Benefits of Healthcare Cooperation between U.S. and India

Published in Knowledge@Emory

 

In order to be effective, health interventions in developing countries have to be low-cost. Though the scale may be different in the U.S., healthcare costs here have long been a major concern, spiraling upwards and contributing to inequities in access and burgeoning health problems among the largely under- and uninsured. Working together on innovations to solve this issue is just one example of how healthcare cooperation between developing and developed countries can benefit both parties.

Speaking at the Emerging India Summit, held recently at Emory University, Dr. K.M. Venkat Narayan, Ruth and O.C. Hubert Professor of Global Health & Epidemiology at the Rollins School of Public Health and professor of medicine at Emory's School of Medicine, explained how a mutual area of interest—like cost—can make connections between the U.S. and countries like India very valuable. "Vaccines have been produced in developing countries for pennies," said Narayan. "Cancer screenings were extremely expensive, but the cost has been reduced several fold; similarly, the costs of testing glucose and developing physician software to manage the complex process of diabetes care. Developing and testing in those developing countries that have substantial technical know-how and then expanding to richer countries is a very feasible model."

He also noted that the speed of discovery is enhanced when researchers from both countries are working together on an issue—when it is night in the U.S., it is day in India and vice versa, providing a 24-hour window for research.

Funding for diabetes and cardiovascular diseases in countries like India is limited, however, since these diseases are seen as concerns of rich countries and, unlike infectious diseases, do not cross borders physically, said Narayan. "In today’s world, we have to start conceptualizing no longer communicable diseases but communicated diseases. There is research suggesting that the communication channels and social networks that spread these diseases—such as CNN broadcasting ads for fast foods—are very powerful."

Collaborations between the U.S. and India can also be hampered by differences in business cultures, said Narayan. India inherited the British bureaucratic system, which is process oriented rather than results oriented.

"The Indian paranoia is, 'If I collaborate with you, will you take over?' The U.S. paranoia is 'Why should we invest in you? We have our own problems.' Opening this conversation is the beginning of the process to a solution," he remarked.

Also speaking at the summit, Dr. Bhagirath Majmudar, professor of pathology & laboratory medicine at Emory shared some of his observations on medical education in India. He noted that many of the country’s medical schools and libraries are poorly equipped, with students using books seven and eight years old. On the other hand, fancy gadgets flow into the teaching hospitals. "I call them 'ribbon-cutting ceremony gadgets,'” he said. “You can have a minister come there and get the applause, and the gadget or instrument is uncovered and seldom used again. Meanwhile there is a scarcity of necessary tools."

Majmudar also related growing concerns that new medical schools are emerging without vigilant quality control and that teachers have become less accessible.

"When I was a teacher, we were not allowed to practice in a private setting, and we got paid for that. Now the government says it can’t afford it—let them practice—so now most of the teachers’ offices are empty. They are out there practicing instead of teaching. Dangerous." He suggested that a Flexner-like quality report would be helpful in eliminating substandard schools.

As India’s economy has rapidly expanded, another worry has emerged: “An alarming increase in the number of vehicles on the road has not been matched with a corresponding increase in the number of physicians and trauma centers specifically trained to treat trauma-related injuries,” said Majmudar.

One way to address the existing—and future—shortage of physicians, he suggested, is “to create an army of health workers—not full fledged doctors, but medical workers capable of catering to the basic health needs of people, especially those in rural areas.”

He also proposed “a concentrated focus on public health and health education to help prevent a whole gamut of diseases rampant in both cities and villages.” Medical students could be encouraged to specialize in public health, he added, and “collaboration with western countries in furthering public health initiatives in India would be very valuable for all concerned.”

Majmudar said he is happy to see strong family support for female medical students in India and he has hopes for a formal program where more students from U.S. medical schools could volunteer in India to learn about the country’s culture and health needs. "They would love it!" he concluded.

In response to a question about why healthcare collaboration between the U.S. and developing countries succeeded in the AIDS crisis, moderator Dr. James Curran, dean of the Rollins School of Public Health, said that HIV/AIDS was a case of a new problem that was spreading fast, attracting new scientists and new money.

"When you went to an international AIDS conference you would see half of the American scientists saying we need to be doing research overseas, forming the IRBs and processes," he said. "There was a huge lobbying effort by American scientists. And it was an American problem as well, unlike, say malaria, which is not perceived by American scientists as a major public health problem."

Founded in 2010, the Emerging India Summit was created by faculty and students at Emory University to showcase India’s rising geopolitical and economic star, and to foster deeper bonds between Emory and India.

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