Prabhat Jha

Once thought of as a disease that only affected older adults, diabetes is now being diagnosed increasingly in people under the age of 30 – the implications of which have yet to be fully studied.

“It is a global phenomenon occurring not just in Canada, but also in places like Hong Kong and India,” said Dr. Calvin Ke, an endocrinologist and a clinical epidemiology PhD student at the University of Toronto's Institute of Health Policy Management and Evaluation (IHPME).

Ke is in the process of completing a three-part international PhD project looking at the rising rates of diabetes in South and East Asian populations in Toronto, as well as in India and Hong Kong. It is a unique approach that combines data from international partners to develop new insights into the management of the disease.

“Ke’s PhD research is a wonderful blend of clinical epidemiology and global health," said Dr. Rob Fowler, program director of the clinical epidemiology program at IHPME. "I suspect his findings will tease out and tremendously advance our understanding of influential factors on patient and population outcomes with respect to this disease.”

The first part of Ke’s project took him to India, where he worked with renowned U of T epidemiologist Dr. Prabhat Jha to determine how diabetes increases the risk of mortality from heart disease and stroke. While in Hong Kong, Ke has been researching the rising rates of hospitalizations among young people with diabetes, under the guidance of Dr. Juliana Chan, a leading diabetes researcher in China.

“Diabetes is a global epidemic that cannot be fully addressed by one country alone,” said Chan. “Over the last two decades, we have been building a collaborative, international diabetes management and research platform that includes over 80,000 patients spanning 13 countries across Asia. These efforts are an essential first step to managing the global diabetes epidemic, and they necessitate the co-ordinated involvement of many international researchers.”

“This is a big change from previous decades,” Ke added. “We are learning more and more about what happens to people when they get Type 2 diabetes at such a young age, and we urgently need to develop better solutions for young people facing this growing epidemic on a global scale.”

A combination of factors, from genetic predisposition to rapid economic development and food abundance, are thought to be contributing to the rates of earlier diagnoses. Add in a sedentary lifestyle, and you have the perfect recipe for the development of this chronic condition.

Data that Ke is studying has also shown that young people with diabetes are being diagnosed with and hospitalized for further complications of the disease, such as kidney disease and heart attacks. Each hospitalization costs the health system and the economy in terms of lost wages and productivity, but there is also an indirect cost placed on the families and caregivers of patients.

“One of our main goals is to reduce the rates of hospitalization, and help those diagnosed better manage their condition over the course of their life, by improving their knowledge of the disease,” said Ke.

Better recognition from health-care providers about the level of risk associated with Type 2 diabetes at a younger age is also needed.

“While many assume that youth confers good health, we need to understand that this is not true when it comes to young people with diabetes. In fact, we found that the overall risk of suffering complications is actually higher for young people, because they are exposed to diabetes for a much longer period of time,” said Ke.

An international experience like this has added an interesting perspective to Ke’s research, and has allowed him to integrate data from three different countries in a meaningful way. “Studying how diabetes affects people in different global contexts reveals unique aspects of this complex disease. Each study adds an important piece to the puzzle, and lessons learned in one country can be incredibly valuable to informing interventions in other settings,” he said.

As it becomes more important to have an international research network, Ke encourages other students to think about the global aspects of the projects they are working on.

“I didn’t know coming into my graduate studies that my work would look like this, but to see it come together and to reflect on it, it’s quite amazing.”

Higher cigarette prices would save millions of people, especially poor smokers: U of T leads study

ullahnor — Thu, 12 Apr 2018 18:56:02 +0000

Higher cigarette prices would save millions of people, especially poor smokers: U of T leads study

ullahnor Thu, 04/12/2018 - 14:56

Cutline

Photo by Andrew Pons on Unsplash

Ana Gajic

Topic

Global Lens

Dalla Lana School of Public Health

Subheadline

Research finds taxing cigarettes could keep people out of poverty and save lives

Higher cigarette prices would save millions of people from extreme poverty and poor health around the world, while also cutting health treatment costs for families across the globe, suggests a new study.

The analysis, led by U of T Professor Prabhat Jha and the World Bank's Patricio V. Marquez, concludes that people with lower incomes would benefit the most from higher cigarette prices. Examining 500 million male smokers in 13 countries, they found that a 50 per cent increase in the tobacco excise tax would result in 67 million men quitting smoking, with the largest share being low-income men. It would also reduce years of life lost and decrease the risk of high medical costs.

The study was published this week in The BMJ. It adds to a growing body of knowledge that tobacco taxes, which are not implemented globally, have significant health benefits.

“Our study debunks the current narrative that higher cigarette prices would negatively impact the poorest among us,” said Dr. Jha (pictured at left), a professor of epidemiology at U of T's Dalla Lana School of Public Health.

“This analysis shows the opposite – a higher price would encourage cessation, lead to better health and save money, much more strongly for the poor than the rich.”

Small steps taken by governments can lead to unprecedented health gains and poverty reduction, he added.

Read about the research at Fortune

Read the Daily Telegraph story

The higher price would lead to 15.5 million men avoiding catastrophic health spending in the seven countries studied without universal health coverage, according to the study. This would result in 8.8 million men avoiding extreme poverty, half of whom are in the bottom income group.

Quitting smoking would result in 449 million years of life gained, the study showed. Higher tobacco costs would also benefit households globally, with about US$157-billion averted to treat the four main tobacco-attributable diseases examined: chronic obstructive pulmonary disease, stroke, heart disease and cancer.

Despite more awareness of the risks, Jha said, if nothing changes, smoking will be responsible for one billion deaths in the 21st century. Most of these will be in low- and middle-income countries. Previous research by Jha, who is also director of the Centre for Global Health Research of St. Michael’s Hospital, has shown that raising taxes on tobacco is the single most effective intervention to lower smoking rates and to deter future smokers.

Building on his earlier research, Jha and the team undertook this new analysis to understand the true impact of higher cigarette prices around the world. They conducted an assessment across 13 middle-income countries with diverse socioeconomic characteristics, tobacco use and health-care coverage. Focusing on male smokers – who make up 90 per cent of smokers in the selected countries – the researchers used mathematical models to quantify the effect of a 50 per cent increase in prices.

“The findings of our new analysis will have a far-reaching impact,” said Marquez, the lead health specialist at the World Bank. “Not only does increasing tobacco taxation reduce smoking and its health consequences, but the study’s findings are also relevant to the United Nations sustainable development goals to reduce poverty and improve health.”

The study was supported by the Fogarty International Center of the U.S. National Institutes of Health, the Dalla Lana School of Public Health, Canadian Institute of Health Research, the Bill & Melinda Gates Foundation, Bloomberg Philanthropies, and the International Development Research Centre.

Paul Dalla Lana commits second $20-million gift to the University of Toronto’s Boundless Campaign

lanthierj — Thu, 01 Feb 2018 19:06:31 +0000

Paul Dalla Lana commits second $20-million gift to the University of Toronto’s Boundless Campaign

lanthierj Thu, 02/01/2018 - 14:06

Cutline

Alessandra and Paul Dalla Lana

Topic

Global Lens

Dalla Lana School of Public Health

Meric Gertler

Prabhat Jha

Almost a decade after making a $20-million gift to establish the Dalla Lana School of Public Health at the University of Toronto, Paul and Alessandra Dalla Lana are doubling down on their investment.

Today, the couple announced they are making an additional $20-million gift to the school, located in the heart of Toronto’s innovation and health district.

“It’s been amazing to watch the school grow and to see the impact its research is already having on critically important but often overlooked public health and health system issues across Canada and globally,” said Paul Dalla Lana, founder of NorthWest Healthcare Properties REIT, the largest private owner and manager of medical buildings in Canada.

“This funding will enable the school to expand this work to improve the quality of life for us all.”

In the years since the couple’s original donation – the largest gift ever given to public health in Canada – the school has grown into a global leader in public health, health policy and health systems education, research and service, known for research like Professor Prabhat Jha’s innovative Million Death Study. Jha is the Endowed Chair in Disease Control at DLSPH, funded by the Dalla Lanas' original gift.

U of T's Prabhat Jha, head of India's Million Death Study, on how public funds make his research possible

ullahnor — Wed, 13 Dec 2017 05:00:00 +0000

U of T's Prabhat Jha, head of India's Million Death Study, on how public funds make his research possible

ullahnor Wed, 12/13/2017 - 00:00

Noreen Ahmed-Ullah

Topic

Global Lens

Dalla Lana School of Public Health

David Naylor

Faculty of Medicine

Fundamental Science Review

Global

Naylor Report

Prabhat Jha

Research & Innovation

After working as a senior scientist at the World Health Organization on efforts to control malaria, HIV/AIDS and tobacco-related diseases, Dr. Prabhat Jha was contemplating a return to academia –the University of Cambridge, perhaps, or Harvard University.

For guidance, he turned to his former supervisor David Naylor, then the dean of University of Toronto’s Faculty of Medicine. Naylor told him that if he came back to Toronto, he could focus on his research.

What Jha wanted was to explore how to improve the way the world collects death statistics or mortality data, because more accurate numbers could help shape global health policy on fighting curable diseases like malaria.

U of T and St. Michael’s Hospital helped Jha, who did his PhD at the University of Oxford under a Rhodes Scholarship, find the funding needed to set up the Centre for Global Health Research and establish the Million Death Study in India.

“Without funding, we would not have been able to start the Million Death Study,” says Jha. “In my own case, a Canada Research Chair and early support from Canadian Institute for Health Research, along with U of T and St. Michael's Hospital, were crucial to start my centre and establish the Million Death Study in India.”

The study, which began in 2002, involves hundreds of specially trained non-medical staff knocking on doors across India to gather first-hand accounts of the symptoms and circumstances behind recent deaths. The results of those “verbal autopsies” are then sent to two of 400 physicians working online to establish a probable cause of death.

It is considered one of the largest studies of premature deaths in the world and in a country like India, where many deaths occur at home and go unrecorded, has become an important tool to improve public health. The mortality study, which has now reached 3.5 million homes and more than 23 million people, costs less than a dollar per household per year in India, but the impact has been tremendous. Data have revealed that global estimates for adult malaria and snake bite deaths were too low, leading WHO to put the latter on its list of neglected tropical diseases. The organization is also re-examining global malaria numbers.

Mortality data also showed that one million more children are alive today because of simple, affordable prenatal care and reductions in specific diseases since 2005. The tobacco-related findings have enabled a global treaty signed by over 180 countries to help reduce deaths worldwide.

“We are well on the way to changing how the world counts its dead and describes causes, and in so doing are providing a GPS for global health,” says Jha, a professor of global health and epidemiology at the Dalla Lana School of Public Health.

“This has now spurred others to take an interest in similar studies. We’re working with the Gates Foundation and the Canadian government to introduce systems like this in Mozambique, Sierra Leone and Ethiopia.”

But Jha says that the research and the results would not have been possible without money and leadership, two things recommended by the Naylor report. The 35 recommendations made by Canada’s Fundamental Science review, which was led by Naylor, U of T's President Emeritus, called for sweeping changes on how research is overseen and a $1.3-billion increase in federal research funding over the next four years.

Interested in publicly funded research in Canada? Learn more at U of T’s #supportthereport advocacy campaign

“The Canada Research Chair has been a successful model to attract researchers back to Canada, and I’m one of them,” he says.

The funding has helped him to focus solely on research, unlike scientists in other parts of the world.

“Without core support for my salary, I would’ve been in a bind which many U.S. researchers find themselves – where they’re actually trying to raise money to cover their salary rather than focusing on research and building research programs,” he says.

Jha’s Centre for Global Health Research also conducts risk factor epidemiology globally – not just in India – on tobacco hazards, alcohol, vegetarianism, exposure to particulate matter and other risk factors.

Research is the key reason for the 20-year gain in global life expectancy over the last few decades, he says.

“Why is that? When you look carefully, as we have done, that’s not because the world grew richer or we became more educated. It’s because of research,” Jha says. “Research led to huge fundamental discoveries that have transformed human health – vaccines that became available, the discovery of smoking as a big risk factor for cancer and other diseases, low-cost antibiotics – almost all of that knowledge has been driven by publicly funded research.”

And much of the funding for that research has been through sustained public dollars, he says.

“Since about 1980, we’ve somehow been thinking that the private sector will come in, and it’ll fund research. Well, it’s just not really true. Fundamental achievements in public health – if you take anything, any big success – and trace its roots back, it all comes back to government funding for research that is slow and deliberate and usually goes through universities.”

Jha, who was born in India and grew up in Winnipeg, received his medical degree from the University of Manitoba. At Oxford, he worked under the renowned epidemiologist Sir Richard Peto and developed a passion for digging into how seemingly preventable factors like tobacco contribute to diseases in developing countries.

He came to U of T for his post-doctoral research, working under Naylor, and then went on to the World Bank and then the WHO, where he studied the health of the global poor. It was while he was at the WHO that he says it became obvious to him that better mortality data would help inform how to best control the major diseases and also the degree to which smoking kills people.

Colleagues say Jha’s epidemiological approach has changed global health policy.

"Not only has his Million Death Study contributed to our understanding of premature death in India, China and beyond, he is also instrumental in training maternal and child health researchers across the globe who will continue to have a far-reaching impact in decades to come," says Erica Di Ruggiero, an assistant professor and director of the Dalla Lana School of Public Health's office of global public health education and training.

Jha’s next steps with the Million Death Study will include leading an interdisciplinary team to expand the collection of mortality statistics and develop innovative new tools to analyze the data for patterns.

“Prabhat’s research in tobacco control and premature mortality has influenced health policy globally and is saving lives,” says Adalsteinn Brown, interim dean of the Dalla Lana School of Public Health and the Dalla Lana Chair in Public Health Policy. “By using innovative approaches to population health data, he demonstrates the need for evidence-based change – such as tobacco tax increases – to national and institutional leaders, ultimately helping global populations live longer, healthier lives.”

He says for Canadian researchers like him, the Naylor report has been a reminder of how Canada can excel and what its potential could be for the future.

“[Naylor] reminded us that if there is a single way Canada can punch above its weight globally it could be to become the research powerhouse,” says Jha. “The report is spot on to recognize the enormous social and economic returns possible if Canada significantly upped its game in research funding and leadership.”

U of T's Prabhat Jha inducted into the U.S. National Academy of Medicine

ullahnor — Tue, 18 Oct 2016 18:54:11 +0000

U of T's Prabhat Jha inducted into the U.S. National Academy of Medicine

ullahnor Tue, 10/18/2016 - 14:54

Cutline

Prabhat Jha's research on tobacco control enabled a global treaty that has been signed by over 180 countries (photo by Margaret Mulligan)

Nicole Bodnar

Author legacy

Nicole Bodnar

Topic

Global Lens

Dalla Lana School of Public Health

Prabhat Jha, a professor at U of T's Dalla Lana School of Public Health known for his research on tobacco control, was inducted Monday into the National Academy of Medicine in Washington DC.

Jha is one of 10 international members selected by the academy in 2016. He joins four other University of Toronto faculty members who are already members, including U of T President Emeritus Dr. David Naylor.

The National Academy of Medicine (NAM) is an independent organization of eminent professionals from diverse fields including health and medicine and the natural, social and behavioral sciences. Through its domestic and global initiatives, the academy addresses critical issues in health, medicine and related policy.

“The NAM does so much to advance science and its uses," said Jha, professor of global health at U of T and director of the Centre for Global Health Research at St. Michael’s Hospital. "I am delighted to be accepted by my peers into this prestigious organization.”

Prabhat Jha

Rising rates of diabetes among young people inspire international PhD project

Higher cigarette prices would save millions of people, especially poor smokers: U of T leads study

Read about the research at Fortune

Read the Daily Telegraph story

Paul Dalla Lana commits second $20-million gift to the University of Toronto’s Boundless Campaign

Read more about Jha and his research

Read more about Stewart and her research

U of T's Prabhat Jha, head of India's Million Death Study, on how public funds make his research possible

Interested in publicly funded research in Canada? Learn more at U of T’s #supportthereport advocacy campaign

U of T's Prabhat Jha inducted into the U.S. National Academy of Medicine

Read more about the induction

Read more about Professor Jha's research