SUMMARY
Research in global health has so far helped to identify economic deprivation as the single most powerful force in the emergence, spread and entrenchment of communicable and non-communicable diseases, and their attendant resulting disability, complications and death. This research indicates that economic development is by far the greatest cause of improvement in health. A sustainable model for global health recognizes the role of the animals, the economy and the environment in human health. Indeed, sustainable health production in global health is a function of a system that integrates simultaneous operation of human health, animal health, environmental health and economic health.The four modes of production of health (i.e., production of health of humans, production of health of animals, production of health of the environment, and production of health of the economy) must work together, jointly and simultaneously as one entity. To try to produce the health of one element, without the other three leads to failure, in a typical fixes-that-fail systems archetype. The four modes of health production rely on one another to operate effectively to create joint meaning of global health as a comprehensive entity in one.BRIEF REPORT DETAILIn the Spring Semester of 2015, a team of members of faculty and students from Texas A&M engaged in work to find out how we can be effective in tackling the grand challenge of global health. This engagement resulted from request by members of Ustawi Biomedical Research Innovation and Industrial Centers of Africa (UBRICA), to investigate a theoretical model that could explain how we could build sustainable health communities in African countries that helped to overcome the increasing incidence of poverty, disease, disability and death in the continent.People at UBRICA had noticed that the prevailing model of delivery of global health did not result in sustainable health communities, and many global health interventions resulted in shifting-the-burden of health production from the local people to the international interveners, with exasperating systematic fixes-that-fail that resulted in worsening of the condition they tried to solve.Malaria and tuberculosis are two major global health challenges that have suffered from shifting-the-burden, where interveners had the tendency to provide foreign solutions to local people, leading to inexorable decay of the local knowledge on how to deal with diseases in the communities. The decay of local capability to deal with local diseases left local people vulnerable to the disease in the rebound. Repeated interventions that shift-the-burden entered into a loop of fixes-that-fail, as each intervention failed to produce good results, and ultimately ending up worsening the local situation. Repeated external fixes-that-fail in global health produced the multi-drug resistance malaria and TB that pervades the African continent.Many well-intended and well-funded global health projects proposed for African countries generate much information about poverty and disease among people living in Africa. Such studies have established a direct link between material poverty, or economic deprivation and increased incidence of communicable and non-communicable diseases. Indeed, a myriad of global health researchers have generated widely published evidence that poor people are more susceptible to illness and death due to viral, bacterial and parasitic infections. Much worse, poor people are more likely to succumb to most non-communicable diseases and their complications. Diabetes, high-blood pressure, kidney failure, stroke and heart attacks are on the rise in the African continent. The rate of increase of cancer cases in Africa is alarming.Research in global health has so far helped to identify economic deprivation as the single most powerful force in the emergence, spread and entrenchment of communicable and non-communicable diseases, and their attendant resulting disability, complications and death. This research indicates that economic development is by far the greatest cause of improvement in health. This indication notwithstanding, global health workers lack a model that can help them to put into operation a comprehensive engine for economic development in their work. Ubrica had noted that a model that operationalized an economic engine in global health interventions would help to overcome the grand challenge of global health by creating thriving wealthy communities. The problem was that a model for global health that integrated economic development as a basic principle was lacking.To find answers to this problem, our teams of faculty members and students at the College of Architecture’s Center for Health Systems and Design (CHSD), and the School of Public Health’s Center for Health Organization Transformation (CHOT) joined forces to lay groundwork for a comprehensive model of global health that acknowledged the force of economic development in global health. Soon enough our teams discovered that production of health in any given community relies on comprehensive understanding of how humans interact with animals and their environment. This idea emanated from the public health model that considers human factors, characteristics of the source of harm, and the environment, identifying causes and suggesting possible ways to intervene. In this model, public health practitioners comprehend that disease, disability and death among humans can come from animals and from the ecology in which they operate. Texas A&M College of Veterinary Medicine had already created the ONE HEALTH MODEL of health production that acknowledged the intimate relationship between animals and humans and the environments where they lived, as the primary determinants of disease, disability and death. The One Health Model stipulated that we can prevent human and animal illnesses from occurring, and therefore produce healthy communities, if we designed our health production/health care systems to integrate considerations for human health, animal health and environmental health.We have learned however from the workers in the field of organizational science that a sustainable design is the one that integrates people, the environment and the economy in its structure. Mounting evidence over the past three decades has clearly shown that a sustainable global enterprise observes three bottom lines: (a) the economic bottom line (i.e., how well the organization is doing financially), (b) the social bottom line (i.e., how well the organization treats people in general, and particularly the fringe stakeholders, the poor, the marginalized and the disenfranchised), and (c) the environmental bottom line (i.e., how well the organization treats the environment). It is from this triple bottom-line theory that the concept of corporate social responsibility (CSR) gained much prominence, to the point that companies that are traded in the stock market report CSR to boost market value.Our teams noticed that the two theoretical models (One Health. model emerging from field of health production, and sustainability’s triple bottom-line model emerging from organizational science) had striking similarity and purpose, but operated independently in silos. One Health Model overlooked economic bottom line as a critical piece to health production. Triple bottom-line overlooked the role of animals as a critical piece in health production. Much worse, global health neither caught up with the one health model nor the sustainability model.After many months of observations, discussions, and review of literature, it became clear to members of our teams that the emerging model for a sustainable global health is the one that combines all the elements of the sustainability theory and all the elements of one health theory. A sustainable model for global health recognizes the role of the animals, the economy and the environment in human health. Indeed, sustainable health production in global health is a function of a system that integrates simultaneous operation of human health, animal health, environmental health and economic health. The four modes of production of health (i.e., production of health of humans, production of health of animals, production of health of the environment, and production of health of the economy) must work together, jointly and simultaneously as one entity. To try to produce the health of one element, without the other three leads to failure, in a typical fixes-that-fail systems archetype. The four modes of health production rely on one another to operate effectively to create joint meaning of global health as a comprehensive entity in one.The next question became one of how to design for sustainable health production in global health as a comprehensive entity in one. Our teams went to work again for many weeks to refine the model that integrated the four elements. The emerging model of One Health Communities is proposed as project in Kenya that would implement world-class life-science and health care capability as a completely integrated model for global health production, known as UBRICA ONE.Ubrica One Global Health Communities Demonstration ProjectThus, we propose to implement Ubrica One, a demonstration project for a sustainable global health communities that is rooted in economic development as the most powerful means of health production, but integrating the production of human health, animal health and environmental health. At the root of economic health production is industrial development in life science, to support sustainable research, education, translation and commercialization of innovations in health. This aspect proposes implementation of a biomedical industrial city. The team from Department of Landscape Architecture and Urban Planning at Texas A&M developed the master plan for Ubrica One biomedical industrial city to respond to economic production, for the health of humans, animals and the environment. Biomedical industrial city will be located on 4,330-acre site in Nakuru County Kenya, at the foothills of Mt. Suswa.Ubrica One masterplan proposed optimal spatial arrangements of diverse land uses including (a) a medical campus with five ultramodern academic specialty medical centers, (b) a research center for advanced science in biomedicine, (c) a biomedical industrial park for the high-powered biotechnology in biomedical translation and innovation, (d) a residential community with diverse and mixed housing options and a Metro Center for high-density mixed-use development, and (e) a recreational district with a state-of-the-art sports complex supported by multimodal transportation systems and extensive green infrastructure, and responding to the local history, culture, and landscape.The master plan of the City will be developed under the four main overarching guiding principles: (a) healthy living for all – HUMAN; (a) biological diversity and ecological integrity – ANIMAL; (c) sustainable and low-impact development – ENVIRONMENT; (d) economic and cultural development – ECONOMY.UBRICA ONE is planned and designed to meet the full range of healthcare needs, including curative and preventive cares, of those residing and working in the City as well as those visiting the City for health and medical tourism and other purposes. The long-term goal of the Ubrica One is to enhance one health of human, animal, environment, and economy.Ubrica One Retail Clinical CentersTo ensure equitable distribution of possibility in health production throughout Kenya, and other African countries, the biomedical industrial city will be connected to a franchised network of retail clinical centers, distributed in all counties throughout the country. The clinics contain a strong retail component that can cater to the grocery and produce shoppers. The grocery and produce shopping will power the economic engine of the retail clinical center, by working to attract shoppers, who in turn become clients for health, wellness and clinical services. All primary care clinical centers will carry space for basic ambulatory clinical capability. These include a clinical examination room, a dispensing pharmacy, and a clinical diagnostic laboratory. In addition, all clinics will be designed to carry clinical trials research work, in support of central bio-equivalence laboratory in Nairobi.In this demonstration project, Ubrica One will roll-out three models of retail clinical centers:Model 1. Primary Care Retail Clinical Center—this model is a basic community health center with added space for collection of specimens for samples for clinical trials and for bio-equivalence testing. Model 1 retail clinical center will be distributed widely throughout the country, all the way down to the village level.Model 2. Secondary Care Retail Clinical Center—this model contains 20 inpatient beds in addition to the basic services in Model 1. A section of the inpatient bed space will serve the bio-equivalence program. For this purpose, approximately 10 beds will be set aside to cater to clients coming for specimen draw for bio-equivalence testing. The remainder of the inpatient bed space will be used for short term in patient care for maternity services, simple surgeries such as hernia repair, etc. This indicates that Model 2 will have a small operating room, and has features of a secondary community health center.Model 3. Tertiary Retail Clinical Center—this model will also contain a full-scale bio-equivalence laboratory, in addition to all the features of Model 2. The bio-equivalence laboratory is a testing center for effectiveness of pharmaceutical products.