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We aim to conduct high-quality research that leads to informed policy-making and innovative approaches to health challenges at local and global levels. Ultimately, we strive to make contributions to achieve the national goals identified in Healthy China 2030 and other Chinese policies as well as globally the health-related Sustainable Development Goals such as universal health coverage, health system strengthening, and infectious and NCD risk reduction.
With a growing number of faculty members and ever-expanding needs for more global health research in the world, we identify three key priority research domains and, in each domain, three specific priority areas. Priority setting is not meant to exclude other research domains or areas, but to focus our resources to achieve larger impacts in the time period covered by this plan (2022-2027). Innovation is at the core of all research endeavor and spans all priority areas. Of note, these domains and priority areas are not mutually exclusive due to the interdisciplinary and complex nature of global health issues.
Innovation Lab for Vaccine Delivery Research (VaxLab)
In December 2021, with the support of the Bill and Melinda Gates Foundation, the Global Health Research Center at Duke Kunshan University established the Innovation Lab for Vaccine Delivery Research (VaxLab). Led by Professor Shenglan Tang, VaxLab aims to strengthen the national immunization program and improve people’s health by producing high-quality scientific evidence and conducting policy advocacy activities. To comprehensively strengthen the immunization program in China, the VaxLab has identified four key research areas, including developing relevant strategies to strengthen the national immunization program, improving vaccine delivery efficiency and coverage, enhancing vaccine fundraising and services, and advocating for the inclusion of key vaccines recommended by the WHO in the national immunization program.
The project’s teams have cooperated on multiple parts of the vaccine delivery research and have achieved major milestones. VaxLab regularly produces high-quality policy briefings on the project’s WeChat Official Account (vaxlab_dku) to share important research findings with policymakers and the academic community. Partnered with experts from the Development Research Center of the State Council, VaxLab has published three high-quality policy briefings in 2022, entitled Strategic Thinking on Strengthening China’s National Immunization Program, Improving HPV Vaccine Access to Accelerate the Elimination of Cervical Cancer in China, and Increasing Uptake of Key Non-National Immunization Program Vaccines in China.
Integrated Care for Tuberculosis and Diabetes Comorbidities in Asian Countries
Professor Abu Abdullah led a multi-country study that examined the health system efficiencies in integrated public health and primary care addressing tuberculosis (TB) and diabetes mellitus (DM) comorbidities in six Asian countries including Bangladesh, China, India, Indonesia, Nepal, and the Philippines. The dual burden of TB and diabetes is a major global concern in public health and a critical challenge in low- and middle-income countries. This multi-country study, completed in 18 months with collaboration from researchers in participating countries, explored the available policy initiatives and service provisions to address TB-DM comorbidity within the existing healthcare systems of these countries, documented potential health system challenges for integrated care for TB-DM co-morbidity, and made recommendations for potential policy initiatives. The study was funded by the Asia-Pacific Observatory on Health Systems and Policy (APO) of the World Health Organization (WHO). VaxLab has published several peer-reviewed articles in top international and national academic journals, including The Lancet Public Health, Human Vaccines & Immunotherapeutics, China Public Health, Modern Preventive Medicine, and China Health Economics. In addition, VaxLab regularly invites national and international experts to hold technical workshops, and actively conducts quarterly exchange meetings to facilitate networking and share current research findings. On a virtual social landscape, VaxLab has created a website to build a vibrant online vaccine delivery research community.
Integrated Primary Care for Co-Management of Tuberculosis (TB) and Diabetes Mellitus (DM) in Jakarta, Indonesia
Funded by Duke-NUS Global Health Institute, Dr. Qian Long led Duke Kunshan Health Policy and System team collaborated with researchers of University of Indonesia to investigate a model of integrated care for co-management of tuberculosis (TB) and diabetes mellitus (DM) in the primary healthcare setting in Jakarta, Indonesia. The study found improvement of DM screening and case detection among TB patients after the introduction of TB-DM co-management program. However, the program implementation remains sub-optimal, especially in the coordinated efforts of TB and DM control. The research team engaged the decision-makers for TB control at the regional and national level in Indonesia and discussed the key findings with them. Researchers proposed to strengthen policy dialogue and multi-sector cooperation for improving the performance of TB and DM co-management in Indonesia.
Monitoring, Learning and Evaluation for the China-Gates Project Phase III: Implementation of Comprehensive Models of TB Care and Control in China
This project, led by Professor Shenglan Tang and initiated in 2016, was completed in 2020 with the Gates Foundation’s final report. The project has produced robust evidence on the implementation and the effectiveness of the comprehensive TB care and control models including interventions in TB system strengthening, clinical quality improvement, human resources capacity building, new financing policies to reduce patients’ financial burden, the roll-out of the electronic medication monitor (EMM) and the pilot and promotion new information system. The final evaluation’s key results that show the major achievements of models especially in the improvement of the clinical quality of B diagnosis and treatment, have been presented to the academic experts and policy makers at the National Health Commission-Bill & Melinda Gates Foundation Tuberculosis Prevention and Control Cooperationl0-Year. In 2020 the evaluation report was finalized, and a special issue of academic papers on this project is under preparation.
National Basic Public Health Chronic Disease Management Service Quality Evaluation Project
With the support of United Nations agencies, the Health Policy and System Research Team led by Professor Qian Long at the Global Health Research Center participated in a series of studies on the quality of healthcare services for chronic disease management in low- and middle-income countries. The research team targeted the National Basic Public Health Services Project and analyzed the current situation and quality of chronic disease management services in China using quantitative and qualitative research methods. The research focused on the impact of current financing and payment models on the quality of chronic disease management services and summarized the experience and challenges during the implementation phase.
The study found that current chronic disease management interventions have not achieved the expected results. Preliminary results summarized the reasons from different perspectives, such as (1) insufficient project funding and a lack of effective incentive mechanisms; (2) a shortage of primary healthcare workers and inadequate professional skills among existing healthcare workers; (3) insufficient information to effectively evaluate project performance. The research team submitted the mid-term research report on October 2022 and the final report was completed on April 2023.
Integrated Care for Chronic Diseases in Asia Pacific Countries
Edited by Dr. Chang Liu, Managing Director for Singapore and mainland China at ACCESS Health International, and Dr. Shenglan Tang, Mary and James Semans Professor of Medicine and Global Health, the research paper addresses emerging health challenges posed by ageing populations across Asia Pacific through more integrated healthcare systems. The study looked at integrated care across the Asia Pacific region, examining systems in China, Singapore, the Philippines, India, Vietnam and Fiji, through a combination of desk-based research, interviews and deep-dive case studies. The paper recommends tackling these issues by shifting focus away from hospital care to “ensuring care coordination and continuity of care across primary, hospital, and post-acute settings.” It identifies several factors that help with the development of such a system including strong leadership combined with local flexibility, financial and non-financial incentives for both healthcare providers and users, training for community care workers, collecting accurate health information, and ongoing performance assessments for integrated care programs to measure their effectiveness.
Use of E-Health Programs to Deliver Urban Primary Healthcare Services for Non-Communicable Diseases in Middle-Income Countries
The research paper was authored by a group of researchers including three from DKU: Lijing Yan, Professor of Global Health, Shangzhi Xiong, a 2018-class Global Health master student and research analyst at GHRC, and Hongsheng Lu, a 2020-class Global Health master student. They worked on it with Lia Palileo-Villanueva, a professor at the University of the Philippines, Hao Li, Associate Professor at Wuhan University, Abha Shrestha, who works at Kathmandu University School of Medical Sciences, and Peter Otieno, a researcher at the African Population and Health Research Center. Healthcare providers saw multiple benefits to e-health measures, including reduced workloads, higher efficiency, and more convenient data storage and communications, according to the study. Patients described greater satisfaction with services, better continuity of care and higher quality of care.
Mechanisms and Path Analyses for Health Management among Chronic Diseases Patients in Urban China: A Community Empowerment-Based Approach
Non-communicable diseases (NCDs) have become a major challenge that threatens the health of residents and the national economy. Besides individual factors, community-level forces are potentially important for NCD prevention and control too. Led by Dr. Lijing Yan, Professor of Global Health at Duke Kunshan University, and funded by the National Natural Science Foundation of China, this four-year project was completed this year. The project was divided into two phases. The aim of the first phase was to develop and validate the “Community Efficacy for NCD (COEN)” evaluation system, which was defined as the communities’ abilities to provide NCD prevention and management and health promotion. The aim of the second phase was to collect information through the COEN scale to evaluate community-level factors associated with NCD control.
Early Warning Signs, Diagnosis and Intervention Strategies of Sarcopenia in China
As the sub-project leader, Dr. Chenkai Wu, Assistant Professor of Global Health, participated in the research on early warning signs, diagnosis and multidimensional intervention strategies of sarcopenia in the project of “Active Health and Technological Response to Aging”, a national key research and development program of the Ministry of Science and Technology led by West China Hospital of Sichuan University. The project will last three years, with the overall goal of establishing a biological specimen bank and animal model of sarcopenia, developing a prevention and treatment system for sarcopenia in China, building an application demonstration area, and formulating guidelines for the diagnosis and intervention of sarcopenia in China. Dr. Wu’s team will develop a sarcopenia early warning system and sarcopenia prevention and treatment demonstration area by establishing sarcopenia risk prediction model, diagnostic techniques and differentiated intervention technology validation and evaluation suitable for the elderly in China.
System-integrated technology-enabled model of care for stroke secondary prevention in rural China (SINEMA Project)
Stroke is the first leading cause of death and disability in China and imposes a major societal and economic burden. Co-Funded by UK Medical Research Council, Economic and Social Research Council, Department for International Department and Wellcome Trust, the research team led by Professor Lijing L. Yan conducted the SINEMA project between 2016 and 2019, with an aim to develop and evaluate a system-integrated and technology-enabled model to improve stroke secondary prevention in rural China. The research team worked with multidisciplinary collaborators to co-design the intervention package, including Beijing Tiantan Hospital，Peking University First Hospital, China Mobile Research Institute, Hebei Province Centre for Disease Control and Prevention, village doctors, stroke patients and stake-holders in the study setting. A cluster randomized controlled trial involving 50 villages and 1299 stroke patients was conducted in the rural areas of Hebei province. Results from this project provide a new model of care that empowered the primary healthcare system to manage stroke patients in resource-limited settings with the support of innovative digital health technologies. The research team has published four manuscripts in international peer-reviewed journals, and the research findings have been presented in international conferences. The research team is also making efforts for scaling up this intervention model to benefit more people suffering cardio-metabolic diseases.
Adaptive Design to Reduce Unnecessary Caesarean Sections in China
This study, led by Prof. Qian Long, aims to identify local drivers of caesareans, and the barriers and facilitators to change, to inform the design of a multiple component intervention programs to promote optimal caesarean use in China. China has witnessed a dramatic increase of CS rate over the past three decades. In collaboration with University of Central Lancashire (UCLan) in UK and Hangzhou Normal University and Chongqing Medical University in China, the research team analyzed factors associated with caesarean use using the national household health survey data and conducted qualitative interviews with health professionals and pregnant and postpartum women to explore their perceptions on the potential interventions to improve quality and experience of maternity care. The preliminary findings have been presented in Global Women’s Research Society (GLOW) 2020 conference and Sixth Global Symposium on Health System Research 2020. The research team is planning a pilot trial study based on the evidence gained from this study.
Plakoglobin and High-Mobility Group Box 1 Mediate Intestinal Epithelial Cell Apoptosis Induced by Clostridioides difficile TcdB
A collaborative study involving researchers at Duke Kunshan University’s Global Health Research Center and Wang-Cai Biochemistry Laboratory has made important ground in understanding Clostridioides difficile infection, an antibiotic resistant pathogen that can cause severe diarrhoea, belly pain, fever and potentially lead to death. The research, published in the American Society for Microbiology journal mBio, sheds light on key genes that are involved in tissue damage caused by the infection, which is a growing problem across the globe, and could help with the development of medicines to treat it.
Clostridioides difficile infection (C. diff) is a “significant threat to public health,” said Linfeng Huang, associate professor of biology at DKU, who led the research. “As a global health care problem, there is an urgent need to understand the infection mechanism and develop efficient therapeutics.”
One Health projects
Gregory C. Gray leads emerging infectious disease projects with a particular focus on One Health research, which occurs at the intersection of human and animal health and the environment. China has seen numerous recent infectious dis-ease outbreaks-SARS, avian influenza and dengue fever to name a few that have their sources in animals and insects, therefore, focused multidisciplinary work among physicians,public health researchers, veterinarians and environmental health experts is critical.
Impact of Preconception and Onward Exposure to Air Pollution Growth Trajectories of Infants and Children
Prof. Jim Zhang leads environmental health research projects on topics such as air pollution exposure and health impact assessment. He and his team have discovered novel bio-markers that show human exposure to toxins in the air and have examined the biological mechanisms by which environmental exposures cause adverse health effects. They also assess health benefits resulting from air pollution interventions at the public policy and household levels. This study has received a S2 million grant from the National Institute of Environmental Health Sciences (NIEHS).
There is much robust scientific evidence to improve health and health equity in China and around the world, but they are not fully used. A lot of research findings end at publication rather than timely and systematic translation into health policies and interventions to improve health outcomes and equity. The gap between what is known and what is done in practice is the so-called “know-do” gap. The Global Health Program will make efforts to bridge gaps between evidence, policy, and practice.
With a growing number of faculty members and ever-expanding needs for more global health research in the world, we identify three key priority research domains and, in each domain, three specific priority areas. Priority setting is not meant to exclude other research domains or areas, but to focus our resources to achieve larger impacts in the time period covered by this plan (2022-2027). Innovation is at the core of all research endeavor and spans all priority areas. Of note, these domains and priority areas are not mutually exclusive due to the interdisciplinary and complex nature of global health issues.
Initiated by MSD (China) and supported by the Global Health Research Center at Duke Kunshan University together with the International Center for Communication at Tsinghua University, the Media Academy Project (also known as the Knowledge Camp project) was launched in September 2021. The project is jointly led by Dr. Meifang Chen, Assistant Professor of Health Policy, and Dr. Fan Liang, Assistant Professor of Media, both of whom are from the Global Health Research Center. This project aims to provide more cutting-edge, professional, and reliable health education, information and insights to journalists working in health-related fields, and to foster a more sustainable educational ecosystem for health promotion.
The launch of the Media Academy Project marks an important exploration by the Global Health Research Center to popularize health science and strengthen interdisciplinary collaboration. As one of the academic support parties of Health Knowledge Camp, the Center will continue bringing together multiple sectors such as industry, academia, research, media, and others. The goals of these collaborations include: integrating high-quality academic resources, fostering health information dissemination activities with a global perspective, promoting the transformation of cutting-edge scientific research results and knowledge dissemination, and expanding the breadth and depth of science popularization content of the Health Knowledge Camp.
Since 2014, the Duke Kunshan University Global Health Research Center has held a series of global health seminars during the fall and spring semesters, featuring three to four talks per month. These seminars invite leaders, scientists, and industry experts in the global health field to exchange information on the latest research progress, international and domestic development trends, and global health teaching and practice experiences. Since 2020, Xingzheng Global Fund Management Co. and Ningquan Asset Management Co. have provided funding support to hold the global health seminars, which have now been named the Aegon-Industrial Global Health Seminar Series. As of the end of 2023, 186 seminars have been successfully held.
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