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Highlight: Addressing the social roots of disease

01/10/2012, IDRC


Research results from the far-ranging Teasdale-Corti Global Health Research Partnership program point the way to future gains in global health.

Since its founding in 1961 by Canadian Lucille Teasdale and Italian Piero Corti, Uganda’s St Mary’s Lacor Hospital has endured civil wars, and the devastating rises of HIV/AIDS and outbreaks of Ebola disease.

But it was not just “the capacity to adapt and change that has allowed our hospital to survive these horrific emergencies,” says Dominique Corti, the daughter of the hospital’s founders, speaking to a recent Ottawa gathering of more than 200 global health researchers drawn together in a program bearing her parents’ names.

Equally important in Lacor’s evolution into a hospital that treats 300,000 patients annually, she says, is “the idea that offering the best possible care to the greatest number of people at the most affordable cost” also requires research and reflection. Healthcare providers need to examine what they do, and ask how they could do it better.

That idea of research improving practice is also central to the Teasdale-Corti Global Health Research Partnership program. The innovative initiative was launched in 2005 by the Global Health Research Initiative (GHRI), itself a collaborative initiative of IDRC, the Canadian Institutes of Health Research, and the Canadian International Development Agency.

In Lacor’s case, recalls Corti, conducting research in the early 1990s meant compiling an electronic database of patient records — later a vital component in Uganda’s fight against AIDS — even as bullets flew outside the hospital walls.

Research rooted in real life

Many members of the 14 research teams and 13 Global Health Leadership Awardees working under the Teasdale-Corti banner may also recognize that feeling of undertaking research under pressure. Their work similarly unfolds in the face of challenging real world conditions — often as “action-research” projects where data flows from on-the-ground activities. Insights from research are typically fed back quickly to the health practitioners or policymakers responsible for improving health systems and care.

Research supported under the program has examined such varied topics as how migrant labour patterns could contribute to the spread of AIDS in China; what social factors feed the linked epidemics of malnutrition and childhood obesity in Mexico; how the health system can reach indigent people in Burkina Faso; what barriers keep pregnant women from delivering in hospitals in South Africa; and how improved veterinary public health in Sri Lanka might prevent a possible pandemic.

Researchers began their work after responding to GHRI’s 2005 request for proposals. GHRI’s goal was to support teams blending Canadian and international researchers. They would tackle emerging global health issues by probing the local roots of those problems, building in-country capacity to implement solutions, and transferring knowledge across disciplinary and geographical borders.

With those projects now completed, the researchers assembled to share the results of their work and to contemplate how its lessons can positively influence the future direction of global health research.

What determines good health?

They also dealt with the larger context of their inquiries. Keynote speaker Tim Evans, dean of the James P. Grant School of Public Health at Bangladesh’s BRAC University, indicated that future declines in global disease rates will likely result not from bio-medical breakthroughs but by unravelling complex social and environmental issues — like the ones that Teasdale-Corti researchers grappled with — that put good health out of reach for millions.

“Health is not purely biological factors, although many people still think ‘it’s all in the genes,’” he says. “Nor can it be reduced to lifestyle choices.  Health is enormously conditioned by social structures and norms that we as individuals have little control over.”

Solutions require broad, intense effort

Fixing the systemic problems that keep the world’s poor in bad health is a complex and difficult task, however, as many project reports indicated. Lofty goals are tough to translate into practical change.

For example, a four-country program to support culturally specific psychological services for victims of war, says McGill University’s Duncan Pedersen, addresses the global reality that “psychological warfare has become a central feature of contemporary warfare. Today there are many more survivors who live with severe trauma.”

But dealing with that fact in Guatemala — where a 35-year civil war killed 250,000 people, but mental health services are almost non-existent —requires intense work at multiple levels. Guatemalan researcher Victor López says his team both provided support for an indigenous women’s organization building a grass-roots, self-help program, and lobbied for a national mental health policy “by sitting with decision-makers and telling them what our research means, because they normally wouldn’t read research papers.”

Similarly, a program to reduce the spread of infectious disease in Honduras required constructing new infrastructure from scratch. Brock University health science professor Ana Sanchez collaborated with colleague Lourdès Enriquez, at Honduras’ National Autonomous University (UNAH), to write curriculum, build state-of-the-art facilities, and supervise research for UNAH’s new graduate program in microbiology.

Already, research by the program’s first graduating class on topics such as insecticide-resistance in dengue-carrying mosquitoes and the range of viruses causing diarrheal diseases in children has helped strengthen the country’s disease-control efforts.

As graduate Gustavo Fontecha remarked, “Teasdale-Corti has changed the life of future research in Honduras, and that will change the health of the Honduran people.”

Read more about the Teasdale-Corti projects.

Watch the slideshow about the legacy of Lucille Teasdale and Piero Corti at St Mary’s Lacor Hospital, and read about the photography exhibition Lacor Hospital: An African Success Story.

Stephen Dale is an Ottawa-based writer.

Photos: Greg Teckles
Top: Sudha Chandrashekar from the St. John’s Research Institute in Bangalore, India, is contributing to the development of the field of health economics in India.
Right: Dominique Corti, president of the Lucille Teasdale and Piero Corti Foundation.

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IDRC funds researchers in the developing world so they can build healthier, more prosperous societies
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