘unfair and unjust’.
The review also estimated the cost of health
inequalities in England, including: productivity losses of
£31–33 billion every year; lost taxes and higher welfare
payments of £20–32 billion per year; and additional
NHS healthcare costs well in excess of £5.5 billion per
year. It called for health inequalities to sit alongside
tackling climate change as one of society’s core
priorities. Creating a sustainable future is, the review
argued, compatible with action to reduce health
inequalities: sustainable local communities, active
transport, sustainable food production and zero-carbon
houses will all have health benefits across society.
Previously, Professor Marmot chaired the WHO
Commission on Social Determinants of Health.
The WHO established the commission in 2005 to
provide advice on how to reduce widening health
inequities. Its final report, published in 2008, contained
three overarching recommendations: improve daily
living conditions; tackle the inequitable distribution of
power, money and resources; and measure and
understand the problem and assess the impact of
action. In response, health ministers and senior health
officials from 192 countries agreed to: call upon the
international community to take note of the findings;
collaborate to assess the impacts of policies and
programmes on health inequalities; work together to
enhance health equity; and consider health equity as
they work toward core global development goals.
13
NON-COMMUNICABLE
DISEASES
During the last two decades there has been a
fundamental shift in global patterns of disease.
New epidemics of chronic illness are following in
the wake of rapid urbanisation and economic change,
and the epidemiological profile of poorer countries is
becoming similar to that in developed nations.
This convergence in global health creates a new
impetus to use insights gained at UCL on the
prevention and management of chronic illness for
our work across the world – especially with low-cost,
low-tech interventions in mind.
Examples of our engagement with
non-communicable diseases during 2010:
Dr David Batty (UCL Epidemiology & Public Health)
and colleagues examined associations of adult obesity
with cancer mortality in more than 400,000 participants
from Asia, Australia and New Zealand. In Asia
particularly, data are sparse on the risks of obesity.
The authors found that overweight and obese
individuals in populations across the Asia-Pacific
region have a significantly increased risk of mortality
from several types of common cancers. Strategies to
prevent individuals from becoming overweight and
obese in Asia are needed to reduce the burden of
cancer that is expected if the obesity epidemic
continues. In a separate study Dr Batty is examining
risk factors for suicide in more than one million adults in
South Korea, which has one of the highest rates of
suicide worldwide.
Professor Robert West (UCL Tobacco Research Group)
and colleagues completed a randomised controlled
trial of a compound, cytisine, to help people stop
smoking. This medication is extremely inexpensive and
may bring affordable life-saving treatment to hundreds
of millions of smokers worldwide.
14
People with poor oral hygiene have an increased risk
of heart disease compared to those who brush their
teeth twice a day, UCL research found. Led by
Professor Richard Watt (UCL Epidemiology & Public
Health), the researchers analysed data about lifestyle
behaviours such as smoking, physical activity and oral
health routines. Once the data were adjusted for
established cardio risk factors such as social class,
obesity, smoking and family history of heart disease,
the researchers found that participants who reported
less frequent toothbrushing had a 70% extra risk of
heart disease compared to individuals who brushed
their teeth twice a day, although the overall risk
remained quite low.
In a similar study, Dr David Batty (UCL Epidemiology
& Public Health) and colleagues from the George
Institute for International Health, Australia, found that
tooth loss (an indicator of major oral disease) was also
associated with an increased likelihood of heart
disease in a large group of Asian and Australasian
study participants.
The UCL Institute for Global Health held its 14th
symposium, The Global Burden of Mental Health
Disorders; see page 28.
Genetic testing was shown to provide no real help
in predicting the risk of developing type 2 diabetes
– a major risk factor for heart disease – UCL research
found. The study was led by Professor Steve
Humphries (UCL Centre for Cardiovascular Genetics)
and published in the British Medical Journal. He used
20 genetic variants with two risk prediction tools
based on age, body mass, index and family history
of diabetes. The findings questioned the benefit of
genetic direct-to-public home screening tests currently
available on the market, which claim to be able to
predict the risk of diabetes.
UCL researchers discovered a new screening method
which could be much more effective for diagnosing
cervical cancer. The research, led by Dr Daniel
Ndisang (UCL Institute of Child Health), could
significantly reduce the death rate from cervical
cancer, which accounts for about one in 10 female
cancer deaths worldwide each year. The team found
that a molecule called Brn-3a is present at high levels
in both cervical cancer and pre-cancer lesions.
Measuring this molecule would be cost effective and
could therefore help reduce the deaths from cervical
cancer across the globe.
A UCL study investigated whether pregnant women
taking food supplements other than folic acid could
reduce the risk of neural tube birth defects. Professor
Andrew Copp, Director of the UCL Institute of Child
Health, led research intended to find out whether
inositol and folic acid are more effective than folic acid
alone in preventing these birth conditions.
Professor Charles Newton (UCL Institute of Child
Health) is collaborating on cross-sectional surveys
of epilepsy in five African countries – Kenya, Tanzania,
Uganda, Ghana and South Africa – to determine the
burden and causes of epilepsy and the magnitude
of the treatment gap. Professor Newton is also
collaborating on studies of sickle cell disease to
examine the causes of the premature mortality
associated with the disease, as well as the risk factors
and consequences of neurocognitive impairment.
A pioneering breast cancer treatment device was
brought to market by Endomagnetics Ltd, a UCL
spin-out company co-founded by Professor Quentin
Pankhurst (UCL Physics & Astronomy). In nearly all
cases of breast cancer, surgery is required to remove
the tumour as well as locate and remove the sentinel
lymph nodes – by keyhole surgery – and then to inspect
them to determine whether the cancer has spread to
other sites in the body. The SentiMag device locates
the sentinel lymph through magnetism rather than by
injecting radioactive material – the conventional, but also
more expensive and painful, approach.
Globally, 1.25 million new cases of breast cancer are
diagnosed each year. With lifestyle changes, this figure
is increasing by around 20,000 cases year on year
across the developed and developing world.
Dr Mark Hamer (UCL Epidemiology & Public Health)
is collaborating with colleagues in South Africa on
the SABPA study, to examine cardiovascular disease
(CVD) risk factors in black Africans. There is an
emerging burden of CVD among urban black Africans
in South Africa, thought to be partly explained by the
transition from traditional African lifestyles to more
westernized behaviours. Research has shown that
black participants have more risk factors including
higher blood pressure, blood lipid levels and central
obesity, as well as poorer health behaviours, such
as lower physical activity levels, higher smoking
rates and alcohol abuse, compared to Caucasians.
Future public health strategies that focus on improving
lifestyle and aggressive treatment of risk factors are
urgently needed to reduce the burden of CVD in
black Africans.
Tumour detection by Endomagnetics
15
INFECTIOUS
DISEASES
The full range of disciplines from basic laboratory
science and diagnostics to clinical trials,
epidemiology, statistical and behavioural science
are all strongly represented at UCL.
Our approach is deliberately cross-disciplinary
and ranges from the biological and behavioural
determinants of transmission of infectious agents
(and the interactions between them) through large
cohort studies of the natural history of infections
and the impact of therapy, to randomised clinical
and complex intervention trials, several in
developing countries.
Examples of our engagement with tackling infectious
diseases during 2010:
A joint HIV/AIDS ‘treatment as prevention’ trial was
announced, with Professor Marie-Louise Newell –
seconded since 2006 from the UCL Institute of Child
Health to be Director of the Africa Centre for Health
& Population Studies, South Africa – as a principal
investigator. The research will be conducted by the
Africa Centre and will investigate whether widespread
HIV testing, with immediate antiretroviral therapy for all
those identified as infected, significantly reduces the
spread of HIV in their community. The French AIDS
research agency ANRS has provided €3 million for
the first phase of the study.
The HIV Research Trust awarded two scholarships
for research in UCL Infection & Population Health.
Emmanuel Nshom’s work involved comparing two
strategies for enrolling HIV-infected pregnant women
during antenatal care in Cameroon – developing links
between prevention of mother-to-child transmission
services and HIV care and treatment centres – in
collaboration with the Cameroon Baptist Convention
Health Board. Dr Xiaojie Huang used data from
the Beijing You’an PRIMO Cohort study to examine
immunological progression in primary HIV-1
infection according to early immunological and
virological parameters.
16
World TB Day was marked by UCL with a symposium,
The Challenge of Tuberculosis: UCL’s response
(see page 28), chaired by Dr Tim McHugh (UCL
Centre for Clinical Microbiology), and the publication
of an editorial in the South African Medical Journal
co-authored by Professor Alimuddin Zumla (UCL
Centre for Clinical Microbiology). The editorial reflected
on the paradoxical fact that, although effective and
cheap therapy has been available for over 60 years,
TB kills nearly 1.8 million people every year, which
equates to 5,000 people every day. The authors note
that together with HIV/AIDS and malaria, TB remains
one of the most important causes of death from
infectious diseases worldwide, and that eradicating the
disease in sub-Saharan Africa requires effective and
committed partnerships between the West and the
developing world.
In a Medical Research Council-funded study to
evaluate new biomarkers for monitoring therapy in
tuberculosis, Dr Isobel Honeyborne (UCL Centre for
Clinical Microbiology) worked with collaborators in
Durban and Cape Town to define the transcriptome
of tuberculosis and map the changes in biomarkers
during the course of treatment. The programme
provided support for the recruitment of patients and
processing of specimens, and extended the skills
range of the laboratory staff in Durban and provided
a platform for further collaborations.
The importance of a global perspective on UK
healthcare provision was acknowledged through the
adoption of Migrant Health as a theme for the
NECLES Health Innovation and Education Cluster,
of which UCL Partners – comprising UCL, the Great
Ormond Street Hospital for Children NHS Trust, the
Moorfields Eye Hospital NHS Foundation Trust, the
Royal Free Hampstead NHS Trust and UCL Hospitals
NHS Foundation Trust – is a principal member.
The increased burden of infection in many non-UK-born
populations is related to the higher prevalence of
infections in the countries from which they originate,
usually acquired before arrival in the UK. The Migrant
Health theme will develop integrated care pathways
in relation to migrant health and infectious disease,
to produce better health outcomes and responsive
service delivery through community health mapping
in North Central and North East London, and Essex.
UCL and UCH
A collaborative study between the Copenhagen HIV
Program and the UCL HIV & Biostatistics Group,
led by Professor Andrew Phillips (UCL Infection
& Population Health), looked at the differences in
quality of care and one-year mortality rates in HIV/TB
co-infected patients across Europe. Mortality at
one year was 27% in eastern Europe compared
with 7% and 9% in central/northern and southern
Europe, respectively.
Evidence A UCL-led study identified key
demographic and psychological factors that
into
may predict protective behaviours during
Policy
pandemics. Dr Alison Bish and Professor
Susan Michie (UCL Clinical, Educational & Health
Psychology) reviewed studies of how people behave
during pandemics – including Severe Acute Respiratory
Syndrome, avian influenza and swine flu – to
understand protective behaviour and to improve
interventions and communication in the future.
A lecture, Sexual Health of Sexual Minorities in
Pakistan: From analysis to action, marked Lesbian
Gay Bisexual Trans History Month; see page 28.
Nobel Laureate Professor Barry Marshall delivered the
2010 UCL Prize Lecture in Clinical Science, Past
Lessons and Future Opportunities for Helicobacter
pylori; see page 29.
The Inaugural UCL–French Embassy Conférence-Débat
was held on the topic of HIV; see page 29.
The UCL Institute for Global Health held its 16th
symposium, From 3 by 5 to 0 by 15: HIV treatment in
rural South Africa; see page 30.
The critical role of improved diagnostic technology
in the control of tuberculosis was highlighted by
two studies initiated by Professor Alimuddin Zumla,
Dr Matthew Bates and Dr Justin O’Grady (UCL Centre
for Clinical Microbiology), with colleagues at the
University of Zambia. Using a variety of new and
improved diagnostics technologies to detect TB
infection both pre and post mortem, the first involved
autopsy studies in adult and paediatric inpatients, and
of maternal deaths at the University Teaching Hospital,
Lusaka. The second study focuses on TB and TB/HIV,
and the threat of TB in prisons to the local communities.
This study is mirrored in London by TBReach, led by
Dr Andrew Hayward (UCL Infection & Population
Health), which is using these technologies to improve
detection in hard-to-reach groups, including prisoners.
17
Image: Wellcome Photo Library / Wellcome Images
Focus: Tuberculosis
Evidence Professor Alimuddin Zumla (UCL Centre for
Clinical Microbiology) launched the Lancet
into
TB Observatory, a global initiative to address
Policy
key issues around TB treatment and
diagnosis, at the World Health Organization in Geneva.
The launch coincided with publication of the Lancet TB
Series, a set of ‘state of the art’ reviews in specialist
fields, led by Professor Zumla.
A set of eight articles covered: the current status of the
epidemiology of TB; drug-resistant TB; TB diagnostics
and biomarkers; new drugs and drug regimens for TB;
new vaccines for TB; TB/HIV issues; health systems and
TB; and a call to action for governments, funders and
donor agencies. Professor Zumla said: “In the final
paper we call for a serious and sustained worldwide
effort to bring tuberculosis under control and start
targeting elimination. Strong political commitment at
both the international and national level is essential. The
call to action speaks to a wide audience, since
synergistic action is required on multiple fronts, both
inside and outside the traditional confines of TB
control.”
In order to monitor this call to action and make sure that
the pronouncements, requests and pledges made in
this series will be driving urgent policy changes, the
new Lancet TB Observatory will assess and monitor
progress in TB control and research, evaluate domestic
and global financing, regularly disseminate information
and advocate for intensified efforts with stakeholders at
all levels.
Later in 2010, in a comment piece published in The
Lancet, Professor Zumla called for recommendations
from a UK TB review to be implemented urgently to
keep this re-emerging problem under control. The
number of TB cases in London has increased by nearly
50% since 1999 and accounts for nearly 40% of all TB
cases in the UK. In all European countries TB is mainly
concentrated in high risk groups such as migrants,
refugees, homeless people, drug users, prisoners and
HIV-infected groups.
Referring to the London TB Service Review Assessment,
Professor Zumla said: “This review, if implemented by
the NHS, would allow standardisation of TB clinical
policy and practice and improve responsiveness of
London’s TB services needs. This will require a serious
political and financial investment if the tide is to be
turned against the current return of the ‘White Plague’
to London.”
18
As the sponsor of REMoxTB (a regulatory standard
international clinical trial), UCL is at the forefront of
initiatives to develop an international infrastructure to
support clinical trials in those communities most
affected by tuberculosis. REMoxTB passed the halfway
mark for recruitment (1,000 patients) and is on target to
complete recruitment by the end of 2011. Building on
the original sites in south and east Africa, new sites
were initiated in Johannesburg, Kuala Lumpur and
Bangkok. Members of the UCL Centre for Clinical
Microbiology, UCL Infection & Immunity, the UCL
Finance Division and the Joint Research Unit have
provided training and support in all aspects of the
delivery of this study.
Poor mental health accounts for considerable disease
burden among young people globally. Dr Frances
Cowan, Dr Lorraine Sherr (UCL Infection & Population
Health) and colleagues published research highlighting
high levels of psychological morbidity among rural
Zimbabwean youth, which was associated with sexual
risk taking. Interventions to prevent, identify and treat
mental health disorders in this vulnerable population
are urgently required. In HIV-endemic countries such
interventions may also help reduce HIV transmission.
The critical aspects of global health – interaction
with policymakers and professionals in developing
countries, policy development by national and
international organisations, questions of funding
and prioritisation, the social determinants of health,
education, governance and capacity-building –
all take place within a complex political, moral
and philosophical environment.
Our responses draw on collaboration between
academics, among them epidemiologists,
anthropologists, economists, psychologists,
political scientists and historians.
Our engagement within this environment is
informed by a commitment to social justice, equity
and opportunity. We promote the concepts of human
rights and justice, while improving the developed
world’s understanding of and ability to support
health priorities in the developing world.
Examples of our engagement with governance,
rights and justice during 2010:
Evidence The world’s first formal standards for the
communication of electronic health records
into
– developed by the UCL Centre for Health
Policy
Informatics & Multiprofessional Education
– were jointly published by the European Committee
for Standardization (CEN) and the International
Organization for Standardization (ISO). This standard
defines the way in which clinical applications and
electronic health record systems can communicate
patient records. It therefore helps to support shared
patient care between healthcare organisations, and
enables lifelong care to be informed by a patient’s
full history whenever and wherever they next
need healthcare.
The standard also supports information about who
should be allowed to access the data in each record,
for example to comply with national regulations and
the wishes of the patient, and enables patients to
review who has been accessing their health record.
Image: LTH NHS Trust / Science Photo Library
Image: Wellcome Photo Library / Wellcome Images
GOVERNANCE,
RIGHTS & JUSTICE
The second UCL–French Embassy Conférence-Débat
was held on the topic of development, provision of
public goods and practical norms in West Africa;
see page 31.
19
Image: © Arseny Chervonenkis / Dreamstime
Dr Basak Çali (UCL Political Science) delivered a UCL
Lunch Hour Lecture, Listening to Foreign Judges from
Far Away Places: Why the European Court of Human
Rights is a good idea, in which she discussed the
findings of a three-year Economic & Social Research
Council project studying the legitimacy and the
authority of the European Court of Human Rights, and
defended the importance of the Strasbourg Court for
the political health of European states. The project is a
comparative, cross-sectional analysis of the perception
of the European Court of Human Rights in five different
political and legal contexts to understand how the
Court’s rulings are interpreted and implemented in
the domestic setting.
Evidence A UCL team led by Dr Christopher
Gerry (UCL School of Slavonic & East
into
European Studies) found that there is no
Policy
evidence in the available data to support
previous claims that rapid economic reforms in 1990s
post-communist Europe led to the deaths of thousands.
The researchers uncovered a series of measurement
errors and shortcuts in procedures that resulted in the
unjustified claims.
Image: © Baloncici / Dreamstime
European Court of Human Rights, Strasbourg
Dr Gerry said: “It is important for policymakers in
emerging market economies, it is important for
countries seeking to understand the health problems
they face and it is important for academics,
practitioners and policymakers alike as they too seek
to understand the downstream effects of upstream
social and economic choices.”
UCL launched Mapping for Change, a social enterprise
that will support sustainable communities through
online mapping and geographical information systems.
The organisation is a partnership between Dr Muki
Haklay (UCL Civil, Environmental & Geomatic
Engineering) and the London 21 Sustainability Network,
a charity that works across Greater London to help
create a greener, healthier and more sustainable city.
Mapping for Change specialises in providing a suite of
innovative mapping tools that communities, voluntary
sector organisations, local authorities and developers
can use to communicate complicated information in a
visual format that is affordable and easy to understand.
The UCL Institute for Global Health held its 13th
symposium, Evidence-Based Decision-Making: Who’s
counting the evidence and whose evidence counts?;
see page 27.
20
EDUCATION,
ENGAGEMENT
& CAPACITY-BUILDING
UCL aims to enable people to reflect on their
own experience, to enhance it through exposure to
cutting-edge teaching and research, and to apply it
as part of a collaborative effort to achieve global
health for all.
Our engagement work connects UCL research best
practice with the efforts of other organisations by
disseminating our work and engaging with others.
Examples of our education, engagement and
capacity-building activities during 2010:
Umodzi (Together), a visual anthropology film, explored
the power of community mobilisation through women’s
groups in Mchinji District, rural Malawi, to improve
mother and child health and reduce mortality. Women,
chiefs and healthworkers discussed the transformations
in their communities brought about by community
members collaborating in more than 250 women’s
groups established by the MaiMwana Project, a
collaboration between the Malawi Ministry of Health
and the UCL Centre for International Health &
Development. The project is funded by Saving
Newborn Lives and the Wellcome Trust.
Four African Graduate Scholarships were awarded by
the UCL Centre for International Health & Development
(CIHD). The scholarships exist to support African
nationals with a high-quality academic and professional
background who wish to further develop their skills and
knowledge in their specific field through a one-year
UCL CIHD postgraduate programme.
Image: Mercy Evasoni, women’s group member, MaiMwana Project
Our capacity-building aims to engage in partnerships
to produce self-sustaining and locally focused
solutions on the ground.
Mchinji District residents
21
PhD student Aiden Sidebottom (UCL Jill Dando Institute
of Security & Crime Science) was awarded the
Transparency International Anti-Corruption Research
Network Prize at the 14th International Anti-Corruption
Conference. He studies the effective delivery of
healthcare in insecure environments – specifically,
how environmental criminology and situational crime
prevention might contribute to improving the security
and efficiency of health systems in developing
countries. The Jill Dando Fund provided support for
the creation of this PhD in Crime Science & Global
Health Scholarship.
Working with collaborators at Addis Ababa University,
Ethiopia, Professor Steve Humphries and Dr Neil
Bradman (UCL Genetics Institute) found that the extent
of genetic diversity among Ethiopia’s many different
populations exceeded initial expectations, including
the variation in genes that code for enzymes that
metabolise more than half of all prescribed drugs,
P450 proteins. Since many of the P450 enzymes are
involved in metabolising drugs used to treat, for
example, malaria and hypertension, there are clear
healthcare benefits for both the developing and
developed world, particularly given the growth of
long-range migration and urbanisation.
This work relates to the UCL Genetics Institute’s advice
to ministers in the Ethiopian government on how best
to develop local expertise and attract investment for
pharmaceutical research and development.
Postdoctoral workers ranked UCL as the top university
outside the USA in the Best Places to Work for
Postdocs Survey, run by The Scientist. UCL’s rank
among universities outside the USA was: first place
overall in the ‘Quality of Training & Mentoring’, ‘Value
of the Postdoc Experience’, ‘Funding’ and ‘Equity’
categories; and second place overall, and first place
in the UK, in the ‘Quality of Communication’ and
‘Networking Opportunities’ categories.
22
In cooperation with the Economics Department of the
European University at St Petersburg, Dr Christopher
Gerry (UCL School of Slavonic & East European
Studies) won an award to launch a three-year Global
Health Economics programme. The project, funded
through the Open Society Foundations, aims to educate
a new generation of university teachers and
researchers interested in developing a contemporary
health economics syllabus and associated research
agenda in universities in parts of the post-communist
world.
A medicinal herb spiral created in central London by
Dr Vivienne Lo (Wellcome Trust Centre for the History
of Medicine at UCL) addressed issues around the use
of food and herbs as medicine in everyday home
remedies or as dangerous substances to be regulated.
The herb spiral forms part of Dr Lo’s current project
researching the history of food as medicine in China.
Dr Lo’s work formed part of a conference on Potent
Substances: The boundaries of food and medicine,
which offered recommendations for both policy and
practice in relation to the boundaries of food and
pharmacy and drew on the interdisciplinary knowledge
of the participants. Sub-themes covered over the
three days included: Old Food and Drugs for New;
Boundaries and Expertise; and Medico-Culinary
Arts, Media and the Environment.
Image: Teddy Tun Win Hla, UCLU Photo Society
Image: © David Snyder / Dreamstime
In conjunction with the Makerere University School of
Public Health, Uganda, the Nutrition in Emergencies
Regional Training Project (NIERTP) – organised by the
UCL Centre for International Health & Development
– developed and delivered a module on Nutrition in
Emergencies within a new MSc in Public Health
Nutrition. The NIERTP works with organisations in
Asia, Africa and the Middle East to set up sustainable
training courses in emergency nutrition, providing a
combination of theoretical and hands-on training in
a wide range of issues.
Image: Teddy Tun Win Hla, UCLU Photo Society
Image: © David Snyder / Dreamstime
Evidence Professor Imran Rasul (UCL Economics)
published an analysis of the intention of
into
adolescent girls in Uganda to participate
Policy
in BRAC’s Adolescent Development
Program, which emphasises the provision of life
skills, entrepreneurship training and microfinance.
The research, a collaboration with colleagues at the
London School of Economics and the World Bank, found
that girls who are more likely to benefit from the program
are more likely to intend to participate. Almost one third
of the population in developing countries is under the
age of 15, hence improving the effectiveness of policy
interventions that target adolescents is of importance.
Focus: Building trials capacity
A project secretariat was established at Kilimanjaro
Christian Medical Centre (KCMC), Tanzania, for the
four-year Pan African Consortium for the Evaluation
of Antituberculosis Antibiotics (PanACEA). An initiative
funded by the European & Developing Countries
Clinical Trials Partnership, PanACEA consolidates three
clinical trials for treatment of tuberculosis into a single
capacity-development programme encompassing five
European and 12 African partner institutions.
UCL offered 100 UCL Grand Challenge Studentships
in Biomedicine over three years, a PhD training
programme designed to attract researchers with
intellectual promise, an evident capacity for critical
thinking and a desire to address fundamental
questions in biomedical and life sciences relevant to
human health and wellbeing.
The specific focus of these studentships range from
investigations into fundamental aspects of human
health and disease or translational approaches to
prevention and early disease detection, through to
the development of novel therapies and interventions,
addressing global health issues such as HIV/AIDS in
the context of global politics and economics, or the
application of mathematical techniques to basic
questions in biology and biomedicine.
UCL Grand Challenges students will be encouraged to
establish links and collaborations that cut across
traditional laboratory, departmental and discipline
boundaries, with supervision by UCL’s outstanding
basic and clinical research teams. In return, they are
expected to engage fully with UCL in its commitment
to addressing the Grand Challenges.
KCMC also hosted the second annual PanACEA
meeting, at which partners approved co-funding of
three MSc and three PhD studentships.
Within PanACEA, UCL is providing leadership on
delivery of the laboratory aspects of the trials. The UCL
team has produced manuals and documentation as
exemplars of good practice and specialist laboratory
training in the techniques required for a high standard
clinical trial. Of critical importance has been training
and advice in handling Mycobacterium tuberculosis in
the laboratory and support in developing laboratories
that meet international standards for safety. In a needs
assessment, undertaken during the first year of this
project, the limited number of personnel trained in
delivery of clinical trials was identified as rate-limiting
for the initiation of further trials. One essential group in
execution of a trial are the clinical monitors, who ensure
the quality and safety of the study. Outside South Africa
the pool of trained monitors is very limited and so to
address this need the PanACEA network has
established a distance learning and mentoring
programme in collaboration with the African Clinical
Research Organisation, South Africa.
23
STUDENT ACTIVITY
UCL students are encouraged to engage in
advocacy and campaigning about issues
critical to global health.
Examples of our student activity in global health
during 2010:
A student-run festival, Food Junctions, was held over
two weekends, crossing cultures, countries and
communities to celebrate the fabric of food in all its
forms. Held at Kings Cross, London, it was designed to
promote healthy living and local food production, as
well as to encourage visitors to explore the world of
food politics, culture and research. More than 200
contributors from the academic community and beyond
presented talks, hands-on workshops, demonstrations,
tasting sessions, art and architecture installations,
performance and film. Food Junctions was facilitated
through the UCL Public Engagement Unit, one of the
six UK Beacons for Public Engagement.
24
Image: Lea Gimpel, UCLU Photo Society
UCL Union Friends of Médecins Sans Frontières (MSF)
held an event featuring henna artists and Pakistani
cuisine and music, to raise money for the millions of
victims of flooding in Pakistan during the monsoon
season. It was followed by a talk from Jean–Marc
Jacobs, Press Officer for MSF UK, who provided
an update on the situation in Pakistan.
Image: Lea Gimpel, UCLU Photo Society
A panel discussion, What Can Students Do for Global
Health?, was organised by UCL Union Medsin and UCL
Union Friends of Médecins Sans Frontières (MSF), in
association with the UCL Institute for Global Health,
the Global Development Initiative and UCLU Engineers
Without Borders. Panellists included Dr Sidney Wong
(MSF UK Board of Directors), Nina Neeteson (Article
25), Professor David Heymann (World Health
Organization) and Johnny Currie (UK Medsin).
Key themes were deploying evidence, passion and
pragmatism, pressuring governments to influence
change and being proactive within their own careers.
Image: Lea Gimpel, UCLU Photo Society
Nine UCL students and a UCL Laws teaching fellow
were awarded sponsored places at One Young World,
a three-day summit which brought together 1,000
young leaders from 192 countries to address major
global challenges. Subjects discussed ranged from
global health and interfaith dialogue to the environment
and the media. The debates were supported by
counsellors including Desmond Tutu, activist and
Nobel Peace Prize Laureate, Bob Geldof, musician
and activist, and Kofi Annan, President of the Global
Humanitarian Forum. The aim was to generate
resolutions for a better future and in so doing to
develop and link up a global network of alumni.
Image: Teddy Tun Win Hla, UCLU Photo Society
Fourth-year UCL medical student Andrew Lewis
volunteered for ten days with the Northern Cleft
Foundation in Nagpur, India. He formed part of a team
that conducted operations on 104 children with cleft
lip and palate deformities, free of charge. He also
accompanied the team’s specialist cleft nurse as she
lectured on cleft nutrition to local social workers.
Martin McCann, Chief Executive at Red R (a
humanitarian organisation providing disaster relief), and
Stephanie Johnston from Article 25 (which specialises
in post-disaster reconstruction and development)
described their careers in the humanitarian sector and
the roles professionals from different disciplines take in
their organisations during an evening organised by
UCL Union Friends of Médecins Sans Frontières.
Evidence Former students Umar Ahmad and Kirsty
Benton (UCL MSc Global Health &
into
Development), and Davina Patel (UCL
Policy
Intercalated BSc International Health),
undertook internships at the World Health Organization,
where they put the skills and knowledge developed
during their studies into practice.
25
INDIVIDUAL
ACHIEVEMENT
Effective cross-disciplinary work in global health is
underpinned by individual expertise and excellence,
as reflected in these awards and appointments.
Examples of individual achievements in global health
during 2010:
Professor Anthony Costello (UCL Centre for
International Health & Development), Co-Director of the
UCL Institute for Global Health, was among nine UCL
academics elected to the Fellowship of the Academy
of Medical Sciences.
Dr Alexandra Alvergne (UCL Anthropology) and
Dr Pedro Hallal (UCL Institute of Child Health) were
awarded Newton Fellowships to undertake two years
of research relevant to global health.
Professor Graham Hart (UCL Infection & Population
Health) was appointed Chair of the Expert Panel that
will oversee the Medical Research Council/Department
for International Development’s African Research
Leader Scheme, which aims to strengthen research
leadership and capacity in sub-Saharan Africa.
Professor Alimuddin Zumla (UCL Centre for Clinical
Microbiology) was shortlisted for the 2010 British
Medical Journal Lifetime Award.
Dr Amina Aitsi-Selmi (UCL Epidemiology & Public
Health) was awarded a Wellcome Trust Fellowship to
examine whether increased household income among
the poor contributes to a reversal of the social gradient
of obesity in Egypt.
26
Dr Paul Foster (UCL Institute of Ophthalmology) was
awarded a visiting professorship at Zhongshan
Ophthalmic Center/Sun Yat-Sen University in
Guangzhou, China, widely regarded as the leading
academic eye unit in China.
Professor Anne Johnson (UCL Population Health),
Co-Director of the UCL Institute for Global Health, was
appointed to the Wellcome Trust Board of Governors.
Professor Sir Michael Marmot (UCL Epidemiology &
Public Health) was elected President of the British
Medical Association.
Professor Peter Sammonds (UCL Institute for Risk &
Disaster Reduction) was appointed Strategic Advisor
on Increasing Resilience to Natural Hazards in
Earthquake-Prone & Volcanic Regions for the Natural
Environment Research Council.
EVENTS
UCL holds a range of challenging and stimulating
events to encourage UCL staff and students
– and those beyond the university – to learn more
about global health issues from varied perspectives.
These events include the UCL Institute for Global
Health Symposia Series, which can be viewed online
at our website (www.ucl.ac.uk/global-health/events)
or UCL on iTunes U (itunes.ucl.ac.uk).
Sex Workers: Stigma and barriers to health
Evidence-Based Decision-Making: Who’s counting
the evidence and whose evidence counts?
January 2010
February 2010
Graham Scambler (UCL Infection & Population
Health), Professor of Medical Sociology, began the
12th UCL Institute for Global Health Symposium
by outlining the concepts of stigma and deviance,
and the discourses around stigma and sex workers.
He described the heterogeneity of sex-worker
careers and issues surrounding regulation.
The 13th UCL Institute for Global Health Symposium
brought together speakers from the worlds of
research, funding bodies and public policy, to
discuss who uses evidence and how they use it.
‘Evidence-based policy and practice’ tends to
assume a direct relationship between the gathering
of evidence (through research, for example), and
the use of that evidence in public policymaking.
In reality the relationship between evidence and
policy is much more complex. Presentations
featured Professor Peter Piot (Imperial College),
Malcolm McNeil (UK Department for International
Development), Dr Kalipso Chalkidou (NICE
International) and Dr Sanjoy Bhattacharya (Wellcome
Trust Centre for the History of Medicine at UCL). The
event was chaired by Dr Sarah Hawkes (UCL Centre
for International Health & Development).
Issues of stigma were expanded upon by Helen
Ward, Professor of Public Health at Imperial College.
Professor Ward has been involved in developing
services for sex workers for many years, and used
examples of her research to examine stigma,
prostitution and its impacts on health. Contrary to
popular belief, the most important health impacts
of stigma are not sexually transmitted infections
or violence, but psychological problems. Dr Petra
Boynton (UCL Open Learning) used stigma
as a lens to focus on the obstacles and barriers
encountered by sex workers in health and social
care globally. She also highlighted the lack of
consultation with sex workers when developing
services and policies.
A lively discussion followed, including debate
around trafficking, normalisation of sex work, male
sex workers, and empowerment and agency.
Audience questions and comments led to debate of
various issues, including: whether lessons learned
from getting HIV-related evidence into policy can be
applied in other areas of global health, particularly in
maternal and child health; whether political priorities
are more important to policymakers than evidence;
and whether researchers should agree on core
values and key messages for policymakers.
27
Sexual Health of Sexual Minorities in Pakistan:
From analysis to action
Disability and Poverty: A perspective from
the World Bank
February 2010
March 2010
Dr Sarah Hawkes (UCL Centre for International
Health & Development) presented lessons learned
from a survey of almost 2,000 sex workers and
injecting drug users in Pakistan, in collaboration
with the Pakistan National AIDS Control Programme.
While the prevalence of HIV is currently low, the
levels of other STIs were high in some groups – for
example, close to half of the transgender sex
workers were infected with syphilis. Multidisciplinary
analysis of the survey highlighted the importance
of addressing the social context of risk (for example
human rights abuses perpetrated by state actors) in
addition to individual level risks. The lecture marked
Lesbian Gay Bisexual Trans History Month.
Daniel Mont, a Senior Economist with the World
Bank Poverty Reduction & Economic Management
Team in Vietnam – and formerly with the World
Bank’s Disability & Development Team – explored
the relationship between disability and poverty from
the perspective of the World Bank. The event was
a UCL Global Disability Research Group Seminar.
Humanitarian Disaster Relief: Disability and the new
Sphere guidelines
February 2010
Dr Maria Kett (Leonard Cheshire Disability &
Inclusive Development Centre at UCL), Dr John
Twigg (UCL Earth Sciences) and Jazz Shaban
(World Vision) explored the high-profile theme
of humanitarian disaster relief and how the new
Sphere guidelines, which set global standards
for disaster relief efforts, can support disabled
people in post-disaster countries (see page 10).
The event was a UCL Global Disability Research
Group Seminar.
The Challenge of TB: UCL’s contribution
March 2010
UCL marked World TB Day with a symposium
showcasing work on tuberculosis from a range of
UCL disciplines and featured presentations from
leading academics in the field.
Plenary sessions were presented by Dr Marc
Lipman (UCL Medicine) on What’s Going On with
TB in London and the UK?, Professor Stephen
Gillespie (UCL Infection & Immunity) on Trials and
Tribulations to Get Better TB Treatment, Dr Carole
Reeves (Wellcome Trust Centre for the History of
Medicine) on In Search of the Lost Children of
Craig-y-nos and Professor Graham Rook (UCL
Infection) on Immunotherapy: Possible solutions to
the trials and tribulations to get better TB treatment.
28
The Global Burden of Mental Health Disorders
May 2010
Professor Steve Iliffe (UCL Primary Care &
Population Health) opened the 14th UCL Institute
for Global Health Symposium by explaining the
links between dementia and depression, focusing
on mental health and primary care in the developing
world. While 66% of people with dementia live
in low- and middle-income countries, only 10%
of population-based research is carried out in
these areas.
Michael King (UCL Mental Health Sciences),
Professor of Primary Care Psychiatry, highlighted
that low-income countries spent proportionately less
on mental healthcare. For example, 12% of the
UK’s health budget is spent on mental health, but
in many developing countries less than 1% of the
health budget funds mental health. He also noted
that there are many different systems of mental
healthcare globally, and countries such as Brazil
and Chile were developing mental health systems
in primary care, with marked effects.
Irwin Nazareth (UCL Primary Care & Population
Health), Professor of Primary Care & Population
Sciences, gave an overview of primary care – the
work of health professionals who act as a first point
of consultation for patients. He outlined the history
of primary care, reviewing the success of Alma Ata
(the first international declaration underlining the
importance of primary health care) and the
Millennium Development Goals, before describing
how primary care applied to mental health is
implemented around the world and the range of
barriers faced globally.
He cited examples of research UCL is conducting in
Chile, India and South Africa, such as the predictD
study. Led by Professor Nazareth and Professor
King, researchers involved in this project developed
an online tool to predict the risk of depression, for
use by family doctors and local clinics, which was
evaluated in Chile and six European countries. UCL
is also leading research on applying the General
Practitioner Research Framework – a network of
practices involved in clinical trials, epidemiology and
health services research – to low-income settings
such as Goa, India, and Umtata and Eastern Cape,
South Africa.
Professor Sir David Goldberg (King’s College),
currently leading the World Health Organization’s
reclassification of Mental Health Disorders in
Primary Care, presented the background to this
reclassification and the lessons learned to ensure
this document is useful globally.
Panellist Dr Kate Walters (UCL Primary Care &
Population Health) raised the issue of classification,
querying whether the vast differences in mental
health burden between countries such as Nigeria
and the USA are correct. Dr Sushrut Jadhav (UCL
Mental Health Sciences) focused on the culture and
context of medicine in low-income countries, and
questioned how to avoid medicalising social
suffering. Dr Alisher Latypov (Wellcome Trust Centre
for the History of Medicine at UCL) highlighted that
biomedical professionals weren’t always the first
point of call, and that traditional healers, spiritual
healers and other indigenous practitioners needed
to be incorporated into systems.
The audience raised a wide range of issues,
including: differing views on wellbeing and stigma;
the medical rigour of diagnosis; whether individual
countries should be allowed to decide which
conditions should be included in the classification of
mental health disorders; training of medical students
in mental health and primary care; the relationship
between community-based care and primary care;
the role of families in care; and links between mental
health, poverty and accessing treatment.
influenced the discourse on population in the 1820s,
as well as Bentham’s work on sex.
Professor Judith Stephenson (UCL Institute for
Women’s Health) emphasised how Bentham’s views
have resonance now because of current concerns
about global population, reproductive rights and
stigma around ‘unnatural’ practices. Using
homosexuality to reduce population was explored
further by Dr Richard Mole (UCL School of Slavonic
& East European Studies), who also emphasised the
role of religion on attitudes towards homosexuality.
Audience members and the speakers then
discussed topics such as: religion and Bentham’s
belief that religion should play no part in the law;
population and climate change; conflicts around
Bentham’s views on population growth and
happiness; contraception; and the unintended
negative consequences of philosophy.
Inaugural UCL–French Embassy Conférence-Débat
July 2010
Dr Bruno Spire (INSERM, Marseille) spoke on
medical and social support for those living with HIV
infection. In his response, Professor Robin Weiss
(UCL Infection & Immunity) addressed the promise
and pitfalls of developing an HIV vaccine to prevent
infection tomorrow. The series – proposed by
Professor Mike Wilson, UCL Pro-Provost (Europe),
and Dr Serge Plattard, Counsellor for Science &
Technology at the French Embassy in London –
brings together distinguished figures from
research-intensive universities and industry in
France and from UCL, to speak on and debate
issues of major contemporary importance at the
interfaces between science, technology and society.
The series was sponsored by the French Embassy,
the UCL Pro-Provost (Europe) and UCL Grand
Challenges.
The Pleasures of the Bed: Jeremy Bentham on sex,
population and happiness
June 2010
The 15th UCL Institute for Global Health Symposium
explored the philosopher, jurist and social scientist
Jeremy Bentham (1748–1832), considered to be
UCL’s spiritual father, whose writings on sex,
population growth and wellbeing remain significant
for current global health debates.
Professor Philip Schofield and Dr Michael Quinn
(UCL Bentham Project) described Bentham’s
changing views on population growth, and how he
Past Lessons and Future Opportunities for
Helicobacter pylori
September 2010
Nobel Laureate Professor Barry Marshall delivered
the 2010 UCL Prize Lecture in Clinical Science. In
the course of his research, Professor Marshall
courageously infected himself with a microscopic
corkscrew-shaped organism called Helicobacter
pylori in order to prove this bacteria was the cause
of many chronic, painful and often disabling
29
stomach ailments (such as ulcers and gastritis) and
that these conditions could in fact be permanently
cured by a short course of antibiotics. The medical
profession had previously taught that these illnesses
were caused by emotional stress and dietary
factors, and required a lifetime of treatment.
From 3 by 5 to 0 by 15: HIV treatment in rural
South Africa
October 2010
At the 16th UCL Institute for Global Health
Symposium, Professor Marie-Louise Newell,
Director of the Africa Centre for Health & Population
Studies – seconded from the UCL Institute of Child
Health – gave an overarching picture of the
successes and failures in the treatment of
HIV/AIDS globally.
Focusing on mother-to-child transmission (MTCT),
Professor Newell showed the effectiveness of
prevention by treatment, through provision of
anti-retroviral treatment (ART) to mothers. Addressing
the issue of heterosexual transmission and claims
based on statistical models that it is possible to
“treat ourselves out of the epidemic” through
treatment upon diagnosis, Professor Newell stated
that a phasing-out of the disease will take decades.
After discussing shortcomings of the ambitious
‘3 by 5’ initiative introduced by the World Health
Organization in 2003 – a global target to provide
three million people living with HIV/AIDS in low- and
middle-income countries with life-prolonging ART
by the end of 2005 – Professor Newell moved on
to research findings from her work in South Africa.
The Africa Centre, based in Hlabisa, South Africa,
works with the local community in providing frontline
care in a rural area heavily affected by the disease.
The centre – which through 17 health posts provides
treatment primarily through counsellors and nurses
– also gathers data on the impact of ART within the
local community.
Professor Newell estimated that the programme has
had a large impact on reducing the transmission of
HIV from mother to child, using treatment as
prevention, stating: “Children whose mothers were
HIV-infected but not on ART were three times more
likely to die, while children whose mothers initiated
ART were no more likely to die than children of HIV
negative mothers.”
The findings emphasise the need for treatment for
young women, considered a high-risk group.
30
Professor Newell mentioned some of the potential
issues which may complicate the trial, including
the risks of migration and contamination, as well as
the fact that testing is taboo in many communities.
Professor Newell discussed how the team works
to control issues of cross-contamination through
containment of social and sexual networks.
Joining Professor Newell as panellists were
Winnie Ssanyu Sseruma, an activist who works
with Christian Aid, and Professor Jonathan Wolff
(UCL Philosophy). Ms Sseruma – who has a
wealth of experience through working with several
organisations within the field – spoke passionately
about the need for treatment as prevention, and
the need for positivity and hope when dealing with
issues which affect people living with HIV and/or
AIDS. In agreement with Professor Newell,
she supported the need for testing of new
programmes in order for treatment to be given
in greater numbers and more quickly. She also
advocated a change in the CD4 count upon which
treatment is started. A CD4 count indicates
how weakened the immune system is from the
replicating HIV virus, with the higher the count
the stronger the immune system. In moving the
CD4 count requirement from 350 to 500, treatment
will be available for more individuals and will be
started earlier.
Taking a different approach to the topic, Professor
Wolff discussed some of the ethical implications
of HIV/AIDS as a funding priority, including the
diversion of funds from other health programmes.
He challenged the audience to consider that there
are a multitude of health problems which cause
mortality in the developing world, and that
systemic issues such as ‘brain drain’ must also
be examined for their implications for health
promotion.
The Future of Global Disability Research
October 2010
This one-day conference provided an opportunity
to reflect on and discuss the key issues for
disability research in global contexts, and how
these issues might be addressed. The event was
funded by a UCL Futures Grant, which promotes
innovation and collaboration between academics
across the university. The conference was the
culmination of the UCL Global Disability Research
Group Seminar Series.
Second UCL–French Embassy Conférence-Débat
October 2010
Professor Jean-Pierre Olivier de Sardan (Ecole des
Hautes Etudes en Sciences Sociales, Marseilles)
spoke on development, provision of public goods
and practical norms in West Africa. In his response,
Professor Yves Cabannes (UCL Development
Planning Unit) addressed the issues raised in the
context of participatory budgets in African countries.
Watch previous events online
(www.ucl.ac.uk/global-health/events)
or comment on the UCL Events Blog
(blogs.ucl.ac.uk/events).
Overcoming Public Health Challenges: Meeting
the Millennium Development Goals
November 2010
Helen Clark, Administrator of the United Nations
(UN) Development Programme and the first woman
to hold that post, delivered the annual UCL–Lancet
Lecture. She is also Chair of the UN Development
Group, a committee consisting of the heads of all
UN funds, programmes and departments working
on development issues.
Helen Clark served three successive terms
(1999–2008) as Prime Minister of New Zealand.
Throughout her tenure as Prime Minister, she
engaged widely in policy development and
advocacy across the international, economic, social
and cultural spheres. In her lecture, she stressed the
need for stronger partnerships between state and
non–state actors in the health and development
sector, which would result in greater health and
empowerment for those who are most in need.
31
THE UCL INSTITUTE
FOR GLOBAL HEALTH
Theme Leaders
Education: Mike Rowson (UCL Centre for International
Health & Development)
Evidence into Policy: Dr Sarah Hawkes
(UCL Centre for International Health & Development)
Infectious Diseases: Dr Tim McHugh (UCL Centre
for Clinical Microbiology)
Directors
Professor Anthony Costello
UCL Centre for International Health & Development
a.costello@ich.ucl.ac.uk
Professor Anne Johnson
UCL Population Health
anne.johnson@ucl.ac.uk
International Health Research Programme Director
Susan Crane
s.crane@ucl.ac.uk
Research & Programme Development Manager
Sarah Ball
s.ball@ucl.ac.uk
Administrator
Rikke Osterlund
r.osterlund@ucl.ac.uk
30 Guilford Street
London WC1N 1EH
+44 (0)20 7905 2889
www.ucl.ac.uk/global-health
global-health@ucl.ac.uk
@UCLGlobalHealth on twitter
32
Non-Communicable Diseases and Social Determinants
of Health: Dr David Batty (UCL Epidemiology &
Public Health)
Vulnerable Populations: Professor Nora Groce
(Leonard Cheshire Disability & Inclusive Development
Centre at UCL)
Board
Chair: Professor David Price, UCL Vice-Provost (Research)
Dr Philip Gothard, UCLH NHS Foundation
Professor Malcolm Grant, UCL President and Provost
Dr Richard Horton, Editor of The Lancet
Professor Ian Jacobs, Executive Dean of
UCL Biomedicine
Professor Maria Lee, UCL Laws
Caren Levy, UCL Development Planning Unit
Professor Sir Michael Marmot, UCL International
Institute for Society & Health
Professor Mark Maslin, UCL Environment Institute
Professor Deenan Pillay, UCL Centre for Virology
Professor Chris Rapley, UCL Earth Sciences
Professor Nanneke Redclift, UCL Anthropology
Professor Sir John Tooke, UCL Vice-Provost (Health)
Professor Jonathan Wolff, UCL Philosophy
Professor Michael Worton, UCL Vice-Provost
(Academic & International)
Professor Alimuddin Zumla, UCL Centre for
Clinical Microbiology
THE UCL
GRAND CHALLENGES
UCL – London’s global university – has the opportunity
and the obligation to address the major problems
facing the world.
Across the breadth of academic disciplines – from
neuroscience to urban planning, from security to health
informatics and environmental law – our world-leading
researchers apply their insight, creativity and daring
to the planet’s major intellectual, cultural, scientific,
economic, environmental and medical challenges.
We can only address major challenges by harnessing
our collective expertise, by working across and beyond
traditional disciplines. Profound outcomes result from
great minds acting in combination. Bringing together
differing perspectives, understandings and procedures
generates novel solutions.
The world’s most pressing problems are complex
and systemic. Their resolution requires partnership
transcending the boundaries between disciplines.
WHY UCL?
We have identified areas in which new interdisciplinary
partnerships can thrive, and where UCL’s critical
mass will deliver novel achievements. We call these
the Grand Challenges. They are global in significance
and will draw on the complete scope of our expertise.
Our initial Grand Challenges are:
Global Health
Sustainable Cities
Intercultural Interaction
Human Wellbeing.
We are positioning ourselves to build on our
contribution to these objectives. We are forming
alliances and collaborations, across multiple
disciplines, focused on issues of global significance.
We are removing internal barriers to interdisciplinary
collaboration. We are establishing mechanisms
whereby our expertise and analysis of these
challenges can be brought into forums to engage
funding agencies, opinion formers, legislators
and the public.
External engagement is central to our vision. We invite
you to deploy your own expertise and objectives in
partnership with ours; simply because together we
can transform the world.
UCL is London’s leading multidisciplinary
university, with 8,000 staff and 22,000 students
from more than 140 countries.
UCL is one of the world’s leading universities
(rated fourth in the QS World University Rankings
2010), is the best UK university for health research
(according to the Department of Health) and 11th
in the world for medicine (according to the
Shanghai Jiao Tong University Rankings 2010).
Focused on the translation of research into
solutions to the world’s major problems, UCL works
across the disciplines and with partners all over
the world. Current activities include leading the
search for an HIV vaccine to developing the clinical
use of stem cells in heart disease, blindness and
spinal cord repair.
UCL is Europe’s second most productive
partnership for biomedical science research
(according to the Partnership for Science &
Technology Studies), which accounts for 65%
of all university activity.
Design studiospecial.com
Professor David Price
UCL Vice-Provost (Research)
In the 2008 Research Assessment Exercise, UCL
was rated the best research university in London,
and third in the UK overall, for the number of its
submissions which were of ‘world-leading quality’.
A study sponsored by the Department of Health into
health research found that, between 1995 and 2001,
UCL produced more highly cited papers than any
other university in the UK – over 1,000 more than
the university in second place, Oxford.
21 Nobel Prize winners have worked or studied at
UCL. These include Professor Francis Crick, who
co-determined the structure of DNA, and more recently
Sir Martin Evans in 2007, for discovering the principles
for introducing specific gene modifications in mice
through embryonic stem cells.
UCL Partners – the new academic health science
partnership comprising UCL, Great Ormond Street
Hospital for Children NHS Trust, Moorfields Eye
Hospital NHS Foundation Trust, the Royal Free
Hampstead NHS Trust and University College London
Hospitals NHS Foundation Trust – forms the largest
centre for biomedical research in Europe.
www.ucl.ac.uk/global-health
LONDON’S GLOBAL UNIVERSITY
global-health@ucl.ac.uk
@UCLGlobalHealth on twitter
THE GRAND
CHALLENGE OF
GLOBAL HEALTH
10 /11