As the summer holiday approaches, Changzhi students experience their busiest time of the year as they prepare diligently for their exams and wait for the results of the year-end parent-teacher conference. At the same time, researchers from the Changzhi School Edu-Salt “salt reduction in school children” project rush to collect the project’s baseline data that including samples and data from the students and their families, before the summer holiday.

Research fellow Jing ZHANG and intern Yuan MA have been in Changzhi for nearly a month collecting data. Their colleagues in Beijing barely hear anything from them except for a few texts messages.

“It’s exhausting! Everyone is under a huge strain.” Jing adds a frowning emoticon at the end of his sentence. “It feels like 70% of the time is spent on communicating with different people.”

His experience may break the stereotype held by most people about medical research. Generally speaking, clinical research is thought to be about the data analyzed and achievements published in professional medical journals. The reality of implanting a project in the field is very different from that impression.

Non-communicable diseases (NCDs) studies aim at searching for approaches to improve health cost-effectively and in a short time. By communicating with different populations and winning their trust, The George Institute for Global Health at Peking University Health Science Center (TGI @ PUHSC) is able to translate our research findings into policy guidelines and practice, influencing policy-makers to bring the best available evidence into their decision making, which will then affect crucial change and benefit more people.

Since our focus is on behavioral change rather than biological samples, good communication skills are particularly important. Especially in the field of NCD research, communication is an essential and indispensable tool.

The 40 days of a large-scale baseline assessment reveals the art and power of communication.

Tenaciously follow-up with the participants

A prefecture-level city of Shanxi province, Changzhi city has a population of over three million, half of which are reside in urban environments. A total of 28 primary schools with 280 children aged ≈11 years were recruited into the study. Additionally, 560 adult family members of the participating children were invited as well. Implementing this study in an urban area, as opposed to rural area, may result in low compliance and high participant attrition.

“During the baseline assessment, we need to measure blood pressure, height and weight circumference, and collect two 24-hour urines, the latter being of the greatest importance. However, people in urban area all live a fast-paced life with enormous pressure from work, so it is hard to make appointments with them at home to collect the data. Collecting two 24-hour urines is a considerable inconvenience. In addition, factors such as the long distance between work and home also impacts on the time and quality of urine collection,” said intern Yuan MA.

She added “It’s quite common that people miss appointments. Therefore we need to proactively communicate with the students and their parents, confirm everything, and be flexible to respond to any emergencies that may turn up.”

Eliminate concerns

It’s natural for some participants to miss appointments, but the main challenge is to remember this fact when in the field. Jing said, “Some participants were very cooperative, some refused to participate immediately due to personal reasons, and there were others who had agreed to participate at first but when we tried to collect urine thought we might be trying to sell drugs or promote particular hospitals and withdrew. We understand their behavior in view of today’s social environment in China.”

He continued, “Therefore our key work is to be upfront and explain that that our study has with no commercial purpose. We provide detailed information about every procedure of the study, and reiterate the difficulties of urine collection. At the same time, results of the laboratory tests, the accuracy of which we explain to them is determined by the correctness and timeliness of the urine collection, will be returned to them. As long as they are aware that the study is for their health, their concerns can be alleviated. In fact, most of the participants are quite supportive of our work after being introduced thoroughly to the whole project.”

Jing recalled, “There was a father, a truck driver, whose work required him to drive at night. Unfortunately he failed to meet us at the agreed upon time for the urine collection. When the clock said 20:00, we figured this collection was a failure when suddenly we got a call from him. He assured us that he had finished the collection as requested and would deliver it directly after finishing his work at 23:00. We were deeply touched by his dedication, especially since at first he was reluctant to participate, but then obviously had a change of heart”

Mobilize personnel

It’s not possible for Jing and Yuan to coordinate 280 students and their family members on their own. Approximately 20 professors and 40 students from the Changzhi Medical School, led by provincial PI Dr. Xiangxian FENG, served as local research coordinators and assistants. To coordinate a team of this size, personnel management and time management became crucial to work efficiently while maintaining data quality.

“Challenges and disagreements are inevitable; motivation may wane. Yet we need to be aware of our role. In addition to research work, we were also responsible for coordinating the promotion of the study and all the local staff,” Jing said. “We respect and appreciate everyone that has participated in the study. Timely and proactive communication is critical to problem-solving. Seeking help from the management team is also important when the problem we can not solve problems on our own.”

Communication skills are acquired and accumulated through experience, and key to the successful implementation of projects. The School Edu-Salt project in Changzhi is halfway through its course, providing our researchers an important opportunity to enrich their communication experience. TGI @ PUHSC can capitalize on this field experience for future NCD studies when working with unique study populations that require a localized approach.

On the 3^_rd July 2013 The George Institute for Global health in China had the honor of hosting Professor Norbert Berend, Professor Emeritus at the University of Sydney and Head of Respiratory Research at the George Institute for Global Health. Professor Berend presented on chronic obstructive pulmonary disease (COPD) and comorbidities.

The presentation was relevant to the current environment in Beijing, since air pollution is a significant causative factor in the development of COPD. In his presentation, Professor Berend commented on the relationship between air pollution, particularly particulate matter (PM2.5), and COPD.

In the introduction by Professor Yangfeng Wu, Professor Berend’s many academic accomplishments were highlighted. Professor Berend has a distinguished background in respiratory research, and he has also held several administrative positions in the field of public health. Currently, Professor Berend holds the position of Head of Respiratory Research at George Clinical in Sydney, Australia.

Professor Berend highlighted the facts that COPD is associated with increased hypertension, cardiovascular disease, diabetes, osteoporosis, and muscle weakness as well as a number of other debilitating conditions. These comorbidities have traditionally been regarded as coexistent medical conditions. However they are increasingly being regarded as causally related to COPD. These comorbidities have an important effect of the quality of life, morbidity and mortality associated with COPD as well as affecting disease management and treatment outcomes. New research reveals that the link between these comorbidities and COPD may be through systemic inflammation, which subsequently opens up pathways for new treatment options.

Professor Berend’s presentation sparked debate amongst the researchers in attendance, including Professor Hebei and Huangwei of Peking University Health Science Center. There were many areas of common research interest and it is hoped that this will lead to future academic collaborations.

In his closing remarks, Philip Gregory, the General Manager of George Clinical China thanked Professor Berend for his informative presentation and for the lively discussion from the audience. Today’s Beijing Health Research lecture Series marks the first time that the George Institute and George Clinical have co-hosted such a presentation and it is hoped that this will form the basis for collaborations in the future.

On Wednesday 22 May, over 40 professional from a variety of backgrounds including academics, healthcare professionals, government and industry met at The George Institute for Global Health at Peking University Health Science Center for the eHealth and Healthcare Innovation Workshop, which engaged participants in detailed discussions on integrated eHealth systems and future potential applications in healthcare innovation in China.

eHealth is a term for healthcare practice supported by electronic technology and communication technology. It can be applied on disease diagnosis, prevention, control, and treatment. Examples of eHealth include electronic health record, mobile Health, and healthcare information systems.

Speakers included Dr Li Qun Xu, Chief Scientist at China Mobile Research Institute (CMRI), Dr Gari Clifford, Director for Affordable Health Technology at George Center for Healthcare Innovation, University of Oxford, Dr David Clifton, Lecturer from Institute of Biomedical Engineering at University of Oxford, Professor Jian Cai, Executive Dean of Innovation Research Institute at Peking University, and Associate Professor David Peiris, Head for Primary Health Care of The George Institute for Global Health Australia at University of Sydney. They each gave a keynote speech on cutting edge technology and information.

These speeches introduced a great number of flagship projects and international collaborations operated by the institute and organization they were affiliate d with. Topics ranged from mobile health (mHealth), affordable and sustainable health care technology, “big data” machine learning methods in healthcare sector, relevant policies and regulations, to barriers emerged from practice.

Dr Xu introduced the end to end mHealth services delivery architecture by listing ‘I Shang’, a carefully designed wearable gadget, and Remote monitoring system and service for cardiovascular conditions developed by CMRI.

Dr Clifford described how his research group is combining the latest research in artificial intelligence, with low cost sensor design and open source information infrastructures to deliver rapid and accurate healthcare support in remote regions. The current beneficiary and achievements of eHeath, said Professor Cai, is great, “It can decrease the trust cost between doctors and patients, provide an opportunity to develop social capital, and let the patients make use of their fragmented time more efficiently, thus improve their lifestyle and increase their time value.”

Yet there still lies a long and difficult way in front of all health care workers and experts from a global perspective. It is facing huge challenges today. As Professor Peiris, whose work focusing on disadvantaged populations, said, “Access to affordable, high quality health care is limited.”

One prior task is to figure out a way to increase the products of eHealth research, and enlarge the scale of resent studies. The current health system in China is even worse, as the existing social and financial barriers hold back the process of reform; the distrust between patients and doctors raise fierce disputes; and inadequate integration of the system reduces efficiency.

Solutions have been raised and put into practice, for instance,reengineering workforce, developing technology supported and evidence based care, patient centred approaches, and innovating systems strategies, to release the global burden. But more need to be done as soon as possible.

However, as the path unfolds in front of us, we can look forward to the bright future led by the eHealth and new health care system.

By Veronica Le Nevez

This article was first published on croakey.org and is reproduced with permission.

As the news started to filter out from America that Donald Trump had been re-elected to the White House, hearts sank across the global health community. As a President who sees little value in institutions like the World Health Organization (WHO) and who has sought to withdraw from or de-fund them, his re-election is certainly worrying.

But it would be foolish to focus solely on Trump. He will come and go, but unless the causes of political dissatisfaction are addressed, more Trump-like figures will fill the void.

Indeed, even if Kamala Harris had won the election, it is likely that she would have faced a divided and combative Congress that has struggled to find consensus on many issues for the last several years.

So, the question is not so much how to deal with Trump (diplomats and policy makers will already have well-formed ideas on that), but how to rebuild trust in the foundations of our democratic institutions, including global health bodies like the WHO.

1. Take a systems approach

A systems approach recognises that in complex situations, simple fixes rarely exist.

Solutions need to come from working together across specialities. The relationships and feedback loops within systems need to be recognised and addressed rather than focusing on a narrow slice of the issues.

Back in 2006, I was working on the establishment of a marine conservation reserve in NSW. Some of the fringe opponents of the reserve regularly raised their belief that it was a plot by the UN ‘World Government’ to undermine their (perceived) rights to fish anywhere.

Fringe debates about personal rights versus community good have been amplified by the algorithms of social media, fed by state-sponsored bad actors and adopted by populist leaders as a route to power.

We need to take a more sophisticated approach to global health, consider the wide range of inputs and feedback that affect it, and restore community faith in democracy.

For example, a couple of weeks ago I met with climate activists from Kiribati and Tuvalu, two of the most vulnerable nations to climate change. They spoke about how their drinking water is becoming brackish because of saltwater intrusion caused by rising sea levels, and how this has caused health impacts.

It has also impacted their ability to grow their own food, and they rely heavily on imported food. The change in diet towards more highly processed foods has caused a sharp rise in non-communicable diseases such as type-2 diabetes, hypertension and cardiovascular disease.

And not everyone has equal access to scarce fresh water and food – some foreign embassies have greater access than local populations as they have funded their own supplies.

There is a complex interplay between environmental issues, health, governance, financing and commercial interests. We need to continue to support and advocate for cross-sectoral collaboration including community participation and co-production to achieve meaningful progress.

2. Sharpen the ‘why’ for global health

The election of Trump is a loud rejection of the status quo. If we accept the view that every election is about the economy, we should look at inequality as a fundamental cause of political dissatisfaction.

At the macro level in the US, growth is relatively high, inflation has been reducing and wages have risen. However, income inequality remains high; in 2022 it was 25 percent higher in the US than the OECD average, and the relative poverty rate was 50 percent higher.

The high cost in the US of basic services, including healthcare and a limited social safety net, are impacting households.

If people on average incomes can’t afford to get sick, why would they want their government financing health in other countries?

Advocates need to re-engage with policy makers on what makes global health a sound investment to a potentially hostile audience.

A greater focus on co-benefits to donor nations and quantifying the benefits and costs of investments will be necessary.  Achieving the green light on investments from the US will likely need the personal endorsement of people the Trump administration trusts.

We will be operating in a changed decision-making environment, where the patronage of powerful people like Elon Musk and others is likely to be increasingly important.

We need to actively consider and counteract disinformation. It will be vital that advocates explain how failure to address global health issues has negative impacts in the countries where investment decisions are being made.

3. Engage in ‘shoe leather diplomacy’

As US Secretary of State, Hillary Clinton visited 112 countries building relationships through direct, personal communication.

We need to be like Hillary and engage in active leadership, advocacy and diplomacy for global health. This means engaging policy makers across parties in the US and building coalitions of support across a diverse group of nations.

As Moisés Naím writes in ‘The Revenge of Power’, “The way to strengthen democracy is not to withdraw from universalist bodies, which are the battleground for influence, but to build up alliances and… use them more effectively.”

This requires all of us to more effort to keep our multilateral institutions not just alive, but vital.

While global health isn’t a priority of the incoming administration, maintaining American power and influence is. The U.S contribution to overseas development assistance as a share of total GDP is 0.2 percent, half the OECD average.

Even a 30 percent reduction is not likely to have a material impact on the budget position of the government, but it may have a negative impact on relationships with allies and building trust in the U.S as a reliable global partner.

Development assistance for health is also a key ‘soft power’ tool – good health benefits everyone, and costs comparatively little.

The UN estimates that to achieve universal healthcare for all by 2030 would cost $58 per person per year, or $371 billion per year globally.

In comparison, the US alone spent $820 billion or 13 percent of the total federal budget on its military in 2023.

The argument we need to make is that global health is a good investment – not just for health, but to maintain international relationships that strengthen trade and security as well.

4. From little things, big things grow

One of Australia’s biggest successes in global health is the development and rollout of the HPV vaccine against cervical cancer. The technology behind the vaccine was developed by Dr Ian Frazer at the University of Queensland.

Australia rolled out one of the first vaccination programs in 2007 and is now on track to eliminate cervical cancer. The knowledge and expertise developed is now being shared across the Indo-Pacific through the EPICC program, and on 21 September, the Quad Countries Launched the Cancer Moonshot Initiative.

While continued support under the Trump administration is not guaranteed, programs like this have demonstrated benefits in both high and low/middle-income countries and are more likely to receive support from an administration with a transactional approach.

We need to take these beacons of success and grow them further. Integrating non-communicable disease screening and follow-up into existing programs such as vaccination rollouts, where appropriate, can be an effective way of increasing our impact efficiently.

Similarly, we should be looking to build in measures that strengthen primary healthcare within the target populations so that health continues to improve across multiple dimensions after the initial program has ended.

5. Be patient and determined

COP29 is currently under way in Azerbaijan. The US Special Envoy, John Podesta said that “The fight is bigger than one election, one political cycle, and one country…we are all living through a year defined by the climate crisis in every country in the world.”

Despite valid concerns about what the future might hold, progress continues. The UK Prime Minister announced ambitious new goals to cut emissions by 81 percent by 2035. New carbon market financing standards have been agreed – and more commitments and agreements will come as the conference progresses.

So I am hopeful and I encourage others to be hopeful too. Doom and gloom, however justified, sows more disengagement and undermines what we are all trying to achieve. We need to move forward with purpose, patience, determination, clarity and empathy.

Public policy will always be contested space – nowhere more so than on the international stage – and progress takes sustained effort over a long period.

We should not be too disheartened by changes in political direction, which are par for the course.

The challenge is to ask yourself what you can do in the context in which you work to advance global health. If we all take advantage of the opportunities we have to make progress, we will achieve it.