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Academic Medicine:
doi: 10.1097/ACM.0b013e318160b101
Global Health Initiatives

The Johns Hopkins Center for Global Health: Transcending Borders for World Health

Quinn, Thomas C. MD

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Author Information

Dr. Quinn is director, Johns Hopkins Center for Global Health, Johns Hopkins University, Baltimore, Maryland.

Correspondence should be addressed to Dr. Quinn, 720 Rutland Avenue, Ross 1159, Baltimore, MD, 21205-2196; telephone: (410) 955-7635; fax: (410) 614-9775; e-mail: (tquinn@jhmi.edu).

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Abstract

The causes and effects of many health problems, whether infectious, environmental, lifestyle related, or caused by manmade or natural disasters, are becoming increasingly global in nature. Integrated approaches to solving these problems require the expertise of large and diverse groups of health professionals, to design lifesaving research and to implement effective responses. The Johns Hopkins University public health, medical, and nursing communities have a history of leadership in both modern medicine and public health, and they have unparalleled human resources in the clinical, research, programmatic, policy, and educational domains, with an extensive network of international colleagues and collaborators. To best utilize these resources to have a positive impact on global health issues, the university created the Center for Global Health in 2006 to facilitate and coordinate the various international activities of the faculty and students in the field of global health. The center has seven specific initiatives aimed at educating students and facilitating the faculty’s collaborative research: serving as a resource center for global health activities within the university; facilitating and coordinating topical areas of global research; promoting educational programs in global health; providing global health field training grants; granting global health scholarships; focusing on global health research and practice; and coordinating symposia, forums, and policy initiatives. The author elaborates on these initiatives and discusses challenges experienced in establishing the center, as well as evaluation methods for determining the center’s success.

The past several decades have seen globalization of communities worldwide, and with it, a marked increase in the need to address health problems throughout the world.1 In a number of areas of the world, health indicators are getting worse, not better. This decline is a result of a combination of factors, including the emergence of new diseases, such as HIV/AIDS, SARS, and avian influenza; the reemergence of infections, such as tuberculosis and malaria; the epidemiologic transition that is causing a rise in chronic diseases before the dominance of infectious diseases has waned; and social and political instability caused by conflict and economic dislocation.2 During the next 25 years, the worldwide distribution of deaths will shift dramatically from younger to older ages, and causes of deaths will shift from communicable to noncommunicable diseases. Among the 58 million deaths in the world in 2005, noncommunicable diseases were estimated to account for 35 million, which is double the number of deaths that year from all communicable diseases (including HIV/AIDS, tuberculosis, and malaria), maternal and perinatal conditions, and nutritional deficiencies combined.3 The majority of deaths (80%) from noncommunicable diseases, such as cardiovascular disease, strokes, cancer, respiratory disease, and diabetes, occur in low- and middle-income countries where most of the world’s population lives, and the death rates from these diseases are higher in these countries than in high-income countries. In addition to this high death toll, noncommunicable diseases cause disability. Almost half of the global burden of disease is now caused by noncommunicable diseases. This is compared with 13% caused by injuries and 39% by communicable diseases, maternal and perinatal conditions, and nutritional deficiencies combined.3

To complicate the situation, the World Health Report 20061 identified major inequities in the distribution of health workers among countries. Countries with the lowest relative health care needs have the highest number of health workers, whereas those with the greatest burden of disease must make due with a much smaller health workforce. The region of the Americas, including Canada and the United States, carries 10% of the global disease burden, yet almost 37% of the world’s health workers live there, and more than 50% of the world’s financial resources for health are spent there. Europe has a similar, disproportionate share of the world’s human and financial resources for health. In contrast, the African region suffers more than 24% of the global disease burden, but it has access to only 3% of health workers and less than 1% of the world’s financial resources, even when loans and grants from abroad are included. The eastern Mediterranean region, which has 9% of the disease burden, has only 3.5% of health workers and 1% of the world’s financial resources. Southeast Asia has the largest share of the world’s disease burden (29%), but it contains only 12% of the health workforce and 1% of financial resources.

Each year, the total global expenditure for health is in excess of $4 trillion.4 The country with the highest total spending per person per year on health is the United States, with more than $6,000 per person. This is in contrast to Burundi, where only $3.00 is spent per person per year on health. Eighteen percent of the world’s population lives in high-income countries, which devote 80% of the world’s total financial resources to health. Of the 193 World Health Organization member countries, 64 spend less than the recommended $50 per person per year, which is the minimal estimate to provide basic lifesaving services. Thirty countries spend less than $20 per person per year.

Global health education and research can play an important role in addressing the increasing burden of illness among the poorest countries of the world.5 For research to offer the hope of progress on these important problems, new and current research investigators and global health leaders in nursing, public health, and medicine must be trained and taught through new educational initiatives in global health. The combination of past successes and increasing challenges to achieve better results in addressing global health topics has increased the need for students and young investigators to focus their careers on issues of global health. The environment at Johns Hopkins University in Baltimore, Maryland, is supportive of students interested in these issues, and that is reflected in the increasing volume of applications to our graduate degree programs in global health.6 During the last five years alone, the department of international health in the university’s Bloomberg School of Public Health had a 35% increase in applications to its master and doctoral programs. Although the pool of students in this area is growing, we need to do more to make international health careers attractive to the best students and young investigators. To address these issues and to coordinate the various global health activities across the university, the Johns Hopkins Center for Global Health was launched in May 2006 as a central coordinating body to help further the programmatic areas of global health within the university.

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The History of International Health at Johns Hopkins University

The Johns Hopkins University was founded on the philosophy that education, research, and practice are inextricably linked. This view of the education–research–practice triad remains an organizing principle of all schools across the university. The three health divisions of the university directly involved in global health issues—the Bloomberg School of Public Health, the school of medicine, and the school of nursing—are described briefly below.

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The Johns Hopkins Bloomberg School of Public Health

The Bloomberg School of Public Health is the oldest and largest school of its kind in the world and has an extensive history of involvement in international health. It was founded in 1916 by Dr. William Welch and John D. Rockefeller specifically to address the public health issues prevalent at the time. Its mission today remains much the same: “[The Bloomberg School of Public Health is] dedicated to the education of research scientists and public health professionals, a process inseparably linked to the discovery and application of new knowledge; and through these activities, to the improvement of health and prevention of disease and disability around the world.”7

Approximately one quarter of the school’s 1,200 full-time and 600 part-time students are from foreign countries. International health was acknowledged as a distinct academic discipline in 1961, when the first program of its type was introduced at Johns Hopkins to directly address problems of global health in developing countries, using an interdisciplinary approach. The school of public health’s department of international health today is the oldest and largest department of international health in the world, with 93 full-time faculty, more than 200 part-time or adjunct faculty, approximately 190 master and doctoral students, and research and technical assistance projects in more than 30 countries. Other departments within the school are also actively involved in global health research, including the departments of population and family health sciences, epidemiology, environmental health sciences, molecular microbiology and immunology, health policy and management, and biostatistics.

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The Johns Hopkins School of Medicine

Founded in 1893, the school of medicine is a leading center of excellence in medical education and research and also has a long history of involvement in international health issues. Dr. William Welch, the first dean of the Johns Hopkins School of Medicine and cofounder of the School of Hygiene and Public Health at Johns Hopkins, was instrumental in the creation of the Rockefeller Institute for Medical Research and served as the president of its board of directors. Welch had an interest in international public health. To this end, while at the Rockefeller Institute he cofounded the Peking Union Medical College in what is today the People’s Republic of China, which remains as a testament to Hopkins’s interest in global health. A division of geographic medicine was originally formed in the school of medicine, but it merged with the department of international health in the school of public health in 1967, illustrating the cross-collaboration of the faculty of these two institutions. Faculty from the division of geographic medicine were directly involved in the development and testing of oral rehydration therapy, and current faculty in the departments of medicine, pediatrics, and pathology operate large clinical and community trial sites for HIV/AIDS in Uganda and India. Faculty from the school of medicine’s departments of medicine, pediatrics, ophthalmology, pathology, obstetrics–gynecology, oncology, and emergency medicine are also actively involved in both research and education in developing-country settings.

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The Johns Hopkins School of Nursing

The mission of the Johns Hopkins School of Nursing is to provide global leadership in reducing disparities in health care access, quality of care, and health outcomes for vulnerable populations. The school’s vision is to advance the profession of nursing through global education, research, and practice. Faculty have been involved in developing-country settings in both research and education and have a number of international educational and training grants in Africa, Latin America, and Asia. Specifically, the school’s faculty work in interdisciplinary teams to improve the effectiveness and quality of nursing care internationally on a broad range of topics, including maternal, newborn, child, and reproductive health. The School of Nursing at Johns Hopkins has formal academic collaborations with 10 schools of nursing in nine countries, supporting educational and research initiatives. The Institute of Johns Hopkins Nursing, a partnership between the school of nursing and the Johns Hopkins Hospital Department of Nursing, houses the Office of Global Nursing, which coordinates international activities for both the school and the hospital. The Office of Global Nursing works closely with Johns Hopkins Medicine International (an organization within John Hopkins Medicine that primarily advances hospital management, education, and patient care internationally), the Bloomberg School of Public Health, and JHPIEGO (an international health organization affiliated with The Johns Hopkins University) to provide consultative services, educational programs, and site visits to nurses and health care organizations worldwide. The faculty of the school of nursing address many areas of global health, including violence against women, injury control, reproductive health, maternal mortality, home visitation programs for improved maternal/child health, chronic health conditions, and health disparities in public health nursing practice, as well as emergency preparedness and disaster relief.

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Johns Hopkins University’s contributions to global health

The faculty members of Johns Hopkins University’s schools of public health, medicine, and nursing have made myriad landmark contributions to the field of global health. Many discoveries impacted millions of people by improving overall health through discovery. In 1913, E.V. McCollum isolated the first vitamin, which he named factor A, and which later became known as vitamin A.8 Seventy years later, Alfred Sommer discovered that providing children with a four-cent dose of vitamin A can save millions of lives.9 In the 1930s, Abel Wolman urged the World Health Organization to recognize the importance of sanitary engineering and pure water supplies to overall health after his investigations with the chlorination of Maryland’s water supplies proved successful.8 Nathaniel Pierce’s and Brad Sack’s work in Calcutta in 1967 showed that a solution of varying concentrations of glucose and sodium could maintain hydration during severe diarrhea without the need for intravenous infusion. Their studies guided the formulation of an oral rehydration solution.10 More recently, Robert Black’s work on zinc supplementation for the prevention and treatment of diarrhea has resulted in UNICEF recommending this treatment in developing countries, resulting in a significant reduction in child mortality.11

Many advances in the world of infectious disease have also been achieved by Johns Hopkins University faculty. In the 1940s and 1950s, David Bodian and colleagues demonstrated that polio spread through the oral–fecal route, and they also identified three types of poliovirus, noting that an effective vaccine would have to defend against all three.12 In 1956, Richard Riley achieved a major breakthrough in disease transmission. He ran ducts from the tuberculosis ward of a Baltimore hospital to a cage of guinea pigs elsewhere in the building. The resulting sick guinea pigs illustrated that disease could be spread by drop nuclei, tiny particles coughed up by patients, thought to be benign.13 George Comstock’s 1967 pioneering work on tuberculosis control and use of the drug isoniazid (INH)14 led health professionals to adopt INH as a mainstay in treating the killer. Carl Taylor’s work in the use of community health workers for the treatment of serious illness in the community, and his collaborative 1976 work with Nevin George Scrimshaw and J.E. Gordon on the concept of synergy between infectious diseases and undernutrition, were both landmark studies in global health.15 More recently, Laura Guay and Brooks Jackson advanced HIV treatment by preventing mother-to-infant transmission of the virus with single-dose nevirapine in Uganda.16 In 2003, Sheila West and colleagues worked on a mass antibiotic treatment for control of blinding trachoma,17 and four years later, Ronald Gray and Maria Wawer achieved another HIV/AIDS research landmark by demonstrating a reduction of HIV transmission by male circumcision.18

Many breakthroughs in chronic diseases were also achieved by Hopkins faculty. Most notably, biostatistician Raymond Pearl first linked smoking to decreased lifespan in a 1938 paper,19 and university faculty continue to do much work on tobacco control today. In 1999, Keerti Shah coauthored a groundbreaking paper demonstrating that cervical cancer could be linked to the sexually transmitted human papillomavirus,20 paving the way for diagnostic testing and the eventual vaccine. Pioneering work is also being done on cancer, diabetes, hypertension, and other chronic diseases across the university.

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Creating the Johns Hopkins Center for Global Health

Given the breadth and depth of the environment for global health research, training, and practice at Johns Hopkins, the deans of the above three schools created the Johns Hopkins Center for Global Health in May 2006. The mission of the center is to facilitate and focus the extensive expertise and resources of the Johns Hopkins institutions together with their global collaborators to effectively address and ameliorate the world’s most pressing health issues. The center accomplishes this mission by initiating and facilitating interdisciplinary and interdivisional collaborations and partnerships for addressing global health challenges across all Johns Hopkins institutions, particularly the center’s founding schools, and in global collaboration with universities, research organizations, nongovernmental organizations, and communities affected by the center’s efforts. In addition to the promotion of research, programs, and policy development, the center has committed itself to the development of new leaders in global health both at home and overseas.

The Johns Hopkins schools directly involved within the Center of Global Health are the Bloomberg School of Public Health, the school of medicine, and the school of nursing. Each of these schools has faculty and students active in global health education, research, and practice. There is also collaboration among the faculty across other departments and schools at Johns Hopkins, including the Krieger School of Arts and Sciences, the Whiting School of Engineering, and the School of Advanced International Studies (SAIS). For example, there is a Global Health Initiative at SAIS that is designed to improve the effectiveness of global health policy making through research and training of graduate students in global health and foreign policy. In addition to the schools, two additional institutions are involved in global health issues that also utilize the expertise of the faculty of each of the above schools: JHPIEGO and the Johns Hopkins Medicine International. Although the center interfaces with the faculty of all of the above institutions, its primary responsibility is to the deans of the Bloomberg School of Public Health, the school of medicine, and the school of nursing.

Each of the schools and institutions mentioned above has individual centers involved in international research. Typically, these centers are based within individual departments, and the faculty members involved with the centers have their primary appointments within their departments. However, the Center for Global Health is not based within a department; rather, it interdigitates equally with the schools of medicine, public health, and nursing. In its coordinating function, it also relates indirectly to JHPIEGO, SAIS, Johns Hopkins Medicine International, and the schools of arts and sciences and engineering.

The center’s faculty are full- and part-time faculty members who are involved in global health activities from either research, education, or practice perspective. They retain their primary appointments within their home departments but have all agreed to be affiliated with the center and to help accomplish its mission. As shown in Figure 1, the center serves as a central coordinating and resource center for many other health-related centers throughout the university. In addition to the director, three associate directors work with the center, one each representing the schools of medicine, public health, and nursing. Each of the associate directors is appointed to the center by the dean of each respective school and serves to help coordinate and facilitate the various international activities within the three schools. The center for global health is also an active participant in Johns Hopkins International Affairs Coordinating Committee that is coordinated by the provost office. This committee coordinates the international activities of the entire university, including health, but also including engineering, policy, history, anthropology, and many others.

Figure 1
Figure 1
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Specific Initiatives of the Center for Global Health

Serve as a resource center for global health activities within the university

The university leadership (president, provost, and deans) recognize the significant role global health plays in the research, training, and practice activities of the university as a whole. Thus, the Center for Global Health serves as an informational resource for all international activities within the university directly relating to health. One of our first goals was to catalog the myriad international health projects conducted at Johns Hopkins University. This extensive activity yielded a substantial and interesting database of projects, which is accessible on the center’s Web site (http://www.hopkinsglobalhealth.org).

Currently, this Global Projects Database includes more than 361 faculty and staff of the schools of medicine, public health, and nursing, who are involved in 486 active global health research and service programs. These projects occur in 117 countries, or 60% of officially recognized countries of the world. A key feature of the database is that it is searchable by key word, faculty name, and country name, and it may be navigated by location using an interactive map (Figure 2). A search by country yields a list of projects in that country, and drilldown yields a description of a particular project. Projects listed in both of these page views have links to the faculty investigators’ biographies.

Figure 2
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Asia and Africa are the major regions in which Hopkins faculty, staff, and students participate in health-related initiatives, reflecting the university’s commitment to the health of people in developing countries. Johns Hopkins faculty are most active in India, with 50 active projects, Uganda (46 projects), Bangladesh (39 projects), South Africa (33 projects), Brazil (28 projects), China (29 projects), Tanzania (22 projects), Nepal (19 projects), Thailand (18 projects), and Pakistan (15 projects).

In addition to the interactive database, the center’s Web site features a variety of resources for faculty, students, and staff to utilize. Listings of program funding, scholarships, fellowships, global experiences, and job opportunities are updated weekly, and there are plans to catalog all of these opportunities into a searchable database in the future. A calendar of events is also updated several times a week, advertising events being held on campus as well as international meetings being held around the world. Listings of all Hopkins global-health-related courses for students looking to add coursework to their schedules are posted, as well as announcements which regularly note news from around the university as well as from agencies such as the National Institutes of Health (NIH). In addition, we also maintain a listing of global health headlines from around the world on our Web site, so visitors can see at a glance what has happened recently in the field.

In addition to the Web site, we at the center publish the Center for Global Health Bulletin, a streamlined, weekly e-newsletter that updates the Hopkins global health community on upcoming events, new funding opportunities, job opportunities, and announcements. We distribute a global health e-newsletter monthly that includes links to all of the global health advancements made at Hopkins during the prior month. These milestones are also catalogued on the Web site for historical purposes.

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Facilitate and coordinate topical areas of global research

Because of the tremendous burden of infectious diseases in the developing world, Hopkins devotes substantial effort to this area. Approximately one third of the current active projects within the center’s database address HIV/AIDS. Many other projects address infectious diseases of growing importance, including tuberculosis, malaria, and infectious diarrhea. Despite this strong commitment to infectious diseases, Johns Hopkins global health projects span a tremendous breadth in topics. Among international health initiatives, there has been a long interest in nutrition, including vitamin and mineral supplementation, and reproductive health and family planning in overseas settings. More recently, Hopkins faculty have responded to needs in other international health topics, including violence and injuries, environmental health, disaster response, tobacco use, birth defects, and hearing impairment. Global health research and practice range from basic science applied to disorders common in developing countries, such as tuberculosis, malaria, HIV/AIDS, diarrhea, nutritional deficiencies; to epidemiologic, behavioral, and clinical studies; to translational research that addresses the transfer of research knowledge into programs and policies on a population basis. Johns Hopkins University is truly a leader in global health research, having received more than $100 million in NIH grants in the area of global health as well as more than $370 million in non-NIH grants in global health, including the U.S. Agency for International Development (USAID), the Food and Drug Administration, the Centers for Disease Control and Prevention, the Bill and Melinda Gates Foundation, the Doris Duke Foundation, and other foundations and private donors.

The Johns Hopkins Center for Global Health adds a new dimension to the global health research being conducted across the university by introducing the idea of cross-school and cross-organizational collaboration. Our creation was based on the concept that only a coordinated, multidisciplinary approach to solving global health problems will ultimately help to solve the world’s health problems, particularly for the disadvantaged in developing countries. Although these types of collaborations occurred from time to time in the past, the center now works full-time to recognize new synergies and establish new relationships so future research can benefit from the expertise of faculty in all three schools, as well as other affiliated organizations. In this vein, the center has collaborated with its partners at JHPIEGO and the Center for Communication Programs (which is affiliated with the school of public health and uses strategic communication and advertising to educate and improve health internationally) to pursue government-sponsored grants and has submitted several grant applications to funding agencies that feature this unique collaborative arrangement. We also maintain strong collaborations with institutions in developing countries. Johns Hopkins has established formal, collaborative agreements for research, technical assistance, and educational programs with institutions in 22 countries, and we plan to pursue funding to support similar activities as well.

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Promote educational programs in global health

The department of international health within the Bloomberg School of Public Health has a 40-year history of educating both U.S. and foreign students in the topical areas of global health. This department alone offers 57 courses directly related to global health issues, leading to graduate degrees in the global health field at either the master or doctoral level. Subsequently, 69 additional global-health-related courses have been added in other departments within the health institutions of medicine, nursing, and public health, as well as in the undergraduate institutions. In collaboration with the Fogarty-sponsored Framework Program in Global Health at Johns Hopkins (described later), the Center for Global Health is helping to coordinate a global health curriculum that is initiated at the undergraduate level but then provides a transition in educational opportunities through the graduate level, resulting in a master or doctoral degree. These degree programs are then supplemented with seminar series for all hospital residents and nursing students, as well as specialty fellows, to integrate the global health perspective into all health professions training at Hopkins. New courses have been added during the last several years to enhance the already existing and extensive set of course offerings in the department of international health.

At the undergraduate level, public health studies is the second-largest major within the undergraduate schools at Johns Hopkins. New courses have been added that use the foundational public health courses that were already present within the school of arts and sciences to focus on health problems in developing countries. A minor in global health has also been established for undergraduate majors in the public health studies program. This minor will include a new undergraduate global health course in the school of arts and sciences in addition to extended selection of international health courses offered at the school of public health.

Besides the new undergraduate global health course, a second course has been designed to introduce medical and nursing students to research challenges in global health. Medical and nursing students already take foundational courses in public health sciences as part of their curriculum. This new elective seminar course builds on that initial training and focuses on the application of public health, behavioral, and biomedical research challenges in the area of global health. A third course has been designed to expose undergraduates to global health issues, both at Hopkins and at other two-year and four-year schools in Maryland who have very limited exposure to international health perspectives; this will be part of an outreach by the university to other schools within the region. Students from the region may come to Hopkins to attend courses, or, in some cases, the faculty may rotate to these schools. Distance education via the Internet is also being offered. The goal of this course is not specifically to support interests in research capacity, although students motivated by the course may decide to focus in this area. The emphasis is to build a societal capacity to support the commitment of resources required to address the health needs of developing countries in a rational and comprehensive manner. This building of political will in the population may be an influential factor in progress toward outcomes such as the Millennium Development Goals agreed to by the United Nations member countries aimed at helping the world’s poor.

Undergraduate, nursing, and medical students now have opportunities to enroll in a course entitled Special Topics in Global Health. This course covers many topics, including measures of disease burden in developing countries, measures of population growth and basic concepts in demography, the epidemiologic and demographic transitions, the major causes of death and disability in developing nations, and conceptual approaches to disease control, including prevention paradigms, eradication, elimination, and control. In addition to these topics, the course will cover the role of poverty and social inequities on disease burden and approaches to controlling these factors, as well as the role of globalization and climate change on the ecology of disease. It is important to introduce students to the role of international and donor agencies and public health programming in developing countries, the role of public–private partnerships, and successful programs that have resulted in reductions in disease morbidity and mortality. Specific problems in global health will be discussed as case studies, which might include the smallpox-eradication campaign; eradication/elimination programs for polio, measles, and guinea worm; vaccine-preventable diseases; primary-care-based approaches to population health, including reproductive health problems, STDs, and HIV/AIDS; emerging infections, including SARS, avian influenza, malaria, and tuberculosis; and tobacco control, injuries, and other topical issues.

A seminar series specifically designed for nursing and medical students will focus on opportunities and challenges in global health. When implemented, the series will be taught by faculty from the schools of public health, medicine, and nursing, and it will use a case study format in which a faculty member presents a broad topic and then challenges students to design a research project to address the key challenges for that topic. Students will work in teams, guided by the faculty, to develop a research proposal that directly addresses open questions for that topic area. Students will present their proposals to the class as a whole for discussion and critique, and it is expected that some of the students will use these proposals as a foundation for their internship proposals.

In addition to the educational activities described above, Hopkins faculty are committed to technical assistance, program development, and education of foreign professionals. As part of the Hopkins education mission, in addition to training a number of people from a variety of countries to become health professionals, Hopkins faculty have succeeded in developing a number of special projects which address the educational needs of people in the developing world. There are 10 NIH-funded educational programs devoted to training foreign nationals seeking educational health experiences at Johns Hopkins University: the AIDS International Training and Research Program, the International Collaborative Trauma and Injury Research Training, International Training and Research in Population and Health, the African Bioethics Training Program, Innovative Approaches to TB Control in Brazil, infectious diseases training programs in Peru, a collaborative genetics research training program, a minority global health disparities research training program, a malaria research and training program in Zimbabwe, and training programs in international maternal and child health. Since their inception, these programs have trained thousands of foreign students in specific graduate programs in epidemiology and global health. The AIDS International Training and Research Program alone has trained more than 1,000 students from 28 different countries during its 18-year history. Many of these students obtained master degrees, doctoral degrees, and certificate degrees in Hopkins programs related to global health.

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Global health field training grants

One of the key objectives of the Center for Global Health is to provide support to students and residents so they can apply their education in the pursuit of global health to field opportunities. To this end, the center has partnered with the Johns Hopkins Department of International Health in funding a research internship program that supports short-term research experiences in developing countries for undergraduate, nursing, medical, and public health students. This internship, the Framework Program in Global Health, is the educational core of the Johns Hopkins Center for Global Health and takes advantage of the extensive set of research activities already being conducted by faculty and faculty contacts at leading international organizations involved in global health.

All students who are eligible can submit an application to be considered for a Framework Award. Any undergraduate or graduate student at Johns Hopkins is eligible to apply, as long as the internship isn’t supporting the student’s dissertation research. Twelve students are selected, on the basis of the strength of their academic records and project proposals, by a review committee each semester. Center-affiliated faculty compose the review committees, and the committees change each semester according to availability and interest. The awards cover travel, immunizations, visas, and specific research expenses. All students are supervised by a member of the faculty at a research site in a developing country, or by a member of the adjunct faculty on the staff of a major international health organization or nongovernmental organization. Students work with this faculty member to develop a research proposal that can be accomplished in a short period of intense work, usually three months. In most cases, students are expected to participate in the analysis and reporting of the data they collect while at the research site. For students with a primary interest in the basic sciences, this internship experience can be accomplished with a focused effort in a laboratory setting at Johns Hopkins rather than abroad, with the caveats that the research is directly related to global health problems and that the student will have an opportunity to travel overseas to experience the specific health problem he or she is researching within the endemic or indigenous setting.

The Framework Program is similar to the master’s program in the department of international health at the Bloomberg School of Public Health, which also requires an internship of three to six months. All students in these programs must take a course in the responsible conduct of research before their internship experience. Students whose internships involve human-participants research must also complete training in human-participants protection before the start of the internship.

So far, the Framework Program has awarded 39 grants. Students have traveled to Bangladesh, Brazil, Chile, China, the Democratic Republic of the Congo, Egypt, Ethiopia, Ghana, India, Mexico, Mozambique, Peru, South Africa, Uganda, and Zambia, and have participated in an array of research. All of their project abstracts can be read on the center’s Web site (www.hopkinsglobalhealth.org).

Students returning from their overseas Framework experiences have been very enthusiastic about the experience and all they were able to learn. Student Jessica Shearer commented, “The only way to learn about working in a developing country is to actually be there. While frustrating or slow at times, my experience in Lucknow, India provided me with the context and insight for future work in global health. I learned so much about the local work culture, communication, and about public health generally.”

Student Andrea Wirtz, who worked in Peru, stated, “The well-rounded quality of this experience has taught me much more than I could have hoped any standard internship would provide, has exemplified the details that I had learned during my coursework at the Johns Hopkins School of Public Health, and has given me many skills that I will carry with me into future research endeavors.”

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Global health scholarships

In an effort to further its educational mission, the Center for Global Health supports students who exhibit outstanding academic records and a strong desire to pursue global health careers. Each year, we plan to award global health scholarships at the Johns Hopkins Bloomberg School of Public Health, six in the MPH program and three in other master-degree programs. The scholarships are awarded through a competitive process open to all accepted master students at the school of public health. Recipients may be either an international student or a domestic student aspiring to work in an international context, and they may be joint nursing–MPH or MD–MPH candidates. This year, we offered nine global health scholarships, six within the MPH program and three within the MHS program in international health. Several of the recipients were from Uganda and India, and others were American students who had already worked overseas. Hopefully, these scholars will not only form a cadre of committed global health workers but will also act as a resource for the university in future efforts including research, program implementation, and education overseas.

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Global health research and practice

Where appropriate, the Center for Global Health orchestrates responses to global health opportunities, not only through research activities but, just as importantly, through programmatic and educational initiatives and by promoting the practice of public health, nursing, and medicine to enhance the collective impact that Johns Hopkins University faculty can make on the health of the world. As part of this initiative, and to be “value added” to the faculty, we created Faculty Grants in Global Health Research, a fund that provides grants to faculty in the schools of public health, medicine, and nursing, to enable and support global health research projects.

The prime purpose of these awards is to strengthen individual faculty members’ ability to secure extramural funding. The fund is budgeted at $500,000 per year per grant through 2018. The maximum award allowed is $50,000, and the funds are primarily for junior faculty in the allied health schools. Applications for collaborative projects, particularly those involving faculty in different schools at Hopkins and overseas collaborators, are encouraged. This money can be used to support the research endeavors of the faculty member recipient (i.e., international travel, technical support, computer time, and research equipment). Recipients must use funds to support projects in global health, especially projects conducted in a developing country on a topic of importance to that country, and projects which research emerging threats to the whole world (e.g., pandemic influenza). Projects proposed for developed countries are not considered unless they have a unique application to the health of the developing world (e.g., a laboratory test for malaria).

We just announced this program to the faculty at Hopkins, and it has been met with much enthusiasm. Although we don’t currently know how many applications will be submitted for the first round of awards, 60 faculty members have already volunteered to be on the review panel. This unprecedented response points to the support this program has garnered among the faculty.

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Global health symposia, forums, and policy initiatives

To increase the visibility and value of the Center for Global Health to the Johns Hopkins faculty, the center has, in collaboration with the department of international health, developed the Global Heath Leaders Forum. The forum features a series of speakers who are influential in the field of global health. We identify three to four speakers each year and invite them to travel to Hopkins for a day or two. During their visit, they give a speech open to the entire Hopkins community, in which they address global health topics relevant to their position or research. Often, select members of the Hopkins faculty and student body are also afforded the opportunity to meet with these leaders in a more personal environment. Speakers thus far have included Ruth Levine, PhD, vice president for programs and operations, Center for Global Development; Roger Glass, MD, PhD, director, Fogarty International Center, and associate director of international research, NIH; and Tadataka Yamada, MD, president of global health programs, Bill and Melinda Gates Foundation.

In addition to the Global Health Leaders Forum, the Center for Global Health will lead the development of policy initiatives and white papers. These initiatives are a high priority of both the faculty and the center leadership.

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Challenges

The Center for Global Health has accomplished much in its first 15 months of operation, as the discussion above illustrates. We enjoy great support from the leadership of the university and enthusiasm from the faculty, staff, and students. However, like every organization starting out, we have encountered our share of challenges, most notably communication and fundraising.

The schools of medicine, public health, and nursing have all enjoyed great success and have all been rated at the tops of their fields when compared with their peers. As one contributing factor to long-term success, each of the three schools has perfected communication within that specific school. Communication between the schools, however, has not been as efficient. The center for global health is changing this internal model by serving as an umbrella organization representing all three schools. The center’s staff has had to meet with leaders in all three schools to determine their communication strategies and to learn how to integrate them into center communication. Our Web site and e-mail newsletters have been created as solutions to these communication challenges. Through these mechanisms, constituents of medicine and nursing are now aware of events occurring at the school of public health, and vice versa.

The center’s encouragement of collaboration has also allowed faculty members to talk to their colleagues in different schools, and students with an interest in global health from all three schools have formed an umbrella global health interest group with plans to hold monthly meetings where they can network with each other. The communication challenges we first experienced have largely been overcome at this point in our development. Because of our facilitation, all constituents are now much more aware of the activities of the other schools and seek out information about them.

As is common with most nonprofit organizations, another challenge the center faces is fundraising. We have an operating budget composed of seed money gifted from the schools of medicine, public health, and nursing, and from an anonymous donor. However, the various programs discussed in this article are spending this money down, and we must look for ways to replenish the funds. One of the main ways the center is fundraising is through applications for funding from various agencies, such as the Gates Foundation, the Doris Duke Foundation, and USAID. The center also plans to work with the fundraising professionals at the university to attract individual and corporate donors who would be willing to support the global health work at Hopkins.

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Evaluation

As the center enters its second school year of programming, we will begin to turn an eye toward evaluating its programs. There will be ongoing review of process indicators, such as number of scholarships given, number of grants received, number of visits to the Web site, etc. We have also planned other, more specific evaluations of how the center is achieving its goals:

* Serving as a resource center. We plan to ascertain the perceived value of the Web site and center communications, using survey methods.

* Facilitating and coordinating topical areas of global research. We will tabulate new international partnerships, new grant applications, and new funding in global health that grow from this activity.

* Promoting educational programs in global health. We plan to determine the perceived value of new education initiatives, via survey methods.

* Providing global health field training grants. We plan to ascertain the perceived value of the grants initiative, via survey methods. We will also attempt to maintain contact with program alumni to ascertain the nature of their career paths after graduation.

* Granting global health scholarships. We will attempt to maintain contact with program alumni to learn the nature of their career paths after graduation.

* Focusing on global health research and practice. We will track the number of pilot grants that result in subsequent grant applications and the number that are funded; the amount of these subsequent awards will allow a ratio of return on investment. We will also track the number of publications that grow from the pilot grants.

* Coordinating symposia, forums, and policy initiatives. We plan to ascertain the perceived value of these activities, via survey methods. We will also attempt to describe the number and kinds of partnerships and activities that grow from visits by speakers.

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Planting the Seeds for Permanent Global Health Solutions

Because so many solutions to global health problems depend on innovation and new research, and because so many of the associated discoveries can provide benefits to all nations, the Center for Global Health at Johns Hopkins is dedicated to furthering the mission of the university in promoting research, education, and practice in addressing these global health needs. As the burden of diseases and injuries around the world is shifting, the center will continue to identify and address the top priorities in global health. Educating future leaders in global health through research and practice will always remain the center’s primary mission.

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Acknowledgments

The author wishes especially to acknowledge the gracious support and financial commitment of Dean Michael Klag (Bloomberg School of Public Health), Dean Edward Miller (School of Medicine), and Dean Martha Hill (School of Nursing). The success of the Center for Global Health is only possible through the dedication and commitment of its three associate directors, Drs. Robert Bollinger, Chris Beyrer, and Nancy Glass, and its staff Richard Dunning, Heidi Glatfelter, Melissa Riedesel, and Patricia Buist.

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References

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