Australian Medical Research
Australian Research Globally: Making a difference across the planet
1. INDIA: HIV AND MENTAL HEALTH
Dr Michelle Kermode is a Senior Research Fellow with many years of experience as a public health practitioner working in research and education. Her main areas of work are HIV prevention and care, and mental health.
“I work in the field of global health at the Nossal Institute, University of Melbourne. Our approach is to form partnerships with organisations in low-income countries in order to build capacity for public health responses to locally identified problems. We work in the Asia-Pacific region and in Mozambique. The main focus of my work is applied public health research related to HIV and mental health, primarily in India.”
“The socio-economic and health problems associated with the HIV epidemic have been well described and evidence for effective responses is growing, but there is still much to learn about which interventions are most effective in particular contexts if we are to achieve a decrease in HIV prevalence. The north-east region of India, bordering with Burma, is a geo-politically complex and socio-economically underdeveloped part of India. Two states of north-east India, Manipur and Nagaland, have the highest HIV prevalence in the country, in part fuelled by widespread injecting drug use. In this unique context there is a great need for public health research.”
“Unlike the situation with HIV, there’s not such widespread recognition of the burden of disease associated with poor mental health in low-income countries. Most people experiencing mental disorders in countries such as India do not have access to affordable and effective treatments, and remain untreated, sometimes for decades. Mental disorders are stigmatising, not just for affected individuals but also their families. Having a family member with a mental disorder contributes to social exclusion and poverty for the whole family. Generating knowledge and understanding of local concepts of mental health and illness, including beliefs about causes and treatments, will contribute to the design, implementation and evaluation of effective and appropriate communitybased interventions for improved mental health.”
“As I undertake most of my work with Indian partners, I am hopeful for the future. The public health challenges in India remain substantial but as the country develops, so does the local capacity to respond to these challenges. Because of its economic growth and considerable human resource capacity, India has the potential to showcase to the rest of the world effective strategies for addressing communicable diseases such as HIV, TB and malaria and also non-communicable diseases such as diabetes and heart disease. They also have an opportunity to address neglected areas such as maternal and child health, disability and mental health. Similarly, India is an ideal setting for developing better systems for delivering health care to disadvantaged communities by strengthening primary health care services.”
2. HEART DISEASE IN THE DEVELOPING WORLD
Associate Professor Amanda Thrift is a senior research fellow at the Baker IDI Heart & Diabetes Institute, where she heads the Stroke Epidemiology Unit, Melbourne, VIC.
“Socioeconomic disadvantage, manifested as overcrowding, poverty, and infection, is a signifi cant contributor to chronic disease worldwide but the biological pathways are not well understood. Traditionally, people in such poor regions have died from infectious, parasitic and nutritional diseases. With increased availability of clean water, food, shelter and medical care there has been a reduction in these diseases and an increase in life expectancy. Economic development has also occurred and populations now have greater exposure to tobacco advertising, processed foods and labour-saving devices. This has led to the adoption of lifestyle habits that predispose to man-made diseases such as heart disease, stroke and cancer. Vascular and other chronic diseases are rising rapidly in the developing world and not exclusively among the affluent. Better information about the occurrence and risk factors of the emerging epidemic of vascular diseases in the developing world is required to help develop public health actions to minimise this epidemic.”
“Biological predisposition and lifestyle habits differ between disadvantaged and more affluent regions. For example, in disadvantaged regions, anaemia and underweight are common yet diets may be high in salt and fat. We don’t know how the combination of these factors contributes to the development of man-made diseases. By finding out which are the most important risk factors and how they interact, we may be able to prevent this epidemic of man-made diseases from reaching its full potential. Following identification of the most critical behavioural determinants of vascular diseases, low cost strategies to modify risk and educate the community can then be developed.”
“It’s my hope that we can prevent the epidemic of vascular diseases in developing countries from reaching its full disastrous potential; that we can minimise the impact of these diseases. I believe that we can reduce the inequity of health around the world. This must involve better health education so that people have better knowledge about health issues and can make more informed choices about lifestyle and treatments. I’m passionate about this area because research into chronic disease in disadvantaged groups has been largely neglected with research being more focused on affluent regions. This has contributed to an increase in the disparity in health between disadvantaged and affluent communities.”
3. CAUSES OF CANCER
Associate Professor Sean Grimmond’s NHMRC funded research will contribute directly to the International Cancer Genomics Consortium (ICGC). This alliance of over 20 countries is working to generate new discoveries on the genomics of up to 50 types of cancer over the next decade.
“We’ve known for several decades that the underlying cause of cancer development and progression is the accumulation of genetic damage. Despite this, we still do not know what combination of mutation and chromosomal changes are capable of driving a particular tumour type. My research focuses on pioneering approaches to define the entire genetic blueprint of individual pancreatic and ovarian tumours and creating complete repertoires of genetic and epigenetic perturbations they possess.”
“Genome sciences are currently undergoing a revolution. Where the sequencing of the first human genome took 13 years of international research and several billion dollars, it’s now conceivable to determine the entire genetic blueprint of an individual for approximately $50,000 in a single laboratory. It’s expected that these technologies will be rapidly refined to a point where a complete genome can be analysed for less than one tenth of this cost.
“The most urgent question in human genetics right now is, how do we harness the potential of genome sequencing for biological and clinical benefit?”
“A short-term aspiration is to generate a molecular atlas of pancreatic and ovarian cancer, which will enable cancer genetic research for some years to some. The mid-term goal is to integrate the technologies required to perform genome-based analyses to the point where we can use them in a clinical setting. My ultimate dream would be to see cancer genome sequencing taking the guess work out of deciding on a best course of action by informing the
clinician what pathways are susceptible to therapeutic intervention.”
This article was originally published in Australian Health and Medical Research – Working to Build a Healthy Australia.