Dr. Susan B. Shurin, Acting
Director of the National Heart,
Lung, and Blood Institute
(NHLBI) at NIH
Dr. Susan B. Shurin is Acting Director of the National Heart, Lung, and Blood Institute (NHLBI) at NIH, where she oversees an extensive research portfolio with an annual budget of approximately $3 billion. The NHLBI conducts and supports research to prevent, diagnose, and treat heart, lung, and blood diseases; fosters training of emerging investigators; and communicates research advances to the public.
What is the significance of the U.N. committing to hold this High-Level Meeting on NCDs?
This is only the second high-level meeting on a health-related topic the U.N. has ever held - the first one was on HIV/AIDS - so the U.N. recognizes NCDs as a very significant global problem. The important thing is defining the impact of this problem beyond the health sector on economic development, quality of life and on peace and prosperity. Chronic diseases - heart and lung disease, diabetes and cancer - have been the major causes of morbidity and mortality in the developed world. Now these diseases are having an increasing impact on low- and middle-income countries. These are diseases that strike people in the prime of life when they should be productive citizens, and are largely preventable. Nutrition and physical activity are major contributors to cardiovascular disease, cancer and diabetes. Indoor and outdoor air pollution are contributors to cardiovascular and pulmonary diseases and cancer.
How is the NIH providing leadership on this critical research area?
The NIH is working to keep research on the agenda of the Summit on NCDs. A major focus has been on recommendations for interventions. We know what needs to be done, but often we don’t know how to effectively implement change. The NIH focus is on the generation of evidence of the effectiveness of an intervention, and its applicability on a population-wide scale. We’ve probably been most effective in vaccinations and in maternal and child health. There are crucial basic science questions that will help us get a better handle on the mechanisms of disease causation and design more targeted and effective interventions adapted to local demographics, culture and environments. We need more research to guide the economic and public policy changes that need to be made.
What is the Global Alliance for Chronic Diseases and what are its priorities?
The GACD is a group of public funders of biomedical research in both developed and developing nations who have identified common issues and plan to conduct implementation research to guide the investments that will come out of the U.N. meeting. Our initial research focus is on hypertension. Out of these research projects we hope to provide guidance that will enable policymakers and industry to make wise decisions to benefit the public health. Given the limited funds available, public and private entities need to know that their investments are based upon evidence of efficacy.
How do you view the importance of prevention versus treatment in combating NCDs?
When it is possible to do so, it’s both easier and more cost effective to treat than prevent disease. Prevention and treatment of hypertension, high blood cholesterol and smoking have a huge impact on the morbidity of cardiovascular disease in the developed world. We see these as complementary processes. In much of the world, prevention depends on having healthy options for food consumption, for example. These are not things that can solved within the health care system.
What are the priorities in terms of research questions to address NCDs?
We don’t have good data about the prevalence of risk factors for disease, although we have some data on the prevalence of disease. Both are necessary if countries are to make informed decisions on the priorities for their investments. Building sustainable health care systems is exceedingly important. With these, we can target specific interventions in countries. At the basic science level, we need much better understanding of population-based differences in genetic susceptibility if we are to develop interventions to prevent and treat disease around the world.