Big change: world health Annual report 2011/2012 Big change now
The time for incremental change to world health has passed – it is the past, an old fashioned view, well-intentioned, but not able to deliver the healthcare revolution we need. It is time to fast forward to better healthcare. It is time for big change.
Modest health reform packages to change the 20th century models of high cost, doctor-centred and hospital-focused – will not deliver the care we need in the 21st century nor the radical change required to transform health policies and practices. So the work of The George Institute for Global Health is about driving big change to world health. Our projects are specifi cally designed to provide the evidence for action that will directly change health policy, health practice, drugs and devices. Our work has already changed the healthcare received by millions of people worldwide, but there is much more to do.
The George Institute for Global Health ABN 90 085 953 331 All amounts are in Australian dollars unless otherwise specifi ed Who we are Big change now
Change health, change the world 5bFive billion people have no reliable access to basic healthcare for the conditions most likely to kill or disable them prematurely.
1 Who we are Our mission and our values
Who we are
We are advocates for big change and our mission is to improve the health of millions of people worldwide. We will achieve this by: Providing Engaging Targeting Focusing the best evidence with decision global epidemics, on vulnerable to guide critical makers to enact particularly of populations in health decisions real change chronic diseases both rich and and injury poor countries
Our values Our humanitarian Our focus Our creativity Our integrity Our “can do” Our emphasis commitment will on excellence will will challenge will underpin all approach will on impact will spur us to tackle produce scientifi c traditional thinking our work and produce timely, ensure our the health issues evidence that is and provide an interactions, effective action, work has real affecting high-risk ethical and of the impetus for new including our even in the face consequences for and disadvantaged highest quality. and innovative collaborations of adversity or those who are people worldwide. solutions to the with partner other barriers to most vulnerable to world’s leading organisations implementation. disease and injury. health problems. worldwide.
Our partners
The George Institute 2 Annual Report 2011/12 Contents
Who we are Big change now 1
Our mission and our values 2
Chair and Principal Directors’ Report 4
Our research Introduction 6
Chronic and critical conditions 8
Injury, ageing and disability 12
Healthcare innovation 15
Disadvantaged populations 19
Our investment Introduction 22
George Clinical 24
George Ventures 26
Our people Introduction 28
Organisational Structure 29
Governance: Board of Directors 30
Governance: Board and Research Committees 32
Senior Management Committee 34
Academic leaders 36
Human Resources Overview: Our staff 39
Our fi nancials Financial highlights 40
Statement of Comprehensive Income 41
Statement of Financial Position 42
Statement of Cash Flows 43
Our contacts 44
3 The George Institute for Global Health ABN 90 085 953 331 All amounts are in Australian dollars unless otherwise specifi ed Who we are Chair and Principal Directors’ Report
Chair and Principal Directors’ Report
Becoming a global organization, capacity will work with all four regional a three-in-one blood pressure lowering while continuing to build on our strong offi ces in supporting our global research pill; the development of a national salt Australian base, was a key focus for programme. Anushka brings to this role reduction program for India; and a the organization over the previous year, her experience in heading the Institute’s multi-site study to explore the barriers and indeed the previous three years, Cardiovascular Division in Australia, as to diagnosis and effective treatment of as articulated in our strategic plan. Our well as her leadership role as Executive hypertension control in rural India. In success in achieving this goal was best Director of The George Institute in India. China, funding will support a school- exemplifi ed during the year by our ranking Research with a global impact based education program to reduce salt as the leading scientifi c research institution intake in children, and a further project As outlined in more detail throughout in the world, as measured by the impact will investigate the cost effectiveness the report, the results of our research, of our published work, based on citations of salt reduction interventions in the even if conducted in a single region, of our research. The 2011 report from the Pacifi c Islands. All of these projects have global signifi cance. This year, for independent European agency, SCImago, involve collaborations across several of example, FoodSwitch, an Australian-fi rst ranked more than 3,000 research our regional offi ces, and most involve smartphone application, developed by institutions on the basis of their scientifi c partnerships with external collaborators. Professor Bruce Neal and his team at The publications from 2005-2009. The George George Institute in Australia with support Our teams were also successful in Institute for Global Health was ranked from Bupa, and based on an extensive obtaining substantial funding to further number one in a fi eld largely dominated research data base, was launched to help grow our research programmes in both by North American institutions. consumers make healthier food choices stroke and diabetes. In Australia, Professor This recognition supports and indeed and reduce high levels of fat, salt and Craig Anderson and his collaborators reinforces our commitment not only to sugar from their diets. By simply scanning were successful in obtaining the highest conduct research of the highest quality the barcode of Australian packaged foods ever level of funding awarded for a but also to conduct research that has an using a smartphone camera, consumers NHMRC project grant in stroke research – impact on policy and practice globally receive immediate, easy to understand The Enhanced Control of Hypertension and leads to improvements in the health nutritional advice via the FoodSwitch app. and Thrombolysis in Stroke Disease of millions of people worldwide. Foodswitch has been downloaded more (ENCHANTED) study. In China, Professor than 230,000 times and as result of the LI Linong and his team were successful A global organization with four huge interest in its release, is now being in obtaining funding to undertake not regional offi ces trialed across the world. only a comprehensive survey of patients During the year we restructured the living with type 1 diabetes, but also a Major new funding awarded this year, organization to more clearly distinguish study aimed at investigating the use through the Global Alliance for Chronic our global “head offi ce” operations from of basal insulin in 20,000 patients with Disease (GACD), with support from the our regional operations. In Australia, type 2 diabetes. Australian National Health and Medical Professor Vlado Perkovic was appointed Research Council (NHMRC) and the A fi nancially strong organisation as the inaugural Executive Director of British Medical Research Council will Our research achievements are built The George Institute for Global Health further strengthen our global impact. on an increasingly strong fi nancial in Australia, where he brings to this role, Funded research projects include an base with structures and systems not only a distinguished academic career evaluation of a smartphone system responsive to the demands of managing in renal medicine, but also his leadership called Healthtracker to assist Indian budgets and people across all our offi ces experience as Executive Director of rural healthcare workers detect and worldwide. The 2011/2012 year has seen George Clinical. manage hypertension and cardiovascular a signifi cant fi nancial improvement for Professor Anushka Patel was appointed risk; a project aimed at improving the organisation, with the Institute as the Institute’s Chief Scientist, based blood pressure control in India, using a reporting a solid surplus that will enable within the global offi ce, and in this simplifi ed treatment strategy including us to strengthen our fi nancial reserves.
The George Institute 4 Annual Report 2011/12 1 23
Our major strategic enterprise, George research; growing our existing enterprises low income countries alike, there Clinical, had a particularly successful year and developing new enterprises that is increasing acknowledgement that and as a consequence was able to make generate both social and fi nancial current health systems are under stress a substantial fi nancial contribution to the dividends; strengthening our development and that without major changes in Institute, much of which has been used and communications activities to support the way healthcare is delivered, they to support the activities of our research our future and raise our profi le; and will not be able to deliver on the programmes worldwide. consolidating our governance and promise of safe, effective and accessible healthcare for all who need it. For the During the year we were also successful management to ensure that we have Institute, this provides both a challenge in raising some modest philanthropic a robust global operation. and an opportunity. funds, which were used in full to fund Those who support The George Institute our research programmes. As part of We were honoured to have Gina We are fortunate to have world-class our fundraising strategy we hosted for Anderson and Will Delaat join our Board researchers, who think big, who think the fi rst time, in Australia, a major event of Directors this year. Gina’s professional, innovatively and who are able to on World Health Day, addressed by business, government and community undertake research to address these the Australian Federal Health Minister, acumen, and particularly her experience challenges. The next 12 months will see the Institute playing a leading role The Hon Tanya Plibersek MP. in the philanthropic sector, has already in supporting the need for BIG CHANGE A roadmap for the next three years proved invaluable. Will’s expertise in the and contributing the evidence-base to pharmaceutical industry and in particular We undertook a major exercise during drive such change. the year, involving the Board and senior his experience in the development of management across the globe, developing innovative medicines is highly valued, our strategic plan for the coming three as the Institute increases its focus on the years, 2012-2015. As part of this process, conduct of research and the development of enterprises focused on innovative we also outlined our vision for the next 10 years and reaffi rmed our commitment approaches to providing effective and to our mission and values. affordable healthcare globally. Over the next 10 years we want to We also acknowledge the very important contributions of the other members of continue to produce high quality research Michael Hawker AM (1) that will inform changes in health policy the Board and its committees and the CHAIR and practice. However, we also want to signifi cant input of the Research Advisory take a much greater role in ensuring that Committee in India. Senior staff were our research fi ndings are embedded into key players in the development of our practice and to this end, we envisage strategic plan as well as making major developing social enterprises, particularly contributions to the overall success of focused on delivering safe, effective the Institute during the year. As always, and affordable healthcare to those who though, every single member of staff Professor Stephen MacMahon (2) currently have no or limited access to worked as part of the wider team and PRINCIPAL DIRECTOR such care. so we recognize their contributions also. In order to achieve this 10-year vision, our The next 12 months three-year strategic plan has a particular In closing, we would like to make focus on strengthening our organisation reference to our Annual Report cover to ensure long-term sustainability. We and the focus on BIG CHANGE as agreed specifi c measureable outcomes referenced throughout this report. Professor Robyn Norton (3) focused on maximising the impact of our For governments in high, middle and PRINCIPAL DIRECTOR
5 Our research Introduction
Our research
We look for answers that deliver a big change to the current health system and provide new ways to make healthcare accessible and affordable, delivered in a safe and effi cient system. We will educate, equip and re-engineer a new workforce of healthcare practitioners, give people access to low cost medicines that are safe and effective and fi nd new ways to use technology to make healthcare innovation really count by giving communities more control over their healthcare prevention, treatment and medication.
Big action is needed now to prevent more than 100 million people dying prematurely from preventable causes in the next decade.
The George Institute 6 Annual Report 2011/12 There are about 250 million people with diabetes. 250m Most will die or be disabled by complications of their condition.
Cardiovascular diseases are the leading causes of death in the world.
Seven billion people 7Oneb mission 5th Road traffi c injuries are projected to rise to the fi fth leading cause of death globally in 2030. 9b 2050 The world’s population is expected to reach 7 billion 2011 9 billion by 2050.
3 billion 2 billion 1960 1 billion 1930 1800 7 Our research Chronic and critical conditions
Kidney disease complexities drive enduring commitment to fi nd solutions The complexities of chronic kidney disease, which affects a billion people, has occupied researchers at The George Institute for a decade. Their work holds not only the hope of better treatment, but also new ways of working together to achieve breakthroughs and drive big, lasting change.
Big change: We found ways to better manage and reduce risk
The George Institute 8 Annual Report 2011/12 In searching for a kidney disease 9,400 breakthrough, we initiated the world’s largest trial which included more than 9,400 affected people.
Chronic kidney disease shortens life, planning a global study of high-risk kidney included more than 9,400 people with reduces quality of life and is expensive patients, called the Therapeutic Evaluation kidney disease. The Study of Heart and to treat. Finding a solution, and innovative of STeroids in IgA Nephropathy Global Renal Protection (SHARP) showed that the ways to treat or prevent this chronic Study (TESTING study). The global study combination of two cholesterol lowering condition and its complications, has will include 1,300 people from around the drugs prevented almost one in fi ve heart been a focus for The George Institute world and will follow them for fi ve years, attacks, strokes and operations to open for more than a decade. Our studies and assess whether steroids safely prevent blocked arteries in people with chronic have proven that prevention is key, kidney failure. kidney disease. but relatively few treatments have The TESTING study randomised its fi rst The results were the fi rst to show been shown to be effective. patient in 2012 and will provide data defi nitive evidence of the benefi ts of In the last year, our work has included that will guide the treatment of IgA cholesterol lowering in combating the IgA Nephropathy, which affects mostly Nephropathy patients globally when exceptionally high rates of cardiovascular young adults and occurs when abnormal completed. The study will engage with diseases suffered by people with chronic activity of the immune system causes patients via hospitals around the world kidney disease. kidney damage. It is one of the most and will adopt a new collaborative Acknowledging the opportunity to common causes of kidney failure, clinical trial model led by international harness these fi ndings and continue to but has no specifi c proven treatment. renal experts and leaders in clinical trial follow this large group of patients, we Following a small pilot study of conduct. TESTING’s model and approach launched SHARP-ER in 2012. treatments in Beijing, by Peking have been acknowledged globally and This work will extend follow-up for another University First Hospital, researchers are already attracting the attention of the fi ve years, allowing researchers to see if the within the Institute with colleagues International Society of Nephrology. at Peking University and several heart protection benefi ts persist or perhaps international kidney specialist For patients with kidney disease, TESTING even increase among patients with kidney organisations, have worked together to holds hope of better treatments and disease. They will also focus on safety conduct a systematic review examining improved care but patients with issues and the impact of chronic kidney the effects of steroid treatment for IgA established chronic kidney disease are also disease on patients and their families, such Nephropathy. The review demonstrated at risk of cardiovascular disease. People as the fi nancial, employment and social that steroid therapy appeared to prevent with severe kidney disease are at risk of implications of the condition. having a heart attack that is many times kidney failure, but with a potential 55% SHARP is the fi rst study that clearly higher than people without kidney disease. higher risk of adverse events in patients. demonstrated that an intervention reduced As part of the war on disease, researchers According to researchers more extensive the risk of cardiovascular disease among at the Institute are looking at ways to investigations were needed to obtain high- patients with chronic kidney disease. It better manage and reduce this risk. quality and reliable data. For this reason, reduced the risk of heart attack, and these the authors from China, Australia, India, In searching for a breakthrough, we also fi ndings are set to translate into global the UK, the USA and Canada commenced initiated the world’s largest trial which policy and practice in the coming year.
9 Our research Chronic and critical conditions
No excuses – time to change health practice Stroke patients are missing out on vital treatment that reduces the likelihood of a second stroke. Our evidence shows it’s time to change how they are treated.
Our research has shown that stroke patients are only half as likely to be prescribed the preventative treatment that may reduce the risk of a repeat event. Our fi ndings provide hard evidence to change health practice – now.
George Cepak has no recollection heart attack and this is greater for stroke in patients with cardiovascular disease. of the stroke that left him speechless patients compared to those who suffer According to Dr Emma Heeley, one of and unable to walk. Four years later, from coronary artery disease. our Senior Research Fellows, the concern after what seems unending therapy, Research published by The George is that Australian stroke patients and his speech has returned. Institute in 2011 has shown that stroke their clinicians are less likely to take up or prescribe these therapies. This appears “I didn’t know anything had happened patients are only half as likely to be to be related to different perceptions of until three to four days after; I realised prescribed the preventative treatment the risk of future cardiovascular events I couldn’t talk or move my right side. that may reduce the risk of