Global Reach in Health Sciences

Drug-resistant malaria. "Risk factors" such as tobacco, alcohol abuse, and poor diet. "Delivery issues" from the training of healthcare providers to the design of health systems. Statistical tools for program evaluation. Drug discovery and intellectual property rights. The philosophical and public-health ethical issues surrounding human trials of new medicines or procedures. That breathtaking agenda and more are fair game for Harvard's emerging "global health initiative," now taking shape through consultations with faculty members across the University. In charge is Christopher Murray, Saltonstall professor of public policy in the School of Public Health (SPH), who returned to Harvard in September after five years at the World Health Organization (WHO), where he led the 350-person policy-analysis unit.

Christopher Murray
Photograph by Stu Rosner

Murray aims to shape a supra-school program built on the expertise of the 80 to 100 professors whose work already touches on these issues, or could. Some of those scholars began thinking about Harvard's opportunities before he arrived, as part of a working group convened by Provost Steven E. Hyman.

Common interests have emerged. Dyann Wirth, professor of infectious diseases and director of the Harvard Malaria Initiative at SPH, seeks molecular mechanisms to defeat drug resistance in protozoan parasites, while Daniel L. Hartl, Higgins professor of biology in the Faculty of Arts and Sciences (FAS), uses molecular tools to study the evolution and population dynamics of the malaria parasite. Work on AIDS is even more widespread. At the Medical School, Finland professor of medicine Raphael Dolin is involved in both AIDS vaccine research and clinical trials. The Harvard AIDS Institute, chaired by Myron Essex, Given professor of infections diseases at SPH, runs facilities and research trials in Botswana. And FAS economist Michael R. Kremer, Gates professor of developing societies, who has lived in Africa, has devised ways to create incentives for vaccine development for diseases like malaria and AIDS that plague lower-income nations.

Hyman outlined the program rationale before alumni in London on November 15 (see "European Outpost"). Health, he said, is not a luxury that developing countries acquire as their economies grow, but rather a precondition for and source of that growth. To help them, it does not suffice to discover a treatment for, say, malaria or drug-resistant tuberculosis; an effective delivery system must also be created.

Further, economists will have to work on payment mechanisms and intellectual property—Kremer's problem of poor patients in poor nations and manufacturers' need for some return to justify research and development costs. And there remain huge issues of governance (South Africa's refusal to face up to HIV transmission) and human rights (the risk many African women face if they undergo AIDS screening and test positive).

In this sense, Hyman said, global health represents powerful intellectual opportunities for scholars and students, while promising a real impact on lives. It is, he said, "a perfect example of how we have to go from molecules to culture" in the widest sense, and therefore a natural University initiative for Harvard.

Making a coherent program out of this spectrum of expertise falls to Murray and Shawn Bohen, the initiative's administrative director. As a scholar, Murray's interests are themselves global. He pioneered the "Global Burden of Disease" study in the early 1990s, the first comprehensive, international assessment of mortality and disability attributable to infectious diseases, chronic diseases (cardiovascular illness, for example), and accidents, injuries, and violence. The results of that work, as it happens, were reported to the World Bank and its then-chief economist Lawrence H. Summers. During his WHO sojourn, Murray began studies of the most effective organization of healthcare,
the first fruits of which have just been published in a massive coedited volume titled Health Systems Performance Assessment.

Bohen, who will take on the grittier details, is a veteran of multidisciplinary projects at Harvard. She helped organize the medical school's division of addictions and substance abuse and then the University's interfaculty program on mind, brain, and behavior, both launched by Hyman during his professorial days. Her most recent assignment was managing the Hauser Center for Nonprofit Organizations at the Kennedy School.

Murray expects that the health initiative will have refined its initial subjects of inquiry by the end of the academic year. In the meantime, he anticipates three modes of action. The first is education. As President Summers told an SPH gathering in October, "I hope and I expect that we will provide instruction to our undergraduates in issues relating to global health that will bring together in an interdisciplinary way their thinking in the social sciences and in the sciences in much the same way that we do with issues like environmental sciences." (Discussion within FAS is only exploratory so far, given the current work on revising the College curriculum overall.) Graduate and postdoctoral study would be augmented, too.

Second is a selection of research priorities. Murray envisions comparative work, possibly including American healthcare and systems in other developed nations, as well as those in the industrializing world, and scholarship on problems of inequality. Based on his meetings with colleagues thus far, he can readily imagine involving professors from SPH, the Medical School, FAS, the Kennedy School, the Business School, and the Law School, to "harness the enormous advances that have come and are coming" in biomedical research, and more sophisticated social-science and ethical analyses.

Finally, the initiative expects to promote large doses of international travel and study abroad—for students and faculty members based in Massachusetts, and for experts from other nations coming to Harvard to collaborate. Bohen terms this two-way process "engagement." She sees it as an important pilot for the globalization of the University envisioned in the undergraduate curriculum review—and so an initiative that crosses Harvard boundaries and international ones as well.         

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