LONDON'S GLOBAL UNIVERSITY
UCL – LONDON’S
GLOBAL UNIVERSITY
THE UCL INSTITUTE
FOR GLOBAL HEALTH
Directors
Board
Professor Anthony Costello
UCL Centre for International Health & Development
(CIHD)
Chair: Professor David Price,
UCL Vice-Provost (Research)
30 Guilford Street
London WC1N 1EH
+44 (0)20 7905 2122 (internal x82 72 2122)
Professor Ed Byrne, UCL Vice-Provost (Health)
Professor Michael Freeman, UCL Laws
Dr Philip Gothard, UCLH NHS Foundation Trust
Professor Malcolm Grant,
UCL President and Provost
Professor Anne Johnson
UCL Centre for Sexual Health & HIV Research
4th Floor Mortimer Market Centre,
off Capper Street
London WC1E 6JB
+44 (0)845 155 5000 (extension x8706)
Research and Programme
Development Manager
Dr Richard Horton, Editor of ‘The Lancet’
Professor Ian Jacobs,
UCL Institute for Women’s Health
Caren Levy, UCL Development Planning Unit
Professor Sir Michael Marmot,
UCL International Institute for Society & Health
UCL began as a radical, struggling upstart on the
fringes of London. Its founding principles of innovation,
accessibility and relevance were intended to disrupt
the status quo of England’s establishment – simply
because that was the most effective way to enhance
social justice and opportunity.
Almost two centuries later – following the exploration,
discovery and application of knowledge undertaken
by generations of researchers – we have grown into
one of the world’s leading universities, now in the
heart of one of the world’s most cosmopolitan cities.
The breadth, depth and quality of our current
research exceeds the imagination even of our
visionary founders.
A world to transform
The world is in crisis. Billions of us suffer from
illness and disease, despite the existence of proven
preventions and cures. Life in our cities is under
threat from social tension, pollution and climate
change. The prospect of global peace and cooperation
remains under assault from tensions between
our nations, faiths and cultures. Our quality of life
– actual and perceived – appears to be diminishing
despite technological advances.
These are global problems, and we must resolve
them if future generations are to be provided with
the chance to flourish.
Despite this advancement, we remain intent on
disrupting the status quo – simply because that is the
most effective way to eliminate the world’s unnecessary
suffering, destruction, conflict and inequity.
Professor Mark Maslin, UCL Environment Institute
Professor Deenan Pillay, UCL Centre for Virology
Sarah Ball
Professor Nanneke Redclift, UCL Anthropology
2 Taviton Street
London WC1H 0BT
Professor Jonathan Wolff, UCL Philosophy
+44 (0)20 7679 8584 (internal x28584)
Professor Michael Worton, UCL Vice-Provost
(Academic and International)
global-health@ucl.ac.uk
www.ucl.ac.uk/global-health
Professor Alimuddin Zumla, UCL Centre for Infectious
Diseases & International Health
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THE GRAND CHALLENGE OF
GLOBAL HEALTH
08/09
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UCL – LONDON’S
GLOBAL UNIVERSITY
UCL began as a radical, struggling upstart on the
fringes of London. Its founding principles of innovation,
accessibility and relevance were intended to disrupt
the status quo of England’s establishment – simply
because that was the most effective way to enhance
social justice and opportunity.
Almost two centuries later – following the exploration,
discovery and application of knowledge undertaken
by generations of researchers – we have grown into
one of the world’s leading universities, now in the
heart of one of the world’s most cosmopolitan cities.
The breadth, depth and quality of our current
research exceeds the imagination even of our
visionary founders.
Despite this advancement, we remain intent on
disrupting the status quo – simply because that is the
most effective way to eliminate the world’s unnecessary
suffering, destruction, conflict and inequity.
THE UCL INSTITUTE
FOR GLOBAL HEALTH
A world to transform
Directors
Board
The world is in crisis. Billions of us suffer from
illness and disease, despite the existence of proven
preventions and cures. Life in our cities is under
threat from social tension, pollution and climate
change. The prospect of global peace and cooperation
remains under assault from tensions between
our nations, faiths and cultures. Our quality of life
– actual and perceived – appears to be diminishing
despite technological advances.
Professor Anthony Costello
UCL Centre for International Health & Development
(CIHD)
Chair: Professor David Price,
UCL Vice-Provost (Research)
These are global problems, and we must resolve
them if future generations are to be provided with
the chance to flourish.
Professor Anne Johnson
UCL Centre for Sexual Health & HIV Research
30 Guilford Street
London WC1N 1EH
+44 (0)20 7905 2122 (internal x82 72 2122)
Professor Michael Freeman, UCL Laws
Dr Philip Gothard, UCLH NHS Foundation Trust
Professor Malcolm Grant,
UCL President and Provost
4th Floor Mortimer Market Centre,
off Capper Street
London WC1E 6JB
+44 (0)845 1555000 (internal x8706)
Research and Programme
Development Manager
Design studiospecial.com
Printed by Seacourt
Professor Ed Byrne, UCL Vice-Provost (Health)
Dr Richard Horton, Editor of ‘The Lancet’
Professor Ian Jacobs,
UCL Institute for Women’s Health
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
Sarah Ball
Professor Nanneke Redclift, UCL Anthropology
2 Taviton Street
London WC1H 0BT
Professor Jonathan Wolff, UCL Philosophy
+44 (0)20 7679 8584 (internal x28584)
Professor Michael Worton, UCL Vice-Provost
(Academic and International)
global-health@ucl.ac.uk
www.ucl.ac.uk/global-health
Professor Alimuddin Zumla, UCL Centre for Infectious
Diseases & International Health
INSIDE
GLOBAL HEALTH
03
THE GRAND CHALLENGE
OF GLOBAL HEALTH
04 – 06
THE UCL INSTITUTE
FOR GLOBAL HEALTH
07 – 28
GLOBAL HEALTH AT UCL
07 – 10 / Education, Outreach and Capacity-Building
11 – 14 / Health Effects of Climate Change
15 – 16 / Maternal and Child Health
17 – 22 / Infectious Diseases
23 – 25 / Non-Communicable Diseases
26 – 28 / Politics, Policy and Justice
29 – 31
IGH SYMPOSIA
32
WHY UCL?
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THE UCL
GRAND CHALLENGES
UCL – London’s global university – has the opportunity
and the obligation to contribute to tackling the major
problems facing the world.
Dynamic expertise
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.
Our academics deliver solutions.
We embrace and celebrate the outstanding problemand curiosity-driven research conducted by individuals
and small groups. However, we can only address major
challenges by harnessing our collective expertise, by
working across and beyond traditional disciplines.
Transcendent partnerships
Our strategy
Profound outcomes result from these 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 more than interdisciplinary collaboration; it
demands partnership transcending the boundaries
between disciplines. Implementation of the UCL
Research Strategy is the mechanism through which
such transcendency will be achieved.
We are positioning ourselves to build exponentially 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.
UCL Grand Challenges
As part of the UCL Research Strategy, we have
identified areas in which new interdisciplinary
partnerships can thrive, and where UCL’s critical
mass will deliver novel achievements.
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.
We call these the Grand Challenges.
They are global in significance and will draw on our
expertise right across the arts and humanities, the built
environment, biomedical sciences, laws, life sciences,
mathematical and physical sciences, and social and
historical sciences. Our initial Grand Challenges are:
Professor David Price
UCL Vice-Provost (Research)
Global Health
Sustainable Cities
Intercultural Interactions
Human Wellbeing
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THE GRAND
CHALLENGE OF
GLOBAL HEALTH
UCL’s Research Strategy defines Grand
Challenges: those areas in which we are facilitating
cross-disciplinary interaction – within and beyond UCL
– and applying our collective strengths, insights and
creativity to overcome problems of global significance.
The first of these is the Grand Challenge
of Global Health.
Billions of us lack access to adequate food, water,
sanitation, medicine and education. Unnecessary
suffering – for example through HIV/AIDS and malarial
infection – prevails, despite the breakthroughs in
medical sciences that have made it possible to prevent,
contain, manage and eliminate much disease.
Solutions to a whole range of health problems around
the world are within our grasp, yet societal and natural
forces conspire to prolong and extend the destruction
of huge numbers of our fellow humans.
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.
Global health problems are complex and systemic.
Their resolution requires more than interdisciplinary
collaboration; it demands partnership transcending the
boundaries between disciplines. The UCL Institute for
Global Health is the mechanism through which such
transcendency will be achieved.
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.
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THE UCL INSTITUTE
FOR GLOBAL HEALTH
The cross-fertilisation of our expertise in global
health is being 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. It is developing an institution-wide
agenda leading to strategies, programmes, research
and teaching to bring our combined expertise to
bear on global-health challenges.
We need your involvement, your energy and your
disciplines’ intellectual capital to make a difference.
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).
Our activities
Our research
Within our university, the UCL Institute for
Global Health is:
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:
•initiating and enhancing discipline- and departmentspecific programmes, research and teaching
•stimulating interdisciplinary discourse and intellectual
debate across the university
•enabling the development of activity to make possible
effective large-scale multidisciplinary approaches
and interventions.
Beyond UCL, we are:
•creating real and virtual spaces for academic
discourse, in the public-policy arena and international
political processes
•exploring partnerships with other universities,
government, industry, funding bodies, trusts
and charities, UK and international agencies to
support our 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.
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 premier overseas institutions, policymakers and
practitioners, and with local teams in resource-poor
settings, 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.
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Our programme is empowering. We support
locally led actions developed in poor communities,
strengthening their capabilities and facilitating their
engagement with governments. We build international
networks of academics to promote research and
teaching capacity in the developing world.
Our activity promotes equity and security. We are
alert to the social and economic determinants of
health and recognise that the reduction of social
inequities and insecurity results in 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.
Opportunities for graduate students include:
an MSc/Diploma in Global Health & Development;
an MSc/Diploma/Certificate in International Child Health;
a European MSc in International Health, with more
than 200 modules provided through a network of
28 European partner institutions; an MSc/Diploma/
Certificate in International Primary Health Care;
and a variety of taster and short courses.
Our graduates include students from more than
70 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.
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
is holistic; our efforts are evidence-based; our
approach is collaborative; our work is action-oriented;
our programme is empowering; and our activity
promotes 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.
A UCL education relevant to global health draws upon
the breadth of our research and teaching expertise.
Students in our biomedical and life-sciences faculties
benefit from a fertile intellectual environment in which
scientific discovery transforms our understanding of
life and health.
Prenatal check-up, Nepal
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Our outreach programmes include the annual
‘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.
Image: Professor Matthew Gandy (UCL Geography)
Furthermore, beyond the biomedical sciences our
taught and research degree programmes impact on
global health. They include:
•biochemical engineering with bioprocess management
(UCL Biochemical Engineering)
•earthquake engineering with disaster management
(UCL Civil, Environmental & Geomatic Engineering)
•development and transition economics
(UCL Economics)
•environmental-systems engineering (UCL Civil,
Environmental & Geomatic Engineering)
•environmental law (UCL Laws)
Slums in Mumbai
•gender studies (UCL Centre for Intercultural Studies)
•geographies of globalisation (UCL Geography)
•hydrogeology and groundwater resources
(UCL Earth Sciences)
•modern history (UCL History)
•housing futures and urban economic development
(UCL Bartlett School)
•human rights and international relations
(UCL Political Science)
•theories of identity (UCL French)
•digital health information and electronic-records
management (UCL School of Library, Archive
& Information Studies)
•political philosophy (UCL Philosophy)
•facilities and environment management
(UCL Bartlett School)
•medical anthropology (UCL Anthropology)
•environmental and resource economics
(UCL Economics)
•science communication and policy
(UCL Science & Technology Studies)
In education, as in research, world-changing
developments occur most often when the expertise
and perspectives of different academic disciplines
are brought together. One exemplary initiative is the
development of the UCL MSc in Global Health &
Development, which is being developed to bring
together all UCL education relating to global health.
In doing so, it will offer a unique, cross-disciplinary
perspective on global health – drawing on partnerships
between biomedicine and social sciences, humanities,
engineering and the built environment.
The programme will empower students to affect
change, through the combination of theoretical insight
with practical relevance. It will equip them with an
advanced analytical ‘tool kit’ to conduct independent
applied research, they will be able to criticise the main
theories, approaches, research, policy and practice in
global health.
•history of medicine (Wellcome Trust Centre for the
History of Medicine at UCL)
•urban studies (UCL Urban Laboratory)
•international welfare and social policy (UCL Laws).
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EDUCATION,
OUTREACH AND
CAPACITY-BUILDING
A key failure in global health has been the inability of
poor countries to implement evidence-based policies
at scale, in order to have an impact on the lives of
millions of people. Bridging the gap between what
is known and what is done – the implementation of
efficacious policy – is at the crux of improving
global health.
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 outreach connects UCL research
best practice to the efforts of other organisations
by disseminating our work and engaging with others.
Our capacity-building aims to engage in partnerships
to produce self-sustaining and locally focused
solutions on the ground.
Examples of our recent engagement with education,
outreach and capacity-building:
A dynamic new MSc in Global Health & Development,
to begin in 2009, was jointly developed by academics
from the UCL Institute of Child Health, UCL Geography,
the UCL School of Slavonic & East European Studies,
UCL Epidemiology & Public Health and UCL Primary
Care & Population Health, and will include optional
modules from across a wide range of UCL
departments. The programme will integrate and
transform existing UCL courses, offering students
an interdisciplinary perspective on global health,
combined with rigorous teaching of core concepts
and techniques.
UCL hosted the Medsin National Conference, ‘Power
and Politics in Global Health’, in October 2008. The
annual medical students conference brought together
more than 450 future leaders in global health and was
a platform for student thinking on global-health issues.
Contributors included Clare Short MP, former Minister
for International Development, Dr Richard Horton, Editor
of ‘The Lancet’, and Martin Wolf, Editor of ‘The Financial
Times’. It was run with the support of the UCL Institute
for Global Health and UCL Grand Challenges.
Health clinic, Nepal
07
An ‘Improving Training in Nutrition in Emergencies’
workshop was held in November 2008 in Nairobi,
Kenya, to enhance capacity to respond to nutritional
issues within countries affected by emergencies and to
develop effective and sustainable emergency-nutrition
training courses. Dr Andrew Seal, UCL Lecturer in
International Nutrition, coordinated the workshop for
the Global Nutrition Cluster (GNC), an umbrella group
of humanitarian agencies led by UNICEF. For the first
time, universities, training institutions and humanitarian
agencies were brought together to discuss how to
improve nutrition in emergency training and capacity.
Workshop participants were also introduced to the
GNC’s new Harmonised Training Package.
A team led by Dr Timothy McHugh, UCL Reader in
Medical Microbiology, introduced a short course in
molecular biology for East African scientists. The
two-year programme – funded by the Wellcome Trust,
UK Medical Research Council and British Council,
together with commercial support from Applied
Biosystems and Corbett Research, which
have loaned equipment – will train staff in molecular
tools for respiratory microbiology for a number
of new and ongoing projects across East Africa.
Distributing food rations
The book ‘Asian Medicine: Tradition and Modernity’,
edited by Dr Vivienne Lo and Ronit Yoeli-Tlalim
(Wellcome Trust Centre for the History of Medicine
at UCL), was conceived at the conference ‘Medicine
on the Silk Roads’. It is a first attempt to bring together
scholars from many different countries, working across
a range of different fields, to research the transmission
of medical knowledge along the routes through central
Asia that have become to be known as the Silk Roads.
The articles exemplify the exchange of medical
knowledge between peoples and cultures beyond
the immediate reach of the centrifugal force of
any single cultural elite.
08
Image: Dr Rachael Pearson UCL Institute of Ophthalmology
In March 2008, on the first World Glaucoma Day,
a team of researchers from the UCL Institute of
Ophthalmology revealed an exciting new development
in the detection of glaucoma to a group of MPs in the
House of Commons. There are an estimated 67 million
people with glaucoma, the most common cause of
preventable blindness, yet 90% of these cases in the
developing world are undiagnosed. The new Moorfields
Motion Displacement Test is designed to be effective,
affordable and accessible to all over the internet,
enabling clinicians around the world to use it.
Confocal image of a retinal stem/progenitor cell
transplanted into a diseased eye
The UCL Institute for Women’s Health’s first
international conference, ‘Innovations and Progress
in Healthcare for Women’ was held in April 2008.
A lecture by Professor Ian Jacobs, who leads the
institute, featured the Uganda Women’s Health
Initiative, a collaboration between the institute,
Makerere University, Mulago Hospital and Hospice
Africa, Uganda. The institute’s work to date includes:
training in the prevention of postpartum haemorrhage;
training of doctors in vesico-vaginal fistula repair;
training and education fellowships for doctors and
nurses; training of nurses and midwives in neonatal
resuscitation; breast-cancer screening; radiotherapy
treatment and palliative-care for cancer patients;
construction of the Radiotherapy Hospital; and the
transfer of medical equipment from the Middlesex
Hospital, London, to Mulago Hospital.
Image: Dr Tim McHugh (UCL Medical Microbiology)
In ‘Refiguring Unani Tibb’, Dr Guy Attewell
(Wellcome Trust Centre for the History of Medicine
at UCL) examined the ways in which unani tibb
(Graeco-Arabic medicine) reconstituted its identity
in the light of modernising trends at the turn of the
20th century in India. An analysis of interconnecting
themes drew attention to the tensions manifest in
different spheres of unani activity, as practitioners
reconfigured their knowledge and practices through
the prisms of biomedical concepts, language,
nationalist and communitarian politics, changing
social and moral norms, and colonial-inspired
models of legitimacy.
Capacity development programme, Tanzania
The MSc/Diploma in Health & Society: Social
Epidemiology, run by UCL Epidemiology & Public
Health, is unique in that it combines conceptual issues
linking the social environment to population health,
the strong methodological base of epidemiology,
statistical analysis and policy. This programme
is our response to the need for trained researchers,
health professionals and policymakers who are able to
answer competently such questions as: Why is social
status so strongly linked to health? Does economic
growth produce greater wellbeing? How important is
the area of residence for the health of its community?
Professor Alimuddin Zumla (UCL Centre for Infectious
Diseases & International Health) negotiated preferential
prices for the softback versions of two new books he
co-edited. ‘Manson’s Tropical Diseases 22nd Edition’,
internationally known as the ‘bible’ of tropical medicine,
and ‘Tuberculosis: A Complete Clinical Reference 1st
edition’, with 112 chapters and 120 international
authors, will be made available for sale at greatly
discounted prices for affordable purchase by health
workers in developing countries.
Uganda Women’s Health Initiative
09
Image: Basak Demires Ozkul (UCL Bartlett School of Architecture)
Langworthy neighbourhood, Manchester
As Director of the new UCL Centre for Applied Global
Citizenship, David Napier, UCL Professor of Medical
Anthropology, is focusing on involving its students in
internship work to develop and apply their research
skills towards achieving a better understanding of
disaster relief. The centre will facilitate placements
with London-based health, environment, development
and human-rights NGOs as an integral part of
taught-degree programmes for students in a variety
of disciplines. These placements will be supported
by a full academic framework of lectures, seminars
and supervisions. In addition, UCL Anthropology
offers an MSc in Medical Anthropology, which
provides sufficient knowledge of advanced medically
related anthropology to enable students to utilise
anthropological approaches in a wide range of
research, applied and professional contexts.
The 2008 UCL Health & Society Summer School was
held both for public-health workers to refresh their
knowledge of population health, and people who are
investigating a career in public health or associated
subjects. The five-day course was coordinated by UCL
Epidemiology & Public Health, and included options in
social determinants of health (such as class, work,
gender, ethnicity and area effects) and in international
health (such as global-health patterns, socio-economic
development, in-country health, inequality, globalisation,
governance, health systems and fragile states).
The intercalated BSc in International Health for medical
students received a quarter of the 480 applications
to UCL’s 20 intercalated undergraduate degree
programmes. Among its lecturers are academics and
medics from UCL Anthropology, the Leonard Cheshire
Disability & Inclusive Development Centre at UCL,
Great Ormond Street Hospital for Children, King’s
College Hospital, the Hammersmith Hospital and
the Royal Free Hospital.
UCL postgraduates in the lab
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HEALTH EFFECTS
OF CLIMATE CHANGE
Climate change is potentially the most significant
global health threat of the 21st century. The scale
and complexity of the problem demands an urgent,
integrated and multidisciplinary approach.
To reduce 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.
The latest book by UCL Professor Bill McGuire (UCL
Earth Sciences) was a call to arms for humanity to
avoid environmental catastrophe. In ‘Seven Years to
Save the Planet: The Questions … and Answers’,
he asserted that for the first time in the history of
the Earth one species has grown so numerous and
so technologically powerful that it has the ability to
destabilise the narrow range of temperature within
which life can flourish:
“This book is a call to arms. We have time still to halt and
reverse the process. However we need to throw our
engines into reverse now to have any chance of
controlling our carbon emissions and winning the battle
against dangerous climate change and potential
environmental catastrophe.”
Professor McGuire has for the last 10 years run the
Benfield UCL Hazard Research Centre, the largest
academic hazard research centre in Europe, which
advises governments, multinationals and NGOs on
natural hazard and climate change.
Image: Professor Mark Maslin (UCL Environment Institute)
Examples of our recent engagement with health effects
of climate change:
Arctic ice
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Image: Dr Helene Burningham (UCL Geography)
Slip face of a dune on Fraser Island, Australia
Tropical storms, floods, earthquakes and the United
Nations Food Summit have all recently highlighted the
huge humanitarian and economic costs of natural
disasters and the pressing need to reduce the impact
of these events. Disasters will continue to be costly
and to take society by surprise unless there is a
significant shift in emphasis from reactive disaster
relief to proactive disaster risk reduction. The United
Nations International Strategy for Disaster Reduction
promotes this need for change, but bringing it about
presents a huge challenge globally, not least because
disasters by their very nature do not respect
international, discipline, organisation or institution
boundaries. The challenge presents opportunities
to devise innovative ways of evaluating and reducing
the impacts of disasters, which will be tackled by
Dr Stephen Edwards (Benfield UCL Hazard Research
Centre) and his team at the newly established
London-based hub at UCL focusing on global disaster
risk reduction.
The hub will present opportunities for much of the
UCL community, particularly for staff in engineering,
architecture, development and planning, mathematics
and statistics, climate physics, earth and environmental
sciences, geography, health, economics and political
science, as well as bringing together relevant UCL staff
and to facilitate their interaction with external partners.
12
In many areas in the world, population growth, climate
change and demand for environmental quality are
placing stress on water resources. Water scarcity is
leading to a frantic worldwide push for increased
efficiency and better management of existing
infrastructure and resources. Successfully addressing
this challenge requires a new generation of modelling
tools that can foster integrated water management of
river basins. Hydro-economic models represent
regional scale hydrological, engineering infrastructure,
economic and environmental aspects of water
resources systems within a coherent framework. They
provide insights into how water resources can be
managed more efficiently, sustainably and equitably
and can help evaluate economic impacts of climate
change and to develop and test adaptation strategies.
Shared vision planning/modelling is a complementary
approach that seeks to involve stakeholders in resource
management modelling projects and requires
user-friendly and visually appealing software. Both
approaches manipulate large diverse datasets and
require specialised software. Dr Julien Harou (UCL
Environment Institute) is leading a project to deliver a
first version of a spatial modelling platform: a computer
programme that manages, stores, and displays spatial
water management data (physical, economic,
institutional) and facilitates access to this data
by mathematical models.
Professor Hugh Montgomery (UCL Institute for Human
Health & Performance) organised a conference in
January 2008 at the Royal College of Physicians, to
warn the medical profession about the health costs of
ignoring climate change. Other speakers included
Professor Mark Maslin (UCL Environment Institute) and
Adrian Lister, Professor of Palaeontology. Professor
Montgomery said:
“As ambassadors for improving healthcare, we have
roles in the NHS, in healthcare and in wider society
to become champions of change to protect the planet
from climate change. For those of us working as
doctors, its imminent and severe threat dwarfs any
survival gains due to our daily healthcare activity.
Such threats are not just of altered disease patterns
for those in distant lands, but are to us and our
children: economic collapse, migration and war
know no boundaries.”
A proposal led by Professor Lim has reached
the final round of a competition to design a memorial
for the nearly 70,000 people who died in the
Sichuan Earthquake of May 2008, and to bring
aid to its survivors.
Lim’s design for the Sichuan Earthquake Memorial
Landscape is the “Thousand Flowers of Sichuan”:
a convoy of inflatable canopies that will float over
the devastated city of Wenchuan, which was at the
epicentre of the earthquake. The vibrant colours and
forms aim to bring energy and reassurance back to the
community and represent a new spring as Wenchuan
and the Sichuan Province undergo reconstruction.
Lim’s proposal provides a practical means of
connecting the city, whose transport infrastructure was
largely destroyed, and bringing aid to at least five
million people who were left homeless by the disaster.
As landslides and uneven terrain have made aid
missions extremely difficult by land or helicopter,
Lim’s flowers are designed to overcome these
obstacles. The flowers perform on the same technical
principles as the hot-air balloon, and are constructed
out of lightweight materials with a large nylon surface
area to maximise stability. Each flower envelope ranges
from 15–30 metres in diameter, and can be folded up
into a canvas bag to be loaded manually onto a truck.
The convoy of inflatable flowers will provide previously
unimaginable access and daily deliveries of temporary
shelters, medical supplies, drinking water and food
to the most damaged and irregular terrains. In contrast
to a helicopter, the inflatable flowers can hover quietly
over sites without causing further risks to unstable
grounds. Flat landing surfaces are not required either
as the flowers can dock in the sky with only ropes
tethered to the ground for stability.
Dr Richard Taylor (UCL Geography) organised the
first-ever conference to discuss the role of groundwater
in improving livelihoods in Africa under conditions of
rapid development and climate change. ‘Groundwater
and Climate in Africa’ – held in June 2008 in
collaboration with colleagues from the Ugandan
Ministry of Water and Environment and UNESCO’s
International Hydrological Programme – was one of
the first conferences in the world to discuss the twin
impacts of development and climate variability and
change on groundwater resources and groundwaterbased ecosystems. The conference was held in
Kampala, Uganda, and brought together more than
300 water scientists, managers and policymakers,
including parliamentarians, from 23 countries in
Africa and 14 non-African countries.
Image: Professor CJ Lim (UCL Bartlett School of Architecture)
Professor CJ Lim (UCL Bartlett School of Architecture)
has designed an earthquake memorial that doubles as
an aid delivery system for South-east Asia.
Sichuan Earthquake Memorial Landscape, “Thousand Flowers of Sichuan”
David Napier, UCL Professor of Medical Anthropology,
worked in Myanmar after cyclone Nargis left as many
as 100,000 people dead and almost every family
in Myanmar’s delta region without close relatives,
homes and the material means to facilitate recovery.
Working with the Myanmar government, the ASEAN
Humanitarian Task Force, Medical Emergency
Relief International (Merlin) UK, the United Nations
and the World Bank, Professor Napier, Mark Myatt
(a UCL spatial epidemiologist) and a team of
international consultants introduced a large-scale
household survey that will assess basic health
outcomes and health needs, a qualitative intervention
tool designed to identify and categorise vulnerable
populations (especially women and children),
and a new methodology designed to train local
researchers to assess levels of vulnerability
among affected populations.
The UCL Environment Institute’s ‘Climate Interactions’
workshop in November 2008 showcased the breadth
and depth of existing climate research undertaken at
UCL and facilitated interdisciplinary discussion and
collaborative research. UCL Fellow, and Director of
the Science Museum, Professor Chris Rapley’s keynote
speech, ‘Humans, Energy, Climate: What Next?’,
was followed by diverse talks by academics from
UCL Earth Sciences, UCL Geography, UCL Space
& Climate Physics and the UCL Bartlett Faculty
of the Built Environment.
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Professor David Napier and
Professor Nanneke Redclift: UCL Anthropology
Professor Bill McGuire:
Benfield UCL Hazard Research Centre
Dr Sarah Bell: UCL Civil, Environmental
& Geomatic Engineering
Dr Adriana Allen and Caren Levy:
UCL Development Planning Unit
Dr John Twigg: UCL Earth Sciences
Daniel Rogger and Professor Stephen Smith:
UCL Economics
Dr Sharon Friel: UCL Epidemiology & Public Health
Professor Mark Maslin: UCL Environment Institute
Sarah Ball: UCL Institute for Global Health
Professor Hugh Montgomery:
UCL Institute for Human Health & Performance
Dr David McCoy: UCL Centre for
International Health & Development
Professor Maria Lee and Professor Joanne Scott:
UCL Laws
Dr Christina Pagel: UCL Mathematics
Professor Jonathan Wolff: UCL Philosophy
Professor Richard Bellamy: UCL Political Science
Professor Anne Johnson: UCL Population Health
Professor Judith Stephenson:
UCL Institute for Women’s Health
UCL students: Mustafa Abbas, Sarah Legrand,
Jinesh Patel and Hannah Rees
In a commentary featured in ‘The Lancet’,
the authors write:
“The creation of this special commission acknowledges
the unprecedented threat that climate change poses
to human health globally – in the medium term, as
a danger to already vulnerable continents (such as
Africa); and in the long term, as a potential speciesextinction process. In the debate over the effects
of climate change, the health sector is sometimes
considered of secondary importance. We reject that
view. The health (and future viability) of the human
species should be a central concern for policymakers
as they consider how best to mitigate the effects of
global warming.”
Image: Professor John McArthur
UCL teamed up with ‘The Lancet’ to launch a joint
commission to study and report in early 2009 on
managing the human-health effects of climate change
– an area often overlooked in the climate-change
debate. The Lancet–UCL Commission is reviewing
the likely health impacts of climate change on human
societies, and documenting ways to manage those
impacts. Chaired by Professor Anthony Costello
(UCL Institute for Global Health), the commission’s
membership reflects a wide range of expertise
and experience:
Drilling, Joypur
The UCL Development Planning Unit held the first in
a series of water-health workshops in Accra, Ghana in
July 2008. With a background of increasing urban slum
sprawl around the world, the five-day meeting, held at
the University of Ghana’s Centre for African Wetlands,
focused on the needs of the developing world and
drew participants from 13 Commonwealth countries.
Dubbed ‘Executive Exposure Programmes’, these
meetings – funded by the Commonwealth Secretariat
– introduced civil servants and other water-industry
professionals to new ideas and encouraged
international networking.
UCL Laws’ Carbon Capture Legal Programme,
together with the International Energy Agency and
the Carbon Sequestration Leadership Forum, hosted
an international conference for regulators looking at
carbon capture and storage (CCS) technology in May
2008. The two-day event brought together delegates
from all over the world and provided a forum for them
to discuss regulatory approaches to CCS; the EU,
UK, Australia and certain US states are all currently
developing legislation in this field and a cooperative
approach is seen as important.
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MATERNAL
AND CHILD HEALTH
Our key concerns are to extend knowledge in
disadvantaged communities and to ensure that
community-based interventions at scale have
a measurable impact on mortality rates.
Image: Professor John McArthur
In countless areas – from trials of multiple
micronutrients in pregnancy to prevention of birth
asphyxia, and from the immunology of pneumococcal
vaccines to gynaecological screening programmes –
we are intent on evaluating initiatives and rolling
out those which are impactful.
Examples of our recent engagement with maternal
and child health:
A Wellcome Trust Strategic Grant of £5.5 million was
awarded to Anthony Costello, Professor of International
Child Health, to develop the evidence base on the
population science of maternal and child survival.
To do so, he has developed links with colleagues in
UCL Mathematics’ Clinical Operational Research Unit,
the UCL Centre for Health Informatics & Medical
Education, the UCL Institute of Child Health,
UCL Philosophy and UCL Anthropology.
UCL Economics Professor Orazio Attanasio and
Dr Marcos Vera-Hernandez began an Institute for
Fiscal Studies examination of the causal effect of
reproductive health on poverty-related indicators and
networks in Malawi. They are collecting new micro-level
data from treatment and control villages over time,
examining the randomised intervention in the Mchinji
district of Malawi managed by the UCL Centre for
International Health & Development since 2006.
Poverty-related variables to be examined include
household consumption and female labour supply,
along with investment in the health and education
of children, which are considered to be critical for
long-term poverty reduction.
Working with NGOs and UN organisations in China,
Indonesia, Cambodia and Laos as a clinical teacher
and manager of health programmes, Dr Therese
Hesketh, UCL Lecturer in International Child Health,
helped develop the first neonatal and paediatric
intensive-care unit and the first neonatal outreach
programme for the training of doctors and nurses
in China. She has also undertaken research on the
impact of population policy on the health of women
and children in China:
“The ratio of men to women in most populations is
remarkably constant if left untouched – between
103 and 107 male births for every 100 female births.
However, the tradition of son preference has distorted
these natural sex ratios in China and other parts of
Asia and North Africa.”
A further study, involving UCL Anthropology, will explore
the impact of that ratio in China.
UCL is also engaged in projects with children in difficult
circumstances, such as HIV orphans in Africa, child
labourers in China and Mexico, and street children in
Latin America. We support networks of the urban poor,
strengthening their capacities and facilitating their
engagement with governments.
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Image: Thomas Kelly
Three of UCL Economics’ research centres have
particular relevance to global health: the Centre for
Microeconomic Analysis of Public Policy, the Centre
for the Evaluation of Development Policies and the
Centre for Economic Research on Ageing.
Women’s community meeting, Nepal
Following the success of a rigorous evaluation of
reducing maternal- and child-mortality rates using
women’s community groups in rural Nepal, new
projects were set up in Nepal, Malawi, Bangladesh
and India. Professor Anthony Costello (UCL Centre for
International Health & Development) was awarded
£5 million from the Big Lottery Fund for a project aiming
to scale up these community-participatory interventions
in seven states in India and across Bangladesh.
He said:
“We believe that women’s groups have great potential
for bringing about change even in the poorest and
most remote communities.”
Professor Catherine Law led colleagues from the UCL
Institute of Child Health in a study which compared
health behaviours during pregnancy (smoking and
alcohol consumption) and after birth (initiation and
duration of breastfeeding) between British/Irish white
mothers and mothers from ethnic-minority groups.
After women immigrate to the UK, their maternal
health behaviours worsen as their length of residency
increases. The longer ethnic-minority women live in the
UK the more likely they are to smoke during pregnancy
or give up breastfeeding early. These findings have
public-health implications for countries with large
migrant populations, and are an important first step
in developing programmes and policies that promote
the health of immigrant women and their children.
Adeola Olaitan, Consultant Gynaecological
Oncologist at UCLH, coordinated the UCL Institute for
Women’s Health cervical-screening project in Nigeria.
The ‘screen and treat’ programme aims to screen
sexually active women aged up to 70 by using visual
inspection techniques, to detect signs of cancerous
or pre-cancerous cells. It is then possible to remove
pre-cancerous cells through a technique called
cryotherapy, which is the application of extreme cold
to destroy abnormal or diseased tissue. Dr Olaitan said:
“Cervical cancer is a huge problem in Nigeria and
a small, inexpensive intervention such as cervical
screening can save numerous lives. This project is an
opportunity for me and my colleagues to use our skills
in another country, working with local hospitals and
health organisations to help educate women about
this disease and to save lives.”
Dr Shanthi Muttukrishna and Dr Ray Noble (UCL
Institute for Women’s Health) are establishing a
medical-ethics course with special emphasis
on women’s rights to reproductive health at the
Alluri Sitarama Raju Academy of Medical Sciences
in Andra Pradesh, India. The UCL academics are
developing undergraduate and postgraduate teaching
in reproductive health in collaboration with staff at
the academy, and plan to carry out research in
reproductive ethics and rights. The long-term aim is
to gain recognition for the course from the Medical
Council of India, and to set up similar programmes
in other medical schools in India.
Professor Ian Jacobs and Dr Nikki Robertson (UCL
Institute for Women’s Health) and Professor Anthony
Costello (UCL Centre for International Health &
Development) worked with the Uganda Women’s
Health Initiative to conduct a pilot study which suggests
that whole-body cooling could be a feasible and
inexpensive treatment of asphyxial encephalopathy
in a special-care baby unit in a low-resource setting.
Rigorous randomised trials to determine the safety
and efficacy of therapeutic hypothermia in this
context are urgently needed so that any benefits
of this novel therapy can reach areas of the world
that might need it most.
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INFECTIOUS DISEASES
The full range of disciplines from basic laboratory
science through diagnostics to clinical trials,
epidemiology, statistical and behavioural science
are all strongly represented at UCL.
Our approach is deliberately multidisciplinary
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.
Andrew Phillips, UCL Professor of Epidemiology &
Biostatistics, developed a computer-simulation model
of HIV infection, used to help advise the World Health
Organization. In most lower-income settings viral-load
tests are not available so patients tend to be left on
first-line regimens for as much as four to five years
longer than in developed countries. A computer
simulation model of the effects suggested that while
both the risk of death and the time spent infectious
with resistance virus are likely to be higher if
patients are not monitored, this is only by a
relatively modest amount.
A Gates Foundation Grand Challenges Explorations
grant (one of two awarded to UCL applicants) for
US$100,000 was awarded to Professor Graham Rook
and Professor Alimuddin Zumla for the application of
nanogold technology to deliver anti-TB drugs directly
to macrophages.
Image: John Wildgoose
Examples of our recent engagement with
infectious diseases:
Cut-away model of human HIV virus
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The findings of the largest study into mother-to-child
HIV transmission showed an infant-infection rate of just
1.2% following the recommended interventions. This is
a drop from more than 20% in the mid-1990s, before
effective antiretroviral therapy (ART) became available
– and the first time that such low rates of infection have
been observed at population level. The study’s lead
author, Claire Townsend, UCL Paediatric Epidemiology
and Biostatistics Research Fellow, said:
“Our findings demonstrate that if women are tested for
HIV early enough in pregnancy for ART to be initiated,
the risk of infection to their baby is very low indeed.
This emphasises the importance of achieving and
maintaining a high uptake of antenatal HIV testing.”
The Wellcome Trust pledged £4 million over three
years from its Seeding Drug Discovery Initiative to
a programme to develop UCL’s patented series of
selective DDAH inhibitors for use in treating sepsis.
Building on a primary series of chemical inhibitors
designed and developed at UCL in part under
awards from the British Heart Foundation, the Wellcome
Trust and UCL Business PLC, Dr James Leiper (UCL
Centre for Clinical Pharmacology & Therapeutics)
assembled a uniquely cross-disciplinary team
spanning chemical, biological and clinical expertise,
in order to fully engage with every aspect of the
drug-development cycle.
Robin Weiss, UCL Professor of Viral Oncology, coauthored a paper published in ‘Cell Host and Microbe’
identifying a genetic variation that makes many people
of African descent more susceptible to HIV. Using data
from a 22-year study of thousands of Americans from
different ethnic backgrounds, researchers focused on a
gene that evolved to provide protection against malaria.
They found that the same gene increases susceptibility
to HIV by 40%. Conversely, it also appears that the
gene prolongs survival among HIV-positive people
by two years, by causing them to develop AIDS more
slowly. Professor Weiss leads a $25 million international
research consortium, funded by the Bill and Melinda
Gates Foundation, which is searching for a vaccine
against HIV.
Deenan Pillay, UCL Professor of Virology, headed
a successful bid for funding from the European
Commission for a major international collaborative HIV/
AIDS research project. €10 million has been awarded
to the Collaborative HIV and Anti-HIV Network (CHAIN),
a programme encompassing 23 partners across
Europe and Africa, including universities, biotechnology
companies, and international organisations. CHAIN
aims to address the biology, epidemiology and clinical
impact of drug resistance, and to devise new
therapeutic and surveillance strategies to maintain
the major benefit of treatment to infected individuals.
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Image: Professor Anne Johnson
A team of UCL scientists identified a combination of
genes in a species of monkey that protects against
retroviruses such as HIV. Led by Greg Towers,
UCL Professor of Molecular Virology, the Wellcome
Trust-funded group found that a species of Asian
monkey called Rhesus Macaques has a sophisticated
‘antiviral arsenal’ – a fusion of the Cyclophilin and
TRIM5 genes generating a fusion protein, TRIMCyp.
The team now aims to develop humanised TRIMCyp
that blocks HIV infection by artificially fusing human
Cyclophilin and human TRIM5.
Image: Mrs Denise Stenzel (UCL Structural & Molecular Biology)
Image: Cláudio Amaral Archives
Vaccinating children, Rio de Janeiro, Brazil, 1971
Dr Sanjoy Bhattacharya (Wellcome Trust Centre for
the History of Medicine at UCL) continued work on
a Wellcome Trust-funded project on the control and
eradication of smallpox in East Pakistan and
Bangladesh. He is examining a variety of themes,
including the impact of the regional political
instability and cold war-related tensions on
smallpox-immunisation campaigns, as well as
the role played by organisations like the US Centers
for Disease Control, USAID and the different World
Health Organization offices in the final stages of
global smallpox eradication and its certification.
Image: Professor Anne Johnson
The combined supercomputing power of the UK and
US ‘national grids’ enabled UCL scientists to simulate
the efficacy of an HIV drug in blocking a key protein
used by the lethal virus. The method – an early
example of the Virtual Physiological Human (VPH) in
action – could one day be used to tailor personal drug
treatments, for example for HIV patients developing
resistance to their drugs. The study, by Professor Peter
Coveney and colleagues at UCL Chemistry, involved
a sequence of simulation steps, performed across
several supercomputers on the UK’s National Grid
Service and the US TeraGrid, which took two weeks
and used computational power roughly equivalent to
that needed to perform a long-range weather forecast.
It promises to replace ‘trial and error’ prescribing with
drugs tailored to individual’s genetic makeup.
Prescribed antiretroviral treatment
The MRC Clinical Trials Unit, led by Professor Janet
Darbyshire, hosts a major programme of research in
collaboration with clinical colleagues at UCL. The
Microbicide Development Project is an MRC/
Department for International Development £30 million
multidisciplinary trial involving partners in six African
countries and colleagues at Imperial College London
and the London School of Hygiene & Tropical
Medicine. Other work includes several trials in Africa of
novel approaches to antiretroviral therapy for HIV and
its rollout in adults and children (the DART trial).
Image: Mrs Denise Stenzel (UCL Structural & Molecular Biology)
Dr Jane Zuckerman (UCL Academic Centre for Travel
Medicine & Vaccines) wrote a leading editorial for
the ‘British Medical Journal’ discussing the issues
accounting for rising cases of malaria among Britons
travelling abroad. Dr Zuckerman argued that the
main reason for this trend is that people are not taking
necessary medications or seeking travel advice,
and that people visiting friends or relatives in malarial
areas often underestimate their risk of contracting
the disease. The success of programmes to reduce
malaria in the Indian subcontinent indicate that similar
programmes in Africa could yield similar results.
Single cell in culture
Dr John Richens (UCL Infection and Population Health)
has undertaken training workshops and policy
seminars on sexually transmitted infection (STI) control
and the syndromic approach in Ukraine, Kazakhstan
and Uzbekistan. He is collaborating the development
of STI-management guidelines in ten countries ranging
from Latvia to Azerbaijan in a project funded by the
Soros Foundation’s Open Society Institute.
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The UCL Centre for Sexual Health & HIV Research and
the UCL School of Slavonic & East European Studies
(SSEES) have been conducting a joint study entitled
Sexual Attitudes and Lifestyles of East Europeans in
London (SALLEE) since November 2007. The project,
funded by the MRC, is motivated by the need to
understand the sexual and reproductive health needs
of the ‘new’ population of largely economic migrants
that have arrived in the UK from the countries of
Central and Eastern Europe (CEE).
Baby being vaccinated
Professor Alimuddin Zumla and Dr Jim Huggett of UCL
and Professor Michael Hoelscher of the University of
Munich were awarded €5 million by EuropeAID,
Brussels, for research and development to improve TB
Programme performance for the Active Detection of
Active TB (ADAT) project. ADAT will evaluate newer TB
diagnostics in children and adults with and without HIV
infection, in between Mbeya, Tanzania, and Lusaka,
Zambia. The results of this study will assist the
Tanzanian and Zambian TB Programmes to refine
diagnostic and management algorithms for TB in adults
and children and will define biomarkers of TB disease
activity, cure and relapse. Under this programme four
Zambian scientists will be registered for PhDs between
UCL and Zambia on work related to the ADAT study.
A memorandum of understanding between Karolinska
Institute, Stockholm, Sweden, the Ministry of Health,
Zambia and the University of Zambia was signed in
Stockholm in October 2008 to supplement funding
to the ADAT project and add a biomarkers aspect
to the study.
The significant increases in sexually transmitted
infections across the CEE region have been well
documented and this multidisciplinary UCL project
represents the first major attempt to identify what action
is needed to improve sexual and reproductive health
services for these migrant communities. The project
has already confirmed that these migrants are already
having a substantial impact on genitourinary medicine
(GUM) services. If attendance rates continue to rise at
the current level, CEE women will soon account for over
10% of all new attendances. In contrast proportionately
fewer CEE males have accessed GUM services.
SALLEE is a methodologically innovative survey-based
project drawing on techniques of social mapping and
respondent driven sampling (RDS) to identify a broadly
representative sample of London’s CEE migrants.
As of October 2008 a total of 1,934 CEE men and
women have completed a detailed ‘Sexual Attitudes
and Lifestyles’ questionnaire either as part of a
community sample, a web sample, a clinic sample
or the RDS sample. Detailed follow-up interviews with
a sub-sample of respondents are now taking place.
Professor Marie-Louise Newell – seconded since 2006
from the UCL Institute of Child Health to be Director
of the Africa Centre for Health and Population Studies,
South Africa – won a £15 million grant over five years
from the Wellcome Trust. The centre is based in
KwaZulu-Natal, an area where more than 20% of
people are HIV-infected. It is using the funding to
evolve from a research centre focused on the recording
of health problems to one focused on intervention and
implementation. Researchers at the centre will monitor
the impact of HIV on individuals, their households and
the wider community, combining data collected within
the bi-annual household survey with that from the
annual individual-level HIV, health and behaviour
surveillance. Professor Newell said:
“The Wellcome Trust grant will help us in our goal of
keeping HIV-negative people negative, healthy people
healthy and HIV-infected people optimally cared for.
In South Africa, as in many areas of sub-Saharan Africa,
HIV is a major problem, compounded as it is by poverty,
migration and lack of access to effective treatments.”
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One of 2008’s inaugural UCL Institute for Global Health
Symposia addressed key issues in HIV. In April 2008
‘HIV/AIDS – With No Magic Bullet, Where to Next?’
explored the consequences of the failure of vaccines
to resolve an epidemic of more than 20 years duration.
Drawing together contributions from – and provoking
discussion between – different academic disciplines,
this series of symposia were a manifestation of
how the breadth of UCL’s expertise can be rallied
to address issues of global significance. The symposia
can be viewed online (www.ucl.ac.uk/global-health)
and printed summaries are also available.
Dr Keertan Dheda (UCL, CIDIH and ex-UCL PhD
student), Professor Graham Rook and Professor
Alimuddin Zumla (UCL Centre for Infectious Diseases
and International Health) were awarded a European
Commission grant worth €1 million to establish a
TB diagnostic and training network between UCL,
University of Cape Town and New Delhi, India.
This will involve training of technical personnel
and three PhD students, and the establishment
of research and development links.
The UCL Centre for Sexual Health & HIV Research
has had extensive involvement with a variety of
sexual-health projects in India. Activities have included
training private practitioners working in red-light
districts in Calcutta, providing technical advice to
the Health Highways Project, the West Bengal Sexual
Health Intervention Project and projects in Kerala,
Gujarat, Andhra Pradesh and Tamil Nadu. The centre
has helped to design and implement several STI
prevalence surveys among sex workers and truck
drivers. Dr Sangeeta Dave (UCL Centre for Sexual
Health & HIV Research) conducted a study to estimate
sexual behaviour, HIV and STI prevalence in male
migrant workers in Surat, India, which attracts high
levels of migrants to its many industries. Annual HIV
sentinel surveillance consistently places the city in
a high prevalence category. In collaboration with
the Department of Community Medicine, Government
Medical College, Surat, the study’s quantitative and
qualitative data should help inform future interventions.
The Centre has also been involved in a review of the
AIDS Prevention and Control project in Tamil Nadu, and
in assisting Heiner Grosskurth in the design of a cluster
randomised trial of periodic presumptive treatment
among sex workers for the Population Council.
TB public information poster
Dr Jim Huggett and Professor Alimuddin Zumla (UCL
Centre for Infectious Diseases & International Health)
were awarded a European Commission grant of
€2 million for the rapid identification of TB by detecting
mycobacterial DNA in urine samples, avoiding having
to use blood samples. This project links three African
countries (Tanzania, Zambia and South Africa) with
UCL, University of Munich and Rome University.
Professor Steve Gillespie, Dr Tim McHugh (both UCL
Medical Microbiology) and Professor Alimuddin Zumla
(UCL Centre for Infectious Diseases & International
Health: CIDIH) and other European and African
co-investigators were awarded €18 million by the
European & Developing Countries Clinical Trials
Partnership (EDCTP, The Netherlands) and the Global
Alliance for TB Drug Development (USA). They will
conduct clinical trials of the flouroquinolone antibiotic
moxifloxacin at collaborative clinical trial sites
developed by Professor Zumla and Professor Gillespie
during the past 16 years in Zambia, Tanzania and South
Africa. Professor Zumla and Professor Michael
Hoelscher (University of Munich) have also been
awarded €9 million by the EDCTP for conducting a
clinical trial of the new anti-TB drug SQ109. These trials
aim to reduce the duration of chemotherapy from six
months to three or four months, making patient
compliance with TB therapy better.
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The Regai Dzive Shiri Project, run by the UCL Centre
for Sexual Health & HIV Research, is a large community
randomised trial of an adolescent HIV-prevention
intervention based in rural Zimbabwe and funded by
the National Institute of Mental Health. Outcomes are
being measured in terms of the intervention’s effect on
HIV, STIs and unintended pregnancy as well as on
reported behaviour, knowledge and attitudes. It is one
of the first rigorous evaluations of a community-based
HIV prevention intervention for young people in
southern Africa. The trial has generated a considerable
amount of preliminary data relating to the increased
vulnerability of orphans to HIV and also answered
some methodological questions related to measuring
sensitive behaviours in young people. The final
results on the impact of the trial is to be presented
at the International African AIDS Conference in
Senegal in December 2008.
A team led by Professor Benny Chain (UCL Infection
& Immunity) is taking a novel approach to developing
an HIV vaccine. Most successful vaccinations work
by stimulating the body to produce antibodies against
particular pathogens, which then kick into action
when a person comes in contact with that disease.
The antibodies neutralise the pathogens, stopping
disease from taking hold.
However, in the case of HIV, the antibodies triggered by
the body in response to trial vaccination programmes
have not been able to neutralise the virus, and the
HIV virus is so variable that it can often escape
the antibodies.
Instead of focusing on paralysing the HIV pathogens
themselves, the team is investigating whether they
can paralyse the mechanisms in our very own cells
that allow HIV access to the human body. This is
known as an anti-self response.
“We are investigating a cell receptor called CCR5,
which plays a crucial role in allowing HIV to cross
over into the body. CCR5 is a chemokine – a family of
proteins excreted by bodily cells, transmitting cellular
information. We know two very important facts about
CCR5. First, approximately 1% of the Caucasian
population do not have the receptor, and this lack
does not cause them significant immunodeficiencies.
Secondly, people with CCR5 deficiency are almost
entirely protected against HIV.”
The group is investigating whether they can trigger
an ‘anti-self’ response to the CCR5 molecule, using
the technology developed by Professor Chain and
patented by UCL. Introduced to the body, they hope
that this treatment will stimulate antibodies to CCR5,
forming a vaccination against HIV. It is thought that
such a simple vaccination strategy will be cheap
to deliver, and UCL and UCL Business PLC, the
technology development company of UCL, are
working hard to get this treatment into the clinic
as quickly as possible.
Zimbabwean school girls
The UCL Urban Pathogen Research Group (Upath) was
founded as a multidisciplinary network to prevent and
mitigate pathogens such as MRSA, avian flu and SARS
in the urban environment. It is using environmental and
infection-control data captured in London hospitals to
produce engineering solutions in environmental health.
The programme is led by Dr Ka-man Lai (UCL Civil,
Environmental & Geomatic Engineering).
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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 when such
changes are developed with low-cost, low-tech
interventions in mind.
As part of the World Health Organization’s Global
Campaign against Epilepsy, Professor Ley Sander
(UCL Institute of Neurology) completed large-scale
projects in China and Brazil, providing the embryo
for National Epilepsy Programmes in both countries.
Another project is being carried out in Georgia to see
if epilepsy management can be provided in its incipient
primary-care system and subsequently deployed
in other countries of the area. The UCL Institute of
Neurology and the UCL Institute of Child Health
are also involved in projects focusing on the
epidemiological, clinical, genetic and health
delivery aspects of epilepsy in Kenya, Tanzania,
the Netherlands, Bulgaria and India. For instance,
in Bulgaria, Professor Sander and his team are
assessing the feasibility of setting up epilepsy services
for the Roma community, which is the most deprived
minority in Europe. In Kenya, Professor Charles Newton
(UCL Institute of Child Health) is leading a major effort
to characterise epilepsy in a malaria-endemic region;
this may have major implications for the delivery of
epilepsy care in other African settings.
Image: Dr Dean Barratt (UCL Medical Physics & Bioengineering)
Examples of our recent engagement with
non-communicable diseases:
Blood vessels in the brain
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Formerly at Yale School of Public Health, USA,
Professor Nora Groce joined the Leonard Cheshire
Disability & Inclusive Development Centre – within UCL
Epidemiology & Public Health – in September 2008.
Professor Groce is a medical anthropologist, interested
in the area of global health and international
development with particular emphasis on cross-cultural
systems of healthcare and health as human-rights
issues, disability in international health and
development, violence as a global public health
problem and equity in access to healthcare in
ethnic and minority communities.
Dr Christopher Gerry (UCL School of Slavonic &
East European Studies) has been examining changing
health patterns and growing health inequalities in the
post-communist world. Life expectancy in parts of
Eastern Europe and Central Asia has fluctuated
dramatically in recent decades. In Russia it has
declined to such an extent that, despite a prosperous
decade, male life expectancy stands at approximately
60 years. The life expectancy gap between EU and
Russian males has grown to more than 15 years
during the post-communist period. The extravagant
loss of Russian working age males that drives these
figures is astonishing.
Mother and baby at a community meeting,
Nepal
The search for the fundamental drivers of these trends
is somewhat more complex. There are a number
of candidate explanations: collapsing incomes,
growing inequalities, deteriorating public health
care, environmental degradation, unhealthy individual
behaviour relating to alcohol, cigarettes, drugs and
sex, changing diets, and the psychological stress
associated with ‘transition’. Current research
investigates the complex social, economic, cultural
and behavioural story underlying these developments.
Image: Dr Sean Davidson (UCL Physiology)
While, across most of Europe, deaths from
cardiovascular disease and ‘external’ causes have
fallen substantially for both men and women, in Russia,
deaths attributable to these causes have snowballed.
Specifically there has been a 70% (51%) increase in
the standardised death rates due to cardiovascular
disease for men (women) and a 47% (61%)
increase in deaths arising from external causes.
As a consequence, deaths in these categories now
dwarf those observed for all other European countries
and account for the overwhelming proportion of total
deaths in Russia.
Heart vessel
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Although a great deal is known about risk factors for
major depression, effective strategies for prevention
are hindered by lack of evidence about the combined
effect of this large number of known risk factors and
whether the risk for major depression can be quantified
in the same way as other clinical disorders such
as cardiovascular diseases.
Professors Michael King and Irwin Nazareth from
the Research Departments of Mental Health Sciences
and Primary Care and Population Health (Division of
Population Health) at UCL have recently developed
the first international risk instrument (predictD) for
predicting the onset of major depression in European
general practice attenders from six countries (UK,
Spain, Portugal, the Netherlands, Slovenia and Estonia)
and they have tested its predictive power in general
practice attenders in a non-European setting (Chile).
The results of this study will be published in December
2008 issue of Archives of General Psychiatry.
Professors King and Nazareth plan to test the utility
of this instrument in early detection of depression
in randomised trials in Europe. They also plan to test
the feasibility of using this instrument in China,
assessing its application and predictive power in such
a setting. The Medical Research Council has funded
the UCL Division of Population Health and the MRC
General Practice Research Framework to run a
workshop in China to develop a research proposal
for the prediction of depression in a Chinese
community setting. This will be the first ever research
initiative of its kind to be undertaken in Asia.
A new mental-health research unit was launched
in Chennai, India, by Dr Sushrut Jadhav, UCL Senior
Lecturer in Cross-Cultural Psychiatry. The Banyan
Academy of Leadership in Mental Health (BALM) is
a non-governmental organisation that offers training
for mental-health professionals. It invited Dr Jadhav
to help them develop new courses and approaches
to mental health and, with initial funding from the
UCL International Office, a collaboration was
established. Two sets of short courses were run
during the unit’s first year.
Image: Dr Sushrut Jadhav (UCL Medical Anthropology)
Major depression is now a leading cause of morbidity
and social disability worldwide and reducing its
prevalence is one of the greatest public health
challenges of the 21st century. Depression will
rank second to cardiovascular disease as a global
cause of disability by 2020.
UCL-BALM Mental Health at the Margins programme
David Beran (UCL Centre for International Health
& Development) is conducting rapid-assessment
protocols in Mozambique, Zambia, Mali and Nicaragua,
producing reports which have become the basis of
national diabetes programmes. Health services in many
resource-poor countries are poorly equipped to
manage patients with chronic disease. The prevalence
of insulin-requiring diabetes in much of sub-Saharan
Africa is an order of magnitude lower than in
industrialised countries, in large part because the
life expectancy of people who develop this condition
is as low as a year. While the cost of insulin contributes
to this problem, diabetes is a condition where drug
availability at affordable cost is only one of several
components of an effective healthcare system
needed to ensure survival – educated healthcare
staff, monitoring equipment, and a referral system for
complex cases are also vital. Beran is also working
with the Ministry of Health and the Diabetes
Association in Mozambique to take forward the
development of services for patients with diabetes
and other non-communicable diseases.
25
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 recent engagement with politics,
policy and justice:
Dr David McCoy (UCL Centre for International Health
& Development) was co-managing editor of ‘Global
Health Watch 2: An Alternative World Health Report’
(GHW2), launched at UCL in October 2008. Speakers
included Professor Anthony Costello (UCL Institute for
Global Health and UCL Centre for International Health
& Development), Professor P Chandra (Institute of
Social Paediatrics, Stanley Medical College, Chennai,
India) and Dr David McCoy (UCL Centre for
International Health & Development). GHW brings
together academics, civil-society organisations and
social movements to promote health and improve the
performance of global-health institutions. More than
100 individuals collaborated to produce the second
report, with more than 20 chapters covering subjects
such as the World Health Organization, the World Bank
and the Gates Foundation. The book describes a range
of health challenges, including the continued growth in
global poverty, climate change, war, food prices, and
water and sanitation.
A landmark report for the World Health Organization
(WHO) led by UCL’s Sir Michael Marmot, Professor of
Epidemiology & Public Health, concluded that humanity
can significantly improve global health within a
generation, but that it must radically re-think
international economic and social policies. ‘Closing the
Gap in a Generation: Health Equity through Action on
the Social Determinants of Health’ was the culmination
of three years’ intense work for the WHO Commission
on Social Determinants of Health, an independent
body made up of international policymakers and
former heads of state and ministers for health. The
commission looked at how the citizens of varying
nations came to have the life expectancy
and health quality they did. Sir Michael said:
“The key message is that the circumstances in which
people are born, grow, live, work, and age are the
fundamental drivers of health, and of health inequity.
We rely too much on medical interventions as a way
of increasing life expectancy – a more effective way of
increasing life expectancy and improving health would
be for every government policy and government
programme to be assessed for its impact on health and
health equity; to make health and health equity a marker
for government performance. It’s not just a matter of
relieving poverty; it’s a matter of taking social action that
involves all of us.”
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Image: Dr Jerome Lewis (UCL Anthropology)
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 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.
Image: Mr Besim Can Zirh (UCL Anthropology)
POLITICS,
POLICY AND JUSTICE
Image: Dr Jerome Lewis (UCL Anthropology)
Dr Jerome Lewis (UCL Anthropology) collaborated with
NGOs and a software firm to provide tools for some of
the most vulnerable communities in the world, to map
and monitor their natural resources. Illegal logging
in Cameroon destroys vital resources for local
communities, who depend on many of the forests for
fruit, caterpillars, medicines and oil. Data acquired
through the use of new handheld GPS mapping tools
serves to develop a dialogue between government,
NGOs and communities over forest planning and
control, and provides an accessible platform to
audit and demonstrate governmental commitment to
good governance. In the long term the project aims
to provide a community-based model that can be
deployed in the other nations of the Congo Basin.
GPS monitoring in Cameroon
Professor Anthony Costello, Co-Director of the UCL
Institute for Global Health, highlighted the debate
around whether food-commodity derivatives are a
new cause of malnutrition. He wrote in April 2008 to
‘The Guardian’, calling for intervention by the G8:
Image: Mr Besim Can Zirh (UCL Anthropology)
“Over the past decade we have seen asset bubbles
burst in the dotcom industry, developing-country stock
markets (the latest is China) and now a colossal
housing bubble in the US and Europe… The new
victims of the unregulated flows of international capital
will be the poorest households on earth… The recent
terrifying increases in food prices means the poorest
households in the developing world, surviving on tiny
fixed incomes, will be hungry right now. In a few months
our TV screens will show the pot-bellies of children with
kwashiorkor and the emaciated faces of mothers and
children ravaged by malnutrition and infection. Many will
die unnoticed… Speculation in agricultural-commodity
markets runs in parallel with the rising costs of gold,
oil and essential metals… Food commodities should be
insulated from speculators and hedge funds who profit
as prices rise, and again when they fall in a few months
time. Anyone profiting from this volatility will do so
at the expense of the lives of thousands of mothers
and children.”
This was followed by a comment featured in
‘The Lancet’ written by Professor Costello,
Dr Noemi Pace and Dr Andrew Seal (UCL Centre
for Health & International Development).
Tarhana, a fermented mixture of grain and yoghurt
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The Human Resources for Health special edition of
‘The Lancet’ featured a new study calling for policy
interventions to resolve issues relating to the income
and pay of health workers in sub-Saharan countries.
Co-lead author Dr David McCoy (UCL Centre for
International Health & Development) noted:
“An increase in public-sector employment and pay
for health workers would require sustained external
or donor financing. Other solutions that need to be
implemented concurrently include non-financial
incentives to affect the motivation of health workers.
Improving job satisfaction and career progression,
enhancing working conditions and the quality of
supervision, addressing on-the-job safety and security
concerns, redressing the unavailability of good schools
for children in rural areas, and improving the structure
and management of the payroll could all contribute to
retention, motivation, and payment of health workers
within the public sector, especially in rural regions
where staffing problems are most acute.”
Four of 2008’s inaugural UCL Institute for Global Health
Symposia addressed key issues in the politics, policy
and justice of global health. In February Professor
Jonathan Wolff (UCL Philosophy) led the symposium
‘Health Systems: What’s justice got to
do with it?’ In March Caren Levy (UCL Development
Planning Unit) chaired ‘Public Inconvenience: The
politics of toilets in India’. In May Dr Richard Horton,
Editor of ‘The Lancet’, moderated ‘Global Health
Governance: Who is accountable to whom?’ In July
2008 ‘Global Health Equity and the Commission on
Social Determinants of Health’ explored how
inequalities in health within and between countries
are a significant feature of the global health scene
and how health inequalities can be tackled by action
on the underlying social determinants of health.
Drawing together contributions from – and provoking
discussion between – different academic disciplines,
these symposia were a manifestation of how the
breadth of UCL’s expertise can be rallied to address
issues of global significance. The symposia can
be viewed at the institute’s website and printed
summaries are also available.
The UCL School of Public Policy – focused on
international relations, political theory, human rights,
and public policymaking and administration – offers
an MA in Human Rights. Its graduates over the last
five years now exercise influence in the United Nations
Office of the High Commissioner for Human Rights,
Amnesty International, the British Institute for Human
Rights and the Council of Europe, and in countries as
diverse as Croatia, Brazil, the United States, Pakistan,
Uganda, Georgia and Hong Kong.
28
Dr Marcos Vera-Hernandez (UCL Economics) led
an Institute for Fiscal Studies examination of the
subsidised health-insurance scheme in Colombia,
which represents an early example of a market-based
approach for providing health insurance for the poor.
He investigated how this health-insurance scheme
has influenced health, healthcare use and healthcare
spending among poor Colombians, as well as how
it has altered the allocation of household resources
and influenced consumption smoothing over time.
UCL Laws’ Centre for International Courts and Tribunals
is a partner in a new collaborative research project,
‘Impact of International Courts on Domestic Criminal
Procedures in Mass-Atrocity Cases’ (DOMAC), which
began in February 2008. DOMAC explores what impact
international procedures have on prosecution rates
before national courts, their sentencing, policies,
award of reparations and substantive procedural legal
standards. It offers methods to improve coordination
of national and international proceedings and better
utilisation of national courts, through greater formal
and informal avenues of cooperation, interaction
and resource sharing between national and
international courts.
The new UCL MA in Philosophy, Politics and Economics
of Health will equip students to play an informed role in
debates concerning distributive justice and health.
It will examine moral and political theory, economics,
and political and historical analysis, to explore the
central ethical, economic and political problems
facing health policy in the UK and abroad, especially
in relation to social justice. The programme is being
developed by the new UCL Centre for Philosophy,
Justice and Health, in partnership with UCL Philosophy,
UCL Political Science, UCL Laws, the UCL Medical
School and UCL Population Health.
UCL INSTITUTE FOR
GLOBAL HEALTH (IGH)
SYMPOSIA
SPRING 2008
This series of challenging and stimulating
multidisciplinary global-health symposia aimed to
encourage UCL staff and students – and those beyond
the university – to learn more about, and get involved
in, the new UCL Institute for Global Health.
The underlying philosophy of our work is that the
solutions to achieving sustained long-term health
improvement reside equally in all our faculties; from
the arts and humanities, built environment, engineering
and law, to basic and applied biomedical sciences.
The monthly symposia explored controversial subjects
related to global health and the barriers to long-term
sustained health improvement. To watch the symposia
online please visit www.ucl.ac.uk/global-health/events
or itunes.ucl.ac.uk
‘Global Health: What’s justice got to do with it?’
February 2008
At the first symposium, staff, students, policymakers
and commentators asked ‘Global Health: What’s justice
got to do with it?’
The session explored issues of morality and justice
behind the global-health agenda: is it the responsibility
of wealthy nations to address health issues in
developing countries, or is this just left-wing rubbish?
A creative and entertaining discussion took place
between panel members including Professor Deenan
Pillay (UCL Infection and Immunity), Colm O’Cinneide
(UCL Laws) and Craig Patterson (UCL Institute for
Global Health). An intrigued audience from across UCL
contributed to the discussion and to a hypothetical
scenario presented by Professor Anthony Costello
(UCL Centre for International Health and Development),
designed to challenge us to discover our own position
on justice and global health by taking us through a
variety of conflicting scenarios in international health.
Professor Jonathan Wolff (UCL Philosophy) set out
some underlying issues, first asking what the concept
of health is: is it just death and illness? Is it the ability
of individuals to influence their own health? What about
the consequences of ill health? Is it about the fear of
ill health rather than the reality? Professor Wolff then
asked if there is a duty for people and nations to take
on global health. Three arguments are typically used to
justify action: justice (that we may violate the rights of
those of the developing world if we fail to act on global
health issues); humanitarian values (that we have a
moral duty emerging from our common humanity to
meet basic health needs across the globe); and
self-interest (we are foolish not to take action).
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‘Public Inconvenience: The politics of toilets in India’
‘HIV/AIDS – With no magic bullet, where to next?’
March 2008
April 2008
The session focused on that most basic of human
needs – toilets. It explored the politics of toilets in
Mumbai and Puna, India, and the implications for
global health, community development and the built
environment. Symposium chair was Caren Levy (UCL
Development Planning Unit), who urged the audience
not to underestimate the importance of sanitation in
making our cities healthy and sustainable: more than
2.6 billion people live without sanitation worldwide.
The third symposium focused on perhaps the biggest
health challenge of all: HIV/AIDS.
Sundar Barra from the Society for the Promotion of
Area Resource Centres gave a fascinating insight
into some of the world’s biggest slums.
Although public solutions are often unavailable, and
private solutions are unaffordable, there have been
real successes, achieved by involving local women
in designing, building and maintaining toilets.
The projects are government-funded but local women
work alongside NGOs and are contracted to provide a
service. Every family in the slum pays 25 rupees every
month for unlimited use. This solution works because
it is not free and the toilets are not unvalued, but they
are not charged at market rates. As a result, 750,000
people have benefited so far in Mumbai. Local families
are motivated to look after the toilets through receiving
salaries and accommodation.
A challenging discussion then took place between
panel members including Dr David Satterthwaite (UCL
Developing Planning Unit and International Institute for
Environment & Development), Dr David Osrin (UCL
Centre for International Health & Development),
Mekhala Krishnamurthy (UCL Anthropology) and
Professor Matthew Gandy (UCL Urban Laboratory),
joined by a motivated audience from across UCL.
After more than 20 years of the HIV epidemic, where
are we? The promised ‘magic bullet’ in the form of
vaccines has failed to emerge. What has this meant for
well-funded education and prevention programmes?
What of appropriately resourced social and behavioural
research? Have our legal and health systems kept pace
or made interventions more difficult?
Professor Robin Weiss (UCL Infection and Immunity)
set the scene by reminding us that HIV/AIDS remains
“high on the Richter scale” of infectious diseases, by
causing a number of deaths equivalent to “two World
Trade Center disasters every day”.
Professor Weiss talked through some of the attempts
at prevention. The overriding paradigm has been ABC:
abstinence, be faithful, condom use. But does it work?
In terms of ‘high-level’ evidence through randomised
controlled trials, only male circumcision has shown a
50% reduction in risk. Other attempts such as treatment
for other sexually transmitted diseases, vaginal
microbicides and vaccines have so far failed.
Professor Deenan Pillay (UCL Infection & Immunity)
followed by asking if ARVs had more to offer in terms
of prevention. Research shows that the risk of
transmission to other people is highest during the
first three weeks of infection. By reducing the viral
replication in the first three weeks, ARVs have the
potential to be used as a magic bullet for prevention
if treatment is given early. However, Professor Pillay
pointed out the potential drawbacks: it diminishes the
safe-sex message; there will be implementation issues,
since only 20% of those who need ARVs for treatment
alone are receiving them; and there are ethical
issues regarding the acceptability of toxic drugs for
primarily public health goals.
Other key contributors included Professor
Anne Johnson (UCL Population Health and
Co-Director of the UCL Institute for Global Health)
and Nick Partridge (CEO of the Terrence Higgins
Trust). Professor Johnson challenged the audience
to consider the ‘best buys’ in HIV and how to
harness the enormous collective energy across
UCL in this area.
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‘Global Health Governance –
Who is accountable to whom?’
‘Global Health Equity and the Commission
on Social Determinants of Health’
May 2008
July 2008
The symposium explored the frustration at improving
global health governance mechanisms. The session
asked what is governance and how does it differ from
government? Should democracy be an important
component of any global-governance structure?
Do major philanthropists contribute to global
governance in health?
The fifth symposium explored how inequalities in health
within and between countries are a significant feature
of the global health scene and how health inequalities
can be tackled by action on the conditions in which
people are born, grow, live, work and age – the
underlying social determinants of health.
Professor Richard Bellamy (UCL Political Science)
started by setting out some key principles of
governance and accountability. Governance was
described as a voluntary arrangement to abide
by agreed norms. These agreements are vital in
complex environments such as global health, where
governments cannot command and control every
aspect. Accountability processes can be used to
give people and organisations a legal or moral duty
to each other, even to enforce such duties.
However, both legal and democratic accountability
are weak; global governance has become governance
without government. The solution perhaps is to create
a system where global-governance institutions are
supported by agreements between governments.
Policies, however, will continue to be chosen so that
national self-governance is not undermined. Policies
that might therefore be limited include humanitarian
intervention, agreements on preferential pricing in
drugs or proposals for global redistribution.
Mike Rowson (UCL Centre for International Health
and Development) focussed the discussions on health
by summarising the changing roles of key institutions
in global health governance. Professor Philippe
Sands (UCL Laws) explored some of the tensions
in supporting legal accountability at the global level,
and Professor David Napier (UCL Anthropology)
challenged the notion that we as citizens are the
best judges of our own interests.
UCL President and Provost Professor Malcolm Grant
introduced the session by outlining the re-emergence
of social determinants in global health policy over
the last 40 years: from the 1970s and ‘Health for All’
through to the current Millennium Development Goals.
Professor Sir Michael Marmot (UCL Epidemiology
& Public Health), Chair of the World Health
Organisation’s Commission for Social Determinants in
Health, and Director of the UCL International Institute
for Society & Health, explained that there is no good
biological reason why health inequalities should occur,
and that ultimately they are due to bad politics, unjust
economics and poor social policy. There have been
huge reductions in child mortality in some low and
middle-income countries in the last 40 years. However,
all countries have a gradual worsening of health
outcomes if you compare the rich population to those
on a middle income, to the relatively poor and finally
to the very poorest. Health problems experienced
in so-called rich and poor countries have therefore
begun to overlap.
Professor Marmot advocated using the Millennium
Development Goals to promote equity not just between
countries but within them. A global movement is
required to focus on this and to make the globe a fairer
place. It would be a calamity not to have this as a goal
and not to try to close the gap within a generation.
Professor Marmot was then joined by panellists
Professor Anne Johnson (UCL Population Health and
Co-Director of the UCL Institute for Global Health),
Professor David Price (UCL Vice-Provost, Research),
Professor Pascoe Pleasance (UCL Laws) and
Dr Stanley Okolo (UCL Medical School), to respond
to questions and comments from the audience.
Full details of the 2008/09 symposia series are
available at the UCL Institute for Global Health
website: www.ucl.ac.uk/global-health
31
WHY UCL?
It is Europe’s second most productive
partnership for biomedical science research
(according to The Partnership for Science
& Technology Studies), which accounts
for 65 per cent of all university activity.
In the 2001 Research Assessment Exercise,
most biomedicine departments at UCL
received 5* or 5 ratings as did the physical/
chemical sciences.
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.
20 Nobel Prize winners have worked or studied
at UCL. These include Professor Francis Crick,
who co-determined the structure of DNA,
and most recently, Sir Martin Evans in 2007,
for discovering the principles for introducing
specific gene modifications in mice through
embryonic stem cells.
UCL is London’s leading multidisciplinary
university, with 8,000 staff and 22,000 students
from over 150 countries.
UCL is one of the world’s top 10 universities
(rated seventh in the Times Higher Education/
QS Rankings 2008), is the best UK university for
health research (according to the Department
of Health) and is one of the top 20 universities
in the world for medicine (according to the
Shanghai Jiao Tong University Rankings 2008).
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 students are given opportunities to excel
and to find their place in the world. Each
student is prepared for their role as ‘global
citizens’ through an international curriculum,
local volunteering opportunities and crossdisciplinary research-led teaching.
UCL’s academic community includes 35 Fellows
of the Royal Society and 77 Fellows of the
Academy of Sciences. At UCL, groundbreaking
discoveries include the hormone adrenaline,
the immune system and auto-immune disease.
Other pioneering developments at UCL include
the first use of x-ray for clinical purposes and
the first ever UK application of gene therapy to
cure children with inherited immunodeficiency.
The university is committed to combining
the talents of world-class researchers and
business brains to allow commercial and social
achievements to flourish. Through licensing
technologies, joint ventures, consultancy and
partnerships, UCL transfers its world-renowned
expertise and knowledge to policymakers and
the commercial world.
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 one of the largest
centres for biomedical research in Europe.
32
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UCL – LONDON’S
GLOBAL UNIVERSITY
UCL began as a radical, struggling upstart on the
fringes of London. Its founding principles of innovation,
accessibility and relevance were intended to disrupt
the status quo of England’s establishment – simply
because that was the most effective way to enhance
social justice and opportunity.
Almost two centuries later – following the exploration,
discovery and application of knowledge undertaken
by generations of researchers – we have grown into
one of the world’s leading universities, now in the
heart of one of the world’s most cosmopolitan cities.
The breadth, depth and quality of our current
research exceeds the imagination even of our
visionary founders.
Despite this advancement, we remain intent on
disrupting the status quo – simply because that is the
most effective way to eliminate the world’s unnecessary
suffering, destruction, conflict and inequity.
THE UCL INSTITUTE
FOR GLOBAL HEALTH
A world to transform
Directors
Board
The world is in crisis. Billions of us suffer from
illness and disease, despite the existence of proven
preventions and cures. Life in our cities is under
threat from social tension, pollution and climate
change. The prospect of global peace and cooperation
remains under assault from tensions between
our nations, faiths and cultures. Our quality of life
– actual and perceived – appears to be diminishing
despite technological advances.
Professor Anthony Costello
UCL Centre for International Health & Development
(CIHD)
Chair: Professor David Price,
UCL Vice-Provost (Research)
These are global problems, and we must resolve
them if future generations are to be provided with
the chance to flourish.
Professor Anne Johnson
UCL Centre for Sexual Health & HIV Research
30 Guilford Street
London WC1N 1EH
+44 (0)20 7905 2122 (internal x82 72 2122)
Professor Michael Freeman, UCL Laws
Dr Philip Gothard, UCLH NHS Foundation Trust
Professor Malcolm Grant,
UCL President and Provost
4th Floor Mortimer Market Centre,
off Capper Street
London WC1E 6JB
+44 (0)845 1555000 (internal x8706)
Research and Programme
Development Manager
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Professor Ed Byrne, UCL Vice-Provost (Health)
Dr Richard Horton, Editor of ‘The Lancet’
Professor Ian Jacobs,
UCL Institute for Women’s Health
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
Sarah Ball
Professor Nanneke Redclift, UCL Anthropology
2 Taviton Street
London WC1H 0BT
Professor Jonathan Wolff, UCL Philosophy
+44 (0)20 7679 8584 (internal x28584)
Professor Michael Worton, UCL Vice-Provost
(Academic and International)
global-health@ucl.ac.uk
www.ucl.ac.uk/global-health
Professor Alimuddin Zumla, UCL Centre for Infectious
Diseases & International Health
LONDON'S GLOBAL UNIVERSITY
UCL – LONDON’S
GLOBAL UNIVERSITY
THE UCL INSTITUTE
FOR GLOBAL HEALTH
Directors
Board
Professor Anthony Costello
UCL Centre for International Health & Development
(CIHD)
Chair: Professor David Price,
UCL Vice-Provost (Research)
30 Guilford Street
London WC1N 1EH
+44 (0)20 7905 2122 (internal x82 72 2122)
Professor Ed Byrne, UCL Vice-Provost (Health)
Professor Michael Freeman, UCL Laws
Dr Philip Gothard, UCLH NHS Foundation Trust
Professor Malcolm Grant,
UCL President and Provost
Professor Anne Johnson
UCL Centre for Sexual Health & HIV Research
4th Floor Mortimer Market Centre,
off Capper Street
London WC1E 6JB
+44 (0)845 155 5000 (extension x8706)
Research and Programme
Development Manager
Dr Richard Horton, Editor of ‘The Lancet’
Professor Ian Jacobs,
UCL Institute for Women’s Health
Caren Levy, UCL Development Planning Unit
Professor Sir Michael Marmot,
UCL International Institute for Society & Health
UCL began as a radical, struggling upstart on the
fringes of London. Its founding principles of innovation,
accessibility and relevance were intended to disrupt
the status quo of England’s establishment – simply
because that was the most effective way to enhance
social justice and opportunity.
Almost two centuries later – following the exploration,
discovery and application of knowledge undertaken
by generations of researchers – we have grown into
one of the world’s leading universities, now in the
heart of one of the world’s most cosmopolitan cities.
The breadth, depth and quality of our current
research exceeds the imagination even of our
visionary founders.
A world to transform
The world is in crisis. Billions of us suffer from
illness and disease, despite the existence of proven
preventions and cures. Life in our cities is under
threat from social tension, pollution and climate
change. The prospect of global peace and cooperation
remains under assault from tensions between
our nations, faiths and cultures. Our quality of life
– actual and perceived – appears to be diminishing
despite technological advances.
These are global problems, and we must resolve
them if future generations are to be provided with
the chance to flourish.
Despite this advancement, we remain intent on
disrupting the status quo – simply because that is the
most effective way to eliminate the world’s unnecessary
suffering, destruction, conflict and inequity.
Professor Mark Maslin, UCL Environment Institute
Professor Deenan Pillay, UCL Centre for Virology
Sarah Ball
Professor Nanneke Redclift, UCL Anthropology
2 Taviton Street
London WC1H 0BT
Professor Jonathan Wolff, UCL Philosophy
+44 (0)20 7679 8584 (internal x28584)
Professor Michael Worton, UCL Vice-Provost
(Academic and International)
global-health@ucl.ac.uk
www.ucl.ac.uk/global-health
Professor Alimuddin Zumla, UCL Centre for Infectious
Diseases & International Health
5581_cover.indd 1
THE GRAND CHALLENGE OF
GLOBAL HEALTH
08/09
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