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>>Narrator: Chronic diseases are universal.
They impact entire communities and nations, and they cost
millions of dollars in lost productivity and care.
Populations in developing countries are disproportionately affected,
with more individuals developing these diseases at younger ages
than those in higher income countries.
Chronic diseases account for around 60 percent of all
deaths globally, and 80 percent of these occur in low- and
middle-income countries.
>>Dr. Susan Shurin: One of the things that has
become increasingly clear over the last several years is that the
global burden of non-communicable chronic diseases is increasing
most dramatically in low- and middle-income countries.
This has been a problem for a while in the developed world
and is becoming an increasing problem in the developing world.
We see this as a huge problem for humankind, and also
a huge economic and community burden for the countries that
are affected by this.
>>Dr. Tracey Koehlmoos: Believe it or not, chronic disease
is killing more people than anything else in Bangladesh.
So, heart attack, stroke, diabetes are bigger killers than causes of
death like delivering your baby safely, or childhood illnesses.
>>Dr. Manuel Ramirez-Zea: In Central America and the
Dominican Republic, the number one killers are
chronic diseases.
>>Dr. Yangfeng Wu: Chronic disease has already
become a big problem in China now.
It accounts for over 80percent of total deaths of Chinese.
>>Dr. Naomi Levitt: Chronic disease is affecting
South Africa, and indeed the African continent in every
increasing numbers.
In a continent where the major diseases are tuberculosis,
malaria, and ***, chronic diseases has been the poor relative
for too many years.
>>Dr. Adolfo Rubinstein: In the last 20 years,
chronic disease has increased very much in the southern cone,
and now they are accounting for more than 60 percent of the
causes of death and disability.
>>Dr. Dorairaj Prabhakaran: Chronic diseases are a huge
burden in India.
The reason why it's a huge burden is because the number are huge,
to begin with, and second it afflicts Indians at a much younger age
as compared to their western counterparts.
>>Narrator: To help combat the growing
burden of chronic diseases in low- and middle-income countries,
The National Heart, Lung and Blood Institute, in partnership
with United Health Group have establish the Global Health Initiative—
a network of 11 Collaborating Centers of Excellence,
focused on building sustainable programs to combat chronic
cardiovascular and pulmonary diseases worldwide.
>>Dr. Richard Smith: What we want to do is to
increase the number of people, institutions, and communities
who are equipped to fight against chronic disease.
We are working with the National Heart, Lung, and Blood Institute,
and I think this is a very strong partnership.
>>Dr. Susan Shurin: Partnerships enable us to
learn from and teach each other.
They enable us to do more things than any of us are able to do alone,
enable us to have a bigger impact.
>>Narrator: These Centers of Excellence are
developing infrastructures for research and training,
to increase their capacity to conduct population-based or
clinical research, with an emphasis on ways to impact
lifestyle factors that can decrease the risk of chronic diseases.
Each Center consists of a research institution in a
developing country, partnered with at least one academic
institution in a developed country;
this helps facilitate the growth of the Center’s research capabilities
and opportunities.
>>Dr. Naomi Levitt: The research we plan to do
in our Center is to look at a model of care that takes care
from the community to the primary health care facility
and back again,
and incorporates all aspects from community health workers,
as well as tools for the management of chronic diseases.
>>Dr. Sylvester Kimaiyo: We want to find out in the
Eldoret area, what are the commonest causes of
heart failure in this population.
We use a lot of firewood,
mainly done by women to cook,
and we want to find the relationship between what we find
in the hospital on specific tests, and finding the right heart failure,
and linking these to the indoor air pollution in the home.
>>Elsa Cornejo: Our primary research focus is
the implementation and evaluation of community interventions to
prevent chronic disease;
and the evaluation and research aspect of it has two components:
One is evaluation of intervention results and the second component
which we believe is just as important is the process evaluation.
>>Dr. Tracey Koehlmoos: What happens to someone when
they have a heart attack or stroke, and then what happens
to the family?
Does having chronic disease make you poor?
Is one of the questions that we’re trying to answer.
>>Dr. Denis Xavier: We are conducting what is
known as knowledge translation research.
We are trying to find out what are the best strategies
with which we can implement what we already know to
counter chronic disease.
>>Narrator: The Global Health Initiative seeks
to develop the next generation of global health leaders in
chronic diseases.
Each Center serves as a training hub for future investigators,
emerging scientists and community health workers.
>>Dr. Christina Rabadan-Diehl: Training and capacity building is
one of the pillars of this program.
The aim is to build capacity in-within the country on chronic
non-communicable diseases.
Our ultimate goal is to create a global community of immerging
investigators that really can conduct research across the borders.
>>Dr. Dorairaj Prabhakaran: Our training has multiple components.
We are training post-docs, or post-doctoral fellows,
into learning research methods, into learning how to do prevention.
We are also training junior faculty in terms of writing grants for
developing prevention programs.
>>Dr. Jamie Miranda: We need to enlarge the
number of people with the capacities to address chronic
diseases and make responses at our own level.
So through the Center, we will bring new scientists to
get familiar with the tools of how to do research in house
for addressing our own problems.
>>Dr. Hassen Ghannem: In Tunisia, we are training
people different ways.
We are doing the short-term training to improve skills of
young researchers, to improve their ability to publish
their research.
We are as also thinking about long-term capacity building
for the medical school to increase the mass of people that can have
high-level degree of public health.
>>Narrator: This global initiative is expected
to stimulate clinical, epidemiologic, policy, translational, and
behavioral research for chronic diseases.
The Centers are collaborating with existing healthcare systems,
raising public and political consciousness,
and building institutional capacity to improve methods for the
prevention and control of chronic diseases.
>>Dr. Christina Rabadan-Diehl: Each of the Centers of Excellence
have the opportunity to conduct research at the local level
with their communities to identify factors that will put these
communities at risk for the development of cardiovascular or
pulmonary diseases, and therefore, try interventions through
research questions of what would be the most effective way of
implementing preventions programs as well as modifying the risk factors.
But they are also very well positioned to interact with policy makers,
so as they develop this evidence they can transmit that evidence
to those policy makers so that they themselves can make decisions
at the country level.
>>Dr. Arun Chockalingam: Chronic disease has got no borders.
It doesn’t differentiate between developed country and
developing country.
It’s quite important that we understand the etiology of
these diseases and ways and means to prevent it so that
we can learn from one culture to another culture,
from one method to another method,
so that collectively, we will gain a better knowledge
in a shorter time.
>>Dr. Tracey Koehlmoos: Our hope is that our global
development partners will become aware that chronic disease is
the biggest killer.
That it is having an impact on families and on households and on
women and on children, and that this is an area that's worth
investing in globally.
>>Dr. Jaime Miranda: We want to generate the evidence
at our local setting so that then we can inform our politicians
on how best to address solutions for our country.
>>Dr. Naomi Levitt: We would also hope to develop
economic models which can cost or enable governments to cost
various interventions so that governments better understand
what they are requiring for a particular interventional effort.
>>Elsa Cornejo: Community health workers are
the people who are on the ground, they’re the people who come into
contact first with the members of the community, and our research
is going to be contributing to building that base of
well-trained community health workers who are also able
to do research, who are also able to evaluation;
and that’s going to translate into a very direct benefit for the
populations that they serve.
>>Dr. Dorairaj Prabhakaran: I think even if we reduce the
burden of chronic disease by 1 percent over the next five years
we will have done a huge job.
>>Dr. Sylvester Kimaiyo: If we know what the problems are,
then we will apply and look for prevention and intervention strategies
to prevent these diseases in the first place.
>>Dr. Cristina Rabadan-Diehl: So one of the true benefits of
this initiative really has been the creation of a true global community
of researchers where the flow of information knows no borders.
So, a research discovery that is made in Africa, or India, or China,
will undoubtedly benefit Americans here at home.
This is really the nature of the global community today:
that there is a dramatic sharing of information and progress
on a global scale.
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