BY SANG WON (JOHN) LEE
The gap between health research and practice in certain fields purportedly spans 17 years.1 While experts argue about the extent of this lag, they agree that it does exist and must be eliminated. Both the public and private sectors have increasingly pushed for research into the mechanisms that translate knowledge into application. The Black Dog Institute in Australia focuses on this issue by conducting research on the diagnosis, treatment, and prevention of mood disorders, with the aim of “rapid translation of quality research into improved clinical practice.”3 The institute has recognized that this lag, perpetuated by the whims and preferences of health practitioners, could deny people access to the best methods of care available. One project run by the institute, called We Feel, seeks to measure the relationship between social, economic, and environmental factors on the emotions in order to monitor and educate people about mental health.4 The project collects public tweets, country by country, then analyzes emotions such as love, joy, surprise, anger, sadness, and fear. The project attempts to bridge the gap between research and practical application, starting with the simple act of placing its research and practice wings in the same location.
The gap between research and practice does not solely exist in the area of mental health. One significant example of the lag between research and practice is the introduction of new drugs onto the market, and their prescription rate by doctors thereafter. Another exists in the use of social networks as a method of health care intervention due to a lack of knowledge required to utilize these networks. The cost of inaction is high both in social and economic terms. A child may be denied access to the best-known medicine, or even a cure, for his or her illness, due to the gap between knowledge and practice. A government may not apply the most cost-effective approach to the promotion of health awareness, wasting resources that would have been better spent on other projects. Fortunately, there have been efforts to address the gap by integrating research into practice – the so-called Knowledge Translation. Going forward, we must infuse a drive for innovation into this domain and constantly rethink the concept and methods of Knowledge Translation. The fields of global health, social sciences, development economics, and medicine have already experienced the push for innovative, multi-disciplinary approaches to traditional problems. We can learn much by their example.
In order to diminish the gap between knowledge and practice in the field of global health, we should direct our attention toward three specific areas. First, we must shift the model of global health and development from the intervention of foreign aid workers to the sustainable integration of local stakeholders into the processes of development. Second, the government and other structural agencies should more actively foster the development of innovative approaches that improve upon or completely replace traditional practices. Third, we must build platforms that encourage both the development of multi-disciplinary solutions and the spread of those ideas across disciplines.
Rethinking global health and development from local perspective
Adam is a top pediatrician who works at a world-renowned hospital in the United States. With a grant from UNICEF, he buys a set of fetal incubators to send to a low-income country, where Ruth works as a midwife. Ruth receives the devices and attempts to use them, but she struggles to learn exactly how the machines function, how they should be repaired when they malfunction, and how to transport the heavy devices, which were made for hospitals with elevators, up and down the stairs in her clinic. Ruth now finds herself facing a “Choose, Use, and Pay the Dues“ problem. This concept describes the failure of good intentions to surmount the fact that the people who choose the medical devices (doctors in high income countries), the people who use the devices (midwives, community health workers) and the people and organizations that fund the technology transfer (UNICEF or other multilateral aid organizations) fail to properly meet the needs on-the-ground health systems operating in low and middle income countries (LMIC). In this case, Adam may not have realized the importance of Ruth’s needs and specific circumstances, but Ruth paid the price for his ignorance.
In order to solve this problem, we need to shift away from the current model, a failing one-way transfer between high-income and low-income settings. We need to further involve all stakeholders, such as local doctors and midwives, into the transfer of goods and ideas. We need to empower them to help us learn about the problems they face, to fully take advantage of the tools at their disposal, and to address these issues themselves. One creative solution exists in India: CAMTech attempts to accelerate the innovation of medical technology by building the entrepreneurial capacity to improve health outcomes in LMIC.5 CAMTech runs hackathons in India that encourage locals to develop solutions to the issues they face by providing them with the support and resources to do so, often publicizing promising solutions and establishing connections with interested aid organizations. Most recently, the hackathon focused on the problem of diabetes.
The CAMTech model has adapted to the circumstances of the region, and it avoids the problem of “Choose, Use, and Pay the Dues” by integrating the people who develop, use, and pay for the new products into the same environment. The products that come out of such hackathons include an infrared device that measures blood glucose through the earlobe, a tool more appropriate for LMIC field use than past devices because it was developed with readily available tools and resources in India. Technoserve, another organization that empowers locals to improve global health and development, provides support for local entrepreneurs to develop, for example, their business marketing.6 This model challenges the one-way dissemination of knowledge by making local people an important source of ideas. A third group, Little Devices Lab, builds easily usable and accessible tools for locals, such as simple design kits/platforms for diagnostic tests.7 Jose Gomez-Marquez, an MIT researcher, builds such DIY health technologies with the goal of empowering locals to develop the kits further. All of these organizations emphasize the need to involve the people directly affected by these issues in order to formulate more comprehensive, sensible solutions to meet local needs.
Structural approach to innovation
Imagine that you were told to get over a bar that was hanging slightly above the ground. How would you do it? The natural instinct would be to step over the bar. Now imagine that the same bar was raised to the height of your knee. How would you do it this time? It might cost you more effort to do so, but you could still jump over the bar.
What is the difference between these two situations, and what does that difference tell us? At the individual level, it shows that we have the untapped capacity to surpass our own expectations. Even when we do not expect to take the leap, the potential to do so lies within us. On the structural level, it tells us that different circumstances elicit different responses. The high bar precipitates the act of jumping, while the low bar requires a single step. This insight suggests that greater involvement of governmental and external institutions would provide a structure that incentivizes people to take the leap, and to reach for a higher goal.
We can apply this concept to knowledge translation. In particular, the government can foster innovation and streamline the implementation of necessary knowledge. One example of such a program is the Smart and Connected Health Program in the United States.8 The National Science Foundation program funds projects working to develop innovative approaches that would support “the much needed transformation of healthcare from reactive and hospital-centered to preventive, proactive, evidence-based, person-centered and focused on well-being rather than disease.” Programs such as this one encourage innovation, in particular the innovation of knowledge translation, by incentivizing individuals to leap rather than step. We need more, similarly structured programs in the realm of global health and development in order to drive large-scale structural changes.
Platforms for sharing ideas across disciplines
The scientific community has used journals in order to disseminate knowledge and ideas for centuries. Journals such as Science cover a range of general topics, while journals such as the Journal of Neuroscience focus on smaller areas of interest. By compiling advances relevant to the field in one location, journals keep those interested in the field up to date on the latest findings. This traditional model has been recently used more and more in a multi-disciplinary approach to innovation. When people come together, they form a think tank capable of producing creative new solutions for existing problems that have defied conventional interventions. The compilation of people from different disciplines can magnify the effect.
The Human Nature Lab at Yale is at the forefront of studying the spread of knowledge and behavior. Under Master of Silliman Nicholas Christakis, the lab works at the intersection of the social and biological sciences, studying social networks in order to determine how they facilitate the spread of knowledge, ideas, and behaviors. One project that the lab runs, which is based in Honduras, looks at the method by which insights in network science, such as centrality to the network, can improve the implementation of health interventions by determining the proper target for these interventions, which range from educational measures to health care. For example, offering lessons to the proper target community about the importance of giving liquids to children with diarrhea would save many sick children from dying of dehydration.9 Stanford Social Innovation Review publishes a magazine and website that cover cross-sector solutions to global problems.10 These media outlets allow the sharing of ideas across disciplines, then facilitate the dissemination of the resulting solutions. Another example of cross-disciplinary contact is the global design firm IDEO, which employs people from areas of research ranging from behavioral science to healthcare services to digital design.11 The firm brings together diverse groups of talent in order to help organizations in the public and private sectors innovate and grow. Both organizations represent a sign of hope for continual innovation in the context of global health and development.
Conclusion
Shrinking the gap between research and practice and increasing the amount of cross-disciplinary research represent two important goals for global health and development. Both contain profound implications for both society as a whole and our daily lives. The focus on Knowledge Translation brings the best practices to those who can benefit the most from them. Knowledge Translation reveals important trends in our conception of global health and development, as well. We have focused on a one-way transfer of knowledge and goods, a simple interpretation of evidence into action that neglects so many possibilities. The application Knowledge Translation to the global health field is currently shifting communications from a one-sided flow of information into a pathway that integrates the local population as per Goal 17 of the Sustainable Development Goals set up by the United Nations. In the future, we need to continue to foster the spread of knowledge and innovation through partnerships between the public and private sector, as well as between various fields of scientific research. We need to address the many needs, often caused by the gap between research and action, around us. By working together, we can help each other fulfill a common goal: to bring our world a step closer to the world in which we wish to live.
Sang Won (John) Lee is a junior in Calhoun College. Sang Won is a Molecular, Cellular, and Developmental Biology major from South Korea. He can be contacted at sangwon.lee@yale.edu.
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References:
1 Morris, Z., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: Understanding time lags in translational research. Jrsm, 510-520.
2 What is Knowledge Translation? (2005). Retrieved November 11, 2015, from http://ktdrr.org/
3 About us. (2015, July 25). Retrieved November 11, 2015, from http://www.blackdoginstitute.org.au/
4 We Feel. (2015, November 10). Retrieved November 11, 2015, from http://wefeel.csiro.au/#/
5 CAMTech’s Mission. (2015). Retrieved November 11, 2015, from http://www.massgeneralcenterforglobalhealth.org/camtech/
6 Home. (2015). Retrieved November 11, 2015, from http://www.technoserve.org/
7 Little Devices @ MIT. (n.d.). Retrieved November 11, 2015, from http://littledevices.org/
8 Research Areas. (n.d.). Retrieved November 11, 2015, from https://www.nsf.gov/funding/pgm_summ.jsp?pims_id=504739
9 About | Human Nature Lab. (2015). Retrieved November 11, 2015, from http://humannaturelab.net/about/
10 Stanford Social Innovation Review: Informing and Inspiring Leaders of Social Change | Stanford Social Innovation Review. (2015). Retrieved November 11, 2015, from http://ssir.org/
11 About IDEO. (2015). Retrieved November 11, 2015, from https://www.ideo.com/about/
Yale Global Health Review 