The SingHealth Duke-NUS Global Health Institute (SDGHI) was launched last year to address global health challenges in Southeast Asia and beyond. Its director, Professor Michael H. Merson, has nearly 50 years’ experience, tackling some of the world’s most pressing health problems at the highest levels and he established the Duke Global Health Institute in the USA. Prof Merson shares some memorable moments from his career, the challenges facing global health today and his plans for SDGHI.
Early in your career, you focused on global health and diarrhoea. What sparked your interest in these fields?
I went to medical school in the late 1960s, in an area of New York where there was a lot of poverty and poor healthcare. I saw for myself the relationship between disease and poverty, and how the conditions in which people grow up, live, and work affect their health. I saw this again during my medical training when I had opportunities to work in Nepal, Brazil and Bangladesh. Watching children die from diarrhoea and cholera was particularly hard because these conditions were no longer fatal in the US.
This motivated me to conduct research on diarrheal diseases at the U.S. Centers for Disease Control and Prevention. I was then appointed as the Chief Medical Epidemiologist at the Cholera Research Laboratory in Bangladesh at a time when dehydration caused by diarrhoea and cholera was killing thousands of children every year. But there was hope. We now had a better understanding of the microbes that caused diarrhoea, and oral rehydration therapy (ORT) had just been developed – a simple, low cost and effective alternative to intravenous fluids. Using ORT, good nutritional practices, and prevention strategies, we managed to treat and save thousands of young lives. I then led a programme in the World Health Organization (WHO), which rolled out this approach globally. It has since saved the lives of millions of children.
How have the priorities of global health changed over recent years, and what do you foresee in the coming decades?
Mortality trends are shifting from infectious diseases to non-communicable diseases such as heart disease, stroke, cancer and diabetes. This is due to better treatments and vaccine programmes which have reduced the burden of infectious diseases, as well as lifestyle changes including unhealthy diets, reduced physical activity, and tobacco use.
However, infectious diseases are still a major concern particularly because they can cause epidemics. The possibility of an influenza pandemic is real and millions of people around the world continue to be infected with AIDS and tuberculosis. Emerging diseases, as we saw with SARS, pose health security and economic threats while diseases we thought we had conquered like measles are re-emerging due to the anti-vaccination movement.
Climate change is also having a significant impact on global health. Rising temperatures have allowed mosquitoes to thrive in regions that were previously too cold for them to survive, putting more populations at risk of malaria, Zika and dengue. Extreme weather is also causing droughts, which impact food supply and nutrition, and flooding, which affects water quality and spreads diseases. The health consequences of natural disasters and civil conflict can devastate communities and countries for generations.
How does improving healthcare in other countries benefit people in Singapore?
For one, viruses don’t need passports. Singapore needs to look beyond its borders and work with neighbouring countries to prevent the risk of outbreaks and the spread of diseases to its shores. But the benefits of such collaborations go beyond health security. Health practices and innovations developed in other countries can be brought back to improve healthcare in Singapore, and healthier populations are more likely to have stronger economic growth, which opens up more opportunities for Singapore’s private sector.
What are the priorities for the SingHealth Duke-NUS Global Health Institute (SDGHI)?
At SDGHI, we are tackling current and emerging health challenges across Southeast Asia with a four-pronged approach:
Through our education and training activities, we aim to develop the next generation of global health leaders. SDGHI will provide training opportunities to residents, fellows and doctoral students and establish a global health certificate programme for professionals working in other fields.
- We are supporting the research of our global health faculty focusing on three key areas:
We seek to become a regional hub for policy leadership and engagement to improve and strengthen health systems in the region. Some of our key focus areas include universal health coverage, access to medicine and health security.We plan to partner with academic institutions across Southeast Asia to increase the region’s capacity in research, education and policy formulation. This will be done through strengthening technical expertise and local infrastructure, including data management; laboratory and research grant management capabilities.
"We offer medical students experiential learning and research opportunities in global health so they can better understand challenges in the field. As the Director of the Global Programme on AIDS in WHO in the first half of the 1990s, I witnessed the stigma and discrimination AIDS patients faced around the world. The enormity of the HIV/AIDS pandemic truly hit home during my first visit to Uganda. I remember visiting overcrowded hospitals with AIDS patients sleeping two or three to a bed. The disease was killing husbands and wives in their economic prime, leaving behind a generation of children orphaned and raised by their grandparents. It was both devastating and heartbreaking."
Will SDGHI work with non-medical fields?
Absolutely! The underlying causes of ill health are complex and often involve social, political, economic and environmental factors. So where possible we want to partner with a range of professionals to address these problems, for example:
- Environmentalists to identify and address the health consequences of climate change.
- Biomedical engineers to develop innovations to improve cancer screening and diagnosis in resource poor settings.
- Psychologists to identify high-risk behaviours associated with non-communicable diseases such as diabetes and develop interventions to mitigate risk.
- Economists to evaluate human behavior and decision-making practices that affect disease transmission and prevention.
- Policy experts to influence food policies to help prevent diabetes.
- Business leaders to advise on organisational management of healthcare.
- Lawyers to advise on intellectual property issues.
What does it take to establish and run an effective Global Health Institute?
To succeed, we need a committed, interdisciplinary faculty which we are currently building up, interested and passionate students and strong support from the leadership of the AMC which we are fortunate to have. It is also key to have engaged, committed and long-term collaborations with partner institutions in low and middle income countries.
As always, funding is key to sustainability. Most of our work is in Southeast Asian countries. We are looking to partner with like-minded individuals, organisations and foundations who want to make a lasting and impactful difference in the region. Improving health and healthcare does more than save lives – it keeps families together, lifts individuals and communities out of poverty and provides health security which benefits us all.