The George Institute for Global Health warmly welcomes the launch of the Global Strategy to Accelerate the Elimination of Cervical Cancer, which represents the first time the world has committed to eliminate a cancer.

The Strategy, which will be launched by the World Health Organization (WHO) on 17 November 2020, provides a roadmap to eliminate the disease. The aim is that by 2030, all countries can achieve 90% HPV vaccination coverage, 70% screening coverage, and 90% access to treatment for cervical pre-cancer and cancer, including access to palliative care.   

Cervical cancer remains one of the most common causes of death for women. Each year, more than half a million women are diagnosed with cervical cancer worldwide, and over 300,000 women die. Glaring disparities exist in access to life-saving information and services, with 9 out of 10 of these deaths occurring in low- and middle-income countries.

The George Institute, which is developing a research programme in India to understand the socio-ecological factors influencing cervical cancer prevention, screening and treatment, fully supports WHO in its ambition, and is committed to playing its part in eliminating needless suffering from this disease.

The launch of the Global Strategy to Accelerate the Elimination of Cervical Cancer will be held at 14.30-16.15 CET on Tuesday 17 November. For more information see here; the full programme is here.

A team of George Institute researchers has been recognised by the American Heart Association for their work on blood pressure treatment with a low dose triple combination antihypertensive polypill.

The Paul Dudley White International Scholar award, being presented virtually as part of the American Heart Association’s 2020 Annual Scientific Meeting, is for the highest ranked abstract submitted from Australia.

Paul Dudley White was one of the founders of the American Heart Association and a champion for global cardiovascular health strategies.

Lead author and George Institute Research Fellow Dr Sonali Gnanenthiran said that the team was delighted to have received such recognition.

“We’re honoured that our abstract was selected by our peers for this award as part of a world-leading conference,” she said.

The winning abstract, Effects Of Low-dose Triple Combination Therapy On Time At Target Blood Pressure - Results From The TRIUMPH Randomized Controlled Trial, describes how treatment with a triple pill increased the time patients spend with blood pressure at target level compared to people who received usual care.

“These results demonstrate the superiority of the triple pill in achieving ’time at target’ - a new way of assessing longer term blood pressure control. This is the first time it’s been used in a clinical trial, representing a major advancement in our approach to blood pressure assessment compared to using standard one-off measurements,’’ Sonali said.

The George Institute research team collaborating on this project includes Nelson Wang, Abdul Salam, Anushka Patel, Anthony Rodgers as well as other TRIUMPH investigators Ruth Webster and Asita de Silva.

The number of people living with diabetes is increasing worldwide at an alarming rate. According to the International Diabetes Federation (IDF), diabetes is one of the fastest growing health challenges of the 21st century, and projected numbers are consistently being surpassed.

The people hit hardest by this condition are from low- to middle-income countries. If current trends continue, 700 million adults will have diabetes by 2045. Yet there are opportunities, all over the world, to aid in prevention and avoid progression to other diseases such as kidney disease.

At The George Institute for Global Health, we understand that tackling diabetes is a critical and achievable goal. Innovation is necessary to ensure this is possible. That’s why we have a range of projects underway to approach the challenge in a number of ways, including developing accessible monitoring systems, innovative management practices, affordable treatments, food policy initiatives, research to learn more about risk factors and collaborations to consider multimorbidity.

Accessible monitoring systems

Evidence shows that regular monitoring of diabetes complications risk factors, such as blood glucose levels and blood pressure, can help reduce hospitalisations and improve clinical outcomes. However, not everyone has access to reliable monitoring systems, particularly in remote areas and/or low- and middle-income countries.

In China, health system infrastructure is struggling to meet the gaps in diabetes care and management and innovative solutions are needed. One potential solution is to incorporate state-of-the-art mobile technology to improve self-management support and build the capacity of family members to provide high-quality care at home. SMARThealth Diabetes aims to provide improved care and management for patients with type 2 diabetes mellitus using innovative mobile technology.

Evolving care practices

Diabetes mellitus is one of the most important causes of death and disability contributing to a significant proportion of healthcare expenditure in India. Primary health centres are the first level of contact for management of patients with diabetes, but for people needing treatment they are not always an attractive option because of barriers such as the distance required to travel, uncertainty regarding the availability of doctors, and cost in terms of loss of wages while away to receive treatment.

The IMPACT Diabetes study proposes the development and evaluation (of the feasibility, acceptability and preliminary effectiveness) of a novel diabetes management program used by non-physician healthcare workers on an innovative technology platform (a clinical decision support system (CDSS)) for the early detection of diabetes, management and prevention of its complications in individuals aged 30 or above.

Addressing the burden of diabetes during pregnancy

1 in 7 births are affected by gestational diabetes (the experience of diabetes during pregnancy). Of these, the vast majority of cases experiencing diabetes-related hyperglycaemia (an excess of glucose in the blood) are in low- and middle-income countries where access to maternal care is often restricted. In a recent seminar Senior Research Fellow Dr Jane Hirst discussed the global burden of gestational diabetes and associated challenges in its management during pregnancy and after birth. The presentation featured new approaches to addressing this burden, including the novel adoption of digital monitoring and machine learning techniques.

Women with gestational diabetes are at a high-risk of getting type 2 diabetes. Our LIVING study is examining whether an education intervention, using the existing workforce, can help prevent diabetes amongst women who have gestational diabetes mellitus in India, Sri Lanka and Bangladesh. The GACD funded study brings together educators, psychologists or social workers, depending upon the health system, to educate these women about lifestyle, diet, exercise, and how to prevent type 2 diabetes.

Food Policy

According to IDF DIABETES ATLAS Ninth edition 2019, ‘The cornerstone of type 2 diabetes management is the promotion of a lifestyle that includes a healthy diet, regular physical activity, smoking cessation and maintenance of a healthy body weight’.

The George Institute has a number of food policy initiatives to improve nutrition and help fight obesity. The FoodSwitch mobile App is available in 10 countries and empowers consumers to make better food choices by providing simple health information on a scanned product and suggesting healthier alternatives to 'switch' to.

In Australia the Australian federal government has endorsed the Health Star Rating scheme – a front of pack labelling system which ranks the healthiness of packaged foods. The George Institute has been reviewing these standards and offering recommendations to improve accuracy and understanding. Read more.

Another project advocating for healthy lifestyle is Action on Salt China (ASC) to improve healthy living by reducing people’s intake of at home, at work and in eating out, across the whole of China. Professor Puhong Zhang, China Director of ASC said, “We will develop and implement a comprehensive, effective and sustainable national salt reduction program targeting various salt intake paths, with the goal of achieving a 15% reduction by 2021 and 30% reduction by 2025."

Understanding new risk factors

In early 2020 a study in Australian adults with diabetes by researchers at The George Institute suggests 1 in 20 people will develop kidney disease each year and that this increases to 1 in 4 each year in people aged 85 years and over. With an ageing population these findings have an important flow on effect on health systems.

Researchers found that in addition to the known risk factors for kidney disease such as age, high blood pressure and obesity, having a history of cancer also increased the risk of developing the disease. Read more

Investigating the relationship between diabetes and infection

With the burden of diabetes increasing among people living in low- and middle-income countries, the incidence of deaths due to infection in hospitals are also on the rise. However, not much research has been done to evaluate the multimorbid relationship between diabetes and infection.

“The major burden of diabetes is now being felt in low- and middle-income countries where the incidence of diabetes is increasing rapidly. Diabetes accelerates susceptibility to infection and exacerbates outcomes for other infectious diseases like tuberculosis, melioidosis and dengue” said Professor Vivekanand Jha, Executive Director of The George Institute in India. The George Institute for Global Health India in collaboration with Oxford University has launched a unique diabetes and infection network to explore how real-world data sets can be used to evaluate the relationship between diabetes and infection in low  and middle-income countries. Read more here

Revolutionary treatments for slowing progression of chronic kidney disease

Around half a billion people worldwide have diabetes and up to 40% will go onto develop kidney disease. The CREDENCE trial identified the first new drug therapy in more than 15 years for slowing down the progression of chronic kidney disease (CKD) in patients with type 2 diabetes and offers hope for hundreds of millions of people with diabetes worldwide.

The drug canagliflozin was developed to lower glucose levels for people with diabetes and through CREDENCE trial has been shown to protect against kidney failure. It also significantly reduced the risk of cardiovascular complications including heart failure, which are common among people with kidney disease. The results, published in the New England Journal of Medicine, also showed heart failure was reduced by over 30%, and major cardiovascular events by about 20%.

Read more about CREDENCE and related trials here

Life-saving treatment that doesn’t cost the earth

There is a growing epidemic of type 2 diabetes worldwide, driven by obesity, inactivity and poor nutrition.  The WHO reports that one in 11 adults has diabetes – around 422 million people.  Diabetes caused 1.6 million deaths in 2016.

Many diabetics develop kidney disease.  According to the US Kidney Foundation approximately 30 percent of patients with Type 1 (juvenile onset) diabetes and 10 to 40 percent of those with Type 2 (adult onset) diabetes will develop signs of kidney disease.  Between 5 and 20% of diabetic patients go on to require dialysis treatment – the number varies from country to country, depending in part on the availability of this life saving but expensive treatment. 

Research by The George Institute published in The Lancet showed that in 2010 between 5 and 10 million people in the world needed dialysis for terminal kidney failure, but only 2.6 million had access to it, mostly due to cost – the rest die a preventable death. Most of these preventable deaths occurred in China, India, Indonesia, Pakistan and Nigeria. That research predicted the global need for dialysis will double by 2030.

Dialysis has been available for more than 60 years however until recently has been no great leap forward in its design or cost, making it unaffordable and inaccessible to most who need it. Our world first affordable and portable dialysis system, being developed by Ellen Medical (an initiative of The George Institute) will prevent millions of people dying unnecessarily because they cannot access treatment, especially in low- and middle-income countries. Costing under $500 to build and $5 a day to run, the Ellen Medical Dialysis System is a breakthrough in low-cost technology that will improve dialysis management and patient outcomes.

The first affordable dialysis is part of a pipeline of innovative, scalable solutions being developed by George Health, to address chronic diseases in underserved populations. George Health was established by The George Institute to harness the power of commercialisation to develop and scale-up innovations arising from the Institute’s research and expertise. Other areas of focus of George Health include innovative multidrug treatments for several conditions including hypertension, diabetes and heart disease, and technologies to improve primary care for people with common serious conditions in low- and middle-income countries worldwide.

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The George Institute for Global Health believes that tackling diabetes is a critical and achievable goal, and that innovation is necessary to ensure this is possible. What is included above is a small sample of the wide variety of projects underway globally to aid in understanding, prevention and avoid progression.

The World Day of Remembrance for Road Traffic Victims is commemorated on the third Sunday of November each year. It affords a special opportunity to remember the many millions of people killed and injured on the world’s roads, along with their families, friends and many more who are affected.

In the last year, 1.35 million people have lost their lives, and 50 million are living with the scars – mental and physical – of a recent road traffic crash. Death and injury caused by a road traffic crash is sudden and traumatic. The physical, social and economic impact, however, is often permanent. The distress and anguish experienced by these many millions of victims is all the greater as many of these crashes could – and should – have been prevented.

The theme for the 2020 World Day of Remembrance is Remember Support ACT, so we asked colleagues from The George Institute’s injury prevention and trauma management team to tell us about their work.

We remember

The George Institute conducts research in 20 countries to understand the risk factors and impact of crashes on individuals, their families, communities, and nations in order to promote evidence-based interventions.

A recent study in Cape Town, South Africa investigated the barriers and facilitating factors to the use of child restraints (such as a booster seat). About 1 in 3 crash-related injuries in the country are caused by unrestrained transport in the back of a vehicle. Currently, national legislation mandates that children under the age of 4 years be placed in an age-appropriate restraint, but usage levels are well below 20%.

Barriers include the cost of seats, a lack of awareness, and poor enforcement. Among the study recommendations, researchers advised increasing the age limit in the law to internationally accepted standards (10 years old or 150cm), and implementing borrowing schemes. The risk of child death and injury in a collision could be dramatically reduced by using an appropriate child restraint system.

In this podcast, Drs Margie Peden (Head of the Global Injury Programme at The George Institute) and Jagnoor Jagnoor (Senior Research Fellow) reflect on road traffic deaths and injuries in India, highlighting where more research is needed, and how the COVID-19 pandemic presents an opportunity to build back safer.

We support

The George Institute provides direct support to NGOs working to prevent future road traffic injuries and deaths through membership on boards and via teaching and capacity building.

For example, as Vice-Chair of the Road Traffic Injuries Research Network, Institute colleagues mentor and work with early career researchers all over the world to undertake locally appropriate research. The team have recently secured funding from the FIA Foundation to support a small research group in conducting and evaluating interventions to improve the safety of children walking to school.

The team’s active participation in the global discourse around how progress can be accelerated towards the target of reducing road deaths and serious injuries by 50% by 2030 supports the United Nations sustainable development agenda to leave no one behind. In this blog in BMJ Global Health, Jagnoor underlines that the ’50 by 30’ goal cannot be achieved without adopting an equity lens that supports collective, focused actions to ensure that road safety includes everyone, everywhere.

Meanwhile, Associate Professor Julie Brown's work supports the aim of reducing the health burden attributable to unintentional injury. She led this study into inequities amongst child victims of road traffic crashes in New South Wales, Australia in order to identify the necessary interventions to reach zero road deaths.

She said: “This work demonstrates that to reach zero road deaths we need interventions targeting crashes in rural and remote areas that are effective for all sectors of the population, particularly for children living in lower socioeconomic areas, vulnerable families and within Aboriginal and Torres Strait Islander communities. This work empowers us to support government, industry and the community to implement changes that can make this happen.”

In July 2020, colleague Dr Kate Hunter and team presented to the Australian Government’s Joint Select Committee on Road Safety. The presentation highlighted the need for nationally consistent data, the need to set clear road safety targets, and highlighted the critical importance of effective speed management. In a subsequent meeting with the National Office of Road Safety the team highlighted again the importance of effective speed management and spoke in detail about ensuring equity in development and application of road safety initiatives and targets.

The Institute also support grantees in seven countries to implement and evaluate interventions to improve the safety of children on their way to school. As part of the Botnar Child Road Safety Challenge, colleagues provide support to the Global Road Safety Partnership to monitor and evaluate projects. Read about one of the projects in Vietnam in this blog.

We ACT

The George Institute acts to save lives by advocating for evidence-based policy change, not only through the conduct of rigorous research, but also through membership of global networks, collaborations and initiatives.

As a designated World Health Organization (WHO) Collaborating Centre on Injury Prevention and Trauma Care, the Institute conducts implementation research on road traffic injury prevention in low- and middle-income countries, and collaborates with the WHO in building capacity in injury prevention and emergency trauma care. You can find out more about this work here.

Similarly, as Vice-Chair of the post-crash project group of the United Nations Road Safety Collaboration, the Institute collaborates with organisations that promote the safe extrication of vehicle occupants and those that provide pre-hospital care, trauma care and rehabilitation as well as with victim-led NGOs.                

We call for context-appropriate, multi-sectoral action in implementing and sustaining road safety interventions and act as a thought leader in raising awareness of the global burden of road traffic injuries and deaths. For instance, this interactive map aims to take viewers on a deep dive analysis of the numbers of crashes, injuries and deaths on the roads of India.

The George Institute Distinguished Fellow, Dr Olive Kobusingye amplifies this action, noting how “sharing experiences is an important tool in our quest to support road safety efforts around the world.”

Colleagues at Makerere University where Olive is Director of the Trauma, Injuries and Disability programme, are commemorating the World Day of Remembrance by hosting a webinar to encourage more researchers to act in those countries which face the greatest road safety challenges. Do join them on 19 November here. 

You can find out more about the Injury Prevention and Trauma Management team’s work here, and join us on Twitter @georgeinstitute @georgeinstUK @georgeinstIN to remember, support, and act to save lives.

The George Institute for Global Health congratulates President-elect Joe Biden and Vice-President-elect Kamala Harris on their election victory in the United States (US).

We are encouraged by the commitment made by the President-elect for the US to re-join the World Health Organization (WHO) upon taking office on 20 January 2021.

The WHO plays a vital role in protecting and promoting health around the world, not only by coordinating the global response to infectious disease outbreaks, but through strengthening health systems, increasing access to medicines, and improving monitoring and information sharing, particularly in resource-poor settings.

As cases of COVID-19 continue to rise around the world, there has never been a more important time for the US to be a member of the WHO. The pandemic reinforces the need to work together as a global community and strengthen the WHO, recognising that the need for a global health agency in our increasingly connected world is greater than ever.