Emerging infectious diseases. Adequate food and safe water. Access to education. Women’s well-being. Childhood mortality. Biodiversity loss. Climate change. The major public health challenges of our time demand that we reach across disciplines and intentionally collaborate to ensure sustainable health for all—all people, all life, even the planet itself.
At the University of Wisconsin-Madison, the Global Health Institute (GHI) builds on an institutional legacy of cross-sector collaboration and community engagement to advance global health. This legacy is defined by the Wisconsin Idea, which suggests the boundaries of the university must expand to include the world, and it pushes GHI to catalyze and convene faculty, staff, students, and practitioners from every discipline and from communities around the world. Together, these partners address how social, medical, economic, political, and environmental factors influence well-being. Through interdisciplinary programs across the educational spectrum and with its history of global outreach, GHI also inspires and trains the next generation of global health practitioners and leaders.
Keith Martin, executive director of the Consortium of Universities for Global Health, saw a unique symbiosis at UW-Madison that continues to drive GHI’s success. “Universities have a difficult time breaking down silos,” he said. “(The University of Wisconsin) started with a foundation of cooperation, and you built on it.”
“The Wisconsin Idea is a marvelous template for other institutions, as a foundation on which they can build to reduce siloing and increase cooperation; and, in doing that, everybody will be enriched.”—Keith Martin, executive director, Consortium of Universities for Global Health
From Personal to Planetary
GHI is defined by its commitment to a sustainable model of global health that includes the entire spectrum from personal to environmental to planetary health. The institute is guided by a “global health ethic” that recognizes that individual health is linked to health for all. This ethic nurtures a respect for community and calls for society to address challenges of such magnitude that progress in alleviating such issues will be measured in generations. It is inspired by Wisconsin conservationist and UW professor Aldo Leopold, whose famous land ethic reads: “All ethics so far evolved rest upon a single premise: that the individual is a member of a community of interdependent parts.”
“It is inconceivable to me that an ethical relation to the land can exist without love, respect, and admiration for land and a high regard for its value.”—Aldo Leopold
The One Health model—recognizing the health of humans, animals, and the ecosystems we all share are interdependent—provides a framework that brings together human health care with other disciplines to address complex challenges across sectors. This fundamental belief in the interconnectedness of health and disease, locally and globally—and the university’s obligation to take on these challenges—has been part of UW-Madison’s global health enterprise since the late 1990s. “Globalization, migration, and widespread health disparities call for interdisciplinary approaches to improve health care at home and abroad,” a team of UW global health pioneers reflected in the February 2008 issue of Academic Medicine. “Our academic institutions have the potential to serve as portals to introduce students to the great health disparities and challenges of our times, and to prepare faculty and students to address urgent health needs at home and abroad.”
GHI’s mission to bring the energy of the whole university to bear on global health challenges is rooted in the Wisconsin Idea, which aims to put education and research at the service of improving quality of life in Wisconsin and across the world. It’s manifest in the university’s acknowledged role in establishing the state’s dairy industry and discovering and applying Vitamin D for health. It pushed the university to establish the Division of University Extension to share knowledge across the state—seven years before the federal government founded the Cooperative Extension. Today, the commitment to multi-sector collaboration can be found in some of the campus’s pre-eminent initiatives, including the Wisconsin Energy Institute, the Wisconsin Institutes for Medical Research, the Nelson Institute for Environmental Studies— and the Global Health Institute.
This is a public land-grant university with more than 43,000 students, 21,000 faculty and staff, the fifth-highest research expenditures in the nation, and the highest number of Peace Corps volunteers. The roots of its collaborative culture can be found in a late-1800s decision to incorporate the more practical land-grant colleges into the existing University of Wisconsin instead of following other states to establish separate land-grant institutions. That decision brings together 21 schools, colleges, and institutes—including medicine and public health, agriculture and life sciences, veterinary medicine, pharmacy, nursing, law, engineering, arts and sciences, human ecology, and business—on a single, central campus.
Members of widely different academic disciplines work side by side, take advantage of intentional meetings, and enjoy the advantage of serendipitous encounters that spark new ideas and remarkable cross-sector collaboration. “By the 21st century when interdisciplinarity has become so important, this decision seems like genius,” Gwen Drury wrote. “In reality, it was probably just a frugal measure at the time.”
The earliest discussions about formalizing UW-Madison’s global health activities grew out of student interest in international experiences, faculty and staff desire to expand international health programs, and the university plan to accelerate internationalization. Leaders from medicine, pharmacy, nursing, veterinary medicine, and international studies saw the potential for a global health center that would address health disparities through lasting interdisciplinary collaborations, producing benefits for all. The Center for Global Health (CGH), established in 2005, morphed into the Global Health Institute after the university’s reaccreditation study reaffirmed that interdisciplinary research is “at the creative center of UW-Madison’s mission” and necessary to confront complex challenges.
Organized in 2011, GHI was designed to consolidate campus-wide global health efforts beyond—and including—the traditional health sciences programs. It served the goals of the reaccreditation report that called for promoting and supporting interdisciplinary research, fostering global proficiencies for students, and working on the cutting edge of global issues—“not only in expanding our understanding of our changing world, but also in connecting this understanding to decision making, public policy, and real-world practice. More than nearly any other university, our faculty, staff, and students are personally dedicated to pushing the frontiers of interdisciplinary research, and to using this new knowledge to make the world a better place.”
In this purposeful, campus-wide expansion, GHI’s charter called for the institute “to discover underlying determinants of global health, no matter the complexity, and in so doing, attain more lasting solutions within and across populations.”
The institute was the first of its kind in the nation to focus on the root determinants of health from across multiple sectors. It connects collaborators through its programs and relationships, and encourages interdisciplinary projects through its Seed Grant program, designed to provide start-up dollars for projects that can then be more competitive for outside funding.
“Too many of our global health interventions are narrowly focused, and, as we try to solve one problem, we inadvertently can create two or three more,” says environment and health pioneer Jonathan Patz, M.D., MPH, who became GHI director in 2011. “This responsibility takes an orchestrated effort. So we are bringing together faculty, staff, and students from across campus to address the health implications of climate change, urban design, air quality, water safety, food security, gender inequality, access to care, and more. We want our approach to disease prevention to be as comprehensive as possible.”
In connecting internationally-recognized scholars and practitioners with communities in Wisconsin and across the world, GHI recognizes that health issues transcend national boundaries and that local partnerships bring critical wisdom to the search for solutions.
“Only they who are on the ground, living the challenges and understanding what really goes on in their location will have any clue how we might be able to help.”—Jonathan Patz
For researchers such as Jeremy Foltz, Ph.D., a professor of agricultural and applied economics and GHI grant recipient, the institute is crucial to making connections. “These are big issues with a lot of intellectual moving parts,” he said. “What’s important is the ability to be able to access other bits of knowledge on this campus and do joint projects. The promise of GHI is to bring everybody in.”
The global interest of students, faculty, and staff, and the collaborative nature of the university have allowed GHI to create interdisciplinary and inter-professional educational opportunities, from the Undergraduate Certificate in Global Health (offered with the College of Agricultural and Life Sciences) and Graduate/Professional/Capstone Certificate (offered with the School of Medicine and Public Health’s Department of Population Health Sciences) to opportunities in graduate medical education and for health care professionals. “UW-GHI (educational) programs emphasize interdisciplinary inquiry, place-based study, and immersion learning through required faculty-mentored global health field experiences,” wrote Lori DiPrete Brown, MSPH, MTS., GHI associate director for education and engagement, in a 2014 Journal of Law, Medicine & Ethics article. “This interdisciplinary integration occurs in core and elective courses as well as the field experiences, with the undergraduate program including the various college majors, and the graduate program bringing together the health science professions.”
From 2007 to 2016, more than 160 students, from fields as diverse as health professions, engineering, French studies, and nutritional sciences, earned a Graduate/Professional/Capstone Certificate in Global Health. Since 2010, more than 1,000 students, pursuing 62 majors in seven schools and colleges, earned the undergraduate certificate, which is similar to a minor. Global health has become the largest certificate program on campus, now with more than 500 students participating each year. More than 1,200 undergraduate and 1,000 graduate/professional students have participated in global health field experiences that include faculty-led courses, internships, clerkships, and independent field studies.
The education program, with its international field courses, was foundational to UW-Madison’s global health mission and “mobilized interdisciplinary groups around the goals of promoting health for all,” according to Cindy Haq, M.D., a professor of Family Medicine and Population Health Sciences as well as the center’s inaugural director. Those resulting collaborations improved nutrition in Uganda, bettered animal health and addressed domestic violence in Mexico, examined successful public health projects in Thailand, and much more.
Collaborating for health care quality and innovation
With deep roots in the health sciences, GHI has been central to initiatives that are improving access to health care and improving the quality of that care. The strength of our health care projects lies in the internationally-recognized researchers and practitioners in the UW-Madison global health community and their strong networks of local and international collaborators.
These UW experts provide technical assistance, facilitate joint learning, and spur innovations through education, training, and quality improvement programs. An emergency room physician, for example, used a GHI Seed Grant to work with clinicians, educators, researchers, and IT professionals to develop a mobile telephone app that lets South African emergency room physicians quickly access the location-specific information they need. A pediatric infectious disease specialist works with local leaders to improve immunization programs in Nepal, Kenya, Ethiopia, and Uganda. A world-renowned palliative care leader is on the front lines to secure needed opioids for pain relief among world populations, and an obstetrician/gynecologist collaborates with local partners in Ethiopia and Wisconsin to give women in low-resource settings a range of contraceptive choices, including long-acting reversible contraceptives.
Girma Tefera, M.D., a professor in the UW-Madison Department of Surgery and an Ethiopian native, laid the groundwork for extensive, ongoing projects through a bilateral twinning agreement between UW-Madison and Addis Ababa University. The work expanded from emergency medicine to family medicine to pediatrics. Residency programs, quality improvement initiatives, and training for numerous health care workers resulted from these collaborative efforts. GHI leveraged Tefera’s network to expand Ethiopian collaborations with air quality, city improvement, and energy projects. Still others are maximizing hydropower and introducing healthy, orange-fleshed sweet potatoes to farmers.
Tefera welcomes the expanding collaborations in his homeland.
“Health is not only giving medicines and vaccines. People also need to be able to eat right. You need clean water and clean air to breathe. The list is fairly long. … That’s why everybody needs to chip in.”—Girma Tefera, UW surgeon
Each year, GHI brings its health care community together to work with international health care leaders during the Quality Improvement (QI) and Leadership Institute. In six years, 111 participants from 16 countries have worked with each other and UW-Madison faculty, staff, and students to initiate or improve health-related in their home countries.
Connecting place, health, environment
As a climate and health pioneer, GHI Director Patz is a leading global voice connecting climate change and health and recognizing the health opportunities that come from limiting fossil fuels. His work brings together engineers, air pollution experts, health and environmental scientists, and local partners to bring theory to practice and positively affect climate policy worldwide.
The UniverCity Alliance, co-founded by GHI, works to foster sustainable, livable cities across the globe. In Ethiopia, teams are reclaiming Bahir Dar’s bicycling culture, addressing air pollution in Addis Ababa, and bringing electrical microgrids to rural villages. In Guadalajara, Mexico, collaborators are working with a new environmental science museum that will explicitly connect the city to the landscapes surrounding it and give people ideas that can better inform their behavior choices. UniverCity Alliance is also making the local-to-global connection. This year the initiative launched its first UniverCity Year project with Monona, Wisconsin, bringing students from a dozen university courses to work on city priorities. Plans are underway to scale up UniverCity Year throughout the state.
Connecting Women and Well-being in Wisconsin and the World
The 4W (Women and Well-being in Wisconsin and the World) Initiative, co-convened by GHI, brings together leaders from gender and women’s studies, Afro-American studies, law, human ecology, medicine and public health, engineering, nursing, education, and more. Led by GHI’s DiPrete Brown, the initiative is grounded in human-rights principles and works toward equal rights for women and girls through recognizing the role that women play in sustaining families, communities, civil society, economies, and the planet. 4W’s initial projects are contributing to the end of human trafficking, establishing equality for women and men in relationships, using motorbikes to deliver health care to rural African women, and supporting microenterprise.
4W also was key in the establishment of the UNESCO Chair on Gender, Well-being and a Culture of Peace at UW-Madison. The chair creates a global platform for 4W and underscores the university’s interdisciplinary ethic that allows faculty, staff, and students to engage with complex issues from many perspectives.
Collaborating for One Health
GHI has, since its inception, embraced the One Health framework, as veterinary medicine experts and human health researchers, educators, and clinicians shaped the institute. The outbreaks of the Ebola and Zika viruses dramatically underlined the essential importance of understanding the animal/human interface for infectious diseases. These recent epidemics catalyzed the whole of campus, joining researchers in epidemiology, pathology, pathobiology, obstetrics, environmental health, and medical history with health practitioners and the capabilities of the UW insectarium (co-funded by GHI) and the Wisconsin National Primate Research Center. Together, they worked on solutions, from potential vaccines to mosquito control to a documentary that gave a human face to the Ebola crisis in Liberia.
GHI also will be closely aligned with the new Upper Midwestern Center for Excellence in Vector Borne Diseases, funded by a $10 million Centers for Disease Control and Prevention grant and headed by two members of the GHI Advisory committee.
Looking to the future
“The university role today (in global health) is more important than ever, particularly in the communication of the problem, the communication of the solution, and having the ability to build capacity and engage in service,” CUGH’s Martin said. “The advantage will be with those who embrace evidence-based solutions to make countries safer, freer, and more vibrant with people who are safe and secure. It’s a race to the top.”
More than ever, the University of Wisconsin-Madison Global Health Institute recognizes the unending challenges in improving the health and well-being of the planet and the life it supports. With its roots in the Wisconsin Idea and Leopold’s land ethic, GHI demonstrates how a leading public university can bring disciplines together from across campus to collaborate, rather than compete, for the social good. This model develops and supports education, research and partnerships in Wisconsin and across the world, giving students the tools to succeed in an increasingly interconnected world, opening mutually beneficial relationships with communities, and furthering science that will lead to new solutions. The path to the future lies in leveraging and fostering new and existing networks across campus, within countries, and among academic institutions, connecting ideas and action for the good of us all.
By Ann Grauvogl/ March 28, 2017
This article is based on previous papers by UW-Madison global health leaders:
- “Creating a Center for Global Health at the University of Wisconsin-Madison,” Academic Medicine, Feb. 2008, by Cynthia Haq, M.D.; Linda Baumann, Ph.D., R. N.; Christopher W. Olsen, DVM, Ph.D.; Lori DiPrete Brown, MSPH; Connie Kraus, PharmD, BCPS; Gilles Bousquet, Ph.D.; James Conway, M.D., FAAP, and B.C. Easterday, DVN, Ph.D.
- “Advancing integrative “one-health” approaches to global health through multidisciplinary, faculty-led global health field courses,” The Lancet special issue, March 2015, by C. Olsen, DVM; J. Conway, M.D., L. DiPrete Brown, M.Sc.; F. Hutchins, Ph.D.; K. Paulsen, DVM; K. Solheim, Ph.D.; C. Krause, PharmD; D. Gaus, M.D.; T. Silawan, Ph.D.
- “History of Global Health at the University of Wisconsin-Madison,” 2011, by C. Haq, M.D.; B. Easterday, DVM; L. Baumann, Ph.D.; C. Krause, PharmD
- “The need for a global health ethic,” The Lancet, November 2015, Tony Goldberg, DVM, Ph.D.; Jonathan Patz, M.D., MPH
- Global Health Institute Charter, 2011
- “Toward Defining Interprofessional Competences for Global Health Education: Drawing on educational frameworks and the experience of the UW-Madison Global Health Institute,” Winter 2014, Journal of Law, Medicine & Ethics, Lori DiPrete Brown, associate director for education and engagement, Global Health Institute
- “The Wisconsin Idea: The Vision that Made Wisconsin Famous,” Gwen Drury