Founding directors Robyn Norton and Stephen MacMahon established The George Institute for Global Health in 1999 in Sydney, Australia, with a focus on non-communicable diseases (NCDs) and injuries that was lacking in many research institutes and countries at that time. “Low and middle-income countries (LMICs) were primarily focused on maternal and child health and infectious diseases; we could see the NCD crisis was looming”, said Norton. “We wanted The George Institute to have its focus on both LMICs and resource-poor individuals and regions within high-income countries (HICs).”
Yet the pair could have hardly imagined that, just 16 years later, The George Institute would have become one of the world’s most renowned global health research institutions, with more than 500 staff in Australia and in centres in China, India, and the UK.
The George Institute has always been involved in large-scale discovery research in areas such as diabetes, intensive care, and injuries. Alongside this work, they are now busy with implementation studies, working with their India and China offices, established in 2007. In partnership with the University of Oxford, the UK office was established in 2010, with Norton saying that this office is focused on things vital to but not obviously within the medical arena, such as entrepreneurship and the use of innovative low-cost technologies to improve health-care delivery.
Nephrologist Vivek Jha heads the Institute’s India offices in New Delhi and Hyderabad, and joined the Insitute because of “its focus on innovation, doing research that is outcome oriented, patient-centred, and leads to policy change, and is relevant to growing nations like India”. A flagship project of the India team is the SMARThealth study, which involves training accredited social health activists (ASHAs)—young female health workers traditionally involved with maternal care—in the systematic medical appraisal, referral, and treatment of individuals with NCDs. The ASHAs collect data regarding cardiovascular risk then show patients their risk profile and use standardised algorithms to advise them about the most appropriate care. “This approach helps ensure those who need to see the doctor go and are appropriately treated”, said Jha. The cluster randomised trial evaluating this approach involves 80?000 people in the state of Andhra Pradesh. Further work is being done on the SMARThealth system to make it suitable for use in managing mental illness and other conditions.
Jha is leading a series of studies to identify patients with kidney disease at risk of progressing to advanced stages through appropriate targeting of preventive therapies, tracking outcomes of patients on dialysis, and utilising electronic tools that will allow patients to monitor and adjust their dialysis treatments at home rather than making hospital visits. “Several hundreds of thousands of people die of advanced kidney failure in India every year, due to unaffordable therapy. These studies will help reduce disease burden and promote cheaper and less disruptive home-based therapies.”
The Institute’s chief scientist, Anushka Patel, was one of its early employees. A cardiologist and epidemiologist, her role is about ensuring the Institute’s research is of high quality and has maximum impact. She is proud of the numerous implementation studies in its portfolio, which include a study in Australia testing sophisticated decision support within electronic health records in general practice to flag high-risk patients and recommended appropriate treatments; and a number of studies on the polypill to reduce cardiovascular risk. “Globally, patients with high cardiovascular risk are undertreated”, she explained. Even in HICs, only half of those who have already had a cardiovascular event are optimally treated. For those at high risk of a first event, a small minority receive optimum treatment in HICs, while in LMICs the proportion is close to zero. One study of inexpensive generic polypills in Europe and India, showed that treatment rates improved by about 30% along with improved blood pressure and cholesterol levels. “We are also running projects that pull together electronic decision support, making polypills available, and task-sharing with non-physician health-care workers, anticipating that such interventions may have a large impact on inadequate treatment rates”, explained Patel.
The George Institute’s Food Policy Team, led by Bruce Neal, is driving further innovation with FoodSwitch, a smart phone application that helps families make healthier choices when grocery shopping. There are already Australian, New Zealand, and UK versions, with launches planned for China, India, and the USA. “This project crowd-sources data on the entire packaged food supply of countries, allowing us to press industry and government for system-level improvements”, said Neal, whose team is also doing a 5-year trial with 2100 patients evaluating the impact of salt reduction on stroke in China.
With its numerous research and implementation programmes now stretching far and wide, The George Institute has come a long way in 16 years. Its researchers are understandably excited about what the next 16 years might bring.