All change for global health

The Health Consequences of Population Change programme The Wellcome Trust’s new Health Consequences of Population Change Programme aims to have a practical impact on public health in the developing world.

Over the next 50 years the world's population will increase by 50 per cent to more than 9 billion people, 96 per cent of this increase occurring in the developing world. In addition, sweeping social changes are triggering profound shifts in the structure and make-up of populations across the globe. These in turn are leading to fundamental changes in patterns of disease and ill-health, and creating new pressures for the healthcare systems of developing nations.

The Wellcome Trust's new Health Consequences of Population Change (HCPC) Programme supports research aimed at documenting and understanding these changes, assessing their impact on public health, and using new knowledge to improve the delivery of healthcare. The £65 million initiative, launched in October 2001, ultimately aims to have a practical impact on healthcare delivery.

Five key factors lie at the heart of the HCPC Programme: population growth, youth and ageing, migration, urbanisation and lifestyle changes.

As well as population growth, the age structure of populations is changing, with many countries experiencing an ageing population. This demographic shift is exerting pressures at a number of levels, from family networks to governments' ability to support an elderly population. Meanwhile, the migration of populations fleeing war and civil unrest, economic migration and other large-scale movements of people can profoundly affect the impact and distribution of disease. Large numbers of people may encounter diseases they have no natural protection against, and the unsanitary conditions of temporary dwellings can promote the rapid spread of disease.

The world is also experiencing a sustained mass migration from rural to urban environments, which produces its own set of pressures: the quality of housing and diet or nutrition can decline; the breakdown of family and neighbourhood networks means vulnerable groups are less protected, and new patterns of disease can arise. Gigantic, sprawling 'megacities' are springing up on almost all continents, stretching existing medical infrastructures.

Also important are widespread lifestyle and behavioural changes. Westernised diets are already beginning to affect many developing nations, smoking looks likely to be the biggest killer of the 21st century, and the adoption of risky sexual practices among adolescents is leading to a surge in sexually transmitted diseases and encouraging the spread of HIV/AIDS.

A changing world

"We're interested in describing what happens when demographic changes impact on health, and in looking at all the relationships and interactions – between population change, new patterns of disease emerging, and how governments and healthcare providers cope with these changes," explains Wendy Ewart, Scientific Programme Manager for the HCPC Programme. "The ultimate aim is to provide evidence to help governments, aid agencies and global health organisations to plan for the best use of scarce resources for better healthcare."

Although proposals will be funded in response mode, subject to international peer review, the Programme has a strong element of strategic targeting. Its scientific remit is carefully defined, and there is a strong desire to devolve activities to regions: "We want to build on the success of the previous Population Studies Programme and the bonding we've already achieved through awards to four centres of excellence in developing countries," says Dr Ewart (see box below).

The idea is that these centres should act as foci of regional activity. "We don't necessarily want to push more projects through those centres per se," explains Dr Ewart. "What we want is to generate some connectivity within the region. For example, a grant could be awarded to a researcher in Africa whose work will build scientifically on work being carried out at the Beirut centre. Or we might fund a university in Laos, or as far away as Australia, if they demonstrate some synergy or strategic relation to something we're doing at Singapore or Mahidol. The idea is to build on what we've already done well, keep it going and create a critical mass of interest."

In addition a region that has not previously received a major award has been targeted for funding "We want to get some large awards to existing centres of excellence in Latin America," says Dr Ewart. "There is much science in Latin America of international excellence. We plan to make awards directly to institutions in this region to stimulate high-quality research on HCPC issues specific to Latin America." A new competition for Latin America is likely in 2002.

Research leaders of the future

Central to the HCPC Programme will be research training – at Master's level for those with little or no research experience and postdoctoral training fellowships for more established investigators. Centres of excellence holding major awards should act as 'beacon' sites for regionally based research training. Project and programme grant support will also be available for innovative proposals consistent with the HCPC Programme's aims.

A key aim of the schemes is to build capacity – to strengthen existing research bases so regions are well equipped to tackle local priorities. "We want to continue training the leaders of the future through the Master's and postdoctoral programme ideally on their home ground, or as close as possible," says Dr Ewart. "For example, people from Laos, Cambodia and China can do their research training in South-East Asia, where the Asian Meta-centre in Singapore and Mahidol University are both beacons of excellence, then, when they complete their training and return home, they'll be more able to keep those links with their regional centre of excellence than they would if they had trained in the UK or USA. We want to train and keep leaders in the regions where they'll be needed so that in five years we've left something that will last."

As part of its capacity building, the Trust works closely with other agencies and consortia. Collaboration is particularly important for funding research that is expensive or long term, such as demographic surveillance. "Demographic surveillance is carried out to understand what’s happening to communities at a house-by-house level over a huge area and a long period of time," explains Dr Ewart. "It’s therefore very expensive research, and since it’s a global resource, no one funder should pay for it all. We need to work in partnerships to ensure that the long-term future of the science is safeguarded. So the Trust has an ongoing collaboration with the Rockefeller Foundation and with IN DEPTH, a network of demographic surveillance groups who have formed a cooperative."

The Trust's experience in this area means it is frequently invited to act as a consultant to newer foundations and is a player in global agency decision making. Hence, as well as the funding schemes, the HCPC Programme will be developing partnerships with other organisations with similar goals, to coordinate and concentrate efforts.

By examining the impact of 'human factors', such as sexual behaviour or social habits, the HCPC Programme embraces both the social and biomedical sciences. Indeed, both disciplines will be important if the Programme is to meet its aim of actually improving the delivery of healthcare to populations.

See also

• Health in transition: Article on Developing demographic research in the Middle East
• Natural protection: Article on Minimizing mother-to-child transmission of HIV
• AIDS and Auntie Stella: Article on HIV and sex education programmes in Zimbabwe
• The generation gap: Article describes twenty years of HIV and AIDS

External links

• Asian Metacentre for Population and Sustainable Development Analysis
• American University of Beirut Lebanon
• Institute for Population and Social Science Research at Mahidol University