Integrating multiple disciplines

JHU has a strong record of multidisciplinary collaboration, usually between a few university divisions. You can learn more about JHU existing multidisciplinary programs here.

However, to generate further groundbreaking research and innovative health solutions, we must engage and unite our best minds across the entire university - in medicine, nursing, public health, international relations, engineering, education, business, the creative arts, social sciences, and bioethics.

Intentional Collaboration Across Sectors

Within the Alliance for a Healthier World, we work together to identify and harness the unique yet intertwined contributions our united disciplines can make. In addition to the technical inputs of each discipline, they will all be used in an integrated way to contribute to research design, implementation, analysis, and knowledge translation. The overall approach includes adaptive research designs and mixed methodologies that involve critical stakeholders throughout the research process, including communities facing the issues as well as policy-makers, implementers, and local universities in low-middle income countries. You can read more about our efforts to actively facilitate and support cross sector teamwork here.

Several examples of how the different disciplines and schools at JHU could each contribute to a solving a difficult health problem are illustrated below.

Recovering from Disaster - Understanding & Building Resilience

Communities around the world are faced with a wide range of disasters, whether from natural disasters, human conflict, epidemic diseases, or other social, economic, and environmental catastrophe. There is growing attention to how to people, communities, organizations, and health systems prepare and respond to upheaval.

Resilience is a term used in many fields. In psychology, for example, it refers to an individual’s ability to adapt or “bounce back” from stressful situations, and involves behaviors, thoughts, and actions, along with supportive relationships to manage stress. In ecological research, resilience is a term used to distinguish between a system (e.g. organization, ecosystem) that persists in a state of equilibrium, and how dynamic systems behave when they are stressed and move away from a state of equilibrium. But staying the same may not be good.  Resilience may go hand in hand with poverty (e.g. chronically poor people are very resilient), often at the expense of improving wellbeing. In many low-income countries, health systems are in a state of low quality, low access, low accountability equilibrium, and do not meet the needs of populations, particularly for disadvantaged groups.  In such cases, it would be better to transform the system, and not simply reach an equilibrium.

The Case of Ebola Virus Disease

Background

The EVD epidemic was one of the most important public health threats this century – a crisis that challenged local governments and communities in Liberia, Sierra Leone, and Guinea, as well as governments around the world.  The epidemic spread to affect over 28,650 cases, including 11,325 deaths. The national health systems were still recovering from years of civil war, and had limited capacity to respond. This was partly due to severe shortages of health workers, health facilities, pharmaceuticals, and other necessary materials and public health systems. The response was hampered by poor road infrastructure, unreliable power and communications networks, and limited access to safe water supply. Other less visible factors were also important. People were suspicious of government intentions and responses in a post-conflict environment. Health workers generally had little confidence in the system and did not trust health authorities. Given the limited trust that people had in government, and the government’s inability to provide health services and safely handle dead bodies as the number of cases escalated, a vicious cycle of suspicion, miscommunication, mistrust, exposure to infectious dead bodies, and explosive transmission took hold. At the same time, other governments closed their borders to the three countries, stopping trade and commerce, creating yet another vicious cycle of loss of income, limited access to food, and heightened illness. The epidemic spiraled out of control, resulting in intense fear and turmoil throughout the sub-region. This fear rapidly extended to other countries around the world, and threatened the cohesiveness of communities and governments in Liberia and around the world.

Berman Institute faculty global bioethics work includes efforts to ensure that traditional public health containment measures can be successfully implemented during large-scale infectious disease outbreaks in low/middle income countries, such as the 2014 West Africa Ebola outbreak, in ethically optimal ways. http://www.bioethicsinstitute.org/containment

Berman Institute faculty global bioethics work includes efforts to ensure that traditional public health containment measures can be successfully implemented during large-scale infectious disease outbreaks in low/middle income countries, such as the 2014 West Africa Ebola outbreak, in ethically optimal ways. http://www.bioethicsinstitute.org/containment

There are historical and contextual issues that shape current vulnerabilities and resilience in the face of recovery from an acute crisis in West Africa. Sociopolitical tensions engendered by ethnic, class, and economic inequalities contributed to mistrust between groups, as well as violent conflict and several civil wars and lasting from the late 1980s to early 2000s in Liberia, Sierra Leone, and Guinea. The legacies of the transatlantic slave trade, inequitable trade policies, aid policies, and land reforms continue to affect the current political and economic systems in ways that may not only be unsustainable, but are harmful to the people who live in them. Understanding factors that have influenced current systems, including how they are connected to each other, helps to explain how the Ebola epidemic spiraled out of control in West Africa, as well as the types of vulnerabilities and adaptive capacities of communities and systems to respond.

Community resilience played a critical role in turning around the EVD epidemic. Although communities are a key component in the health system, they are largely neglected in the efforts to strengthen health systems, including in the post-epidemic plans.  In the case of Liberia, it is difficult to attribute any particular intervention to turning around the Ebola epidemic, yet it’s clear that communities played a leading role.  Hopkins faculty and Ministry of Health officials conducted a systematic analysis of interventions and when they occurred in the epidemic curve, showing that much of the decline in the epidemic curve was driven by critical behavior changes within communities, and happened before the international efforts were organized, while most of the building of treatment units came after the epidemic had waned (Kirsch et al 2016^).  Local leadership and community engagement helped reduce people’s exposure to Ebola, including through culturally acceptable ways of dealing with dead bodies, and a more integrated clinical and public health response, were instrumental in turning around the epidemic.  An important implication is that efforts to strengthen health systems should not only address the physical infrastructure and government health services delivery, but also build up the social infrastructure and systems to enhance community engagement in the health system. 

^  Source: Kirsch TD, Moseson H, Massaquoi M, Nyenswah TG, Goodermote R, Rodriguez-Barraquer I, Lessler J, Cumings D, Peters DH. Impact of interventions and the incidence of ebola virus disease in Liberia-implications for future epidemics. Health Policy Plan. 2016 Oct 29. pii: czw113

Opportunities for JHU to Work Together

There are significant gaps in knowledge and practice concerning the relationships between different types and scale of catastrophic events, and how individuals, communities, and systems can best respond, particularly to benefit marginalized populations.  JHU has many capabilities to conduct research and link research to interventions and policies to better prepare, identify, and respond to different types of disaster.  

Expertise Contributions from all JHU Divisions

JHU has expertise in the following areas disciplines that that can be brought to bear to build resilience that promotes health equity (JHU entities with expertise are indicated in parentheses):

  • Behavioral, communications, educational sciences and creative arts to understand and intervene with individuals, community groups, health providers, health care organizations (Bloomberg School of Public Health, School of Nursing, School of Medicine, School of Education, Krieger School of Arts & Sciences, Nitze School of Advanced International Studies, Jhpiego, Peabody Institute);
  • Epidemiology, biostatistics and computational sciences to characterize the risk factors and population effects for different types of disasters, and to manage and analyze large scale surveillance data (Bloomberg School of Public Health, Applied Physics Laboratory, Whiting School of Engineering, Krieger School of Arts & Sciences);
  • Economics to analyze incentives, economic impact, and implications for the poor of disasters and efforts to build resilience (Krieger School of Arts & Sciences, Nitze School of Advanced International Studies, Carey Business School, Bloomberg School of Public Health);
  • Sociology and anthropology to understand and build community capabilities and facilitate participatory research on interventions to strengthen resilience (Krieger School of Arts & Sciences, School of Nursing, Berman Institute of Bioethics, Bloomberg School of Public Health);
  • Humanities and the liberal arts to understand the role of history, culture, language, and the perspectives of the disadvantaged that places them at risk of disasters and diminishes resilience (Krieger School of Arts & Sciences, Peabody Institute, Berman Institute of Bioethics);
  • Basic sciences to characterize the molecular and genetic mechanisms of responses to stress, and to provide a basis for diagnostic and therapeutic intervention (School of Medicine, Krieger School of Arts & Sciences, Whiting School of Engineering, Bloomberg School of Public Health, Applied Physics Laboratory);
  • Engineering to provide technical interventions to better diagnose disease and provide new opportunities for communications and service delivery (Whiting School of Engineering, Applied Physics Laboratory, School of Medicine, Bloomberg School of Public Health);
  • Management and business expertise to optimize implementation approaches and to test new models of social enterprise to prepare for disasters, provide safety nets, and new opportunities for recovery from disaster (Carey Business School, School of Nursing, Bloomberg School of Public Health);
  • Political sciences to develop the policies and institutions to prepare, identify, and respond to disasters (Krieger School of Arts & Sciences, Nitze School of Advanced International Studies, Berman Institute of Bioethics, Bloomberg School of Public Health)
  • Systems scientists and modelers to clarify the pathways and assumptions of multi-level interventions in a complex environment, and to provide insights on areas for potential interventions and their effects (Whiting School of Engineering, Bloomberg School of Public Health, Applied Physics Laboratory, Krieger School of Arts & Sciences)

Graphic demonstrating the 10 JHU divisions.  The Alliance for a Healthier World also include key players - Berman Institute of Bioethics & Jhpiego Source: JHU Website https://www.jhu.edu/

Graphic demonstrating the 10 JHU divisions.  The Alliance for a Healthier World also include key players - Berman Institute of Bioethics & Jhpiego Source: JHU Website https://www.jhu.edu/

MEETING THE CHALLENGE OF APPROPRIATE ANTIBIOTIC USE FOR PATIENTS

Background

Antimicrobial resistance (AMR) is a looming global health challenge. By 2050, if unchecked, AMR will claim 10 million lives a year—more than the number who die of cancer today—and will cost up to $100 trillion dollars in economic losses (UK Review on AMR). Drug-resistant pathogens do not respect political borders, and such infections lead to more severe illness, increased morbidity and mortality, and greater costs from prolonged hospitalizations. Many modern day miracles of medicine from cancer chemotherapy to surgery depend on the availability of effective antibiotics. This challenge results not only from a faltering R&D pipeline for novel antibiotics, but also from the need to conserve existing antibiotics.

Expertise Contributions from all JHU Divisions

Expertise from a range of disciplines at JHU could work on ensuring appropriate use of antibiotics for patients (JHU entities with expertise are indicated in parentheses). Examples include:

  • Develop diagnostics to target treatment, identify substandard drugs, or detect drug resistance (Whiting School of Engineering, Applied Physics Laboratory, School of Medicine, Bloomberg School of Public Health)
  • Change the sociology of expecting antibiotics in the encounter between healthcare provider and patient (Krieger School of Arts & Sciences, Bloomberg School of Public Health, School of Nursing, Berman Institute of Bioethics, Jhpiego)
  • Realign the economic incentives of healthcare delivery to change provider and patient behavior (Krieger School of Arts & Sciences, Nitze School of Advanced International Studies, Bloomberg School of Public Health, School of Medicine, School of Nursing, Carey Business School, Jhpiego)
  • Apply mHealth interventions to ensure feedback and accountability for rational use of antibiotics by health workers and patients (Bloomberg School of Public Health, School of Medicine, Whiting School of Engineering, Applied Physics Laboratory, School of Education, Jhpiego)
  • Design how healthcare delivery systems will ensure access, but not excess for those in need of life-saving antibiotic treatment (Berman Institute of Bioethics, Bloomberg School of Public Health, School of Medicine, Carey Business School, Jhpiego)
  • Develop and test behavior change communications to better understand patient and provider perspectives and improve the appropriate use of antibiotics (Krieger School of Arts & Sciences, Bloomberg School of Public Health, School of Medicine, School of Public Health, Jhpiego).

REDUCING THE IMPACT OF INDOOR AIR POLLUTION ON HUMAN HEALTH

    Malawian woman stokes flame from sawdust wood fuel in efficiently designed stove constructed of mud. Dedza, Malawi 2011. Image credit: Sheridan Jones McCrae ©

    Malawian woman stokes flame from sawdust wood fuel in efficiently designed stove constructed of mud. Dedza, Malawi 2011. Image credit: Sheridan Jones McCrae ©

    Background

    Three billion people use solid fuels for heating and cooking in their homes. Inefficient cookstoves, inadequate ventilation in the home, or the nature of the fuel used can contribute to indoor air pollution. These fine particulate pollutants and carbon monoxide effluent exact a heavy health toll. WHO estimates that 4.3 million people die from exposure to such air pollution in households each year. Gathering or buying such fuel for these households can impose significant labor and energy costs on the household.

    Expertise Contributions from all JHU Divisions

    Across JHU, expertise can be mobilized across disciplines to reduce indoor air pollution and its health toll. Examples include:

    • Redesign how the cookstove, how its fuel burns, or how homes are ventilated (Whiting School of Engineering, Krieger School of Arts & Sciences, Applied Physics Laboratory)
    • Examine the economics of greater fuel efficiency on household income and labor (Krieger School of Arts & Sciences, Carey Business School)
    • Develop approaches to scale and speed the introduction and diffusion of new technologies and their adoption (Krieger School of Arts & Sciences, Carey Business School, Bloomberg School of Public Health, Jhpiego)
    • Take measure, document and model the health and environmental impact of indoor air pollution and its mitigation (Bloomberg School of Public Health, School of Medicine, Applied Physics Laboratory, Whiting School of Engineering)
    • Develop ways to engage citizens in monitoring and crowdsourcing data on indoor air pollution and progress towards its abatement (Applied Physics Laboratory, Whiting School of Engineering, Bloomberg School of Public Health, School of Medicine, Jhpiego)
    • Understand the cultural, gender, and economic dimensions affecting cookstove choices to provide insights on acceptable and safe cooking strategies (Krieger School of Arts & Sciences, Bloomberg School of Public Health).
    • Provide opportunities for artistic expression for disadvantaged families and women, to basis for developing voice, social cohesion, and enhanced problem-solving capabilities (Krieger School of Arts & Sciences, Peabody Institute)

    Come back and visit this page soon - we'll be adding further examples and visual graphics to demonstrate interconnections between the disciplines.