Gathering public health evidence in South Asia

Heart disease and diabetes are often considered diseases of affluence, afflicting millions and burdening healthcare systems in wealthy countries like Australia and the US, but increasingly these non-communicable diseases are also becoming a huge problem for developing countries. 

It has been estimated that by 2030 non-communicable diseases will account for almost three-quarters of all deaths in India. It is also estimated that the years of life lost due to coronary heart disease will be greater in India than in the US, the Russian Federation and China combined.

As the burden of non-communicable diseases increases across the South Asia region, governments and NGOs are grappling with how best to tackle this issue. What programs and policies have the biggest impact on health and wellbeing? And what evidence do decision-makers need to develop and implement these policies?

Public Health Evidence South Asia (PHESA) aims to address such questions. PHESA is a collaboration between the Cochrane Public Health Group at the University of Melbourne led by Elizabeth Waters and public health organisations across South Asia led by Sreekumaran Nair at Manipal University. 

The collaboration will foster joint research projects, and encourage international leadership and capacity-building to solve public health challenges across the region. 

By working directly with public health and development agencies, the initiative is well-placed to meet the specific public health needs of Low and Middle Income Countries (LMICs). PHESA will also work with new graduates, funders, researchers, and leaders to identify pressing population health issues and provide evidence-based solutions. 

“Solutions to preventing non-communicable diseases are complex,” Professor Waters says.

“Policies that focus on improving healthy eating and physical activity without addressing the social, cultural, financial, and political issues that influence health can fail to make lasting changes for countries and their citizens. 

“To implement effective programs and policies, decision-makers need access to information on what strategies are effective, for whom, how and for what cost. This knowledge-driven approach enables those at the community level and leadership level to invest their healthcare dollars wisely.”

Professor Waters says PHESA builds on CPHG’s strong record in supporting public health decision-making through the production of Cochrane systematic reviews – the gold-standard for summarising all available research literature on a given topic. 

“Since its inception in 2008, CPHG has been committed to making a difference to health inequalities by seeking to understand how social, economic and environmental conditions can impact on health and wellbeing,” she explains.

“The reviews the group produces address the effects of interventions on population health, describe the overall picture of the existing evidence base and reduce the need to rely on individual studies to provide answers to important policy and practice questions. Such synthesis of evidence requires rigorous methodologies to identify relevant studies, assess their quality and understand how the findings might be applied to the region.”

Developing evidence that is relevant to low and middle income countries has always been an important aspect of the work that CPHG does, according to Professor Waters, who heads the CPHG team in Melbourne.

“In partnering with Public Health Evidence South Asia, we will ensure that our reviews further contribute to the evidence needs of the region,” she says. “Through our collaboration, we will look to improve evaluations of health interventions, promote the publication and use of systematic reviews on topics of public health relevance in LMICs, build and mentor local capacity, and use the evidence from these reviews to influence policy.”

PHESA will also play an important role in building research capacity in South Asia. Working in partnership with staff at the University of Melbourne, PHESA will train and develop the skills of South Asian researchers to interpret evidence and extrapolate findings relevant to their own countries.

A recently published review examining the effects of slum upgrading on health and wellbeing, helped to catalyse the development of PHESA. The review exemplifies the type of future activities that PHESA will undertake. 

By examining how improvements to the physical environment and infrastructure of slums impacts health, quality of life and socioeconomic wellbeing of slum dwellers, the review identified a need for better methods of evaluating slum upgrade programs to ensure that future resources are invested in the most efficient and effective ways. 

PHESA will be officially launched by Professor Srinath Reddy, Director of the Public Health Foundation for India, in May this year.

Watch a video of the Cochrane Institute’s Ashraf Nabhan speaking about the Cochrane Collaboration’s work:

http://anniversary.cochrane.org/