Building a Global Health Portfolio

Expanding on the legacy of Minnesota’s public health pioneers

By John R. Finnegan Jr., PhD

Talk with public health leaders today and you will likely hear something like this: “Global health is public health. Public health is global health.” Our notion of “global” is forged in the blazing pace of the 21st century in which all nations share the same chronic diseases, and pandemics can spread worldwide in hours. But Minnesota has a 140-year history of working to improve the health of the state, the nation, and the world.

In 1862, Congress passed and President Lincoln signed what would turn out to be one 

of the important pieces of 19th-century lawmaking: the Morrill Land Grant Act. The idea was that public universities in undeveloped parts of the country would generate knowledge and learning to create flourishing economies of educated, healthy, and prosperous people. After the Civil War, the University of Minnesota responded to the Morrill “tonic,” emerging in the 1870s with its first permanent faculty and president, William W. Folwell. It set about the mission of helping to transform Minnesota, which it has been doing ever since.

 

Health was an important element of this mission. Folwell, a Civil War veteran, appointed his comrade-in-arms, Dr. Charles N. Hewitt, as the first professor of public health in the university (and, very likely, in the nation). Hewitt was a physician, innovator, and global thinker who pushed the boundaries of prevention and public health. He visited Louis Pasteur in France and Robert Koch, who helped frame the “germ theory” of disease, in Germany. Hewitt built relationships with scientific colleagues back East in the U.S., and initiated vaccine production in Minnesota and one of the first disease surveillance systems in the country. As a university faculty member, the founding secretary of the State Board of Health (forerunner of today’s Minnesota Department of Health), and an early member of the Minnesota State Medical Society (MMA forerunner) that sponsored the public health legislation, Hewitt was a key leader. He and others created the organizational infrastructure that established Minnesota as a bellwether for health innovation. From the beginning, global connections were important.

Zip forward to the present. Most developing nations of the 21st century know very well that research universities and higher education are important pathways out of the poverty trap. And they want to partner with the best systems of higher education, especially the land-grants like the University of Minnesota that haven’t forgotten their mission to transform learning into impact on people’s lives.

Launching the “One Health” initiative

While the university has been “global” for a long time, today it is engaged in formal planning about how best to shape its strengths in partnership with global and peer institutions. What is emerging in these discussions so far is the idea of global “portfolios” with a broad, inclusive focus on four areas key to human development and achievement: food, health, education, and economic development and sustainability. Within each portfolio, one can already find many projects, programs, and initiatives that faculty across the university have been pursuing for many years with global partners. But the institutional planning happening today brings the potential of connecting and synergizing disparate activities, improving our effectiveness as global university partners and sharpening our considerable assets in tackling some of the greatest challenges facing the world.

Hewitt’s legacy launching global health at Minnesota is well captured in this process. To illustrate, let me share an example of a recent major initiative in the University of Minnesota global health portfolio.

In late 2009, when the University of Minnesota was among a team of recipients of a five-year, $185 million contract from the U.S. Agency for Inter-national Development (USAID), the College of Veterinary Medicine (CVM) and the School of Public Health (SPH) were poised to take a leadership role in training multidisciplinary teams of health professionals to prepare for and respond to emerging disease outbreaks. The initiative from USAID directed the planning to take place with local partners in several “hot spots” around the globe where the conditions are ripe for an animal-borne disease to make the jump to humans.

Specifically, over the course of the five-year project, the team on the project known as RESPOND will work to:

• improve the training and response capacity for zoonotic disease outbreak identification, investigation, analysis, and control within countries and regions
• strive to improve the coordination among public and private interests involved in an outbreak
• support in-country outbreak response activities
• introduce new technologies to help improve a country’s response to an outbreak

It’s clear from everything we know about emerging diseases that a multi-disciplinary approach is critical. The new framework we are using is called “One Health.” It merges the interests of human and animal health and the environmental conditions within which they interact to shape health for good or ill. The interaction of human and animal health in the environment is a complex “dynamic adaptive system” that requires interdisciplinary collaborations and communications in all aspects of health, from clinical to population and community approaches. While the specifics of One Health are formative in how it is brought to bear on global challenges, we think the potential benefits of collaboration with global partners in building capacity are immense—on both sides.

One of the first activities we undertook through the USAID initiative was a two-week Global Health Institute last August in Kampala, Uganda, one of the initiative’s hot spots. Along with faculty colleagues from the U of M’s CVM and School of Nursing, and from Makerere University, in Kampala, SPH faculty taught a host of courses spanning zoonotic disease, epidemiology, applied biostatistics, risk communication, participatory research, and global public health. [A video from the Global Health Institute is at www.sph.umn.edu/outreach/go/gouganda.asp.]

Twelve U of M students from the schools of public health, nursing, and veterinary medicine joined 65 students and junior faculty from universities in seven East African countries at the institute, which was sponsored, in part, by the U of M.

During the institute, participants traveled to rural Uganda to visit Queen Elizabeth National Park, a health center, and a fishing village on Lake George—where they witnessed an orphaned wild elephant living and mixing with villagers. The situation puts the villagers in danger of being trampled by an unpredictable wild animal, as well as mutual exposure to pathogens. Closer to the topic of emerging diseases was the sight of water buffalo and hippos practically sitting on fishing canoes. This proximity obviously creates many opportunities for the wild, the domestic, and the human to interact, raising the potential to spread disease or even to incubate new ones.

Getting up close and personal with this human-animal-environment interchange “hot spot” illustrated the value of approaching the prevention of emerging infectious disease through a One Health lens. It was a true “aha!” moment for Minnesota participants as well as their African counterparts. And it was gratifying for the faculty members from the U.S. and Africa to witness the exchange of ideas and solutions among the participants. Indeed, we have much to learn from our African colleagues. We have much to share, too.

Reaffirming the land-grant mission

From the beginning, Minnesota medical and public health pioneers like Charles Hewitt recognized that health is global: What happens in the villages and cities of Africa and other places will sooner or later shape what happens in the villages and cities of Minnesota. Just ask our Latino, Asian, and African immigrants and refugees who have enriched this state with their cultures, hard work, and dreams.

Higher education helped transform our nation in areas such as health. Now we can “pay it forward” to assist others in building the capacity they need to sustain a healthy, educated, and prosperous people. In these global engagement efforts, we are reaffirming our own land-grant mission around the world through research, learning, and service.  

John R. Finnegan Jr., PhD, is dean of the University of Minnesota School of Public Health.

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Copyright 2011, Minnesota Physician Publishing. This article originally appeared in Minnesota Physician 25(1): 32, 34, 36, and is published with permission.