How can we
think differently about health?
To help end preventable illnesses?
And improve the lives of millions of people worldwide?
Ideas into impact
At The George Institute for Global Health we are focused on tackling the world’s biggest killers: non-communicable diseases (NCDs) and injury. We’re a 600+ person, world-class medical research organisation, operating in 50 countries with four major centres in Australia, China, India and the UK.
Our mission is to improve the lives of millions of people around the world. We believe that practical, cost effective approaches to managing non-communicable disease offer unparalleled opportunities to help people live longer, healthier lives.
We conduct high quality research, develop answers and solutions, and drive impact.
To complement our world class research, The George Institute’s unique global health policy thought leadership effort focuses on non-communicable diseases and injury, and improved systems for prevention and treatment. We share our insights, challenge the status quo and foster the kind of debates and discussions that lead to improvements in health outcomes. The think tank program involves current researchers at The George Institute as well as non-resident Distinguished Fellows – external experts who are leaders in their respective fields.
Our priority areas
The George Institute’s think tank program priority areas of focus are:
Our think tank advocacy work follows these guiding principles:
- Challenge the status quo;
- Drive critical analysis and reflective thinking;
- Develop networks and collaborations to enact real change;
- Target global epidemics, particularly of non-communicable diseases and injury; and
- Focus on vulnerable populations in both rich and poor countries.
Do you want to be part of this? Are you a leading health researcher, health policy expert, policy maker or health advocate?
Through The George Institute’s Distinguished Fellows program, you can contribute to the global debate. As a George Institute Distinguished Fellow, you’ll stay right where you are at your own organisation. We’ll support your thought leadership work, helping to amplify your insights to key stakeholders around the world.
Our Fellows will be driving the conversations around non-communicable diseases and injury, and improved systems for prevention and treatments. You will do this through blogs, public talks, videos, social media and discussion papers. We’ll even support you leading an event that will highlight specific challenges and solutions or sponsor your conference presentation or similar announcements related to your research. Our Fellows can also seek the opportunity to engage directly with stakeholders through our offices in Beijing, Delhi, Oxford or Sydney. Our social media, design, events and media teams will help you throughout.
Who we are: Jacqui Webster
Head, Public Health Advocacy and Policy Impact Centre, The George Institute for Global Health
Director, WHO CC Salt Reduction
Associate Professor, Faculty of Medicine, UNSW Sydney Honorary Associate Professor, University of Sydney
You are a passionate healthy eating advocate. What inspired you to work in health research?
I have always been interested in food. I grew up on a farm in North Yorkshire in England. Everything was home cooked or from the farm or garden. Mum thought that buying anything like jam or packet gravy from the shop was cheating.
I studied Sociology and then International Development which was when I first became aware of the massive inequalities in relation to food security globally. My first job was advocating for food policies to improve health for people on low incomes in the UK. Later I worked for the UK Food Standards Agency where I helped establish the UK government’s successful salt reduction strategy.
The George Institute’s researchers are leading thinkers on global health. What do you see as the most pressing goals for public health?
A lot of my research to date has been on reducing population salt intake by supporting companies to take salt out of foods and meals. But increasing the focus and spending of governments on prevention policies more broadly is urgently needed. This includes improving environments to support healthier living through better food and nutrition, improved mental health and reduced injuries.
What would you like to see come out of your work with the new think tank?
The George Institute’s research focuses on low cost solutions that have the potential to improve the health of millions of people globally. Our new think tank initiative is about ensuring our research influences policy and practice and ultimately affects people’s health. We will tackle this through cross-cutting issues including healthy living environments, improved health systems, women’s health inequalities and social enterprises. We will engage a suite of different channels including digital media and events to share insights, challenge the status quo and foster the kinds of debates that can deliver real impact in relation to health, both in Australia and globally.
What do you find most intriguing about healthy eating research?
Every individual is different and the factors that influence food choices are complex and changing. The move towards personalised nutrition is fascinating but probably only relevant to a small minority of self-motivated people – for the vast majority of people the food environment, including price, availability, culture, knowledge, and skills, is what influences their daily food choices. Telling people what to eat won’t have much of an impact unless we can change the food environment.
What kind of diets would you like us all to be eating in the near future?
There’s no one size fits all when it comes to diets but in general it would be good to see a shift towards increased consumption of fresh foods and less processed foods. The VicHealth Salt Reduction Partnership tagline, “If it’s packed, chances are it’s packed with salt,” says it all. We need to enable people to eat more fresh foods, including fruits and vegetables, and less processed foods. Obviously, not everyone is going to be able to cook from fresh at home every day so we need to be ensuring that manufacturers increase the healthiness of processed packaged foods and that restaurants and food outlets sell healthier meals.
How have you changed your lifestyle as you learn more about diet through your work?
There isn’t really much I won’t eat occasionally. I love food and enjoy eating out and entertaining. So I try to balance this out by bringing healthy lunches to work and making sure we only have healthy meals and snacks at home most of the time.
When do you think health initiatives work best? Can you give an example of how our research has made a big impact on people's lives, such as with regards to better dietary choices?
Certainly, one of the reasons for the success of the UK salt reduction strategy (that has already reduced salt by 15% and estimated to be saving around 9000 lives a year) was the fact that research, advocacy, government and industry were all brought together on the same page. Plus, the main focus was changing the food environment – in this case reducing salt levels in foods and meals – which was key to success.
Salt reduction programs also have great potential in developing countries and sometimes changes can be made quite quickly. As part of a visit to Mongolia I visited a bread factory and discussed the importance of reducing salt with the manager who immediately reduced the amount of salt added to the bread in the factory – which was producing 50% of the bread in Mongolia. This would have had an immediate and significant impact on people’s health in Mongolia.
But not all changes are that easy. Processed foods are increasingly available in many countries, and I’m concerned about the rising consumption of products like instant noodles, which may be cheap and convenient, but contain huge amounts of salt.
What keeps you motivated to keep helping people eat better?
Initially my interest was in tackling malnutrition in the form of people not having enough to eat. But over the last 10-15 years my priority has shifted to the growing problem of people eating too much, or the wrong kinds of foods, leading to non-communicable diseases such as diabetes or cardiovascular disease. It’s not difficult to stay motivated. Food systems are complex and there is always something new to learn. Plus, everyone loves to talk about food and health.
The George Institute researchers mainly focus on prevention and low-cost solutions, which ones are you most excited about?
One example is the new affordable dialysis machine that has the potential to massively increase access to this life-saving treatment for people with kidney disease globally.
Meanwhile, SMARThealth provides an exciting opportunity to improve efficiency of patient healthcare in many countries and our trials of a new combination pill (that combines treatments for multiple risk factors) will help to increase adherence and has the potential to dramatically cut costs to health budgets around the world.
These are just some of the examples of low-cost solutions that can deliver impact in relation to healthcare choices, treatment and improving efficiencies of healthcare systems. Our challenge now is to make sure the right people know about them so that they are integrated into policy and practice and ultimately impact people’s health and save lives.
Who we are: Kelly Thompson
Program Manager, Women’s Health, The George Institute for Global Health
What inspired you to work in health research, and what keeps you motivated?
I obtained a great deal of satisfaction from being a bedside nurse but it was really tough work in a challenging system and towards the end I often felt like I wasn’t doing “enough”. I’ve always had an intrinsic knowledge that my purpose in life is to be of service to others and in research I can do this on a large scale and without the burnout that often happens when working on the frontline. Knowing my purpose is what keeps me motivated.
If you hadn’t gone into health, what would you have done instead?
As soon as I stepped foot into my first job after school as a medical receptionist, I knew I would always work in health so I can’t imagine myself working anywhere else.
What do you see as the most pressing goals for women’s health?
It’s such a vast area with so much work to be done but the bottom line is about making real, measurable progress towards achieving gender equality in every possible context worldwide. In some contexts it’s about ensuring women are given the same opportunities and in others it’s about women being given the same basic human rights as men.
What would you like to see come out of your work with the think tank?
I’d love to see a really strong advocacy program to support the dissemination of women’s health research outside of traditional models so we can have the biggest possible impact.
When do you think health initiatives work best? Can you give an example of how our research has made a big impact on people's lives?
I think public health initiatives work best when they are designed (from the outset) in consultation with the communities they serve, like all of the Aboriginal and Torres Strait Islander Health research done at The George Institute– that really inspires me.
The George Institute researchers mainly focus on prevention and low cost solutions, which ones are you most excited about?
Obviously – the low cost dialysis project is a mind-blower. It is such an innovative model and will drastically improve the lives of people not previously able to access or afford dialysis. This is particularly important for women who are less likely to access and receive life-saving treatments like dialysis due to gender inequality.
Who we are: David Peiris
Director, Health Systems Science, Office of the Chief Scientist,
The George Institute for Global Health
Professor Faculty of Medicine, UNSW Sydney
What inspired you to work in health research, and what's your background?
I came to research fairly late in my career. I'd been a practicing GP for about maybe 12 years and I was always very much more clinically focused. But in my clinical work, my passion was always around delivering good primary health care to underserved populations.
I worked in a remote Aboriginal community for a number of years and did my junior medical years in the Northern Territory. So I’d been working in Indigenous health as a clinician for quite a long time already when I came back to Sydney. Then I did a Master's of International Public Health at Sydney University, and doing that started to open up my horizons towards public health research.
I then had a year in New Zealand working as the clinical director for a Maori primary health organization. That was a non-clinical role, but it was where I started to look at designing and implementing programs to improve quality of care for Indigenous populations- in this instance Maori and Pacific populations in Auckland.
I moved back to Australia when a job at the George came up to do work on a new Indigenous health services research program. The program was then led by Alan Cass (now at Menzies School of Health Research), Alex Brown (now at SAHMRI) and Anushka Patel. The role seemed right up my alley because it was starting to bring that very practical, clinical focus, and the new work I was doing around quality improvement, into a research lens. That was 12 years ago and for the first few years I focused exclusively on that program of work, and did a PhD on it.
What keeps you motivated?
I think throughout all of my career, the focus hasn't really changed. It's still primary health care and strengthening systems for populations that miss out on access to good care. In the post-PhD era for me at the Institute, this focus was really important as the Institute was also growing regionally in India and China. I was able to take the learnings from the work I'd done in Indigenous health services and see its application in other settings.
This year it's the 40th anniversary of a landmark declaration on primary healthcare which was made in Alma-Ata in 1978 [Declaration of Alma-Ata]. The Declaration really sets up a charter for how to use primary healthcare as, essentially, a kind of restorative justice mechanism for community control of health services and framing access to quality health care as a right.
Way back when I was a medical student, I saw the Declaration as being an absolutely inspirational document. It's interesting that it's being revisited this year, and a new declaration is about to be announced at Astana, Kazakhstan at the end of October.
I think all of the things in there were inspiring for me as a med student. They were inspiring for me when I worked in Indigenous health. And, they still remain very inspiring now as a more established researcher.
What's your role now?
My role now is as Director of Health System Science, which may be difficult to understand. Health systems really encompasses a whole range of things in terms of how healthcare is organized, financed, the workforce that underpins it, and how systems are structured in terms of things like information systems. Then, even more broadly, not just in healthcare, but also how you might influence governments and industry to play an active role in the health of whole populations. So, it's a very broad area.
I come from the more grassroots primary care angle on health systems. At the Institute we've got activities on all ends of the spectrum, from more micro-level clinical interventions to try and improve care, right through to big policy changes. For example, the work in food policy and in injury prevention, which is trying to improve public health through government regulation.
A key part of my role is to harness our strengths across the Institute; provide support to all four regional offices; build networks through multi-lateral, government, industry and academic partnerships; and look at how we can use our expertise and experience to contribute to furthering our mission through stronger health systems.
What's an example of one of the micro activities?
We do a lot of work using point of care decision support systems. One of the things that came out of my PhD work was that it's very hard for clinical people to consistently apply guideline recommendations into practice, and to make those recommendations practical when there is a patient in front of you. This work has grown through our Smarthealth program and our staff lead projects in many countries, particularly in the Asia – Pacific region.
These are simple, low cost tools that can essentially bring guidelines into the consultation, alert a provider to where best practice recommendations might be, and then using communication tools to be able to bring that into discussions with patients.
We've done a lot of trials to assess its effectiveness and learnt greatly how local contexts drive adoption of these types of strategies. For us, the next stage with that body of work is to test if it can be scaled to reach a larger group outside of just research project settings.
That's where the health systems part becomes more important. Asking questions such as ‘how do you pay for these things?’ ‘How do you build a workforce that can sustain it?’ And, in information system management, ‘how can it actually be embedded into existing systems?’
Whereabouts are you thinking implementation of guideline tools into the existing systems?
We've got programs actively in Australia, China, Indonesia, India and the UK as well as other regions. We're at this interesting point where we're looking at how we can improve the process. We clearly can't do all this ourselves. It's about partnerships-
So it’s important to have both private and public partnerships. Particularly, partnerships where people have access to large networks.
In Australia, for example, we're exploring partnerships with industry providers of digital health products. In Indonesia, we're working with one of the district governments to embed the tools into the current information systems that are used there. In China, we're collaborating with China CDC on a project to strengthen their existing health information systems. So, not using our tools, but actually just incorporating our knowledge expertise into those existing systems.
In a number of areas we're now at this interesting point where we can see even bigger possibilities that could become quite big scale national projects.
Is there a particular area that you're most excited about? A particular thing that you're working on, or a challenge that you can see?
To be honest, I find doing the mundane things, like supporting a clinic to function more efficiently, the most exciting stuff. Because, I just see the opportunity being so huge. And, this is always hard to communicate because my work isn't about a fantastic new pill, and, it isn't about a great piece of technology that's going to suddenly transform the world. It's about those slow plod things that might shift a service to a better quality and standard. This may, in itself, only be a little nudge, but if it can be done on a big scale, it actually has a huge reach and implication in terms of improving health.
I get excited about solutions to questions like, ‘how can you make a clinic workflow better?’ ‘How can workers become less busy but at the same time improve the quality of care they provide?’ And, ‘how can you make sure no one in the community gets left behind when delivering a better service?’ Or, ‘where can you find a bit of waste that could be removed out of the system to free up resources that are really scarce?’
Tackling these sorts of challenges is a very granular process, but also exciting in terms of the implications.
Who we are: Bruce Neal
Deputy Executive Director, George Institute Australia
Professor of Medicine, UNSW Sydney
Honorary Professor, Sydney Medical School, University of Sydney
Professor of Clinical Epidemiology, Imperial College London
What inspired you to work in health research?
Probably not the right way to start, but I ended up in health research by chance. I thought I wanted to be a vet and I left school with a place to do veterinary medicine in the UK. Fortunately, I decided to take a year out beforehand and after 6 months on sheep farms in New Zealand it was pretty clear to me that veterinary medicine was the wrong choice. Travelling through Asia on the way home, I decided I needed to save the world(!), and that medicine was what I wanted to do.
I turned up to vet science on the first day and let them know that I’d changed my mind. And then went to the medical school and told them I’d just relinquished that spot and asked if I could be a medical student. Probably because I had been rash enough to quit the vet course before asking to do medicine, they agreed to interview me the next day. The day after I became the shortest application to admission in the history of the Bristol medical school. You don’t need to plan everything months ahead!
After qualifying I worked hospital jobs in the UK National Health Service for about four years completing initial postgraduate training in general medicine. While trying to pick a speciality to further train in, Anthony Rodgers who I went through medical school with, called me from the other side of the world and said, “What about research?” Long story short, I got on a plane to New Zealand for a three month trial and ending up there for five years. I found the work really interesting, got a PhD with Stephen MacMahon as my supervisor ,and decamped to Sydney for the establishment of the George, then called the ‘Institute for International Health’.
How long have you been at The George Institute for Global Health? What’s your role?
I joined the George at the beginning, so it’s been 19 years. I'm now the Deputy Executive Director for Australia. I split my time about equally between clinical and food policy research. My focus at the moment is the latter, as we try to build the program in scale and scope. But the clinical work, where I've done most of my research over the last 20 years, remains extremely rewarding.
How did you come to focus on Food Policy?
The work in food policy grew directly from my clinical research interests. Even as a first year junior doctor, it was clear to me that poor diet, alcohol and smoking underpinned the great majority of clinical presentations. After a decade in clinical research assessing new interventions for the consequences of these issues, I decided we should also work on some of the upstream determinants. Food seemed like the area most aligned to my prior work, as well as being an area in which few people were doing global research and an area where there was an enormous amount to be gained from new discoveries.
I had done a fair bit of research on blood pressure lowering drugs so my interest in sodium (salt) followed from there. The vision was for a new program that spanned the globe – there were some amazing people doing food research, but most of them were working in just one area, or just one institution, and few were taking a global perspective. I also wanted to bring the sorts of methods that we use to such good effect in the clinical space to public health nutrition: research that is highly quantitative, massively collaborative, drives policy change, involves lots of countries and employs standardized methods and protocols. This seemed like something novel that we could bring to the space.
How many countries are you doing that sort of work in now?
We’re working in about 15 countries now. Most recently we launched the FoodSwitch program in the US. We use a franchise-type model with FoodSwitch identifying partners to work with in each country. We have developed technology, tools, and expertise but are not in a position to do it ourselves in all the places we want to operate. Therefore, we find an interested collaborator, typically an academic institution, and then support them to implement the project. We help them raise money, collect the data and use the outputs with government, industry, and their academic colleagues.
What are some of the most pressing goals in food policy?
We’re interested in the issues that cause the most disease burden. Ultimately that comes back to sodium and high blood pressure, fats and high cholesterol as well as sugars and obesity. We're mostly focused on the over consumption part of the malnutrition problem but in many low-income countries there is now a dual burden of malnutrition. With under consumption, mostly during pregnancy and early childhood, accompanying overweight and obesity throughout older life. These problems can now co-exist in communities, families and even an individual.
A big part of the next few years will be figuring out how to link up the research and response agenda to these joint nutrition problems. Bridging that gap between under consumption and over consumption offers a real opportunity, because there is great infrastructure in many low-middle income countries for the under consumption piece. But almost nothing able to address the other over-consumption side of the problem. This is a huge issue, because in many poor countries economic development and greater access to food means that the disease burden caused by over consumption has now overtaken that caused by deficiency disorders.
In terms of the prevention and low cost solutions we're working on at the moment, which ones are you most excited about?
Our philosophy is to focus on the environment, not the individual. Trying to get individuals to do the right thing has been the priority of most initiatives for the last few decades but has been almost entirely ineffective. This is because diet related ill health is caused first and foremost by changes to our food environment – not because everyone has decided to become a sloth or a glutton. They're essentially the same people as they were 30 years ago, they just now live in a food swamp - high calorie, high salt, high fat food in big portion sizes provided at low cost is available everywhere, all the time. In that situation, it is difficult to do anything but get fat and get diet related diseases.
Instead of trying to persuade individuals to do the right thing, we have to change the underlying food system, and that is our focus - generating data that can be used to push governments and industry towards a model that is sustainable from not just the economic perspective, but also for health and the environment.
The potential impact of our food policy work is enormous because everyone eats and almost everyone eats a diet that is sub-optimal for health. The way forward is to change the food environment so that individuals don’t have to make any active change themselves. For example, if industry reduced the salt in every food by 10 per cent almost no one would notice and we would prevent thousands of strokes and heart attacks every year in Australia. And millions more worldwide. If we can figure out how to get the system to make this sort of intervention, it's potentially really low cost and highly cost effective and that's where we’re heading with our research.
We have a long-term plan but it’s happening too slowly. Fifteen countries are contributing toward our program and the transparency and accountability agenda we are pursuing is getting real traction. We believe we can change the food supply in 50 countries, affect what a billion people eat and avert a million deaths each year by 2025. We need a few million dollars investment each year to make that happen and achieve this impact – and getting that is mostly what occupies me right now.
Who we are: Lisa Keay
Acting Program Director, Injury Program
Program Head, Eye Health Program, The George Institute for Global Health
Associate Professor, Faculty of Medicine, UNSW Sydney
What inspired you to work in health research, and what's your background?
I was always interested in working in health. I worked as an optometrist in regional New South Wales which I enjoyed and I certainly have a passion for eye health, but it wasn't until I moved into research that I think I became fully immersed in my work.
I like the variety of medical research; to be able work with other people to find out what the challenges are in health and think of solutions and then to evaluate those.
I really haven't missed a beat since I changed to research. I do appreciate that I have a health background because I have some good insights that guide my research.
What's your role at The George Institute?
I am Acting Director of the Injury Division at The George Institute. I've been at The George Institute in Sydney full-time since January 2009, working in the Injury Division. Coming into injury was a new area for me. Injury is a really interesting field because it's very broad and multi-disciplinary. It's also a major public health concern. One in 10 deaths are due to injuries and the burden of disability is much larger again. Injuries can occur at a young age and have life-long implications.
Those statistics are world-wide. It’s an interesting area to work in, given where I started, however there is a strong link between vision and injury risk. How well you see does dictate injury risk, particularly in later years of life when you're much more at risk of injuring yourself through falls.
A lot of my work is at the intersection of eye sight and injury. For example, we’re working with Guide Dogs Australia, a large community organization that provides solutions for preventing falls in people with low vision or blindness. That's going really well.
I've also done some work with ageing and road traffic injuries, looking at the challenge of keeping people safe on the road but also maintaining their mobility.
What keeps you motivated?
I think a lot of people are motivated about injury because it is something they can identify with. Injuries are not just bad luck. There are reasons and practical ways we can take action to prevent them.
As well as this, it’s often personal. When talking to my peers in road safety research, you realise that everyone can name an event which makes them feel like this is important.
My mother had a very severe car crash when I was a teenager. I think almost everyone has a story like that because it's common enough actually. I don't think that my story's that unique, but it certainly had a pretty big impact on the way I thought about what can happen to people on the road.
What are some of the key challenges in Injury research?
One challenge is engaging people in the philosophy of injury prevention; we need to change the way people think about injuries. Like I said, it's not just back luck that people get injured. If we can prevent injuries, we're preventing a lot of suffering and loss.
It's a different way of thinking; system-level changes to prevent injuries. Because as a society our tendency is to allocate blame for something happening, and it shifts the focus from where it should be. That tendency is detrimental to making gains, and it’s a position we should be challenging.
In road safety as an example there are certainly things you can do behind the wheel that change your risk, but we need to develop systems where it's difficult for people to act in ways that increases risk. When human error does come into the equation we've got to have slow enough speeds and good enough road networks that they don't end up with really severe consequences.
It’s an ongoing challenge to advocate for evidence based prevention strategies and policies. In Australia and in Europe there is a lot of good regulation, and good preventive strategies, but even in these regions there is a constant need for improvements to road safety policy. You have to advocate and challenge politicians to continue to make decisions that can prevent road crashes and save lives.
What are some research areas coming up in the near future that you're excited about?
There are a few areas. Populations across the world are ageing, and different regions have different challenges.
I’m interested in practical solutions such as proactive initiatives in the area of preventing injuries in older people. Lifetime activity fits in well with lots of other healthy ageing programs. There's some challenges with inactivity and having good physical fitness on older age. This is becoming a priority in low and middle income countries with the epidemiologic transition and population ageing in these countries. Falls prevention is gaining importance. We're trying to keep people on their feet and not falling.
For Australia, we've got a really rapidly changing landscape with what we can do with technology in vehicles. I have worked in the space of ageing and driving, and it's a really challenging area. In Australia these days it’s completely common for people to be participating in driving into their 80's.
Keeping people on the road is a good thing for socialization and mobility, but it can be difficult to maintaining safety. There's a lot of capacity to promote safety with just semi-autonomous features that vehicles have now.
That's an area that I'm really interested in. However, I think it can be difficult to get the human technology interface right because you can't have too many bells and whistles and distractions. You need to make use of technology in appropriate ways for the different groups.
We've done studies where we've had devices in cars. We're measuring exactly what's going on in vehicles. That's changed the face of doing research because you can get very large, fairly low-cost systems that can collect a lot of objective information.
I think technology in vehicles will revolutionize road safety. It's an area for debate about how it actually can be implemented but there are real possibilities. That's exciting.