Global Health is concerned with the health of populations in a global context and our research’s main focus is to provide evidence for achieving health equity within and between countries.
Survival represents the most elemental of human rights, and improving the health status of men, women and children is now seen as playing an integral role in reducing poverty and improving human welfare. It is no coincidence that 8 of the 3 Millennium Development Goals are health related. The work of GHaP aims to contribute towards the achievement of these goals; reducing child mortality, improving maternal health and combating HIV/AIDS and other diseases.
The work that GHaP conducts can be organised within the four broad categories below. These categories are all related and research sometimes spans multiple areas.
According to the World Health Organisation , good reproductive and sexual health includes the right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services.
However, it is estimated that there are at least 200 million women who want to use safe and effective family planning methods, but who are unable to do so because they lack access to information and services or the support of their husbands and communities.
More than 50 million of the 190 million women who become pregnant each year have abortions, many of which are clandestine and performed under unsafe conditions. GHaP aims to contribute to improving reproductive and sexual health through its current and recently funded research in the following areas:
Many maternal, newborn and child deaths are avoidable, simply by implementing simple, affordable and effective interventions. Improving the health of these groups is a key test of the strength of health systems and their effectiveness.
About 530 000 women a year die in pregnancy or childbirth, more than three million babies are stillborn, more than four million newborns die within the first days or weeks of life, and altogether 10.6 million children a year die before their fifth birthday. Yet many of these deaths are avoidable through existing interventions that are simple, affordable and effective.
And it isn't just death. Millions of mothers suffer from pregnancy-related disabilities or illnesses. 99% of this burden of mortality and ill health is suffered in poor countries. In the year 2000 the UN brought heads of state for nearly 200 countries together to pledge for action to improve maternal health - designating reduction of maternal mortality as one of the world’s eight most important development priorities. The resulting Millennium Development Goal number 5 aims to reduce mothers’ deaths by ¾ by 2015. Of the eight goals – maternal health has made the least progress.
Access to safe and effective contraception is a key element in the reduction of maternal deaths - when a mother desires the child at that time is strongly related to better health outcomes throughout and after the pregnancy. However, even with good contraception there will be times where the mother feels that the pregnancy needs to be terminated. If this happens, access to safe abortion services is vital. It is estimated by the World Health Organisation that 20 million unsafe abortions occur every year, with 19 million happening in developing countries. Women are more likely to die if the abortion is unsafe, with an estimated 67,000 deaths each year estimated to be attributable to unsafe abortion.
The care of the newborn is a vital aspect of healthcare, with the health of the newborn affecting health throughout the lifecourse. Skilled help at delivery is key to this, followed by regular monitoring of the child in the first few months of life. If illness occurs there should be a clear process for the mother to follow to obtain care. This is often lacking, with poor, under-resourced health facilities offering sub-standard care for a premium that is often unaffordable.
All these issues lie at the heart of the research conducted by GHaP, and a number of projects have been conducted looking at these issues.
In 2007, 33.2 million people were estimated to be living with HIV, 2.5 million people became newly infected and 2.1 million people died of AIDS ( UNAIDS ). Today, AIDS remains among the leading causes of death globally and is the primary cause of death in Africa.
Providing treatment and care to 33.2 million HIV positive people is a huge task given the diverse economic, political, social, and geographic characteristics of HIV population. To stop the further spread of HIV to low prevalence areas and low risk population groups remains a challenge where the epidemic is not generalised. Integrating the HIV positive population to the mainstream community is yet another challenge, particularly where there is social stigma attached to the disease. GHaP continues working on these issues and provides policy relevant input locally, nationally and internationally.
GHaP researchers has been active in research in the area of ‘awareness and prevention’ since 2002 when the Centre for AIDS Research was established. The main focus of our research has been in understanding the socio-cultural factors associated with HIV/AIDS knowledge; the effectiveness and efficiency of media in imparting HIV and AIDS knowledge and developing and telecasting mass media programmes in television for imparting knowledge about HIV and AIDS and removing stigma attached to the disease.
We have conducted analysis of National Family Health Survey and the Demographic and Health Surveys; carried out interviews of people living with AIDS; and developed a short film. Our research sites include, among others, South Asia, China and Sub-Saharan Africa. Although knowledge about AIDS has increased significantly there are still many ‘hard to reach’ areas and population groups where imparting correct knowledge requires more focused efforts and innovative methods. The focus of GHaP in this sub-theme is now to conduct research and develop interventions on these ‘hard to reach’ areas and population groups.
Because of the unique social and medical context of AIDS, the needs of people living with AIDS are different from patients suffering from other diseases. Members of GHaP have undertaken research in both the UK and India to understand the needs of people living with AIDS. This includes a recent qualitative study to assess whether the needs of people living with HIV are being met by service providers in Hampshire and the Isle of Wight. The Final Report and the Executive Summary can be downloaded.
Findings from this and other work highlight the need for reliable HIV testing to confirm the disease, reliable treatment, and social support to continue normal life and to contribute the family and community life. As the needs of AIDS patients are dynamic as a result of social and medical interventions GHaP will continue working on this theme to provide programme relevant information.
The social and economic impact of HIV and AIDS is a major research theme for GHaP. Recent research has focused on both genders in rural settings. Our studies revealed that HIV positive women were hit more than positive men because of lower social status of women triggered by patrilineal family systems. Culturally sensitive interventions are required to address the social and economic impact of HIV and AIDS on women. Women’s rights and law is another area that needs to develop further to protect women’s right over the property of her husband. GHaP will undertake further research on the social and economic impact among the poorest of poor.
The Southampton team is a key partner in the MRC supported Microbicide Development Programme (MDP). The GHaP team, led by Will Stones and Richard Mutemwa, provides specialist support in community liaison in microbicide trials in several sites in Africa. We organised a microbicide workshop with the Indian Council of Medical Research (ICMR) and are a partner for the Microbicides conference in February 2008 at ICMR. GHaP will continue providing social sciences support to clinical trials to international and national agencies.
Sabu Padmadas is collaborating with Professor Allen Wu, Centre for Communicable Diseases and Public Health, Nanjing University on the social acceptability of vaginal microbicides for HIV/AIDS.
Health is inextricably linked to the way people live their lives. It is possible to reduce the risk of becoming ill through altering behaviour. However, health risk behaviour is not just a personal decision but is linked to the population, poverty status and governmental policies.
What we eat, drink and smoke, how much exercise we take and what sort of work we do are all important determinants of health. It is important not just to look at the health outcomes, but the reasons why poor health occurs. For instance, low exercise coupled with a poor diet is likely to lead to overweight and obesity.
Many of the poorer countries in the world are starting to suffer from a double burden of nutritional problems - there is a significant proportion of people who are malnourished while there is a growing proportion who are over nourished.
However, this is not just about food - a large area of research is into the social and economic determinants of tobacco, drug and alcohol use, and their inter-relationships with health outcomes. You cannot separate the health problem from the multifaceted nature of the causes, and especially from poverty.
GHaP has current and recently funded research in the following areas: