5 Questions: Sanjay Basu on preventing chronic illness in developing nations

There’s a new health policy challenge in developing countries. Though many see chronic conditions like type-2 diabetes and heart disease as problems plaguing the wealthiest nations, “nearly 80 percent of the deaths worldwide from these two diseases are coming from the developing world,” said Sanjay Basu, MD, PhD, assistant professor of medicine with the Stanford Prevention Research Center.

But Basu is working to change this statistic, and his efforts just earned him the $100,000 George Rosenkranz Prize for Health Care Research in Developing Countries. Administered by the Center for Health Policy/Center for Primary Care and Outcomes Research at Stanford’s Freeman Spogli Institute for International Studies, the award will help fund Basu’s large-scale data collection project in India. With health data on more than 65,000 people in the country, Basu hopes to improve diabetes screenings there as a step toward better prevention and treatment of the disease.

A researcher focused primarily on global development and human health, Basu is also an internal medicine physician with a master’s degree in medical anthropology and a doctorate in epidemiology. Writer Kylie Gordon recently interviewed Basu about his research interests and plans for the future.

Q: How did you first become interested in global health policy and the developing world?

Basu: As a child, our family went back and forth between the United States and India, and the contrasts in daily life were striking and overwhelming. There is a sense in many parts of India that life is a privilege and a constant struggle to maintain.

Q: Your research in India will involve data collection and mathematical modeling, which sounds rather abstract. How does this work translate into real-world improvements in people’s health?

Basu: Our research serves as a bridge between the clinical science of how to prevent and treat disease, and the detailed operations of how to actually deliver better prevention and treatment in the real world. What we specifically do is combine biological and clinical data with data on program reach, budgets and operations. In other words, we might learn how to build a car in a textbook, but our models look at how to make the car factory operate optimally so that the product, in the end, is drivable. We’ve worked closely with both government agencies and nongovernmental groups to deliver programs in real-world populations, and to continuously improve those programs over time. For example, our work on how to introduce better tobacco-control programs in India has actually resulted in recent legislation that has lowered tobacco use in some critical parts of the population.

Q: What’s different about approaching chronic disease prevention in India versus in the United States?

Basu: The sheer size and diversity of the population is one big difference. India is four times the size of the United States and far more diverse. There is simultaneously malnutrition and obesity, starvation and type-2 diabetes, vitamin deficiency and heart attacks — often in the same city. That means designing programs for a country — or a province, or even a city — requires a lot of attention to complicated, perverse outcomes that may happen. For example, we’ve looked into reducing sodium intake as a strategy to lower hypertension and cardiovascular disease. But we also have to make sure that we don’t generate iodine deficiency, since salt is the major delivery strategy for iodine and, unlike in the United States, iodine deficiency is a serious concern in India.

Q: What are the policy implications of your research?

Basu: Within tight budgets, we seek to inform what policies will most likely generate population-health improvements with minimal perverse outcomes. The key question right now is how to find needles in a haystack: people who have diabetes in a population of 1.3 billion who theoretically are at “high risk” by standard definitions. Within available budgets, it’s not possible to screen everyone door to door. The question is how to find these folks within the limits of current infrastructure, or how to build better infrastructure without taking away funding from other important causes.

Q: What’s next for you? What other research projects might your laboratory pursue down the road?

Basu: We are expanding our analysis of actual health-care outcomes among populations. We’re studying “natural experiments” in which similar populations experience very different health policies — such as new insurance, prevention and treatment programs. And then we follow those folks as they move through similar processes of economic development, urbanization and cultural change to find out what works and what fails in improving population-health outcomes.