With more than 200 full-time faculty members and about 1,700 students, the UNC Gillings School of Global Health has expertise in almost every imaginable area of public health.
Past rounds of strategic planning in the School identified topics for which the School has special expertise and the potential for great impact by solving big public health problems. No organization can be all things to all people. Focus is essential to achieve impact. At the School level, for purposes of communication, fundraising and allocation of scarce resources, it is critical that we identify high-priority focus areas that deserve special attention, where additional resources could help us to accelerate an even more significant, positive impact upon public health, where our impact could be transformative. These areas should be cross-cutting, interdisciplinary and have the potential for inclusion of all the School’s departments and units. For example, the topic of eliminating health disparities includes basic epidemiologic research on social determinants, nutrition interventions to improve access of poor populations to healthy foods, health services research to understand whether minorities experience particular access issues and consequences of health disparities on maternal and child health.
In 2005, Dean Barbara K. Rimer, DrPH, worked with people in the School to map recommendations from prior strategic planning efforts. We concluded that several different strategic planning rounds, including a comprehensive process conducted while William Roper, MD, MPH, was dean, had identified similar priority topics, including: ending the obesity epidemic, improving global health, eliminating health disparities, and providing safe water in North Carolina and beyond.
Following discussions with the Dean’s Council, we decided to build on these prior strategic planning processes and to develop plans in several key areas we identified as strategic initiatives. These initiatives would receive special attention in our fundraising efforts and during the School’s yearly budget process. Strategic initiative areas also are priorities for Gillings Innovation Laboratory funding and for fundraising by our SPH Advancement staff.
Faculty members led the strategic planning process for improving global health, eliminating health disparities and overcoming obesity. These have included slightly different but wide-ranging efforts to solicit and integrate input from a variety of stakeholders across the school and beyond. Jamie Bartram, PhD, professor of environmental sciences and engineering, recently joined the School and will begin developing the water and environment strategic initiative.
Because of opportunities to defeat cancer made possible by the University Cancer Research Fund, we added cancer as an additional initiative.
In 2010, we will build on where we are, asking what is missing and what will be major public health challenges in the future. Over time, we will add additional initiatives and potentially retire some. As a final element of our planning efforts, we are gearing up for a major examination of teaching for the 21st century. All of this is part of our efforts to anticipate future needs and to accelerate our impact.
Cancer, in all its many forms, is a significant public health problem globally and in North Carolina. Consider these statistics:
- Every year, nearly 1.5 million Americans are diagnosed with cancer and about 562,340 will die each year from cancer.
- Globally, the World Health Organization has predicted that cancer will surpass heart disease as the world’s top killer by 2010. In North Carolina cancer already has overtaken heart disease as the leading cause of death.
- An estimated 40 percent of North Carolinians will develop cancer during their lifetimes. Approximately 46,416 North Carolinians are projected to receive a cancer diagnosis in 2009, with 18,277 projected cancer deaths this year.
- African-Americans in North Carolina experience higher incidence and mortality from cancers compared with other groups.
Explore how the UNC Gillings School of Global Public Health is Conquering Cancer.
While advances in prevention, early detection, medical care and treatment have had a notable impact on improving cancer outcomes for some cancers and populations, we still face enormous challenges in closing the gap between what we know works to reduce cancer burden and what we actually do. In other areas, we lack fundamental knowledge.
UNC Gillings School of Global Public Health is a leader in investigating a wide range of important issues in cancer including determining risk factors for cancer, ways to reduce cancer risk, informing treatment options, improving quality of life among cancer survivors, and disseminating information and best practices to stakeholders. Moreover, the School’s cancer research and practice community has placed a high priority on reducing disparities in cancer risk, prevention, and survival among the citizens of North Carolina. These research and practice efforts have engaged faculty, staff, and students across all departments of the School.
The school’s efforts have been greatly aided by a long-standing relationship with UNC’s Lineberger Comprehensive Cancer Center. In August 2007, the North Carolina General Assembly established the University Cancer Research Fund (UCRF), which now provides $50 million a year from the state’s Tobacco Trust Fund for cancer research in North Carolina, especially at UNC Chapel Hill. The UCRF provides the critical mass of resources needed for North Carolina to significantly improve cancer outcomes over the next decade, from prevention to better quality of life among those living with cancer.
The School is playing a major role in the planning and implementation of the goals of the UCRF. These efforts will conceptualize North Carolina as a “laboratory” in the best sense of the word – enabling researchers to discover, develop, and disseminate effective population-based strategies to turn the tide on cancer in communities and health care settings across the state.
A major UCRF strategic planning effort directed by faculty from the Gillings School of Global Public Health led to the development of important new initiatives to improve cancer outcomes for North Carolina. These will be groundbreaking research and resource development projects with far reaching implications for North Carolina and will serve as a model for the nation. Highlights of the strategic plan components include:
- The foundation for optimizing cancer outcomes in North Carolina and beyond will be provided by a unique, comprehensive cancer information system, the North Carolina Integrated Cancer Surveillance and Information System (ICISS). By tapping multiple data sources over time, ICISS will prospectively create valid (and replicable) measures of outcomes of cancer control activities, especially among vulnerable subgroups and communities that have been traditionally under-represented. ICISS will continually link statewide incidence and mortality data with other key data sources such as the North Carolina cancer care databases, information on other outcomes (e.g., quality of life), and demographic, social, geographic, and environmental data. By greatly enhancing the ability of researchers to gather and share information across disciplines, ICISS can help North Carolinians make more informed choices about cancer prevention and control, whether they lead community-based organizations, state and county health departments, university or industry-based research teams, or health policy organizations. No such integrated population-based cancer informatics system exists at the state or national levels in the United States. As envisioned, ICISS could become a model for rational cancer planning in the US and beyond.
- One of the key research priorities of the University Cancer Research Fund is to initiate a repository of specimens and data on UNC cancer patients. The UNC Health Registry will prospectively identify and rapidly recruit 10,000 patients with appointments at the NC Cancer Hospital into a registry. This study will integrate, through a comprehensive database, clinical, epidemiological and interview data with repositories of biologic specimens and tumor tissue obtained from each patient. The UNC Health Registry will form the basis of a survivor cohort a valuable resource making future studies of survivorship feasible.
- We will build a state-of-the-art system to evaluate interventions to improve cancer outcomes in multiple formats accessible to all North Carolina residents. Health-E-NC will harness the power of health information and other communications technologies to prevent cancer and to improve quality of life and other appropriate outcomes for those living with cancer. The goals are to target cancer risk factors (tobacco use, dietary behavior, physical activity, obesity), cancer screening and referrals (e.g. breast, cervical), decision support (colorectal and prostate screening), and uptake of tested prevention and treatment interventions, such as HPV vaccination. An array of proven intervention delivery approaches will be employed, such as message tailoring, social marketing, peer counseling/coaching, health provider interventions, and community participatory strategies. Interventions will be delivered through multiple channels, including print, small media (e.g. direct mail and local radio), the World Wide Web, social networks, mobile devices (e.g. mobile phones, personal digital assistants), peer and professional leaders, and health systems. Health-E-NC will provide fertile ground for novel research on various intervention delivery methods, as well as testing dissemination approaches to accelerate the population uptake of evidence-based approaches.
- Carolina Public Health Magazine explores how we are Conquering Cancer and Fighting Health Disparities.
- The Department of Health Policy and Management has a Cancer Care Quality Training Program.
- Cancer Epidemiology is a major research focus of the Department of Epidemiology.
- Abdominal fat affects breast cancer survival.
- The School’s Clinical Nutrition Research Center examines diet’s affect on cancer risk.
- High fruit, low meat diets may reduce cancer risk.
The UNC Gillings School of Global Public Health has a 70-year history of global health leadership and innovation. Our cutting-edge research programs focus on high-impact, practical applications, with potential to benefit millions in the developing world. Our partnerships with governments, nonprofits and communities have accelerated solutions to many of the pressing global health challenges represented by the United Nation’s Millennium Development Goals.
Many of our students become global health leaders who continue to apply entrepreneurial, out-of-the-box thinking to the health challenges around the world. We use creative, innovative approaches in our global outreach, developing collaborations between health, business and other fields to address human needs.
Our global leadership position was formalized in September 2008, when we became the UNC Gillings School of Global Public Health. We currently are working in more than 50 countries. Our strengths include:
- Infectious diseases. Our interdisciplinary approach focuses on HIV/AIDS, malaria, TB, and other emerging and re-emerging infections. We are pioneering work on these diseases in Malawi, Madagascar, South Africa and the Democratic Republic of Congo addressing adolescent vulnerability to HIV and other sexually transmitted infections in South Africa, Kenya, Tanzania and Haiti and developing stronger health systems in China, Malawi and India. In the Americas, we are building public health preparedness into Guatemala‘s health system, strengthening surveillance in Nicaragua and Guatemala, and developing biostatistical and training collaborations in Chile and Brazil. We collaborate with the Public Health Foundation of India to develop more effective surveillance and integrative responses to zoonotic diseases, such as rabies and avian influenza. Our Gillings Innovation Labs develop state-of-the-art methods to map and control diseases like malaria and deliver vaccines more quickly and effectively and at a lower cost.
- Global nutrition. Nutrition problems – from under-nutrition to obesity – are a cornerstone of our global work on human nutrition from the molecular to the policy level. Founded in 2005, the Interdisciplinary Obesity Center (IDOC) at the University of North Carolina has emerged as a major national and global resource in the area of obesity research. Its 75 scientists from many disciplines form a critical mass of expertise in virtually every area of obesity-related research. The new Nutrition Research Institute in Kannapolis, N.C., is finding ways to use nutrition to enhance brain development and prevent and treat diabetes, cancer and other nutrition-related diseases – issues highly relevant to transitional economies such as India, Russia and China, where malnutrition and poverty exist side-by-side with rising rates of obesity and chronic diseases such as diabetes. Our faculty members coined the term “nutrition transition” to explain these changes. We are working with the Public Health Foundation of India to plan a Center for Excellence in Nutrition, which will focus on using cutting-edge methodology to address problems of chronic under-nutrition, obesity, and all the related complications affecting India.
- Clean water and air. We are internationally known for our innovative work on clean water and sanitation, water harvesting, urban air pollution and toxic chemicals in the environment. We are unique among schools of public health in having a department of environmental sciences and engineering – one of the top 10 environmental engineering departments in the U.S. – within our School. This ensures strong links and cross-fertilization between environmental and human health efforts. Our decades of experience in working with governments around the world include our current partnership with the United Arab Emirates, one of the fastest developing nations in the world, where we are helping to build a strategy to reduce environmental health risks. Our evaluations of safe water filtration and treatment technologies have built our reputation among international organizations as the “gold standard” to use when choosing effective water interventions. In Cambodia, Laos, and Vietnam, we are developing entrepreneurial, market-based approaches to scale up and sustain point-of-use safe water and sanitation programs. Gillings Innovation Laboratories are developing portable field-testing equipment and technologies to detect arsenic exposure from contaminated drinking water. Our School will soon launch a Global Water Institute, and our faculty has a leading role in UNC’s Institute for the Environment, which combines public health, medicine, law, government, business and mass communications.
- Health of Women and children. Our recent designation as a World Health Organization Collaborating Center for Sexual and Reproductive Health reflects our global leadership in this arena. We also are known for our work in infant and young child feeding, early childhood development and family violence. UNC hosts the longstanding USAID-funded MEASURE Evaluation project, which assists countries to use data to plan, manage, evaluate and set policy for population, health and nutrition programs. MEASURE is internationally recognized for developing metrics and indicators to assess the impact of reproductive health programs.
- Public health leadership and management. Our diverse faculty members are working to strengthen health systems, build leadership and management capacity, and assess cost-effectiveness of different health care models and interventions. Considered the leader among public health schools in distance learning for more than 30 years, we have extended the reach of our master’s, doctoral and certificate programs to reach health professionals in distant field stations around the world. We have established long-term capacity-building relationships with universities in a number of countries, notably Malawi, Guatemala, China, Chile, Brazil and India. Our Malawi-Carolina Summer Institute pairs our students and faculty with Malawian counterparts for teaching and internships.
Over the next five years, we plan to consolidate and further strengthen our global health research and training. The most pressing health challenges and emerging diseases know no boundaries: global health is local health. We will continue to find unique, innovative ways to reduce the spread of diseases, improve health-care delivery systems and address global health disparities. We will use our trademark collaborative, interdisciplinary approach to institute transformative changes that can positively affect millions of lives. We also will work with our faculty, staff and students to build momentum and interest in global public health issues in the U.S. and seek more effective ways to shape the next generation of scientists, policymakers, and leaders.
Explore our website for more information on our Global Health projects, including these:
- Global Health Research highlights
- Map of our research projects worldwide
- GSK Global Health Program
- United Arab Emirates
- Clean water and sanitation projects throughout the world
- Student research and internships in global health
Keep up with our numerous global health projects by subscribing to the e-newsletter, This Week in Global Health.
Eliminating Health Disparities
The UNC Gillings School of Global Public Health has been engaged in overcoming health disparities since its earliest days. Overcoming health disparities is one of the School’s highest priorities. Faculty members across our School are leading studies to understand the nature of health disparities, improve health behaviors, reduce disease risk, create more equitable access to health services, and translate what we have learned into policies, teaching and practice. We work in close collaboration with communities in North Carolina and the US to overcome barriers to good health for all. Our students also are making a difference through organizations such as the Minority Student Caucus and the annual Minority Health Conference they have sponsored for the past 30 years.
This work is critical. Racial and ethnic minorities continue to suffer a heavier burden of illness, disability and early death due to health disparities. African-American infants are twice as likely as white babies to die in their first year of life. Rates of diabetes in Latinos, African-Americans, American Indians and some Asian groups far exceed that of whites. African-American women are 24 times more likely to have HIV than white women. Breast cancer is deadlier in black women younger than 55 than it is in white women in the same age group. These and other disparities – in cancer, cardiovascular disease and stroke, and many other preventable conditions – account for billions of dollars in healthcare expenses every year and ultimately keep our nation as a whole from achieving its full potential.
A few examples of our flagship programs include the following:
Interdisciplinary Certificate in Health Disparities, administered by ECHO. This ten-hour course equips professionals working in culturally diverse settings to play a leading role in reducing health disparities through community action, public health practice and policy.
The student-led Minority Health Conference, held each spring and now in its 30th year. This conference is one of the largest student-run health conferences in the country and regularly attracts over 500 participants, including students, faculty, researchers, public health and human services professionals, and community leaders from North Carolina and surrounding states.
The annual Summer Research Institute and Videoconference on Minority Health, which brings together the latest research on health disparities for a state and national audience. The Minority Health Project uses event broadcasts and networking to raise the profile of the Minority Student Caucus and other diversity activities at UNC and nationally.
Health disparities in women and infants
Diane Rowley, MD, MPH, Professor of the Practice of Public Health, has developed a framework that looks at social, cultural, historical, political and economic influences on pregnancy outcome. Vijaya Hogan, DrPH, clinical associate professor of maternal and child health, is conducting longitudinal ethnographic research to understand African- American women’s unique exposure to risks and inequities related to interconceptional care.They will partner with women in the community to combine the School’s research findings with community knowledge of the local health care delivery system to improve access and uptake of interconceptional care among minority women.
Our strengths are notable in several specific areas:
- Cancer – Studies of how to reduce disparities in incidence and long-term survival from colorectal, breast, prostate and head and neck cancers. These programs place heavy emphasis on community-based interventions, such as the School’s innovative use of barber shops, beauty shops and faith communities to promote screening and healthy lifestyles.
- Heart disease and stroke – Church-based programs to improve cardiovascular screening and care for minority men; epidemiological research to understand health disparity impact on disease incidence and mortality.
- Diabetes – Self-empowerment in diabetes self-care.
- Diet and obesity – Working with Black congregations to improve eating patterns among African-Americans, tackling obesity in children through environmental and policy change, and investigating the way mothers care for and feed their infants.
- Aging – Caring for Alzheimer’s patients in disadvantaged communities.
- Environment and health – The effect of hog waste and sewage sludge on the health of poor communities, coupled with community education and empowerment.
- Impact of health disparities on men’s health.
Carolina-Shaw Partnership for the Elimination of Health Disparities. This partnership between the School and Shaw University, the oldest historically Black university in the South, aims to tackle health disparities at research, service and policy levels.
ECHO – The UNC Program on Ethnicity, Culture and Health Outcomes is a cross-university program led by public health and medicine to eliminate health status and health outcomes disparities through translatable, evidence-based research, multidisciplinary training and education and culturally sensitive services to North Carolina.
Hispanic Community Health Study – a multi-center, multi-year study to identify the cultural and behavioral factors that influence disease development in the Hispanic community. The School is coordinating the study, which involves four partner universities.
Explore other examples of our health disparities programs:
- Carolina Public Health Magazine, featuring health disparities in Winter 2007 and cancer research in Fall 2009
- Health disparities initiatives in the Department of Maternal and Child Health
- Increases in health disparities as youths become adults
- View a webcast about Men’s Health Disparities: Implications for Research and Intervention from the 14th Annual Summer Public Health Research Institute and Videoconference on Minority Health.
The United States – and the world – has a serious weight problem.
More than 65 percent of American adults and a quarter of children are overweight or obese, according to the latest National Health and Nutrition Examination Survey. North Carolina ranks 41st among U.S. states in terms of overweight/obesity. In Mexico, South Africa, Egypt, the United Kingdom and Australia, about two-thirds of all adults are either overweight or obese.
Weight problems during any stage of life increase risk for numerous serious health conditions, including type 2 diabetes, stroke, coronary heart disease, hypertension, gallbladder disease, osteoarthritis, sleep apnea, and breast, colon, and endometrial cancers. People in North Carolina and the U.S. South suffer from high levels of heart disease and diabetes related to obesity.
Obesity is a multi-faceted problem that can be solved only by an integrated, interdisciplinary approach that translates research into meaningful and practical clinical and community solutions. At the University of North Carolina at Chapel Hill, more than 75 faculty members from 23 departments and seven UNC schools are working together to address these problems. These faculty members come from fields as diverse as mass communications, city and regional planning, health behavior, nutrition, epidemiology, health behavior, biostatistics, psychology, medicine, biochemistry and genetics. In every department in the School, faculty conduct obesity-related research. This unique atmosphere at UNC has allowed us to be a global leader in understanding the causes and consequences of obesity.
For example, at UNC, we are:
- Discovering new information about how fat is metabolized and uncovering links between metabolism and diabetes that could one day lead to reductions in the debilitation common with this disease;
- Pinpointing the genes that make some animals crave physical activity while others avoid it, and are preparing to do the same in humans;
- Observing moms and babies to understand the effect of early interactions and feeding styles on the development of obesity;
- Tracking changing nutrition patterns around the world and assessing reasons for rapid increases in overweight and obesity;
- Developing and testing practical ways to change environments in child care centers to promote healthier habits in pre-school children;
- Testing neighborhood programs that support children walking to school;
- Creating detailed maps of large sections of the country to understand how neighborhood characteristics influence physical activity and dietary habits of the people who live there;
- Creating and testing Internet programs tailored to individuals of different ages to influence lifestyle and food choices;
- Coordinating a national study of Hispanic obesity and diabetes;
- Developing tools to enable pediatricians to assess patients’ BMIs accurately;
- Launching church-based programs aimed at African-American women and their daughters, tested peer-delivered obesity prevention programs, and developed physical activity programs for middle-school girls in six states;
- Developing processes for partnering family medicine practitioners with community resources to help patients make healthier choices; and
- Discovering the particular risks that obese people face during flu epidemics, and the links between diet, exercise, and many cancers, and developing educational messages and campaigns to reduce these risks.
As leaders in moving from discovery to community and policy solutions, our focus is on solutions to real-world problems. We influence local, state, national and global policies and strategies.
For example, Dr. Alice Ammerman’s service on state-level committees and task forces has led to major changes in the state’s response to the epidemic of childhood obesity. Ammerman also has encouraged state leaders who are tackling the transition from tobacco to prioritize the development of healthy, environmentally and economically sustainable local food supplies.
Dr. June Stevens’ membership on national expert panels has resulted in guidelines for obesity prevention and treatment that will be used by practicing physicians around the country for the management of obese patients with cardiovascular disease.
Dr. Barry Popkin’s new book, The World is Fat, has received national and international attention for its clear, dynamic explanation of how changes in America’s food production, eating habits, and activity levels have driven our obesity epidemic – an epidemic that is rapidly spreading across the globe.
Several of our faculty members participated in the development of the American Institute for Cancer Research report Food, Nutrition, Physical Activity and the Prevention of Cancer, which documents the effect of obesity on multiple cancers.
Dr. Anna Maria Siega-Riz served on a recent Institute of Medicine panel that set new guidelines for the amount of weight women should gain during pregnancy.
Explore our website for more information on how we overcome obesity throughout the world.
- Obesity and breast cancer screening
- Study showing that obesity leads to longer stays in hospital
- Obesity impairs immune response in mice
- Genes found to influence obesity
- Global Obesity Business Forum
- Healthy Heels help students across campus eat better
- North Carolina Institute for Public Health is working with local health departments on obesity programs.
Global Water Solutions
More than one billion people drink unsafe water every day, and 40 per cent of the world’s population – a staggering 2.6 billion – lack basic sanitation facilities. Contaminated water sickens thousands of children daily and causes the deaths of 1.8 million people – 90 percent of them children under five – every year. Unsafe water and poor sanitation kill more young children annually than malaria, AIDS and accidents combined.
Although unsafe water traditionally has been a problem in rural areas, the urban slums in which poor people increasingly dwell are now among the most underserved and unsanitary places on earth. The water crisis is growing despite the fact that water and sanitation represent extremely cost-effective public health investments.
UNC Gillings School of Global Public Health has played a critical role in developing systems to supply, treat and distribute water, since the university started a sanitary engineering program in the 1920s. Since then, the impact of countless projects conducted by our faculty, students and staff have been felt, literally, from the Neuse River in North Carolina to the Nile River flowing across northern Africa.
The School’s Department of Environmental Sciences and Engineering, a leader in the field of water and sanitation for more than 50 years, consistently ranks in the top 10 environmental engineering programs in the nation. It is the only such program within a school of public health – bringing the disciplines of health and environmental engineering together under one roof. Our partners include U.S. government agencies, such as the Environmental Protection Agency and the Centers for Disease Control and Prevention international agencies, such as the World Bank and the World Health Organization private industry; and a number of foreign governments.
The water crisis – and the poor hygiene and sanitation that kill millions of children and adults each year – are problems of global proportions. Finding solutions is a defining mission of the UNC Gillings School of Global Public Health.
Explore more about how we are improving and protecting the world’s water.
- Carolina Public Health magazine: From the Neuse to the Nile
- Faculty with interest in sustainable water resources
- Engineers Without Borders, Daniel A. Okun chapter
- Projects in Orange County, N.C., and Peru
- USAID award for water projects in Southeast Asia
- United Arab Emirates contract
- Carolina Global Water Partnership
- Measures of Water Quality Impacting Disinfection, an Institute of Medicine report by Phil Singer, PhD