An Interdisciplinary Approach to Global Health
.jpg "Jeff Collmann, director of the Center for Disease Prevention and Health Outcomes")
.jpg "NHS Dean Bette Jacobs speaks during the April 2007 launch of the institute")
Jeff Collmann says that Georgetown University—working as a team—can tackle the world’s pressing health concerns.
In February 2008, Collmann joined the School of Nursing & Health Studies (NHS) as director of the Center for Disease Prevention and Health Outcomes at the O’Neill Institute for National and Global Health Law—which NHS co-founded in 2007 with Georgetown University Law Center. He has been busy ever since catalyzing cross-campus collaboration.
“Georgetown University Law Center is a leading center for the study of the role of law in improving health, including public health and health care,” Collmann says. “In many ways, the Law Center has helped define the field of health law.”
The O’Neill Institute brings natural and social science into the production and assessment of health law.
“Our job is to marshal teams of experts who work with empirical data to produce the evidence that our legal experts will then use in their work in health law,” he adds.
The center currently is focusing on five key issues: the recruitment of foreign-trained nurses, food safety, personalized medicine, emergency preparedness, and global health governance.
Nursing Workforce
Kathryn Leonhardy, assistant professor of international health at NHS, is working on foreign-trained nurse recruitment along with Lawrence Gostin, O’Neill Professor of Global Health Law, John Monahan, the institute’s executive director, and Patricia Pittman, executive vice president of AcademyHealth, a health services research organization.
“The problem we have involves the gap in the number of nurses that we need in this country,” Leonhardy says. “We’re not supplying them domestically. Historically, one way to fill that gap is to recruit foreign-trained nurses.”
That recruitment appears to be growing, according to the number of candidates passing the national licensure exam for registered nurses. In 2000, there were 5,231 foreign-trained nurses who passed. In 2007, there were 22,815.
“During the last couple of years, we have looked at the recruitment practices on the part of hospitals and recruitment agencies,” Leonhardy says. “Because of the nature of the health care system in the United States, recruitment is done with virtually no oversight. This leads to abuses on the part of some recruitment agencies.”
The O’Neill team helped coordinate a task force of interested parties from the industry to establish a voluntary corporate code of conduct—unveiled in September 2008—for nurse recruitment agencies and health care organizations in the.
“The code is a model for oversight and monitoring of recruitment practices,” Leonhardy says.
Food Safety
Headlines about food safety regularly appear in the newspaper—from salmonella to E. coli.
At Georgetown Law, several faculty and staff are examining meat safety laws. And at Georgetown Public Policy Institute, a team has launched the Produce Safety Project with funding from the Pew Charitable Trusts.
“[Our] project is an initiative aimed at getting the Food and Drug Administration to go forward with a rule to establish mandatory and enforceable safety standards for fresh produce from farm to fork,” O’Hara says.
O’Hara added that connecting with scientists and legal experts at Georgetown will help address various issues in his project—from statutory authority to the environment.
With the overlap of law, policy, and health, Collmann says this emerging project area is perfect for his center. In collaboration with the Office of the Provost, he convened a campus-wide Food Safety Workgroup to begin discussing a coordinated food safety project with faculty from across the university.
Participants included university representatives from various disciplines, including computer science, business, microbiology and immunology, and academic leadership from the Office of the Provost and the Graduate School of Arts and Sciences.
Personalized Medicine
In July 2008, the FDA began urging physicians to conduct a genetic screening of patients before prescribing abacavir—a drug used to treat HIV/AIDS. According to a New York Times article, patients with a particular genetic variation in their immune system are at a higher risk of a severe allergic reaction to the medication.
Emerging discoveries like this are part of a growing field in health care known as personalized medicine—the idea that treatments can be individualized based upon a patient’s genetic and physiological make-up.
To date, the O’Neill Institute and NHS have convened two major events on personalized medicine and health care, the first of which featured U.S. Secretary of Health and Human Services Michael Leavitt.
Julie DeLoia, a geneticist and associate dean of academic affairs at NHS, is helping lead these efforts on personalized medicine and health care.
“We are perfectly positioned to set the direction of how to employ this technology to improve the health and well-being of all people,” DeLoia says. “Our Jesuit principles of good citizenry and social justice on a global scale must guide us in the implementation of this very exciting technology.”
Emergency Preparedness
Are communities ready to handle a crisis in the nation’s food supply, an outbreak of pandemic influenza, a terrorist attack, or a natural disaster?
Michael Stoto, a professor of health systems administration at NHS, has assisted communities in preparing for these scenarios and evaluating their efforts. Recently, Stoto led a daylong mock pandemic influenza crisis scenario—sponsored by the O’Neill Institute—for graduate students in Collmann’s microbiology course and Gostin’s law course.
“We’ve been focusing on really measuring preparedness to know if we’re ready for crisis situations,” he says. “A great deal of this work has occurred through scenarios. We’ve found ways to measure, with validity, how well organizations are able to respond to complex scenarios.”
Stoto is also co-principal investigator on a new grant Harvard received from the Centers for Disease Control and Prevention to do rigorous research on emergency preparedness planning and assessment.
“The Georgetown piece, which fits nicely with the O’Neill Institute and the school’s Department of Health Systems Administration, is how to modify health systems to improve health outcomes in an emergency situation,” Stoto notes.
Global Health Governance
The O’Neill Institute is also tackling broader issues on the world stage through a more formalized global health governance structure, Collmann says.
“Global health governance enables the delivery of public health and health care to the people of the world with some regularity,” he says. “In the developing world, this is especially important.”
Bernhard Liese, chair of the Department of International Health at NHS, Rudolf Van Puymbroeck, O’Neill Institute senior scholar, and Gostin hope to begin identifying ways to better coordinate health initiatives in developing countries and to focus on key national priorities.
“[The O’Neill Institute] is important because it brings various resources together,” Van Puymbroeck says. “It builds a bridge with Georgetown Law and with renowned scholars like Larry Gostin. In this day and age, almost anything worth doing needs a multidisciplinary approach.”
“Collaborations of this nature are necessary to improve health and well-being for all people,” says NHS Dean Bette Jacobs.
By Bill Cessato
Excerpted from the Fall 2008 issue of Health Care Horizons
