Dr. K.M. Venkat Narayan, director of the Emory Global Diabetes Research Center (EGDRC), and Dr Jim Curran, Dean of the Rollins School of Public Health at Emory talk to SUPRIYA D.G. about their continuing role in promoting transnational research with India, among other countries, and the urgent need for research to address the growing epidemic of lifestyle based diseases, such as type 2 diabetes, cardiovascular disease, cancers, and poor mental health.
Atlanta, GA: Dr. K M Venkat Narayan is regarded as an eminent scholar, medical professional and scientist. He was chief of the Diabetes Epidemiology and Statistics Branch at the US Centers for Disease Control and Prevention (CDC) and led a number of large US national epidemiological, health services research, intervention and economic studies. Dr Jim Curran is a fellow of the American Epidemiologic Society, the American College of Preventive Medicine, and The Infectious Diseases Society of America. Author and co-author of nearly 260 scholarly publication, Dr Curran was also the recipient of Surgeon General’s Medal of Excellence in 1996, and the John Snow Award from the American Public Health Association in 2003.
Dr. Venkat Narayan and Dr Jim Curran were in India for the launch of the new Centre for Chronic Conditions (CCCC) in New Delhi on April 7.
The Centre for Control of Chronic Conditions is an international partnership between the All India Institute of Medical Sciences,New Delhi, Emory University, the London School of Hygiene & Tropical Medicine and the Public Health Foundation of India. The secretariat for this global partnership will be at the Public Health Foundation of India. The centre is multi-disciplinary group of researchers and health professionals representing a spectrum of clinical, public health, genetics, biochemistry and social science disciplines. The work focuses on the priority chronic conditions of – cardiovascular diseases and stroke, mental disorders, diabetes, chronic lung diseases, cancers, injuries and chronic kidney diseases.
According to Dr Narayan, research is a global phenomenon. The Pima Indian study of diabetes in the 1960s showed the transition of an agrarian population, unexpectedly, to one with a dramatic increase in obesity and type 2 diabetes – with nearly 50% of the population having diabetes by age 45. Says Dr Narayan “What happened to the Pimas was, in a way, anticipating what was to happen to the rest of the world.” Set up in 2006, with an early collaborative partnership with the Madras Diabetes Research Centre in India, and soon expanded to partnerships with the Public Health Foundation of India (PHFI), and the All India Institute of Medical Sciences, the EGDRC has grown considerably and a great part of the work is focused on South Asia, Dr Narayan adds.
Adds Dr Curran, “Diabetes and related chronic diseases are growing worldwide problems of special importance in both India and the United States. Rich insights into both the causes and approaches to prevention and care can be garnered from the multiple perspectives and populations in transnational studies. We are fortunate to be an integral partner in the CCCC project with our colleagues in India and others.”
“The problems we share are becoming common across the world”, explains Dr Narayan, alluding to the pace and extent of globalization, its incumbent benefits and perils. He continues, “There are nearly 400 million people globally who suffer from diabetes. There is a rise in chronic diseases such as cancers and cardio-vascular diseases. India is a striking example because the proportion of people with diabetes, in say Chennai, has increased from about 2.5% in 1971 to about 20% now. Of these, type 2 diabetes is the common type, affecting 95% of cases of diabetes, and is increasing dramatically both in urban and rural areas.”
EGDRC’s core faculty has been working collaboratively with institutions across the globe to help set up world-class research infrastructure, train global health investigators, both in the US and in developing countries, and assist in scientific study designs so that a strong combination of “basic sciences and public sciences can help make new discoveries and also aid policy decisions” in the words of Dr Narayan. The impetus for such transnational research also comes from trying to find solutions that may be specific to populations, regions, and cultures.
Although Dr Narayan admits that health patterns are becoming similar across the world, the spread of diabetes, for example, among low- and middle-income countries means that research has to be conducted in local settings. Furthermore, global collaboration can accelerate innovations, and also leverage global talent and resources efficiently for the benefit of human health worldwide. Dr Narayan credits the robustness of local partnership as “essential to bringing local issues to the forefront.” For Dr Curran, the research collaboration provides opportunity for students interested in research as well as benefit to public health. In order to assure maximal benefit and valid comparisons it will be necessary to standardize metrics and clearly understand differences. This partnership will provide important opportunities for students and faculty from India and the United States to learn and contribute.”
Further, according to Dr Narayan, “This kind of research has created scientific opportunities in areas such as maternal child health, study of genes, large clinical trials, as well as opened up new avenues for discovery that are going to be relevant for a very large number of people in the world.” He adds that lowering costs of innovation and treatment can also help put research in perspective for the benefit of the greater good.
Dr Narayan is vocal about the existence of global talent everywhere, of making partnerships complementary and inculcating ethical values and oversight in research. As much as research has become more interdisciplinary in the West, in India, the quality of the education system, which does not adequately emphasize critical thinking and scientific inquiry, as well as the culture of public health research being medically dominated, can present a challenging scenario. But the fact that there is a change in our “food ecosystem” with greater food intake and choices as well as low levels of activity, the prevalence and rise of chronic diseases is not something we can ignore because the risk can affect people at very young ages. Dr Narayan asks, “Do we want to be consumers of knowledge or creators of knowledge and add value?” His question clarifies the need for community support, development of infrastructure and training of researchers so that they can effectively collaborate globally, and come up with new discoveries, multiple solutions, and preventive measures.