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Global Health Histories: the learning curve continues

April 15, 2010

By Thomson Prentice

For the second successive year, the Global Health Histories (GHH) seminar series at the World Health Organization ended in December with a final flourish – and a commitment to the future. The seminars, organised by the WHO’s Department of Knowledge Management and Sharing (KMS) and the Wellcome Trust Centre for the History of Medicine at UCL, are clearly going from strength to strength.

This was emphasised by Dr Nils Fietje, representing the Trust, when he spoke to a packed audience at the final seminar in Geneva. “It is the Wellcome Trust’s great pleasure to support this unique seminar series which enables historians of medicine to engage with policy makers right here at the heart of global health politics, the WHO Headquarters,” he said. “We therefore hope that these seminars can be an important step for closer collaboration between historians, policy researchers and policy makers.”

Further endorsement for the initiative came from WHO Deputy Director-General Dr Anarfi Asamoa-Baah, who attended the December seminar. There was appreciation, too, from Dr Najeeb Al-Shorbaji, Director of KMS, and Dr Hooman Momen, Coordinator of WHO Press, who leads the GHH project and co-chairs the seminars with Dr Sanjoy Bhattacharya.

Dr Al-Shorbaji commented: “Learning from history is our prime objective in this series. There are many lessons in global health that need to be shared and understood to help in avoiding making the same mistakes. Knowledge is made of science and experience. Experience is often the best teacher in the case of health. We want to document and share this experience for present and future generations of health researchers, practitioners and policy makers.”

The seminars began in January 2005 and have grown steadily in prestige and popularity since then. There were only three lectures in the first year, but that rose to ten in 2006. With the full support of the Trust in co-organising the series, a further ten were held in 2008 and in 2009. The lunchtime seminars have always been popular among WHO staff, who regularly filled the 50-person capacity of the WHO’s main library meeting room to hear them.

But the scope broadened dramatically in the spring of 2009 with the introduction of webinars – using the internet to broadcast the sessions internationally, with ‘attendees’ able to hear the speakers, see the presentations and participate with email questions and comments. This innovation was piloted by the WHO through the GHH seminars, and is increasingly influential.

“It’s a terrific advance,” said Dr Sanjoy Bhattacharya, who has co-organised the seminars on behalf of the Centre, with generous support from the Trust, for the last three years. “Thanks to the technology, the seminars now have a worldwide audience of interest to thousands of academics, policy makers, practitioners, researchers and others. We have had participants from as far apart as West Africa and South-east Asia, and the speakers are finding that the webcasts lead to follow-up discussions and contacts with interested parties that they would not otherwise have had. All in all, the 2009 seminars were a huge success.”

All of the ten seminars in the series were devoted to the subject of tropical diseases, and were also supported by TDR and the WHO Department of Control of Neglected Tropical Diseases. The series began in April with a discussion on why the elimination of leprosy has been so elusive, led by Professor Michael Worboys, Director of the Wellcome Unit for the History of Medicine at the University of Manchester, UK, and Dr S K Noordeen, former Director of the WHO Leprosy Elimination Programme and former President of the International Leprosy Association.

Later in April, the topic was the eradication of guinea worm, with Professor Anne Marie Moulin, Research Director of the Centre National de la Recherche Scientifique in Paris, and Dr Dirk Engels, Coordinator of Preventive Chemotherapy at the Department of Control of Neglected Tropical Diseases, WHO, Geneva.

The continuing controversy surrounding sleeping sickness was the focus of the first of two seminars in May. It was presented by Dr Guillaume Lachenal of the Department of the History and Philosophy of Science at the University of Paris Diderot and Dr Jean Jannin, Coordinator of Innovative and Intensified Disease Management at the WHO’s Department of Control of Neglected Tropical Diseases.

Attention then turned in the following presentation to river blindness, or onchocerciasis. Dr Jesse Bump of Harvard University revealed the fascinating detective work that defined the disease in the first place and then explored how political and historical forces gave it an international focus. Dr Janis Lazdins-Helds, from TDR, then discussed how research has always been the key to success in the international control effort.

Later, Dr Bump reflected on the experience. “The GHH seminar was a wonderful forum in which to share diverse perspectives on neglected tropical diseases, which represent some of the most pressing problems in global health,” he said. “This dialogue between historians, policy makers, scientists and practitioners is as valuable as it is rare. The organisers at the Wellcome Trust and the World Health Organization are to be commended for their vision. I was hoping to provide scientists and field staff with a long-term perspective on the achievements and challenges in river blindness control. I was pleased to leave with a much deeper appreciation of the science and personalities involved.”

After a summer break, the series resumed in September to examine malaria, a disease that has defied a global eradication programme and continues to resist countless major public health interventions. The speakers here were Peter Brown, Professor of Anthropology and Global Health at Emory University, USA, and Dr Andrea Bosman, a medical expert on the disease and a senior member of the WHO Global Malaria Programme in Geneva.

In October, the next international historian on stage was Professor Simone Kropf of the Oswaldo Cruz Foundation, Rio de Janeiro, who traced the 100 years since Chagas’ disease was first identified in her country. Her co-speaker was Professor Gabriel Adrián Schmunis, formerly of the Communicable Diseases Unit of the WHO American Regional Office in Washington, DC.

Professor Kropf said afterwards: “My participation in the seminar strengthened my conviction that historians and public health people can and must engage in dialogue about the contemporary global health agenda and how today’s challenges were historically shaped. The current debate on neglected diseases, for example, stands to gain from an exploration of how particular health topics have been assigned varying degrees of political and social relevance over time, depending on national contexts and on the groups, institutions, and interests involved.

“An historical perspective to medical facts and events is a good path to provide knowledge and insights for policy actions. History in this way is important not just as learning, but also to demarcate actions in the present and the future. It was thus a wonderful experience for me to present my research work to people who are engaged in planning and conducting these actions.”

Another seminar in October featured visceral leishmaniasis, also known as kala-azar. Two eminent experts shared their decades of experience. Professor Robert Killick-Kendrick, Honorary Research Fellow at Imperial College London, is a leading parasitologist specialising for many years in the disease, while Dr C P Thakur, Emeritus Professor of Medicine and former Minister of Health in India, helped to revolutionise treatment of the condition. Dr Thakur is a member of the Indian parliament, and thus reflects another important ‘first’ for GHH, in getting national and state-level legislatures involved in the seminar discussions.

Malaria was again the subject in November. Professor Randall Packard, Director of the Institute of the History of Medicine at Johns Hopkins University, USA, probed the limitations of the Roll Back Malaria approach and the consequences for the prospects of malaria, while his co-speaker, Dr Axel Kroeger, a TDR scientist at WHO, described the “institutional memory loss” in the history of vector control efforts.

The series ended in December with a penetrating look at the changing role of pharmaceuticals in world health. Professor Jeremy A Greene, of Harvard University, Brigham and Women’s Hospital and Harvard Medical School, described the evolution of the essential medicines concept. Then former TDR director Dr Adetokunbo Lucas critically examined TDR’s impact on the control of leprosy, onchocerciasis and Chagas’ disease.

He also discussed the new phenomenon of “pharmaco-philanthropy”, in which the pharmaceutical industry seeks partnerships in promoting the health of poor people in poor countries, citing Merck’s commitment to the donation of ivermectin to control onchocerciasis “for as long as is needed” as the prime example.

Professor Greene said after the final seminar: “The Global Health Histories initiative sponsored by the WHO and the Wellcome Trust has taken a remarkable step in coordinating a series of focused conversations that pair historians of global public health with past and present leaders in global health policy. The result is a productive dialogue regarding the promise and pitfalls of international health programmes in the 20th and early 21st centuries. As a scholar and a physician, I have gained immeasurably from my participation in this project and will be excited to see it push forward in the years to come.”

The UCL Centre has been able to raise funding for a series of GHH seminars in 2010, which will deal with emerging issues of global public health importance (see back page). The Centre is also involved in applying to the Trust for further support for the continuation of the initiative over the course of five years, between 2011 and 2015.

Thomson Prentice is former Managing Editor of the World Health Report and former coordinator of Global Health Histories, WHO, Geneva.

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