There is a need to understand the changing global health landscape due to the social and economic effects of globalisation. Rising incomes in poorer countries open up new markets for multinational corporations - unhealthy western commodities such as high sugar foodstuffs and tobacco, perceived as emblematic of affluence, contribute to population health problems globally, such as  obesity and cardiovascular disease. Meanwhile the demands of global trade, the consequences of climate change, and the effects of population pressure affect ecological systems, alter food production priorities and reduce biodiversity, often with negative health consequences.

These factors, along with other public health problems caused by increases in migration, urbanisation, climate change and world-wide instability, call for interdisciplinary strategies which can tackle the many issues of public health that need to be addressed in a global context. Hence the strand aims to include departments and schools without a primary focus on health and healthcare - such as law, sociology, anthropology, education and others - in recognition of the role they might play in developing interdisciplinary global health research collaborations. 

Launch successes

In early 2020, the strand, co-led by Professor Helen Lambert of the Bristol Medical School, and Professor Keith Syrett from the Bristol School of Law, kicked things off with a launch meeting to set the agenda for what was hopefully to come. “The meeting was fantastic,” said Professor Lambert, “it drew people from many different departments, faculties and centres across the University, many of whom hadn’t met before. I’ve been working in what we’re now calling Global Public Health for years - so I felt I pretty much knew everybody - but I found so many new people, and it was a really positive and engaging experience."

Professor Syrett expanded: “We went in with a series of introductions and presentations, and then established a series of extremely brief talks, where a few people talked about their research. And what happened after this was surprising - everyone else basically stood up and did the same thing without formalised presentations. It worked incredibly effectively. Better than we thought it would! But then, of course, COVID-19 got in the way.”

Pandemic focus

Given its focus, the strand leads and Steering Group recognised the need for the strand to play a role in understanding the global COVID-19 pandemic response, even as global research became more difficult thanks to lockdown. Funding was quickly reallocated, and the strand launched two rapid response calls to address COVID-19 in partnership with collaborators in low- and middle-income countries (LMIC). The funding to which the strand has contributed has already yielded significant insights from a number of studies, including the following: 

• Professor David Gordon estimated the vulnerability of African girls and their families to COVID-19 infections, to assess the lockdown and restriction measures implemented in many African countries. In many circumstances, it is necessary for people to leave their homes in order to survive - for food, water, cooking fuel or to toilet. The team mapped these circumstances in 49 African countries and produced policy advice about how governments can assist with social distancing and quarantine. More on this project.

• Dr Jian Zhao assessed pandemic-related sleep pattern alterations and mental health in children in ten schools in Shangai, China. His team found increases in depression, anxiety and stress symptoms, with alterations in sleep patterns associated with mental health issues. More on this project.

• In Malaysia, Dr Laura Johnson assessed the impact of lockdown on physical activity in a specific low income, semi-rural population. She found that levels of physical activity, which were already low, were nearly halved by the Malaysian government’s Movement Control Order, which restricted movement to essential trips only. Even now, as restrictions have eased, activity levels are still below 2018 levels. Dr Johnson’s team has suggested policy changes to address this issue. More on this project.

• Dr Josephine Walker investigated the epidemiology of COVID-19 in Georgia, in an attempt to learn from the country’s initial success in minimising the COVID-19 infection rate. Factors such as early closure of schools and businesses, along with a robust contact tracing strategy and the hospitalisation of anyone who tested positive contributed to 939 cases and 15 fatalities as of 2 June 2020. More on this project.

• Other projects included Dr Duleeka (Dee) Knipe’s investigation into self-harm during the pandemic in Sri Lanka, Professor Eric Herring’s work on COVID-19 responses and sustainable development in Somalia/Somaliland, Dr Celia Gregson’s study into SARS-CoV2 screening as part of new occupational health checks for front line health workers in Harare, Zimbabwe and Dr Ross Booton’s estimation of the impact of COVID-19 on HIV transmission and control among men who have sex with men in China. Find out about research funded by the Global Public Health strand.

“Some of these projects served to strengthen existing collaborations, such as Dr Walker’s Georgia study and Dr Johnson’s work in Malaysia,” said Professor Lambert. “But there are many new collaborations we’ve participated in too - which have also been informed by COVID-19.”

Further work the strand has helped to fund has a wider purview than the pandemic. As well as COVID-19 healthcare in India and the mental health impact of COVID-19 in Sri Lanka, recently funded projects include investigating the health, safety and wellbeing of sex workers in Brazil - and a recently completed third round of funding will focus on mental health care for COVID-19 health workers in Zimbabwe, improving the sexual and reproductive health of Brazilian women, and the first e-Veterinary Vade Mecum (reference manual) in Argentina.

Professor Lambert explained: “All of these efforts connect people at the University of Bristol who are within our networks to new collaborators. And those new collaborators are reciprocating by helping us to link to new partners in several LMICs, with whom they already work.”

Post-COVID-19

From a Global Public Health perspective, however, the repercussions of the pandemic will be felt for some time to come. The issue then became how best to serve this need?

“One of the things we have done is to go back to researchers, particularly from the first round of COVID-19 funding and determine whether they’d be interested in applying for some follow up funding,” said Professor Syrett. “Once researchers have established or deepened networks within LMICs, then that’s an asset which those researchers could use either to progress existing studies, or to branch off into newer territories, whether it’s to do with COVID-19 recovery, or something else.”

This, then, is the heart of what the strand aimed to achieve, and this expansion of the potential global collaborative network is a key impact that has a much wider potential purview than assessing pandemic-related issues.

Perspectives

One of the strand successes, Professor Lambert says, has been bringing together members from the University of Bristol community who perhaps have not worked in a global health context before, and giving them the opportunity and the support to start working with international collaborators.

International collaborations with a health focus do exist, of course - but before now they have mostly been restricted to relationships between individual researchers, with an emphasis on other high-income countries. The strand has sought to establish new avenues of collaboration with the aim that the expertise that exists within the University can be applied to benefit the health of populations in low- and middle- income countries.

“There’s a big learning curve when collaborating with resource-poor partners in low- and middle- income countries”, said Professor Lambert. “As people have so many baseline assumptions about what you can do when you’ve only worked in the UK or Europe (for example, using electronic health records). I think we have already had some success in starting to build those skills and increase understanding within the University, and in encouraging more engagement with potential new opportunities on a wider stage than just with local and national partners. From here, we can continue building sustainable research partnerships across the University with institutions in low- and middle-income countries.”

Re-energising engagement

In September 2021, after a difficult year in which the effects of the pandemic on global health research were compounded by the effects of ODA budget cuts to many projects, the strand conducted a survey and held an online event to re-engage researchers with strand objectives and activities and gain feedback from the University of Bristol global public health community. Presentations on the Elizabeth Blackwell Institute and the strand were followed by a session on current funding opportunities led by Tiernan Williams from the University’s Research and Enterprise Division, and two rounds of networking. The event concluded with the presentation of findings from the University-wide survey of global public health researchers and information about future funding calls.

The strand plans to run a larger, in-person networking event (COVID conditions permitting) on Monday 17 January 2022 which will be opened by Pro-Vice Chancellor for Research, Phil Taylor, and showcase some of the studies that strand funding has supported. New funding calls for pump-priming research and research workshops will be launched in December 2021 and January 2022 to align with this workshop, so, watch this space.