Research & Innovation Focus

Four Thematic Areas

The AHW has identified four thematic areas where an integration of expertise and perspectives is needed to address difficult and inter-dependent social problems.

 

1. Food & Nutrition Security
2. Healthy Environments

3. Gender Equity & Justice
4. Transformative Technologies & Institutions

This intends to focus research and innovation on areas where JHU is best positioned to harness its expertise to make impact.  

  • Each thematic area addresses underlying and systemic drivers that create a large burden of health inequity around the world. They are also connected to each other; the AHW will support work both within and especially across thematic areas.
  • The thematic areas address unresolved, complex and rapidly changing concerns that have consequences for all, while particularly affecting the most disadvantaged populations.

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1. Food & Nutrition Security

Thematic Area Research & Innovation Goals:

Recognize critical linkages between food systems, local context and dietary adequacy to maintain nutritional health across all stages of life, in an era of both inflexibility and transition in dietary imbalance and malnutrition. Research in this area would integrate public health, nutritional sciences, food security and ethics, agriculture and economics to address nutritional inequities in underserved societies across national income divides.  

Image credit: Bartosz Hadyniak/Getty Images


 

 

Concept Summary - FOOD & NUTRITION SECURITY 

Malawian farmer displays a selection of red peppers with more of his harvest drying in background. Dedza, Malawi May 2011.  Image credit: Sheridan Jones McCrae © 

Malawian farmer displays a selection of red peppers with more of his harvest drying in background. Dedza, Malawi May 2011.  Image credit: Sheridan Jones McCrae © 

We are witnessing multiple burdens of malnutrition, with some countries, communities and households suffering from combinations of undernutrition, overweight and obesity, and micronutrient deficiencies. Grappling with these multiple burdens of malnutrition are deeply tied to political, social and economic factors. There are currently 784 million people who are undernourished, 159 million children under five who are chronically undernourished or stunted, 50 million children under five who are acutely malnourished or wasted, and 2 billion and 1.2 billion people who are estimated to be iron and zinc deficient respectively (FAO 2015; UNICEF/WHO 2015; Black et al 2013). Although child mortality and undernutrition is slowly declining, it is unclear if these trends will remain with significant external drivers that will challenge us – climate change, population pressure, persistent social inequalities, and geopolitical conflict.  Current estimates on climate change, for example, are expected to have dramatic impacts on crop yields, notably in South America, Africa, and South Asia, while also leading to greater food price volatility that are likely to have their greatest impact on the poor (Havlik et al 2015). 

Over one billion people live in extreme poverty, earning less than $1.25 a day (Chen and Ravallion, 2008), while more than two-thirds of these extremely poor people go hungry (FAO, 2012). In the past, poverty was associated with severe forms of acute undernutrition, particularly in children, that were frequently seen in times of famine and hunger. Today, we know that poverty affects nutrition throughout the whole life-span and has a broad spectrum of manifestations, such as increased propensity to many diseases, both infectious and non-communicable, reduced physical work capacity, a lower learning and intellectual capacity, increased exposure and vulnerability to lifestyle-related and environmental risks, reduced participation in social decisions, and negligible capacity of resolution in the face of environmental challenges (Peña and Bacallao, 2002). This lack of food and poor nutrition impacts a person’s ability to earn a living, creating a vicious cycle of poverty and malnutrition. Individuals lose 10% of their potential lifetime earnings, and countries lose 2-3% of their GDP due to undernutrition (World Bank, 2006).

Organic green capsicums thriving without chemical fertilizer at Kusamala Institutute of Agriculture & Ecology, a permaculture farm outside of Lilongwe, Malawi. 2011.  Image credit: Sheridan Jones McCrae ©

Organic green capsicums thriving without chemical fertilizer at Kusamala Institutute of Agriculture & Ecology, a permaculture farm outside of Lilongwe, Malawi. 2011.  Image credit: Sheridan Jones McCrae ©

All forms of malnutrition are the result of interactions between poor diets, unhealthy food systems and inadequate health services. Food systems govern the types of food produced and their journey from farm to fork. As populations urbanize, incomes increase and the food industry concentrates and globalizes, the food system struggles to produce healthy food for everyone. The failure to identify and implement actions to make food systems healthier is costly. The human health consequences of malnutrition is detrimental: 45 percent of all under five mortality results from malnutrition and the multiple burdens of malnutrition represent tone of the biggest drivers of global burden of disease, with low-quality diets being the number one risk factor for global disease burdens. Despite the centrality of food quantity and quality as determinants of nutrition adequacy and the fundamental importance of food systems in determining which foods are available, affordable and acceptable, the multiple opportunities to intervene in food systems to promote nutrition are not well known, understood or addressed. This is because both food systems and malnutrition burdens are complex and context-specific, making it difficult to identify the links between them and the actions needed to leverage those links (High Level Panel of Experts on Food Security and Nutrition 2016).

Proposed Research Priorities

  • How can we better understand the complex, multiple burdens of malnutrition in LMICs: Undernutrition, micronutrient deficiencies and overweight/ obesity), their determinants (including genetics), and interactions of nutrition and poor health?
  • How can sustainable diets and food systems for planet and human health be defined, measured and implemented, and where can (disruptive) technology can play a role in ensuring sustainability?
  • What are the mechanism to improve the food environment within urban settings: South Asia, SE Asia, Africa and how can food value chains be more nutrition sensitive?
  • What tools and technology do we have to prevent, adapt, and mitigate against food and water insecurity of populations in conflict regions/ situations and extreme weather (storms, drought)?
  • How can we better design and evaluate national programs / policies to promote adaptation to climate change – do they reach the poor / address inequities?
  • What are the health and environmental impacts of industrial animal production in LMICs?

Theme Lead 

To learn more about links between food and nutrition security and advancing global health equity - view the detailed concept paper on this thematic area.

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2. Healthy Environments

Thematic Area Research & Innovation Goals:

Identify how global climate change and environmental degradation at local, regional and global levels pose risks for decreasing equities in human health and nutrition.  Develop sustainable solutions on how to best act to protect health and nutrition.

Image credit: Bartosz Hadyniak/Getty Images

 

Concept Summary - HEALTHY ENVIRONMENTS

Two major underlying sets of problems that challenge us in our efforts to preserve healthy environments, maintain the ecosystem services associated with them, and limit inequities associated with unhealthier environmental conditions among poor and marginalized populations. One set of problems is typified by greenhouse gas accumulation in the atmosphere. It is a problem at the global level: both the causes and the effects are global. The second set of problems relates to inequity: High-income countries make a much larger contribution to the problem, both historically and currently. At the same time, low-income countries and poor people within countries are more likely to suffer the consequence. The poor are more likely to live in more precarious environments (semi-arid areas, low-lying islands etc.). They are also less resilient to the anticipated climate changes due to limited technical capacity in local institutions and organizations, and fewer resources to devote to local adaptation.

Garbage in canal in Lagos, Nigeria. Image credit: Peeter Viisimaa/Getty Images ©

Garbage in canal in Lagos, Nigeria. Image credit: Peeter Viisimaa/Getty Images ©

Preserving healthy environments must encompass efforts to protect land, air, water and biodiversity that depends on different ecosystems. A major threat to healthy environments is the global demand for extraction of resources (mining, and industrial production, local population pressures with resultant demands on land, water and other resources. The 2005 Millennium Ecosystem Assessment found that 60% of the world’s ecosystem resources were degraded or used in unsustainable ways (Hassan et al 2005). Local and regional environment degradation may take many forms: chemical and microbiological contamination of water, particulates in the air from forest fires, coal-burning power plants, factories, erosion and contamination of soil, depletion of aquifers, loss of forests and wetlands and many others. Each of these can have effects on agricultural production and nutrition, and also directly on the occurrence of infectious and/or non-communicable diseases.

Without investments in protecting environments and ecosystems, and addressing exposure to environmental threats, there will be an increasing likelihood of nonlinear changes. These are accelerating, or abrupt changes, such as disease emergence, abrupt alterations in water quality, creation of dead zones in coastal waters (reduced level of oxygen causing species to be unable to survive), collapse of fisheries, and shifts in regional climates. Dry land ecosystems, which are characterized by their lack of water, are where human population is growing most rapidly, but poverty is highest.

Proposed Research Questions

  • Examine sustainable and demanded alternatives for reducing indoor and outdoor air pollution and their impacts on health
  • Find ways to make front-line health facilities more energy, water, and refrigeration self-sufficient
  • Find ways to re-use water efficiently for communities with water scarcity
  • Understand and intervene in health, nutrition, and agricultural impacts of rising salinity, and degrading land in fragile deltaic regions
  • Develop new program models for combining community health and environmental sustainability

Theme Lead

To learn more about links between healthy environments and advancing global health equity - view the detailed concept paper on this thematic area.

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3. Gender Equity & Justice

Thematic Area Research & Innovation Goals:

Examines impacts of power, oppression and discrimination on gender and health equity. Develops, implements and evaluates initiatives to advance gender and health equity resulting in more peaceful and prosperous societies.

Image credit: Brunoat/Getty Images ©

 

Concept Summary - GENDER EQUITY & JUSTICE

Gender includes the “social roles, social status, culturally established patterns, stereotypes, behaviors and attributes thought to be appropriate and expected for the genders, men and women” (Jewkes, Flood, & Lang, 2015). Gender-based power disparities and limited access to justice are primary drivers of health inequity around the world. Women’s equality shapes health, particularly reproductive health and infant and child health outcomes. (Varkey, Mbbs, Kureshi, & Lesnick, 2010).  Bolstering education, economic and decision-making power can enable a cascade impact on health and well-being through access to care, and ability to implement health promotion.

African woman from Borana tribe using mobile phone, village in Southern Ethiopia,  Africa. The Borana Oromo are a pastoralist tribe living in southern Ethiopia and northern Kenya. Image credit: Bartosz Hadyniak/Getty Images

African woman from Borana tribe using mobile phone, village in Southern Ethiopia,  Africa. The Borana Oromo are a pastoralist tribe living in southern Ethiopia and northern Kenya. Image credit: Bartosz Hadyniak/Getty Images

Gender-based violence (GBV) is a powerful example of how gender influences health and equity. Intimate partner violence and non-partner sexual violence are the most common forms of gender based violence experienced by women and girls regardless of country. The global acceptance of violence in the home and in public reflects restrictive gender and social norms, and is thus a critical metric of women’s equity.  Globally, an estimated 1 in 3 women experience violence by a husband/intimate partner in their lifetime, while men are more likely to be assaulted by a stranger or acquaintance than a wife or intimate partner (WHO, 2005). The multiple consequences of violence are both immediate and long lasting with negative health (e.g. injuries, sexually transmitted infections, depression, chronic pain), economic (e.g. loss of employment, insecure housing) and social (e.g. isolation, stigma) consequences for the woman, her children, family and community (Campbell, 2002). Gender-based violence is not limited to women; and includes violence perpetrated based on sex, gender identity, or perceived adherence to socially defined gender norms; thus victims include populations who are high risk, marginalized, or criminalized, such as men who have sex with men (MSM), transgender population and sex workers (USAID and Department of State, 2012). Lifting the stigma that stems from lack of adherence to socially-defined gender norms may also support gender equity, health, and justice.  Social identities and related systems of power, oppression and discrimination can intersect; gender identity and other biological, social and cultural characteristics, such as sex, age, race, ethnicity, migration, caste or economic status interact on multiple levels (individual, family, community, institutions, and society) to constrain gender and health equity. 

The intersectionality of oppression, power and discrimination and the negative impact on gender and health equity is uniquely evident in humanitarian settings. The displaced population globally continues to grow in parallel with the size of the population displaced by conflict, which is presently estimated at 59.5 million forcibly displaced worldwide (United Nations High Commissioner for Refugees (UNHCR, 2015).  Women and girls are especially vulnerable to gender-based violence. They are forced to leave their homes to seek shelter from conflict or crisis in camps or informal settlements, often isolated from family and living with little resources to provide for safety.

Proposed Research Priorities

  • How can we reduce gender based discrimination and violence, and mitigate health impact, acting across levels of social determinants?
  • What health and equity gains can be achieved through enhancing empowerment for gender-marginalized groups?
  • How can we design, promote, implement and evaluate local or national programs / policies to promote gender and health equity?
  • How can we design, promote, implement and evaluate equitable health systems?
  • How can we best address and promote gender and health equity in humanitarian settings?
  • What are the implementation barriers and facilitators to meaningful social change in this area, and how can they be addressed?

Theme Lead

To learn more about links between gender equity, justice and advancing global health equity - view the detailed concept paper on this thematic area.

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4. Transformative Technologies & Institutions

Thematic Area Research & Innovation Goals:

Discovering, developing and delivering transformative technologies, including design of innovative platforms, financing mechanisms, and reengineering the healthcare value chain (design, market, produce, deliver and support healthcare services and products, emphasizing quality of care and incorporating efficient use of resources). Apply community-user perspectives and systems thinking to improve processes, infrastructure and institutions that enable successful introduction of new technologies focused on reducing health inequities

Image credit: Henk Badenhorst/Getty Images

 

Concept Summary - TRANSFORMATIVE TECHNOLOGIES & INSTITUTIONS

Technologies and institutions have the potential to transform the health of populations and to narrow the disparities between those who have and those who do not have access to such health care. By transformative, we refer to changes in one or more dimensions of health equity--measured in milestones of lives saved, disability averted or improved quality of life. In some cases, the transformation is in how we detect or even prevent disease, and in other cases, in how we treat or cure the disease. The work of TTI bridges to each of the other thematic areas. A female condom can give women greater control over their reproductive decisions—an issue of gender equity. Ready-to-use therapeutic foods not only can effectively treat severely malnourished children, but also shifted such care from hospital to community-based settings, thereby enabling many more children to be treated as outpatients. Better designed cookstoves can not only reduce indoor air pollution, but also save households on energy costs. In each case, whether technology succeeds or fails depends on the institutional context.

 

Biochemist decants fluid in flask. Image credit: Jaco Wolmarans/Getty Images

Biochemist decants fluid in flask. Image credit: Jaco Wolmarans/Getty Images

In moving from bench to bedside, for example, technologies face barriers to therapeutic, financial or structural access. Therapeutic access focuses on whether research institutions and industry undertake or prioritize the research and development (R&D) to address public health challenges. Do research priorities align with public health priorities, or not? Their misalignment results in neglected diseases. Financial access relates to the affordability of the product by those in need when it enters the marketplace. This can be influenced by how knowledge is owned and shared as well as how public sector funding requires fair returns. And structural access considers how the delivery system brings a technology to those whom it may benefit--last-mile challenges. Availability of the products might be limited by stockouts; access, by limits to local infrastructure from the lack of laboratory facilities to shortages of human resources; and quality, by substandard or counterfeit drugs or thermal instability of the product. These three hurdles roughly correspond to different parts of the value chain, and institutions can help lower or raise the height of these hurdles. For the benefits of a technology to be realized, all three hurdles need to be surmounted.

Institutions can shape access to technologies that advance health equity. But technologies can also shape institutions that do the same. New diagnostic tools – simple enough to be placed into the hands of ordinary citizens – could give us a readout on whether the run-off from a factory farm carries drug-resistant pathogens or whether the grocery shelves have retail meat contaminated by these bacteria. Collecting the results from such diagnostic technologies can empower consumers with tools to monitor and hold accountable those in the food supply chain for safety of their products. We see significant potential in such citizen science efforts.

African children using a laptop inside classroom in very remote school. There is no light and electricity inside the classroom. School is located in very remote area in southern Kenya. Image credit: Bartosz Hadyniak/Getty Images

African children using a laptop inside classroom in very remote school. There is no light and electricity inside the classroom. School is located in very remote area in southern Kenya. Image credit: Bartosz Hadyniak/Getty Images

Giving shape to such strategic interventions, the AHW will enhance the impact and reach of University-based research, policy work and education. By focusing on opportunities where there is transformative potential, the AHW can help identify priorities for research, position existing research for more rapid translation, or show how solutions might cross-apply from one context to another. By serving as a convener, the AHW could recruit multi-disciplinary talents to a research project, set the stage for meaningful dialogue among stakeholders that is critical to overcoming an access barrier, or incubate new partnerships or business models. By training the next generation of researchers and policymakers, the AHW can share a vision of systems thinking across disciplines, inspire social entrepreneurs and researchers alike to tackle big societal problems, and create platforms for engaging larger communities of practice in this work.

Johns Hopkins University has consistently led all other academic institutions in the country in total research dollars, and with that public funding comes also significant responsibility to provide returns to benefit humanity and to ensure health equity. TTI provides a framework by which the University can harness the fruits of such research to benefit the most disadvantaged.

Proposed Research Questions

  • Establishing target product profiles for technologies that benefit the poor
  • Creating innovation platforms that favor technologies that benefit LMICs and poor populations
  • Designing innovative financing mechanisms to better address public health needs
  • Reengineering the value chain to address neglected conditions affecting the poor
  • Developing citizen science projects and accountability technologies

Theme Lead

To learn more about links between transformative technologies, institutions and advancing global health equity - view the detailed concept paper on this thematic area.


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