Non-Communicable Diseases in Global Health

The main goal of our research program is to gain a better understanding of non-communicable chronic diseases in global health by taking advantage of unique aspects of our economically developed non-Western setting. Our focus is public health research where we can leverage our extensive cohort studies using a theoretical perspective and cutting edge methods to explicate etiology and evaluate contextually specific prevention strategies. We also provide a sentinel for the majority of the global population, who are currently experiencing the rapid economic development and globalization, which has already occurred in Hong Kong.

 

Our unique setting

East Asia tends to have lower rates of hormone modulated cancers and ischemic cardiovascular disease but higher rates of diabetes and infection related cancers than Western populations. Our group has been instrumental in formulating appropriate cancer screening policies in this setting. We have also specialized in regionally specific psycho-oncology, where we have developed extensive regional and international collaborations, and secured prestigious grants and awards. To complement these strengths, we are now moving onto risk stratification for diabetes and cardiovascular disease, as well as the implications of the pattern of chronic diseases for regional health services policy, health service planning and health service expenditure, and population risk perception. Particularly active areas of investigation are the challenges to received wisdom posed by high rates of diabetes in relatively non-obese populations, the lower rates of cardiovascular disease than would be expected from the level of traditional cardiovascular disease risk factors, comparative disease patterns and responses to oncological and other demands on services in rapidly developing regional populations.

 

Our cohorts

Our family of large, active cohorts spans the life course from infants to the oldest old, including "Children of 1997", a FAMILY cohort, the Guangzhou Biobank Cohort Study, and the Elderly Health Services Cohort. These provide an ideal platform to investigate drivers of non-communicable chronic diseases in a non-Western setting. They also provide a unique testing ground in which to confirm or refute empirically driven hypotheses, because socio-economic patterning of many attributes here differs from that in more commonly studied Western populations. These investigations have confirmed similar effects of smoking and second hand smoking on health as elsewhere, and similar benefits from effective tobacco control. However, the health effects of moderate alcohol use and breast feeding are less consistent. Particularly active areas of investigation are topics where randomized controlled trials are difficult to conduct and triangulation in non-Western contexts may help establish whether observations to date are contextually specific or biologically based.

 

Hot topics

We are currently examining the role of several key factors in non-communicable chronic diseases. These include adverse childhood experiences, family dynamics, lifestyle choices, the microbiome, social disparities, growth patterns, air pollution and climate change. We are also studying the concomitant political-economic, social and personal factors influencing health behaviours and the impact of response, adaption and coping strategies in non-communicable disease management and prevention.

 

Theoretical perspective

Underpinning this research portfolio is a perspective informed by evolutionary biology, where aging and non-communicable chronic diseases may be seen as a by-product of strategies aimed at reproductive success, i.e., of optimal resource utilization and allocation for getting our genes into the next generation. Notably, this approach implies an environmentally driven trade-off between sex hormones and immune function, which leverages our strength in infectious diseases. This perspective has generated guiding principles, a theoretical model for population health and novel insights. Obesity undoubtedly causes diabetes, but in Asian populations limited living conditions during growth precluding the development of muscle mass, could also be relevant. Androgens contribute to differences in the rates of hormonally related cancers between East Asian and Western populations and could also contribute to differences in ischemic cardiovascular disease.

 

Methodology

We are at the forefront of using new methods in public health and epidemiology, such as Mendelian randomization, instrumental variable analysis, mathematical modeling of health services utilisation, latent growth modeling and clinical decision analysis, to facilitate evidence based public health. Specifically, we emphasize the distinction between risk factors, which enable risk stratification, and causal factors, which are reversible and key to prevention policies. We select exposures to assess based on their potential impact on public health practice, and general principles reflecting our theoretical model, the attributes of effective treatments and extrapolations from experimental evidence.

 

Contribution

In summary we have two main goals. First, we aim to generate new insights about the causes of non-communicable chronic diseases by exploiting differences between East and West. Second, given these differences we aim to provide a platform to facilitate the evaluation of contextually specific prevention and control policies.

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