Building Global Environmental Health Capacity through International ...

Special Issue Fogarty International Program Guest Editor DANIEL HRYHORCZUK, MD, MPH

Building Global Environmental Health Capacity through International Scientific Cooperation and Partnerships KENNETH BRIDBORD, MD, MPH, JOEL G. BREMAN, MD, DTPH, ARON PRIMACK, MD, CHRISTOPHER SCHONWALDER, PHD, MELANIE ROUSE, MARIA FERREIRA, SHARON HRYNKOW, PHD Sponsored by the Fogarty International Center, the NIEHS, and NIOSH, the International Training and Research Program in Environmental and Occupational Health (ITREOH) supports training of health professionals worldwide. The program grants awards to U.S. academic institutions, which partner with institutions in low- and middle-income countries to address health threats of regional importance. Key words: Fogarty International Center; international programs; public health; environmental health; occupational health; training. I N T J O C C U P E N V I R O N H E A LT H 2 0 0 6 ; 1 2 : 2 9 5 – 2 9 9

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he risks to human health from exposure to environmental contaminants and occupational hazards challenge scientists and public health officials worldwide. Epidemiologists, toxicologists, environmental engineers, molecular biologists, and other experts are critical partners in developing knowledge and interventions to mitigate the adverse effects of such risks. Many countries where environmental conditions are poor lack trained experts to participate in rigorous scientific and related public health projects. To meet the demand for expertise, the International Training and Research Program in Environmental and Occupational Health (ITREOH) supports training of experts in these critical fields. The program is a unique effort to build global health research capacity through international scientific cooperation and partnerships. The program began in 1995 under sponsorship of the Fogarty International Center (FIC) and the National Institute of Environmental Health Sciences (NIEHS)— both parts of the National Institutes of Health (NIH)— and the National Institute for Occupational Safety and

Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC). The program honors the memories of the late Dr. Irving Selikoff of the Mount Sinai School of Medicine and the late Dr. Norton Nelson of New York University for their lifelong commitment to the training of health professionals in the environmental and occupational health sciences. The ITREOH grants program is one of 14 institutional research training and curriculum development programs designed to support the mission of the Fogarty International Center. That mission is to address global health challenges through innovative and collaborative research and research training programs and to support and advance the NIH mission through international partnerships. These training and capacity-building programs involve awards to U.S. academic institutions, which partner with institutions in low- and middle-income countries1 to address global health threats of particular importance both to the United States and to the international partners.2–4 ITREOH supports training of scientists and public health specialists in partner countries who are preparing for careers to improve environmental and occupational health in their home countries. The focus is on training, both in the United States and in partner countries, related to public health issues of regional importance. The goal is to stimulate collaboration and interaction in projects that will both benefit the developing countries and provide valuable knowledge and information to U.S. researchers and policymakers. Through this program, foreign health specialists come to the United States for training, returning home to assume positions of responsibility in research, teaching, and public health policy development. Research collaborations with NIH grantees in the ITREOH network

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TABLE 1—Features of Fogarty International Center Research Training Programs Flexible Long-term commitment Built on research collaborations Re-entry support Response to local needs Empowerment Networking

Figure 1—Collaborating countries under ITREOH are indicated by darkened areas.

result in additional support through grants, such as the Fogarty International Research Collaboration Award (FIRCA) and the Global Research Initiative Program for New Foreign Investigators (GRIP), described below. We have yet to study the rate of return home for trainees under ITREOH. However, the AIDS International Training and Research Program (AITRP), another FIC program based on the same institution-toinstitution paradigm, showed a rate of return home of 80%.5 This is remarkable in light of a 50% return rate across all scientific fields.5 The experience of FIC with the AITRP, launched in 1988, laid the foundation for ITREOH. The concept for AITRP, moreover, had its roots in two long-standing programs sponsored by NIEHS and NIOSH, the Environmental Health Research Centers supported by NIEHS and the Educational Resource Centers supported by NIOSH. The NIEHS Environmental Research Center grants provide core support for integrating multidisciplinary approaches to research in environmental health. These awards provide infrastructure and administrative support for innovative approaches to the biological and chemical sciences underpinning issues in environmental health. The NIOSH Educational Resource Centers combine multidisciplinary training for occupational health scientists and practitioners with continuing education and community outreach activities. Some features that have contributed to the success of AITRP and

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ITREOH as well as other FIC research training and public health capacity-building programs are listed in Table 1. Today, ITREOH supports 17 institutional training grants to U.S. universities, which are involved in building environmental and occupational health research capacity in 32 low- and middle-income countries (see Figure 1). The projects address critical environmental and/or occupational health problems of importance to the collaborating countries that include air and water pollution, agricultural hazards, radiologic hazards, heavy-metal pollution, respiratory diseases, mining hazards, and ergonomic deficiencies. In the majority of cases, awardees are current NIH or CDC research grant recipients with research collaborations that include foreign institutions in low- and middle-income countries. The main research and training themes for ITREOH include epidemiology, toxicology, risk assessment, occupational medicine, industrial hygiene, and environmental health economics. The Appendix lists the current ITREOH Principal Investigators, awardee institutions and the countries and institutions with which they are collaborating under this program. Among the types of support available under ITREOH are support for master’s and doctoral candidates, postdoctoral fellowships; short courses (in the United States or in the foreign country); trainingrelated in-country research; and advanced research and administrative support for the U.S. university and its collaborating foreign partner(s). Through the 11 years of the program, based on our experience, an estimated 1,000 health scientists have received short- (≤ 6 months) or long-term (≥ 6 months) training in the United States, and more than 10,000 environmental and occupational health science professionals have participated in short-term in-country training courses. In addition to creating new knowledge, ongoing global collaborations have led to the establishment of new faculties for public health in key countries. For example, because of the strong research and public health base established in the Ukraine, the first School of Public Health in the Ukraine, within the Kyiv Mohyla Academy, was established in 2004. Further, the first public health program granting an MPH degree in Russia was established in 2005 at St. Petersburg State University in close partnership with Fogarty and its ITREOH grantees. Fogarty-affiliated and other institutions that helped develop the St. Petersburg State University School of Public Health are the University of Alabama at Birmingham, State University of New York at Albany, State University of New York–Downstate MPH Program, Emory University and Rollins School of Public Health, Johns Hopkins Bloomberg School of Public Health, London School of Hygiene and Tropical Medicine, University of North Carolina at Chapel Hill School of Public Health, University of Southern Denmark

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Health Promotion Institute of Public Health, Yale University School of Public Health, University of Illinois at Chicago, and Case Western Reserve University. In addition to the direct ITREOH awards, FIC supports other efforts to facilitate the career development of former trainees and to build scientific leadership in the home countries of trainees. For example, GRIP provides R01 research awards for former trainees, including those from ITREOH. One ITREOH grantee, Dr. Tom Cook of the University of Iowa, took support to the next level. With pilot funding from Fogarty, Dr. Cook established a regional NIH alumni association based at the Slovak Medical University in Bratislava. Working with the program’s six-country network of collaborators and returned trainees as a foundation, Dr. Cook and his Slovak colleagues established a self-governing association to foster further professional development and independence of NIH-trained scholars throughout the region. A core group of founding members adopted formal bylaws, elected officers, and continues to actively recruit to expand the group. The Central/Eastern Europe NIH Alumni Association is developing its own web site and compiling a database of members and research opportunities. Specifically, association members are making regular use of Internet-based web-conferencing technology to conduct online discussions and educational seminars on grant-proposal writing, environmental health, and occupational injuries. In addition, FIC also developed a pilot program for leadership training for women scientists and mentoring of current and former trainees. The Center intends to extend this program to the ITREOH following the next competition in 2007.

Supporting the new public health initiative in Ukraine. Left to right: Daniel Hryhorczuk (Director of the Great Lakes Centers), Ambassador Herbst (U.S. Ambassador to Ukraine), Natalie Jaresko (Head of Western Enterprise Fund), and Susan Scrimshaw (Dean of UIC School of Public Health).

ITREOH support facilitated the articles in this special issue of the Journal, which exemplify the research accomplishments of trainees and collaborators under this program. We can measure the impact of ITREOH through its contributions to science and public health. We should also be able to measure future impact through the efforts of the many environmental health research and public health leaders who have benefited from training under the program. FIC recognizes that we need this type of training and global health research capacity development for the world to address the global environmental and occupational health challenges of the 21st century.

Measuring arsenic levels in well water. (See pages 300–306.)

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The Fogarty International Center thanks the many individuals and agencies that work with us to support this program, including colleagues at the National Institute of Environmental Health Sciences, and the National Institute for Occupational Safety and Health.

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References

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World Bank. .

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Breman JG, Bridbord K. The International Training and Research Program in Environmental and Occupational Health: partnerships and progress. Int J Occup Environ Health. 1999; 5: 198-202. Hrynkow SH, Primack A.,, Bridbord K. Paradigms and progress in building research capacity in international environmental health. Int J Hyg Environ Health. 2003; 206: 413-22. Claudio L. Building self-reliance in environmental science: the ITREOH experience. Environ Health Perspect. 2003; 111:A460463. Kupfer L, Hofman K, Jarawan R, McDermott J, Bridbord K. Strategies to discourage brain drain. Bull WHO. 2004; 82: 616-8.

APPENDIX Active Awards under the International Training and Research in Environmental and Occupational Health Program, June 2006 Principal Investigator

Institution Name

Collaborating Country(ies)

Collaborating Institution(s)

Scientific Area(s)

Jefferey Burgess

University of Arizona

Zambia Zimbabwe

University of Zambia University of Zimbabwe

Mining Silicosis Tuberculosis

David Carpenter

State University of New York at Albany

Uzbekistan Mongolia Romania Russia

Uzbekistan Academy of Sciences Mongolia Institute of Public Health Romania Environmental Health Center Novosibirsk State University Moscow State University St. Petersburg State University

Heavy metals (lead) Air pollution

Luz Claudio

Mt. Sinai School of Medicine at New York University

Brazil Chile

Neurodevelopment Gene–environment interactions

Mexico

Oswaldo Cruz Foundation (FIOCRUZ) Ministry of Health Chilean Security Association National Institute of Public Health

Thomas Cook

University of Iowa

Czech Republic Hungary Poland Romania Slovenia

Palacky University University of Debrecen Nofer Institute of Occupational Medicine Institute of Preventive & Clinical Medicine Nova Gorica Polytechnic

PCBs Mineral fibers

Sarah Felknor

University of Texas Health Science Center, Houston

Colombia Costa Rica Mexico Venezuela

Pontifica Universidad Javeriana Universidad Nacional de Costa Rica Universidad Autonoma Metropolitana Universidad Centro-Occidente “LA”

Ergonomics Safety

John Froines

University of California, Los Angeles

Mexico

National Institute of Public Health

Reproductive effects, arsenic, pesticides

Joseph H. Graziano

Columbia University Health Sciences

Bangladesh

National Institute of Social and Preventive Medicine

Arsenic in tube well water

Daniel Hryhorczuk

University of Illinois at Chicago

Belarus Russia

International Sakharov Environmental University Institute of Occupational Health at the Russian Academy of Medical Sciences Ufa Research Institute of Occupational Health and Human Ecology Institute of Biophysics Institute for Occupational Health

Radiation Dioxin

Ukraine

Institute for Pediatrics, Obstetrics, and Gynecology Institute of Hygiene and Medical Ecology Institute of Ecohygiene and Toxicology National University of Kyiv–Mohyla Academy

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Dioxin Radiation Coal mine safety and health Children’s environmental health Environmental health Toxicology Public health

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APPENDIX (continued) Principal Investigator

Institution Name

Matthew Keifer

University of Washington

Collaborating Country(ies) Costa Rica Ecuador Mexico Nicaragua Thailand Vietnam

Collaborating Institution(s)

Scientific Area(s)

National University of Costa Rica

Silicosis Air pollution Injury control

National Autonomous University of Nicaragua Burapha University National Institute of Occupational and Environmental Health

Richard Kreutzer

Sequoia Foundation

China

Shanghai Centers for Disease Control

Tobacco

Jerold Last

University of California, Davis

Uruguay

Universidad de la Republica

Environmental monitoring

Rafael Moure-Eraso

University of Massachu setts, Lowell

Brazil Mexico

Federal University of Parana UNISON

Societal impact of work in the informal sector

Thomas Robins

University of Michigan

Botswana Lesotho South Africa

Respiratory disease mining

Zambia Tanzania

Department of Health Department of Labour University of Cape Town University of Kwazulu-Natal University of Zambia Muhimbili University Aga Khan University

Air and water pollution Pesticides Heavy metals

Nalini Sathiakumar

University of Alabama at Birmingham

Pakistan

Allan Smith

University of California, Berkeley

Bangladesh Nepal India

Sri Ramachandra Medical College Indian Institute for Chemical Biology King George Medical College Manipal Medical College

Arsenic in drinking water Indoor air pollution

Nelson Steenland

Emory University

Chile Peru

University of Chile Universidad Peruana Cayetano Heredia

Lead Reproductive effects

Thomas Voice

Michigan State University

Bulgaria Romania Serbia and Montenegro

Medical University of Sofia Institute of Public Health Institute of Occupational and Radiologic Health

Balkan endemic nephropathy

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