Fogarty program HEEDs the call to action.

Interdisciplinary research designed to inform international policy decisions on health, economic, and environmental ills got a boost last fall with the September 2003 award of the first-ever Health, Environment, and Economic Development (HEED) program grants by the NIH's John E. Fogarty International Center (FIC). HEED grantees are joining together across disciplines and continents to outwit the seemingly intractable health problems--ranging from rising infant mortality rates to a resurgence of malaria epidemics--that face developing countries.

The mission of the FIC, established in 1968, is to reduce disparities in global health by promoting and supporting scientific research and training. "We developed the HEED program in close collaboration with colleagues at the NIEHS because we saw the need for data to better understand the linkages between health, economic development, and environmental degradation," says Sharon Hrynkow, acting director of the FIC. Today the program is supported by the FIC, the NIEHS, the National Institute of Child Health and Human Development, and the NIH Office of Behavioral and Social Sciences Research, with the U.S. Geological Survey providing technical expertise. HEED extends two other FIC programs: International Studies in Health and Economic Development, which seeks to bridge the gap between life science and social science, and the International Training and Research Program in Environmental and Occupational Health, which builds scientific capacity in developing countries [for information on the latter program, see "Building Self-Reliance in Environmental Science: The ITREOH Experience," EHP 111:A460-A463 (2003)].

HEED supports projects that "look at how economics affects the environment and how those environmental changes harm human health," says program officer Rachel Nugent. "Instead of just focusing on environmental exposures that affect health, we're saying, 'Let's look more broadly at what's driving the environmental change in the developing country, such as economic factors that influence people's decisions about both health and the environment." In the case of dam building, for example, the decision to construct a dam to provide energy to a growing economy may be supported by cost-benefit analysis on the basis of energy needs versus environmental impacts. But construction may be less advisable when the health impacts of the environmental change are factored in to the analysis.

Project Particulars

This first round of HEED projects includes 11 pilot projects, none of which will exceed two years or $100,000 per year in direct costs. When the researchers finish these prior projects, they may apply for a five-year HEED grant to continue their research.

The projects vary in size from 4 to 12 key personnel. Each project team must have at least one member from the health, social, and environmental science disciplines, and must employ approaches from the behavioral, social, environmental, and biomedical sciences. In addition, each team must be multinational. The HEED program requires grantees to perform capacity building, expanding the skills and knowledge base of team members from developing countries. This would include, for example, ensuring that team members can get credit toward graduate degrees while working on the project or have opportunities to publish, says Nugent.

Policy recommendations are a key outcome of HEED projects. Grantees examine local and national policy issues so they understand the concerns of policy makers before undertaking their research. During the execution of the project and upon its completion, grantees communicate with policy makers and provide data and policy recommendations as needed.

The Program in Action

In one project funded by HEED, Sioban Harlow, an associate professor of epidemiology at the University of Michigan School of Public Health, and her Mexican and U.S. colleagues are examining links between industrialization, urbanization, and infant health in the U.S.-Mexico border towns of Nogales and Hermosillo. Both of these towns are home to maquiladoras, communities that have grown up around the foreign-owned assembly plants that dot the border. Maquiladoras are marked by their poor housing, inadequate water and sewer systems, and insufficient infrastructure to dispose of industrial waste.

Although economic indicators in these regions have improved, infant death rates in some border cities are almost double Mexico's national average, which in 2002 was 13.8 deaths per 1,000 live births. The health effects of economic growth in these northern towns had gone unanalyzed, despite growing evidence of serious deficits in the urban and environmental infrastructure, says Harlow. "Just looking at economic growth doesn't answer the question about whether the development is successful," she says.

Using data collected from maps, the U.S. Census, city archives, and interviews with residents, the team will develop an index of socioenvironmental vulnerability, which rates how well communities can sustain environmental assaults, based on such factors as their economic condition and family support systems. The team will map both vulnerability levels and infant mortality rates to see if an association exists between the two, and then develop strategies for identifying and protecting at-risk populations. If the pilot project is successful, Harlow and her colleagues will use the approach in 8-10 other maquiladora communities.

Further south, HEED grantee Max J. Pfeffer, a professor of development sociology at Cornell University's College of Agriculture and Life Sciences, and colleagues from Cornell, Princeton University, and Brazil's Center of Development and Regional Planning are studying the factors that contribute to the spread of malaria and other diseases in the frontier areas of Brazilian Amazonia. There is considerable road and dam construction, with accompanying deforestation, as the natural resources of this region are being developed. According to Pfeffer, when settlement began in 1984, 100% of the area was virgin forest. By 1999, that figure had dropped to about 58%. The rapidly changing habitat leads to ecologic imbalances that ultimately result in rises in vectorborne disease. Although the dangers of deforestation to the global environment have been well documented, knowledge of the human health-environment relationships within Amazonia is limited, says Pfeffer.

In addition to looking at how changes in land use affect human health, the team is analyzing the effect of social networks and government programs on treatment for malaria. Disease eradication strategies in Brazilian Amazonia that rely heavily on insecticides, particularly DDT, have not halted malaria epidemics. But more recent approaches involving socioenvironmental control and management have enabled public health workers to concentrate efforts in areas with higher risk, promoting more cost-effective interventions for malaria control and significantly decreasing transmission of the disease. Some of the actions included in successful socioenvironmental programs have included reorganizing health agencies at local and state levels, increasing local community participation and knowledge about the disease, and investing in personnel, equipment, and training.

Pfeffer points out that the success of interventions depends on their joint utilization. "No environmental intervention alone will solve the problem of malaria transmission if adequate social structures are not in place," he says. "Similarly, behavioral changes, no matter how appropriate, would not be enough to avoid a high risk of malaria transmission if environmental controls were not implemented." Eventually the team plans to expand their approach to address other diseases, such as dengue.

Local residents are very receptive to the researchers' efforts, Pfeffer notes. Team members work closely with residents, asking about their health and their strategies for protecting themselves from infection; in collaboration with in-country professionals, they are also searching for new approaches to lower residents' risk of developing malaria. "We have to work carefully to show them what we are doing is for them, and that we are not taking anything away [from them]," he says.

A Healthful Collaboration

Although policy makers may nod in approval at the idea of taking an interdisciplinary approach to solving the environmental health problems of developing countries, few opportunities to develop such strategies actually exist, Pfeffer says. Most institutions don't support such research, and scientists themselves are often very focused on their own disciplines, he says.

Leslie London, an associate professor of public health at the University of Cape Town who received a HEED program grant to study the costs and benefits of pesticide use in Tanzania and South Africa, agrees. "Many researchers remain locked in their own disciplinary cocoons, while others actively seek cross-disciplinary links," he says. He adds, "For [our team], some of our most valuable learning experiences have been in collaboration with colleagues outside of usual disciplines."

Other researchers are starting to catch on, as well, which is good news for the future of environmental health research and the problems it addresses. "The value of interdisciplinary research to solve environmental problems is increasingly recognized, including by the National Academies," says Nugent. "We are beginning to make good progress in providing opportunities to solve these complex problems using a multifaceted approach."

HEED Awards: Leaders & Topics

Leslie London (University of Cape         Pesticide use in South Africa
Town, South Africa) and Melissa Perry     and Tanzania, including
(Harvard University)                      farmers' perceptions of the
                                          risks of pesticides

Max Pfeffer (Cornell University) and      Links between economic
Diana Sawyer (Center of Development       development, environmental
and Regional Planning, Brazil)            degradation, and malaria in
                                          Brazilian Amazonia

Jeffrey Griffiths (Tufts University)      Cost-benefit analysis of
and Fernando Sempertegui (Ecuador         public policy strategies to
Biotechnology Center)                     resolve and counter the
                                          health effects of pollution
                                          in Quito, Ecuador

Sioban Harlow (University of Michigan)    Association between rising
and Catalina Denman (El Colegio de        infant mortality and deficits
Sonora, Mexico)                           in urban environmental
                                          infrastructure in maquiladora
                                          communities along the
                                          U.S.-Mexico border

Alan Krupnick (Resources for the          Changes to health outcomes as
Future), Ramanan Laxminarayan             a result of a tradeable
(Resources for the Future), and           emissions permit program in
Zou Shoumin (Chinese Research             Taiyuan, China
Academy of Environmental Sciences)

Kenneth Ward (University of Memphis)      Social, economic, and
and Wasim Maziak (Syrian Society          environmental conditions of
Against Cancer)                           the large urban encampments
                                          of recent immigrants from the
                                          Syrian countryside

Burton Singer (Princeton University)      Community-based vector
and Richard Mukabani (University of       control for controlling
Nairobi, Kenya)                           malaria in a small town in
                                          Kenya

Michael White (Brown University) and      Interrelationships among
Kofi Awusabo-Asare (University of         urbanization, lagoon water
Cape Coast, Ghana)                        quality, fish catches, and
                                          human health in coastal Ghana

Lori Leonard (The Johns Hopkins           Impact of the Chad-Cameroon
University) and Grace Kodindo             Petroleum Development and
(University of N'djamena, Chad)           Pipeline Project on the
                                          health, economies, and
                                          decision making of households
                                          in three affected communities

Stuart Batterman (University of           Relationship between
Michigan) and Rajen Naidoo (University    environmental pollutants,
of KwaZulu-Natal, South Africa)           overall quality of life
                                          (including health), and
                                          economic conditions in a
                                          highly industrialized area
                                          of South Africa

Reeve Vanneman (University of             Impact of air and water
Maryland), Sonalde Desai (University of   pollution on maternal and
Maryland), Abusaleh Shariff (National     child health in India,
Council of Applied Economic Research,     including how social
India), and R. Uma (The Energy and        inequalities, gender, and
Resources Institute, India)               poverty affect exposure
                                          levels, and how public policy
                                          affects health risks

For more information on the HEED program, visit http://www.fic.nih.gov/programs/HEED.html