Science and the Wider Society

By Academician Professor Datuk Dr LM Looi, FASc

Distinguished Professor, University of Malaya

Co-Chair InterAcademy Partnership for Health (InterAcademy Medical Panel)

Dr Wu Lien-Teh Lecture 2016

Commemorative Global Symposium

Penang, Malaysia

Science is about people

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Science has to be

relevant to needs

People’ needs

Solving people’s

problems

Essentials of a good life

• Happiness – Secure home; raise family

– Enjoy friends

– Education & harmonious society

• Wealth (Prosperity) – Pursue interests/leisure

– Quality of life

– Societal progress

• Health (Longevity) – Food security

– Sanitary & healthy environment

– Medical and healthcare services

– Sustaining health

Fu Lu Shou

福禄寿

20th Century advances

• Infusion of Science into education and healthcare practices

• Problem-based innovations

– Water, electricity, food

– Buildings, roads, mass transport

– Communications, IT, entertainment

– Medicine, vaccines

– Etc

• Education, professionalism & ethics

• Led to doubling of human life-span

Today’s World is far from well…

From: Frenk J, Chen L, et al. Health professionals for a new century: transforming education to strengthen health systems

in an interdependent world. Published online at www.thelancet.com on Nov 29, and in The Lancet Dec 4, 2010, vol 376; pp

1923–58); reproduced in expanded book, distributed by Harvard University Press.

21st Century problems: The Unequal World • Gaps and inequities

– Many do not benefit from 20th Century advances

– Poor and developing countries left behind

• 10/90 gap in health research

– Only 10% of global spending on health research is devoted to diseases or conditions that account for 90% of the global disease burden.

Inequalities in health workforce distribution by WHO regions

Source: World Health Report, WHO 2006

Research Capacity of Low and Middle Income Countries

Lags behind high income countries

Less resources to support creative investigation

*Gross domestic expenditure on R&D as % of GDP

China (1.98); Malaysia (1.07), Thailand (0.25); Vietnam (0.19); Philippines (0.09);

USA (2.79); Germany (2.92); Japan (3.67); South Korea (4.04); Taiwan (2.3); Singapore (2.1);

Smaller pool of quality researchers

Brain-drain from under-resourced to high income countries

Global investment in R&D 2007

UNESCO

Science report

2010

*UNESCO UIS 2013/ World Bank 2014

Life expectancy by income group countries, 2012

• We live in an unequal world

World Health Statistics 2014. WHO.

Complex health systems • Rising costs & demands • Explosive growth of

knowledge

• Expanding functions –

prevention, complex care,

community-based,

superspecialisation;

personalised medicine

• Socially diverse patients

• Unprecedented teamwork • Demands on training and

education of healthcare

professionals (expertise)

• Demands on Healthcare

financing

From: Frenk J, Chen L, et al. Health professionals for a new century: transforming education to

strengthen health systems in an interdependent world. Published online at www.thelancet.com on Nov

29, and in The Lancet Dec 4, 2010, vol 376; pp 1923–58); reproduced in expanded book, distributed by

Harvard University Press.

Evolving roles of doctors!

21st Century Challenges in Health and Living conditions

• Multi-faceted, many and rapidly changing

Behavioral

Factors

50%

Inadequate

Access to

Medical Care

10%

Genetic Factors

20%

Environmental

Factors

20%

Causes of Premature Mortality

The Core Function Project: U.S. Public Health Service, 1993

Do scientists and

doctors address

all these factors?

Climate change

• Green house gas emissions & chronic diseases

– Over the last 25 years, global warming has accelerated.

– Climate change affects the social and environmental determinants of health – clean air, safe drinking water, sufficient food and secure shelter.

– In London, strategies to mitigate climate change could reduce heart disease and stroke by 10-20%, breast cancer by 12-13%. In Delhi, they are projected to bring a 11-25% cut in the burden of heart disease and stroke, and a 6-17% reduction in diabetes.

• Environmental disasters & disease outbreaks

• One Health

“One health” is about recognising the interconnection between the environment, animal and human health

• The Manchurian plague (1910-1911)

• Rabies

• SARS

• MERS

• Ebola

• Nipah (1998-1999)

• Dengue

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Most severe haze in SouthEast Asia August – November 1997

El Nino Southern Oscillation event

Anthropogenic deforestation

Forest fires in Indonesia

“Slash & burn” cultivation

50 million ha of forest

Severe haze & drought in Malaysia •Flowering & fruit failure in plantations & jungle

•Economic loss: USD 351 million

Nipah

virus

outbreak

Anthropogenic deforestation, El Nino and migration of fruit bats to orchards

Pteropus vampyrus &

Pteropus hypomelanus

(Natural host of Nipah

virus)

Mixed agro-farming

Fruit trees

overhanging

pig-sties

Spread of the outbreak

Late September 1998, pig-farms in Ipoh Perak Human acute febrile encephalitis with

high fatality

Preceded by respiratory illness in pigs

Surreptitious sale of pigs across boundaries

Most severe epicenter in Negri Sembilan 180 patients

89 deaths

Spread to Singapore abattoir workers 11 cases

1 death

Control of outbreak

Determine the cause Discovery of the novel Nipah virus by UM

virologist (March 1999)

Stopping the transmission Prohibition of pig movement

Closure of abattoirs

Widespread surveillance of pigs

Culling >1 million pigs

Impact 265 cases

105 deaths (40% fatality)

Last fatality 27th May 1999

Direct & indirect costs >USD450 million

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Determine the cause

Stop the transmission

The

Manchurian

plague

(1910-1911)

Photos from: Wu YL 1995. Memories of Dr Wu Lien-Teh: Plague fighter. Singapore World Scientific Publishing Co.

Globalised world: Rapid & mass global travel

• Disease outbreaks

• Cosmopolitan society

“….the concept of [domestic] as

distinct from “international health” is

outdated. Such a dichotomous

concept is no longer germane to

infectious diseases in an era in which

commerce, travel, ecologic change

and population shifts are intertwined

on a truly global scale.”

-U.S. CDC, “Addressing Emerging

Infectious Disease Threats: A Prevention

Strategy for the United States,”

•Antibiotic usage

•Antibiotic policies

•Industrial & agricultural use

•We are running out of antibiotics to use!

Impact of social conflict on society, health & emergence of disease

• Terrorism

• Armed conflicts • Worst refugee crisis in 70 years – Societal upheavals

– Demands on healthcare system

– Disease outbreaks

– Re-emerging infections

Urbanisation

“In 2007, for the

first time in world

history, half of the

world’s population

is urban” UN Habitat, 2003

The problems of

mega-cities • Isolation

• Mental

health

• Adolescent

problems

• Crime

Urbanisation and NCD

Heart disease

Diabetes

Cancer

Premature NCD deaths before the age of 60

0 M

5 M

10 M

15 M

20 M

25 M

30 M

35 M

Low-income

Countries

Lower-

Middle-income

Countries

Upper-

Middle-income

Countries

High-income

Countries

Communicable conditions NCDs < 60 Injuries NCDs > 60

Political Declaration of the High-

level Meeting of the United

Nations General Assembly on

the Prevention and Control of

Non-Communicable Diseases

(New, York, 20-21 September,

2011)

The 20 Most Commonly Diagnosed Cancers Worldwide

Source: International Agency for Research on Cancer, World Health Organisation.

Cancer Statistics, Sept 2011

LATEST

An estimated 14.1 million people

were diagnosed with cancer across the

world in 2012, and 8.2 million people

died from the disease.

Predict substantial increase to 19.3

million new cancer cases per year by

2025.

Source: Malaysian Cancer Registry Report 2007, Ministry of Health.

Disturbing Malaysian Trends (National Health & Morbidity Surveys)

Obesity

Fattest in SE Asia

1996: 4.4%

2011:15.1%

Diabetes

1996: 8.3%

2011: 31.2%

Hypertension

1996: 20.7%

2011: 32.7%

Ageing and healthcare utilization

Scientists wear many hats!

We can

make a

difference

in many

ways!

Why Science Academies are important

Development challenges all require scientific and technological

progress, and decision-makers at every level and in every nation –

as well as the general public – must understand the science

involved.

Academies of Sciences are:

• Merit-based; include scientific leadership in a country

• Free from political interference

• Credible; able to inform public and policy-markers about looming

problems & potential solutions

Science diplomacy

• Science in diplomacy – Informing policy with

scientific advice

• Diplomacy for science – Facilitating scientific

cooperation

• Science for diplomacy – Using science to improve

international relationships

“The soft power of

science”

What we are....

• Global network of national medical and science academies

– 78 member academies

• Committed to improving health world-wide

IAMP works through and in collaboration with member academies

• provide evidence-based advice to governments on health and science policy

• Build scientific capacity of member academies

• strengthen research and higher education in their countries;

• issue consensus and action statements on matters of importance to global health.

IAMP Statements (i)

Some examples: • HEALTH CO-BENEFITS OF CLIMATE CHANGE

MITIGATION - endorsed and presented at UNFCCC (Cancun, Mexico, November 2010)

• Endorsed G8 statements: Water and Health August 2011

• HEALTH RESEARCH CAPACITY IN LOW AND MIDDLE INCOME COUNTRIES (May 2013)

• Disseminated statement on Ebola virus drafted by German Academies – October 2014.

• IAP Statement on REALISING GLOBAL POTENTIAL IN SYNTHETIC BIOLOGY: SCIENTIFIC OPPORTUNITIES AND GOOD GOVERNANCE. (May 2014)

• A CALL FOR ACTION TO STRENGTHEN HEALTHCARE FOR HEARING LOSS (March 2015)

IAMP Network Statements

and Call for Action

IAMP Joint Statements (ii)

Some examples:

• Responsible Conduct in the Global Research Enterprise (2012)

• IAP-IAMP: Antibiotic resistance – a call for action (2013)

• The IAP-IAC-IAMP Co-Chairs Communiqué on “Implementing a New Global Partnership for Post-2015 United Nations Goals”

Joint Statements and Call for

Action

HEALTH PROFESSIONALS FOR A NEW CENTURY: Transforming Education Systems in an interdependent world

30 Nov – 1 Dec 2010

Launch of Lancet Commission Report

Landscaping,

identifying gaps and

opportunities, and

offering

recommendations for

reform

Transformative education Step-wise instructional reforms

• Informative learning:

– acquiring knowledge and skills - produce experts.

• Formative learning:

– socialising around values - produce professionals

• Transformative learning

– developing leadership attributes - produce enlightened change agents.

IAMP is a partner with China Medical Board and the (US) Institute of Medicine in promoting global dissemination of the report

• Discussion of report’s conclusions and recommendations at a national level.

• Encourage regional networks of academies to address these issues, and function as forum for information exchange and coordination.

IAMP Young Physician Leaders (YPL) Programme

• foster “a new generation of leaders in global health for the 21st Century”.

• develop a critical mass of young physician leaders in a learning and action network worldwide

• challenge member academies to support young physicians in their countries and to strengthen their leadership skills.

Launch in 2011 in conjunction

with the World Health Summit

(WHS) in Berlin, Germany

Now a network of 108 YPL

Investing in the Young

Exposure for Young Physician Leaders

• Leadership training in conjunction with World Health Summit (WHS) , Berlin every October.

• Speaking at opening ceremony of WHS held at the Federal Foreign Office, Berlin.

• YPL Core session with World Health Summit

• Scientific visits to the Industry : Bayer Healthcare, Berlin and the Max Delbrück Center for Molecular Medicine (MDC)

• Attendance at the World Health Assembly (2016)

Workshops and

Scientific

Forum: Promoting action in

poverty eradication,

sustainable

development, urban

health

IAMP workshop in Trieste, Italy, 3-4 July 2014. ‘Promoting action on the Social determinants of Health’,

• Over 35 participants from 25 countries

• Academies of Sciences & Medicine and Government officials

Intended outputs:

• Call for action by governments and other stakeholders to address social determinants of health and their impact on health inequity

• Regional versions of workshop to reach a wider audience to increase knowledge, awareness & action

World Health Summit

Forum for discussion with

high level policy-makers

and leaders of industry

Established under

patronage of German

Chancellor, French

President and President of

European Commission

IAMP

initiatives/programmes 1. One Health

2. Urban Health

3. Exploring Traditional Medicine

4. Young Physician Leaders (YPL)

5. Social Determinants of Health

6. Heath Science Education

7. Scientific Writing

8. Disease Control Priorities 3

Changing landscape of global collaboration

• 20 years of change – Millennium development goals

(MDGs)

– Global Fund (fight AIDS, TB, malaria)

– GAVI Alliance (vaccines)

– Development funds for health

• 2010- US$6.7 billion

• 2011 - US$28.4 billion

• Global collaborations are bringing about change!

Millennium Development Goals

• Adopted by World leaders in year 2000

– 192 UN member states & 23 international organisations

– To be achieved by 2015

• Entire international community work together towards common end

– Ensure human development reaches everyone

– Reduce poverty by half

• 8 goals, 21 targets, 60 indicators

1. Eradicate extreme poverty and

hunger

2. Achieve universal primary

education

3. Promote gender equality and

empower women

4. Reduce child mortality

5. Improve maternal health

6. Combat HIV/AIDS, malaria

and other diseases

7. Ensure environmental

sustainability

8. Develop a global partnership

for development

Changing landscape of global collaboration

• Now in critical transition – From MDG to

an era of Sustainable development goals (post-2015)

– 17 goals, 169 targets

At the United Nations Sustainable Development Summit on 25 September 2015, world

leaders adopted the 2030 Agenda for Sustainable Development, which includes a set

of 17 Sustainable Development Goals (SDGs) to end poverty, protect the planet and

ensure prosperity for all, to be achieved over the next 15 years.

Investing in Health

• “Between 2000 and 2011, about 24% of the growth in full income from low-income and middle-income countries resulted from health improvements”

– Governments should prioritize investment in health, not just disease

• Scientists and academics should contribute to this focus

The Lancet Commission on Investing in Health, December 2013

Global Health 2035: a world converging within a generation

Scientific & Societal Collaboration

• Collaboration for evidence-based advice to governments

– WHO

– International projects, action plans, guidelines, etc

• Capacity to deal with crisis

– Medical advances

– Disaster & outbreak surveillance & response

– Displaced populations

• Sustaining Health

– Healthy and safe cities

– Healthy lifestyle

– Combat climate change

– Food security

– “One Health”

Thank you!