Center for Global Health Equity Inaugural Impact Report 2022 - Interdisciplinary Solutions to Advance Global Health
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Center for Global Health Equity Inaugural Impact Report
2022
Interdisciplinary Solutions to Advance Global Health
Inaugural Impact Report | 2022
University of Michigan
Center for Global Health Equity
staff
Director Joseph C. Kolars
Senior Advisor John Z. Ayanian
Managing Director Amy Conger
Administrative Specialist Kelly Espinoza
Finance Lead Parina Kamdar 5 44 39
Communications Manager Josh Messner
Administrative Advisor Tania Piotrowski
Project Manager Kristina Rice
Contents
Education & Outreach Alana Rodriguez
Program Manager Center History 2
Project Manager Christabel Sefa
Investing for Impact
faculty leadership team The Impact Scholars Program 4
Omolade Adunbi, Stomach Bugs, Diarrhea, and Other Paths 6
College of Literature, Science, and the Arts to Global Health Work
Sue Anne Bell, School of Nursing To Be a Good Steward: Strengthening Systems 9
Matthew L. Boulton, for Healthier Women and Communities
School of Public Health
Learning the Many Languages of Global Public Health 12
Paul Clyde, William Davidson Institute
Data Science and Emerging Tech for Earlier Interventions 15
Joseph Eisenberg, School of Public Health
Advancing Healthy Aging in Africa 17
Mary Gallagher,
College of Literature, Science, and the Arts Contextualized Engineering Design for Better Health 20
Gary Harper, School of Public Health Advancing Governance and Citizenship 26
Cheryl Moyer, Michigan Medicine in the Ugandan Health Sector
Amy Pienta, Institute for Social Research Innovative Approaches to Global Vaccine Equity 30
Lee Schroeder, Michigan Medicine
Building Community
Akbar Waljee, Michigan Medicine
Events that Build Community 33
© 2023 Regents of the University of Michigan
Engaging Students 37
The Regents of the University of Michigan
Jordan B. Acker, Michael J. Behm, Mark J. Bernstein, Journeys in Global Health Equity 37
Paul W. Brown, Sarah Hubbard, Denise Ilitch, Ron Weiser,
Katherine E. White, Mary Sue Coleman (ex officio).
Equitable Partnerships
Nondiscrimination Policy Statement
The University of Michigan, as an equal opportunity/affir- On Campus with Lukoye Atwoli 38
mative action employer, complies with all applicable federal
and state laws regarding nondiscrimination and affirmative Top Tweets 41
action. The University of Michigan is committed to a policy
of equal opportunity for all persons and does not discrimi- How We Approach Impact 42
nate on the basis of race, color, national origin, age, marital
status, sex, sexual orientation, gender identity, gender Committed to Changing the World: 44
expression, disability, religion, height, weight, or veteran The Global Legacy of Tachi Yamada
status in employment, educational programs and activities,
and admissions. Inquiries or complaints may be addressed
to the Senior Director for Institutional Equity, and Title
IX/Section 504/ADA Coordinator, Office for Institutional
Equity, 2072 Administrative Services Building, Ann Arbor,
Michigan 48109-1432, 734-763-0235, TTY 734-647-1388, Cover: Center member Jody Lori—professor of Health Behavior and Biological
institutional.equity@umich.edu. For other University of Sciences in the U-M School of Nursing—learns about community health visits
Michigan information call 734-764-1817 for expectant mothers in Butaro, Rwanda.
A Global Movement to Advance Equity in Health
Can you imagine a world where health is not an obstacle to education, employment,
and the pursuit of a fulfilling life?
At the Center for Global Health Equity, we can envision such a world. And with
our many partners around the globe, we are pursuing novel, interdisciplinary
solutions to some of our most daunting health equity challenges.
What’s different about Michigan’s approach to global health? Our founding donor,
the late Tachi Yamada, was so passionate about health equity that our Center is one
of the few to include equity in its name. We are motivated by a conviction that,
while our health is greatly influenced by the circumstances into which we were
born, these barriers can be overcome. While the Center opened its doors during
the pandemic, and we mourn the loss of Tachi, we are now operating at full speed
to fulfill our charge. As you read about our early successes in this inaugural Impact
Report, we hope you will appreciate some unique elements of the Center.
We partner differently. Our partners in low- and middle-income countries define
our partnerships and projects. They identify the most critical needs in health
equity for their communities and develop the research questions that guide
our shared work. We are committed to sharing resources and ensuring that our
partners benefit from Center funding and enabling structures. We have members
around the world, and they confirm with us that our approach to global health
collaboration is different.
We support a movement. We prioritize and invest in projects that advance the
global health equity movement in every way possible. Our work strengthens
systems to improve health and health equity, informs public policy, creates new
technical solutions for community health, and empowers women as health leaders
in their communities. We know there are ways to solve the seemingly intractable
Joseph C. Kolars, MD, MACP
problems that plague global health, and we are committed to finding them.
Director, Center for Global
We maximize our resources. We are doing all of this while based at the University Health Equity
of Michigan, the leading public research university in the US. By leveraging Senior Associate Dean and
Professor of Medicine
the unique strengths of this excellent institution, we reach across disciplines to
create solutions. In addition to supporting innovative research, we have launched Josiah Macy Jr. Professor of
Health Professions Education
educational opportunities for our students and extended training and capacity
University of Michigan
sharing pathways for global partners. These efforts are changing the way we do
global health work. This is a big part of the movement—changing the model itself.
We are dreaming big. Because this is our inaugural impact report, we have
included an overview of the Center’s history (see page 2). We are proud of the
foundation we have built and are preparing to take some big next steps. We
engage more faculty and global partners every month. Our research models are
constantly evaluated and improved so that our partnerships set the standard for
collaboration and co-design. We have already deployed a series of seed grants
that have led to much larger national and international grants, many of which
include global research partners as lead investigators. And we are developing new
models for student engagement to prepare future generations of researchers to
be leaders in the global health equity movement.
Amy Conger, PhD
When we are successful, people in the communities we engage will live longer, Managing Director, Center
healthier lives. for Global Health Equity
Faculty Associate, Center
Thank you for supporting the movement. for the Study of Higher and
Postsecondary Education
University of Michigan
Collaborating across campus and
2016
Exploratory conversations begin between
Tachi Yamada and Joe Kolars about a new
U-M Center for Global Health Equity.
2017
Tachi Yamada meets with U-M leadership
to discuss a catalytic gift to initiate a
Tachi Yamada in India. Center for Global Health Equity.
2019
June. Joseph Kolars and John
Ayanian convene meetings with
diverse stakeholders across three U-M
campuses exploring the idea of a new
Center for Global Health Equity.
October. University of Michigan publicly
announces $10 million gift from Tachi
and Leslie Yamada in support of global
health equity.
John Ayanian, Tachi Yamada, Leslie Yamada,
and Joseph Kolars in 2019.
2020
September. Center opens with offices
on U-M North Campus. Interdisciplinary
Challenge Groups convene with
emphasis on four thematic areas.
Provost Carl Amrhein of Aga Khan University and
Center director Joseph Kolars holding signed copies of October. Partnership launched with Aga
a memorandum of understanding. Khan University.
December. Center reaches 150 members.
2 Global Health Equity at the University of Michigan
around the world to improve health
2021
March. Center launches pilot funding
program for Challenge Group Grants to
advance high-impact projects.
August. Passing of Tachi Yamada, the
Center’s founding donor.
September. Impact Scholars program
launched. Ryan Rego, Victor Rateng, Leon Espira, and Purity Muthoni
with Lukoye Atwoli—dean of the Aga Khan University
October. $6.5M NIH grant for the Medical College, East Africa—on U-M campus.
UZIMA-DS (data science) project with
partners at Aga Khan University in Kenya.
$6.5M NIH grant for the Heat and Health
African Transdisciplinary Center (HE2AT) 2022
project with partners at Aga Khan
University in Kenya, IBM Research Africa, February. Global Vaccine Equity Ideas Lab
the University of Cape Town, and the convened on Ann Arbor campus. Center
University Peleforo Gon Coulibalu. delegation visits partner sites in Uganda
and Kenya.
March. $338K NIH grant for Longitudinal
Study of Health and Aging in Kenya
(LOSHAK) with partners at Aga Khan
University in Kenya.
April. Center reaches 250 members.
CGHE Community Gathering, the
Center’s first in-person event.
May. $440K NSF grant for Characterizing
the Use of Contextual Factors during
Engineering Design project.
The Empowering Women and Communities Challenge September. Seed Grant and Impact
Group meets on north campus to discuss recent
project work and new collaborations.
Accelerator Grant programs launched.
November. Center delegation visits partner
sites in Rwanda. Collaboration launched
with Rwandan Ministry of Health.
Center co-hosts Ghana-UM Conference
for Global Health Collaboration in Accra.
Impact Report 2022 3
Investing for Impact
Our version of a postdoc program is different.
“Being an Impact Scholar with the
Center allows me to dream about
“My time with the Center has
turned everything on its head,
creative interventions and have the helping me understand more
support to turn those possibilities fully how my research can
into realities that improve the change human lives. ”
health of communities. ” —Leon Espira, PhD
—HaEun Lee, PhD
Espira in Kakamega, Kenya, with his father, Abraham
Lee with community research leaders Angella Tushabe Espira, founder and director of Kakamega’s Nala
and Christian Atuhaire preparing to facilitate focus group Community Hospital, a key provider of obstetric and
discussions in the Bushenyi region of Uganda. gynecological services in Kakamega County.
4 Global Health Equity at the University of Michigan
The Impact Scholars Program
The Impact Scholars program prepares exceptional in academia, government, civil society,
early-career scholars for work in global health or advocacy as effective, influential leaders.
research and program development, with a focus on
Working with University of Michigan faculty
measurable impact in low-resource settings.
mentors, scholars engage in projects that involve
Impact Scholars build coherent bodies of their own interdisciplinary collaboration across two or more
work and prepare for successful global health careers themes that have been prioritized by the Center.
“What makes this program truly unique is how it encourages
us to conduct research that pursues impact and to focus
on independent scholarship rather than following traditional
approaches to research and scholarly publishing.
—Ryan Rego, PhD
”
Rego at Leda, Camp 24, Cox’s Bazar Refugee camp in Bangladesh with research
partners—Sirajul Islam, Ashok Barman, and Kabir Ahmed—conducting meetings
with community leaders to refine their survey on vaccination decision making.
Impact Report 2022 5
Rego at the Diarrhea Treatment Centre in the Leda refugee
camp in the Cox’s Bazar camp complex, Bangladesh.
Stomach Bugs, Diarrhea, and Other Paths
to Global Health Work
When Ryan Rego visited family in Pakistan as a child, As an undergraduate at Case Western Reserve
University, I majored in economics and became very
he wondered why he had to be so careful about
interested in development economics. I also wanted
what he ate and drank. This unpleasant but effective to attend medical school to become an emergency
introduction to health inequity led Rego to study room physician—the fast pace and broad knowledge
gastric conditions and diseases. required resonated with me like nothing else.
While at Case Western, I shadowed Justin
Yax, an emergency medicine physician who
As a child, I could never understand why in Pakistan
was also director of the Emergency Medicine
I had to be so careful to eat only hot food and drink
department’s fellowship in humanitarian aid. Yax
only bottled water. Back home in London, everything
was an experienced responder to humanitarian
was safe to eat.
emergencies, and we found ourselves discussing the
field of humanitarian aid more often than emergency
Disease Matters
medicine. He recommended I consider studying
Growing up, my family made frequent visits to public health, and I fell in love with the field while
Pakistan to visit my grandparents. Without fail, on earning an MPH.
each trip, I would eat or drink something I’d been
warned not to and would get a stomach bug. (We’ll Research Matters
come back to the possible outcomes of stomach
Public health combines nearly any discipline—for me,
bugs later.)
medicine and economics—in such effective, problem-
This confusion—and later frustration—with the solving ways that I set aside the path of becoming a
inequity stuck with me, and it still bothers me today. physician for a career as an epidemiologist.
6 Global Health Equity at the University of Michigan
Investing for Impact
“I sought a path that would ensure my research could continue having a positive
impact on human communities and also on how we do research.”
MPH in hand, I moved to Johannesburg, dollar trials claiming that the provision of safe
South Africa, to work for Population Services water and proper hygiene facilities—such as
International, a large global health NGO with pit latrines—did not impact the rate of diarrhea
a focus on reproductive health. I would learn a among children under five.
lot about international health research.
The main critiques of these studies focused
Research can be used to inform public health on the quality of the interventions. We thought
programs directly, which in turn can improve that something else was at play, namely, how
people’s lives. the outcome itself—diarrhea—was defined and
measured.
Research can also have a dark side, if we’re not
careful. When researchers from high-income As was the norm, these study teams had asked
countries conduct studies without true local parents, very simply, if their child had had
engagement—using my colleagues in South diarrhea at any time in the past three weeks.
Africa as little more than a mailbox for IRB But parents might
applications and HR for field workers, despite 1. not understand what diarrhea is
these colleagues being internationally esteemed 2. forget whether their child had diarrhea
and respected researchers—it is little more than 3. not want to answer honestly.
a mechanism through which colonial legacies of
power and exploitation continue to play out. All three were indeed the case, as my
colleagues and I were able to show.
In South Africa, I saw papers get published
where local experts had conducted most or all But another, more important, factor was at
of the work while foreign researchers took the play in assessing the two 2018 studies: the
desired positions of principal investigator, lead interventions used in the trials were not directly
author, and so on. related to diarrhea but instead to enteric
infections generally. That is, these studies had
Coming to the end of my contract in South used diarrhea as a proxy for enteric infection
Africa, I desperately wanted to work in the and from there to evaluate the interventions.
humanitarian aid space but had difficulty
finding jobs. I decided that further schooling But is diarrhea a good proxy of enteric
would be an effective way to contribute to the infection? As we see with COVID, the
field and moved back to the UK to pursue a relationship between a disease and its
PhD in epidemiology. symptoms is complex.
• Having a cough does not mean somebody
On my first day as a PhD student, my supervisor
definitely has COVID
let me know he was most interested in either
pre-hospital care or diarrheal disease. Thinking • Feeling 100% in good health does not
back to my childhood experiences visiting mean someone is COVID free
Pakistan, the choice was obvious: diarrhea. We demonstrated the same for diarrhea—
it does not make a good proxy of enteric
Diarrheal Matters infections because evaluating symptoms and
As I began my PhD in 2018, the world of water, interventions is too complicated.
sanitation, and hygiene (WASH) was rocked
The impact of our work on how other research
by the results of two large-scale, multi-million
teams might approach future studies of
Impact Report 2022 7
Investing for Impact
diarrheal diseases—which affect millions many publications we postdocs can produce
of families every year and kill around 1.5M in a year nor in how much work we can do on
children each year—helped see the importance various topics regardless of our level of interest.
of research that accounted for human
Instead, we are asked to conduct high-quality
experience, including how study participants
research that has a clear line of sight to
experience an intervention and might report
impact—to clearly defined outcomes that can
information about their family’s health.
improve lives. Anyone doing a postdoc in
As my PhD work came to an end, I sought a the health sciences knows what an incredible
path that would ensure my research could opportunity this is. I have the privilege in this
continue having a positive impact on human program of working among and alongside
communities and also—whenever possible— displaced populations in low- and middle-
on how we do research. income countries, with excellent support
and mentorship from University of Michigan
I was delighted to discover the Center for faculty and staff and, most importantly, from
Global Health Equity’s Impact Scholars faculty and staff in the countries where we are
program, which is interested not only in how privileged to co-design and co-lead research. n
Rego (second from right) in an urban informal settlement in the Mirpur neighborhood of Dhaka, Bangladesh, with
research colleagues, including faculty from the International Centre for Diarrhoeal Disease Research, Bangladesh.
8 Global Health Equity at the University of MichiganTo Be a Good Steward
Strengthening Systems for Healthier
Women and Communities
HaEun Lee spent years observing how she was perceived
and treated, especially as a woman, in the various settings
where she has lived. Her research aims to empower women
and change social contexts so that we value women and
their health more in all the decisions we make.
Lee with Sister Dr. Priscilla Busingye—obstetrician and gynecologist and
fistula surgeon at Saint Francis Hospital in Nsambya, Uganda—on a site
visit to a camp that provides free postpartum surgical procedures.
Impact Report 2022 9After my first year of college, I traveled This poignant encounter in South Africa has
to South Africa with a group of friends to stayed with me not only because of the details
volunteer in the townships of Johannesburg. of human suffering but because such stories are
On our way from one settlement to another, all too common, especially for those who are
I met a young woman about my age sitting made vulnerable by the contexts of subjugation
on the side of the road. We had a brief that pervade our communities. The story
conversation in which she shared with me reminds me how difficult life is for so many of
some of the harrowing details of why she was us, and that awareness motivates me to remain
there and not able to be safely at home with focused on the community health engagement
her family. work I conduct as a researcher.
While I struggled at the time to find something
A Bedside Steward Moves
to say, I was feeling many things. I felt
powerless because I didn’t know what to say
into Research
to her and because I knew larger systems I was born in South Korea and, due to my
of oppression were behind her health crises parents’ jobs, had moved more than twenty times
and those of many other women and girls. before graduating high school—between seven
I felt shame from the stark contrast of our countries, attending twelve different schools,
circumstances, knowing they had little to do and using three different languages in class.
with our own merit or worth and everything to Throughout this time, I was observing how I was
do with larger social circumstances over which perceived and treated, especially as a woman.
neither of us have control.
My experiences in South Africa were part of a
More than anything, I felt a sense of larger process of career discernment for me. I had
responsibility—that I needed somehow to already committed to nursing and art majors, two
become a better steward of the privileges I had fields that can tangibly, practically touch people’s
been given. lives. During senior-year clinical rotations—with
Lee on a tour of the simulation
lab at the Virika School of
Nursing and Midwifery in Fort
Portal, Uganda.
10 Global Health Equity at the University of MichiganInvesting for Impact
“Women are painfully aware of the privileges we do and do not have.
With the privileges I have, I am choosing to move through my research career
with a sense of stewardship and responsibility.”
my experiences from South Africa and many have the medication, equipment, and trained
other contexts in my heart and on my mind—I staff whenever and wherever men, women,
began to study in more depth the systemic, and children need them. And we believe that,
structural, and policy-level issues that contribute by empowering local community members
in every way to human illness and health. and politicians to work together in constructive
ways, this project can help improve the overall
As much as I had loved working closely with quality of Uganda’s rural healthcare.
patients, I realized that working as a bedside
nurse would no longer be my path. I became
involved with nursing research, focusing on Research with Hope
women’s health in minority populations. I joined When asked about my passion for research,
a research team working with local, low-income I share how hopeful I remain that good
women on basic menstrual, contraceptive, and research and evidence-based policy can help
other reproductive education. And I worked on women around the world better protect and
a pilot project educating women in underserved promote their own health and the health of the
communities about coping mechanisms for systems and cultures around them, including
depression and anxiety. their own family. In valuing women and their
health, all people and communities have a
As a doctoral student at the University of
better chance at living up to their potential.
Michigan School of Nursing, I worked on
improving access to reproductive health Women are painfully aware of the privileges
services. In my focus region—rural areas of the we do and do not have. With the privileges
central African country of Zambia—I learned I have, I am choosing to move through my
that many pregnant women there do not have research career with a sense of stewardship
basic financial means, not even enough to and responsibility.
secure transportation to a clinic, pay for basic
medications, and purchase baby clothes. Even It has been almost a decade since I sat down
in financially stable families, husbands control with the young woman in South Africa. She
family resources and often will not prioritize was kind and generous to share her story with
expenses related to pregnancy and childbirth. a stranger. Sadly, her story is far too common.
As an Impact Scholar with the Center for Global But I live in hope. I do not yet know, fully,
Health Equity, I work on an interdisciplinary what kind of life I must live to say I was a
research team pursuing novel health good steward of all I’ve been given. I do
governance approaches in Uganda. We know that, compared to ten years ago, today
facilitate regular meetings between community I feel more empowered, less ashamed, and
members and politicians where community extremely motivated to help women and their
members express health care needs and communities be their fullest, healthiest selves.
politicians share policy plans and progress.
My research will continue to address the larger
We train politicians on how to monitor and
schemes of empowering women and changing
supervise the implementation of research and
our social contexts so that we value women and
community information. The primary goal of
their health more in all the decisions we make. n
the project is ensuring clinics in rural areas
Impact Report 2022 11Espira (center) with a Center delegation in Nairobi, Kenya, learning about diagnostic
radiology capabilities on a tour of Aga Khan University’s Cancer Center.
Learning the Many Languages of Global Public Health
Human health is more than what we can define using I was born in Kenya of mixed parentage. My mother
studies and metrics, says Leon Espira. Our health is a is Russian, while my father is Kenyan. I was afforded
reflection of our interactions with others as we seek the luxury of growing up in an atmosphere that
enabled me to define myself not by cultural norms
better lives for ourselves and our loved ones.
but as the sum of all the cultures I straddle. Russian
was my first language, Swahili my second, and
Though I am a scientist by training—with a passion English I only learned in school.
for discovery, analysis and understanding—I realize
that the things that make us human are often not In as much as language defines our perspectives,
tangible or quantifiable. I continue to see the world through my mixed
heritage as well as these commonalities that are
Human health is more than what we can define inherent in all of us.
using studies and metrics but rather is a reflection of
our interactions with others as we seek better lives In my late teens I moved to Winnipeg, Canada, to a
for ourselves and our loved ones. world much removed from my childhood contexts.
But with the common threads and common
It is this recognition that has steered me in the languages that bind all humans together, I found
direction of public health. Knowing that human making friends to be relatively easy. Soon enough, I
health is about more than data helps me approach felt comfortable defining myself as Canadian.
my work with a certain humility, one that recognizes
a key truth in life—all the people I work with, in many After completing a masters degree in cardiac
ways, seek the same things I do. physiology, I worked as an outreach coordinator in
12 Global Health Equity at the University of MichiganInvesting for Impact
“Epidemiologists, like many researchers in public health, speak several languages.”
underprivileged communities in Canada. I then research as such can only enhance our mission
took a job in the Netherlands and, while there, of advancing the health of people in communities
volunteered as a language coach. In these around the world.
roles, my own privilege became clear to me,
Because I know that research can only partly
as did the bidirectional nature of outreach and
describe the human experience, I am glad
volunteer work.
to be an epidemiologist. Epidemiologists,
I have encountered many people during this like many researchers in public health, speak
journey and recognize that the difference several languages. I’ve learned the languages
between many of them and myself is tiny—yet of infectious disease, public policy, economics,
I was afforded privileges that many do not medicine, and ecology. And these help me
have. Kenya, however, remains my defining converse as a bidirectional researcher—trying
experience. Being Kenyan grounds how I see to help communities understand disease and
myself and the world—despite all the distance I prevent it, while at the same time learning
have traveled from my childhood. from the communities to become a better
epidemiologist.
As I look to a career in global health, I continue to
reach back to and draw upon these experiences. It is this versatility in public health that attracts
They give me a sense of perspective. Research, me most—all the languages I get to speak and
too, is inherently bidirectional, and embracing all the perspectives those languages offer. n
Espira (right) with John Luseno
(far left) and Hardley Malema
(center) from Eco2librium visiting
a household in Kakamega County,
Kenya, to learn about water and
sanitation access in rural areas.
Impact Report 2022 13Leveraging Expertise for Larger Funding Opportunities We take individual projects with big potential and connect them with others, adjusting the approach to amplify impact. The University of Michigan knows how to go after major external grants that help our researchers and our partners advance global health equity. Securing external revenue from funding sources like the National Institutes of Health and the National Science Foundation allows our global partners to address these wicked problems. Felix Agoi (right), AKU’s field coordinator, with Josh Ehrlich, research assistant professor with the U-M Institute for Social Research in Kilifi, Kenya, on a site where pilot testing for LOSHAK is being conducted. Agoi and Ehrlich were part of a team that received an NIH grant with seed funding from the Center.
Aga Khan University, Nairobi.
Data Science and Emerging Tech
for Earlier Interventions
Psychology + Medicine + Data Science + Public Health
In partnership with the Center, Aga Khan University and newborn health and mental health. It will also
received a $6.5 million NIH grant to establish a leverage machine learning, an application of artificial
intelligence, to identify creative solutions to aid
cutting-edge data science hub, which has broad
health service providers and policymakers within
implications for implementing new technologies
resource constrained environments.
across the continent.
“Early identification and intervention are critical
Aga Khan University (AKU) is the recipient of a to a good prognosis for all health conditions,”
$6.5 million grant to establish a cutting-edge data said Amina Abubakar, professor of psychiatry and
science hub which will use artificial intelligence, director of the Institute for Human Development
machine learning, and other emerging technologies at AKU and co-principal investigator. “However, in
to improve health and care delivery in local many low- and middle-income countries (LMICs)
communities. there is a dearth of tools that can be used for early
identification of women, children, and young adults
Utilizing Health Information for Meaningful impact at risk of poor physical and mental health.”
in East Africa though Data Science (UZIMA-DS) will
be the first initiative of its kind in the region. Funded The UZIMA-DS project will be a game changer in
by a grant from the US National Institutes of Health two ways, Abubakar says, “First, we will leverage
(NIH), the program will be led by AKU with partners existing data to develop tools and models that can
in Kenya, the US and Canada. aid early identification of at-risk populations. Second,
we will build the capacity of young Kenyan scientists
UZIMA-DS looks to leverage data science to through post-doctoral and PhD fellowships to use
proactively avoid adverse outcomes in maternal large data to inform health policies and practice.”
Impact Report 2022 15Investing for Impact
“There is a dearth of tools that can be used for early identification of women,
children, and young adults at risk of poor physical and mental health.”
–Amina Abubakar, Aga Khan University
UZIMA-DS will leverage machine learning to volume. The University of Michigan Center for
identify creative solutions to aid health service Global Health Equity provided seed funding
providers and policymakers within resource to support the initial partnership, which has
constrained environment. potentially far-reaching implications for a
technology previously associated primarily with
Collaborating institutions include the high-resource settings.
University of Michigan, the Kenya Medical
Research Institute/Wellcome Trust Research “New technologies and innovative partnerships
Programme, and the University of Ottawa. can help us address health data and service gaps
in Kenya,” said Carl Amrhein, Provost and Vice
“I am honored to be working with Professor President (Academic) at AKU. “Since the inception
Abubakar and her colleagues at AKU who share of the UZIMA-DS, it has promised a unique and
my passion for leveraging AI and machine powerful approach to improving health and
learning to impact health equity and improve health equity in East Africa, which aligns well with
people’s lives,” said Akbar Waljee, co-principal AKU’s commitment to global health.”
investigator and professor of Internal Medicine
at the University of Michigan, the top-ranked The grant is part of NIH’s Harnessing Data
public research university in the US by research Science for Health Discovery and Innovation
in Africa (DSI Africa) program, which aims to
leverage data science technologies to develop
solutions to the continent’s most pressing
public health problems through a robust
ecosystem of new partners from academia,
government, and the private sector. AKU will
implement the project through the Institute for
Human Development and the Medical College.
The Research Hubs formed out of this initiative
will serve as a core component within the larger
program, which will also consist of data science
and innovation training programs, research on
the ethical, legal, and social implications central
to data science health research and innovation
in Africa, and an open data science platform
Akbar Waljee (left) and Amina Abubakar and coordinating center. n
at Aga Khan University in Nairobi.
16 Global Health Equity at the University of MichiganFelix Agoi (right), AKU’s field coordinator, with Josh Ehrlich in Kilifi, Kenya, on a site where pilot
testing for the Longitudinal Study of Health and Aging in Kenya (LOSHAK) is being conducted.
Advancing Healthy Aging in Africa
Demography + Psychology + Medicine + Public Health + Economics
An international team of researchers received an of Health (NIH) to address major gaps in population-
NIH grant to address major gaps in population-level level data on aging in Kenya, one of Africa’s most
populous nations.
data on aging in Kenya, one of Africa’s most populous
nations and one that expects its elderly population to “Kenya expects its elderly population to quadruple
quadruple by 2050. by 2050,” says Anthony Ngugi, interim chair of
Population Health at Aga Khan University (AKU) and
co-principal investigator of the NIH grant.2
Africa is getting older. It is vital, says Ngugi, to begin studying “both
The continent home to humanity’s origins and count- population-level trends and individual aging
less ancient civilizations also has the world’s youngest trajectories to understand risk factors for health,
population. But that is changing, and rapidly. disability, and well-being in the Kenyan context.”
While today people over the age of 60 make up 5.6% Over the next thirty years, as Kenya becomes a place
of Africa’s population, by 2050 that is expected to where people live longer and need different kinds of
increase to over 15%.1 care, social structures will need to change. “Kenyan
researchers and our partners can provide data that
With enabling support from Center for Global Health informs the social and policy adjustments we need
Equity, an international team of researchers has in Kenya to address the growing needs of an aging
received a $338K grant from the National Institutes population,” Ngugi said.
Impact Report 2022 17“When the idea for the LOSHAK study was presented, I jumped on it,
because I saw that the need was there.”
–Anthony Ngugi, Aga Khan University
The NIH grant supports pilot work to lay relationships—the trust and understanding
groundwork for future NIH grant applications they’ve built—make all the difference in the
aimed at launching the full-scale Longitudinal quality of the research.”
Study of Health and Aging in Kenya (LOSHAK),
Ngugi and Ehrlich will use preliminary data
a cohort study of Kenyan adults aged 45
and findings collected during this initial phase
and older. The study will eventually enroll
to improve the study’s infrastructure and,
thousands of participants and will follow them
eventually, to propose a larger rollout in Kenya
over the course of years.
to field a nationally representative sample. In
“Such an approach requires commitment from addition to continuing to build relationships
participants and patience to see how results in communities that are new to working
unfold over years,” explained Ngugi. “But data with researchers, the LOSHAK team faces
from such a study is so valuable.” logistical challenges. “Kenya is a large country
with many rural areas that can be difficult to
Key focus areas include Alzheimer’s disease access. But it’s vital that rural as well as urban
and related dementias, mental health, the populations be represented,” said Ehrlich.
health and economic impacts of climate
change and air pollution, and factors During his time with the Kaloleni/Rabai
influencing late-life economic well-being. With platform, Ngugi has also established
the rapid demographic changes and lack of relationships with leaders in local health
corresponding research to understand them, systems, including local clinics and staff,
the project seemed rather timely to Ngugi. and has ongoing collaborations with Kenya’s
“When the idea for the LOSHAK study was National Ministry of Health. “Regional and
presented, I jumped on it, because I saw that national health leaders are excited about
the need was there,” he said. the project, because they understand the
importance of studying aging,” Ngugi said.
Connecting in Coastal Kenya
The LOSHAK study utilizes an existing study
Models Are Important
platform, the Kaloleni/Rabai Community LOSHAK is also part of the Health and
Health and Demographic Surveillance System, Retirement Study (HRS) network, a family
a population-based research platform that of studies on aging in 45 countries modeled
includes more than 14,000 individuals over the on the US HRS that began in the 1990s. “The
age of 45 living in coastal Kenya.3 HRS provides extensive data to understand
how health, economic, and family networks
The Kaloleni/Rabai study is run by AKU, interact over time to affect aging, economic
whose expertise and leadership “is central well-being, and social relations,” said Kenneth
to the success of LOSHAK,” said Josh Langa, associate director of the HRS and
Ehrlich—research assistant professor with co-investigator on the grant.5
the U-M Institute for Social Research,
assistant professor of Ophthalmology and Currently, the only HRS network study in Africa
Visual Sciences at Michigan Medicine, and is in South Africa, making LOSHAK only the
co-principal investigator of the NIH grant.4 second such project in the region. Langa says
“Our partners at AKU have strong relationships the Kenyan study has also provided a variety of
with communities in this region, and these innovations. “LOSHAK is a poster child for how
18 Global Health Equity at the University of MichiganInvesting for Impact
to get smart, talented folks in both countries
together. Anthony and Josh, with support from
“LOSHAK is a poster child for
the Center for Global Health Equity, have put how to get smart, talented
together a remarkable team.”
folks in both countries together.”
“And the way the LOSHAK study will apply
population-level data to issues like climate
–Kenneth Langa
change will be pioneering work. Africa is Health and Retirement Study
already experiencing many risks related to
climate, and this study will help us see in great
detail the connections among climate, aging, (UM), Alden Gross (JHU), Carlos Mendes
and health,” Langa added. de Leon (Georgetown University), Edward
Another key feature of HRS projects is that Miguel (UC-Berkeley), Muthoni Mwangi (AKU),
all data collected are made publicly available. Roselyter Rianga (Moi University), Shaheen
“The National Institute on Aging funds the HRS Sayed (AKU), and Akbar Waljee (UM).
and ensures that all HRS network studies make LOSHAK is funded by the National Institute on
their data public for researchers all over the Aging and the University of Michigan Center
world,” said Langa. for Global Health Equity. The project has also
Along with the population-based insights received additional funding from the Michigan
on aging and health in Kenya and the cross- Center on the Demography of Aging and the
national comparisons LOSHAK will provide, Harmonized Cognitive Assessment Protocol
the study also advances the Center for Global (HCAP) Network. n
Health Equity’s model of collaboration. “The
Notes
Center is committed to fostering sustainable
relationships as we pursue collaborations 1. Wan He, Isabella Aboderin, and Dzifa Adjaye-
with international partners, such as Aga Gbewonyo. US Census Bureau. Africa Aging: 2020
Khan University,” said Center director Joseph International Population Reports P95/20-1. US
Government Printing Office, Washington, DC, 2020.
Kolars. “Such relationships go hand-in-hand
with projects that are truly co-designed, and 2. Anthony Ngugi, Interim Chair of Population
LOSHAK is a remarkable example of bringing Health and Associate Professor of Epidemiology
together two existing studies in a creative way.” and Population Health–Aga Khan University.
Ngugi shares the commitment to this 3. Ngugi, Anthony, et al. “Cohort Profile:
partnership model. “It is rare to come across The Kaloleni/Rabai Community Health and
Demographic Surveillance System.” International
a partner as developed and resourced as the
Journal of Epidemiology 49/3 (June 2020):758–759e.
University of Michigan who is truly willing
to listen, truly willing to partner on an equal 4. Josh Ehrlich, Research Assistant Professor–
basis, and is even willing to learn from us,” Institute for Social Research, Assistant Professor
he said. “It is encouraging to work so closely of Ophthalmology and Visual Sciences–Michigan
with our Michigan partners and to share Medicine.
our capacities so together we can do this 5. Kenneth Langa, Associate Director–Health and
important work in Kenya.” Retirement Study, Research Professor–Institute
for Social Research, Cyrus Sturgis Professor
Other members of the grant team include Felix of Medicine–Michigan Medicine, Professor of
Agoi (AKU), Jessica Faul (UM), Muthoni Gichu Health Management and Policy–School of Public
(Global Brain Health Institute), Jean Ikanga Health, Research Scientist–VA Center for Clinical
(Emory), Pamela Jagger (UM), Elisa Maffioli Management Research.
Impact Report 2022 19Photo. Marcin Szczepanski, College of
Engineering, University of Michigan
Nurses Noelia Calel (center) and Virginia Xicay Garcia (right) joke with M-HEAL students during a meeting at a public health clinic in Santa Cruz, Guatemala. Calel and
Garcia are demonstrating a new stethoscope that electronically records heart-sounds of patients in rural parts of Guatemala and sends them to a Guatemala City
hospital. The stethoscope could eventually prevent major complications for infants born with congenital heart defects.
Contextualized Engineering Design for Better Health
Engineering + Information Science + Medicine
Too little is known about how and when experienced environments of the technology’s anticipated use,” says
engineering designers incorporate contextual factors Kathleen Sienko, professor of Mechanical Engineering
in the University of Michigan College of Engineering.
into their designs. A team of U-M researchers has
been studying how context informs design decisions But little is known about how and when experienced
throughout engineering design processes. engineering designers incorporate contextual factors
into their designs.
Does it matter if an engineer understands the context
To help engineers—especially novices in
in which a design solution will be employed?
the profession—better incorporate the lived
The answer might be an obvious yes. But with environments of local communities into their
more and more processes and products being designs, a team of University of Michigan
shared globally, implementing new technologies— researchers has been studying how contextual
from healthcare to clean water to energy and information informs design decisions throughout
communications—in local contexts is becoming engineering design processes.
increasingly challenging.
Through extensive interviews with experienced
“The successful design of engineered technology engineering designers, Sienko and Kentaro Toyama,
depends on a designer’s appropriate consideration professor of Information in the University of Michigan
of context—the physical, social, and economic School of Information, are exploring exactly how
20 Global Health Equity at the University of MichiganInvesting for Impact
“Designs that better address user needs are always prized
but can be more difficult to actually procure.”
–Kathleen Sienko, U-M College of Engineering
engineers can more fully apply all of the inputs for local temperature, humidity, and other
available to them in a design process. environmental realities, like high amounts
of dust in the air or annual expectations of
Findings from this work will be compared to drought and flooding.
previous research with novice engineering
designers to develop recommendations for Novice engineering designers, however,
best practices in engineering design generally. rarely consider how politics can affect
their design processes. It is important that
The research involves semi-structured designers consider not only what utilities are
interviews, observations, and document reviews available locally and how the reliability of local
across three engineering design domains— transportation impacts supply and delivery of
medical devices, consumer products, and products. Contextualized engineering design
information and communication technologies. must also consider socio-cultural factors
“Our results will help us understand which of consequence, including language and
behaviors are transferable across engineering education access, local symbols and stigmas,
design specialities, levels of experience, and and local aesthetics.
use settings,” said Sienko. “We hope this “Whenever possible, we recommend using
will lead to better design solutions for local context-appropriate graphics and adjusting
populations in need of solutions to critical for language differences, selecting colors
health concerns.” and symbols with meanings appropriate in
Sienko, Toyama, and Grace Burleson, a PhD local contexts, and generally aligning design
student in the College of Engineering, received decisions down to the last detail with local
a pilot grant from the Center for Global Health preferences,” said Toyama.
Equity to collect data on novice engineers. Finally, say Toyama and Sienko, designers
“Context matters, especially in global health,” said should consider all facets of local and regional
Burleson. “It’s well documented that when we fail politics. “We need to be asking what local
to incorporate context it leads to design failure.” initiatives and policies could impact the
Building on this enabling support, Sienko regulatory processes around the projects
and Toyama recently received a $440K grant we hope to implement. Who are the local
from the National Science Foundation (NSF) stakeholders and how can they be engaged
to describe and better understand the use of positively as supporters of your project?”
contextual factors in engineering design. Sienko said.
They will focus on multiple categories of Sienko and Toyama hope their research will
contextual factors that can affect design and lead to a range of innovations in processes and
design implementation—environmental and products designed with local environments and
infrastructure factors, socio-cultural factors, local stakeholders front and center.
and local political factors. “Anyone working in global health knows that
Based on Burleson’s preliminary results, novice new challenges are constantly emerging,”
engineering designers readily consider local said Sienko. “Designs that better address
climates when designing devices. For example, user needs are always prized but can be more
they aim to select materials that account difficult to actually procure.” n
Impact Report 2022 21CGHE Funded Projects
1 Mexico
Liberia 2 4
Ghana
Ecuador 2
Peru 1
$787,000
Research Investments
# Total number of Center-funded projects in the country
Some impact projects operate in more than one country.
222 Nepal
2
Bangladesh
Thailand 1
2 Nigeria
2 Uganda
5 Kenya Indonesia 1
1
Rwanda
2 Zimbabwe
Thematic Priorities
Based on potential for impact, institutional strengths,
and perceived needs, Center leaders and stakeholders
2 identified four primary themes to guide initial
collaborations and efforts.
South Africa • Strengthening systems to improve health and
health equity, including creative approaches with
the private sector—human resource development,
collaborative care models, supply chain and access
• Informing policy and programming related
to social and environmental determinants of
health—climate change, food security, education,
health economics, and economic development
• Developing technical solutions for health
equity—artificial intelligence and data science
approaches, telehealth tools, and systems
• Empowering women as effectors of health for
themselves, their families, and their communities
23Health and Maternal
Challenge Socioeconomic Impacts Depression in Rural
Family Planning
Group of Water Intermittency Uptake in Ghana
and Urban Ecuador
in Mexico
Grants
Collective
Solutions
for Complex
Problems
Challenge Groups
comprise faculty from
across the University
of Michigan who share Anthropology + Anthropology + Public
complementary expertise Nursing + Medicine
Public Health + Health + Psychiatry +
and interests.
+ Public Health
Engineering Environment
These interdisciplinary
Sergio Bautista Fu Yu Chang Sarah Compton
communities explore
National Institute of University of Cuenca-Kaleidos U-M Medical School
potential partnerships and Public Health-Mexico Center for Interdisciplinary
Veronica Dzomeku
projects that align with their Ethnography
José Luis Figueroa-Oropeza Kwame Nkrumah University of
respective interests, with an National Institute of Mayra Flores Science and Technology-Nursing
eye toward collaborations Public Health-Mexico University of Cuenca-Kaleidos
Jody Lori
that carry the greatest Center for Interdisciplinary
Jaclyn Goodrich U-M School of Nursing
Ethnography
potential for impact. U-M School of Public Health
Cheryl Moyer
Rebecca Hardin
Branko Kerkez U-M Medical School
Challenge Groups meet U-M College of Engineering
U-M School for Environment
and Sustainability Emmanuel Nakua
regularly and provide
Elizabeth Roberts Kwame Nkrumah University of
opportunities for research- U-M College of Literature,
Gwenyth Lee
Science and Technology-Public
ers to share ideas and Rutgers University-Epidemiology
Science, and the Arts Health
receive feedback on current Brisa Sánchez
Maria Muzik
Easmon Otupiri
projects. Many members U-M Medical School
Drexel University, Public Health Kwame Nkrumah University of
value this time together Mara Téllez Rojo
Jorge Núñez Science and Technology-Population,
with colleagues in other University of Cuenca-Kaleidos Family, and Reproductive Health
National Institute of
Center for Interdisciplinary
units who nevertheless Public Health-Mexico
Ethnography
Emily Treleaven
understand their goals, U-M Institute for Social Research
James Wagner
Maka Suarez
approaches, and passion U-M Institute for Social Research
University of Cuenca-Kaleidos
for global health. Krista Wigginton Center for Interdisciplinary
Challenge Group
U-M College of Engineering Ethnography Empowering
As experts from around
Women and
the university convene to Challenge Group Challenge Group Communities
discuss wicked problems Climate Empowering
in global health, they Vulnerability Women and The project explores
build communities of
and Health Communities the know-do gap among
practice that advance postpartum Ghanaian
collective solutions. The project seeks to women to identify potential
The project documents the interventions that enable
understand the effects of
The Center has funded a multiple facets of maternal them to realize fertility goals.
intermittent water supply
mental health in Ecuador
number of high-impact on chronic disease and
and explores how health
projects—shown here—that economic and gender
professionals understand,
inequality globally, and to
arose from these respective diagnose, and treat
develop evidence-based
Challenge Groups. maternal depression.
approaches to address them.
24Investing for Impact
Gender-Based Empowerment Empowerment Dementia
Violence on among LBQ Women among Indigenous Biometrics in the
University Campuses in Western Kenya Women in Thailand Chitwan Valley
in Sub-Saharan Africa of Nepal
Social Work + Anthropology + Public Health +
Nursing + Medicine
Psychology + Medicine Public Health + Medicine +
+ Social Work
+ Public Health Medicine Social Sciences
Michelle Munro-Kramer Gary Harper Tawatchai Apidechkul Dirgha Ghimire
U-M School of Nursing U-M School of Public Health Mae Fa Luang University U-M Institute for Social Research
Sarah Compton Laura Jadwin-Cakmak Amanda Flaim Kenneth Langa
U-M Medical School U-M School of Public Health Michigan State University, U-M Medical School
Sociology
Lisa Fedina Ashley Lacombe-Duncan Carlos Mendes de Leon
U-M School of Social Work U-M School of Social Work Chutimav Morlaeku Georgetown University,
Indigenous Mountain Peoples Public Health
University of Cape Coast, Ghana Anita Mbanda
Education and Cultural Association
Kwame Nkrumah University of Western Kenya LBQT Janak Rai
of Thailand
Science and Technology, Ghana Feminist Forum Tribhuvan University
Cheryl Moyer
Takoradi Technical University, Sara McClelland Meeta Sainju Pradhan
U-M Medical School
Ghana U-M Women’s and Gender Studies Institute for Social and
Malee Sitthi Kriengkrai Environmental Research, Nepal
University of Liberia, Liberia Wilson Odero
Chiang Mai University
Obafemi Awolowo University, Maseno University Uttam Sharma
Nigeria Laura Rozek Institute for Social and
Becky Odhiambo
Georgetown University, Environmental Research, Nepal
Sefako Makgatho Health Sciences Western Kenya LBQT
Public Health
University, South Africa Feminist Forum
Emily Treleaven
University of KwaZulu-Natal, Caroline Rucah
U-M Institute for Challenge Group
South Africa Western Kenya LBQT
National University of Science Feminist Forum
Social Research Data Science
and Technology, Zimbabwe
Challenge Group Challenge Group The project addresses health
Empowering Empowering inequities in the older adult
Challenge Group Women and Women and population of Nepal. As
Empowering Communities Communities
the size of the older adult
population grows, increasingly
Women and larger numbers of adults
Communities Kenya is home to an are affected by Alzheimer’s
increasingly visible sexual and Working with local partners, disease and related
gender minority community. the project develops dementias (ADRD). The
The project will conduct
Through a mix of qualitative ethnographic and related project designs and conducts
a cross-country campus
individual in-depth interviews qualitative instruments to a pilot test of the procedures
climate survey to inform
and focus group discussions, explore how indigenous and logistics of collecting
development of culturally,
the project takes first steps women in Thailand con- blood samples in the context
contextually appropriate
toward developing policies, ceptualize empowerment of a new large survey study of
interventions for universities
programs, and services that and its relationship to their ADRD in Nepal.
in sub-Saharan Africa.
promote health equity among health and the health of their
LBQ women in Kenya. children.
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