University of California Los Angeles, Los Angeles.
Public Health Foundation of India, IIPH-H, Bangalore campus
As the eldest son to a teacher couple, I always fancied being a civil servant. I thought it would be a cool job with power to solve various societal problems. In hindsight, my choice of medicine was perhaps in line with this underlying desire in me to solve the problems afflicting people. The real learning process began for me at medical school, where I observed several patients dying or suffering from potentially preventable causes. I realized the importance of public health during this time. The most challenging job, however, was to make people recognize that ill health is not a random event, but a result of many antecedent factors, often avoidable or else manageable. Thus, the pursuit of my calling originated in exploring these determinants and seeking required paradigm shifts in policy to create healthy societies.
After my graduation as a medical doctor from Kasturba medical college, Manipal, I joined as a Junior Resident at the Center for Community Medicine, All India Institute of Medical Sciences, New Delhi. Subsequently, I was fortunate for the vital transition in public health career through the World Health Organization (W.H.O)’s job as a Surveillance Medical Officer. The excitement of contributing towards the eradication of a disease inspired me. Over the next six years, my field experience in several high-risk polio affected states of India shaped my understanding of the public health situation in India. As state coordinator for polio program of the W.H.O, I successfully led the efforts to manage the crisis of outbreak of wild polio virus transmission in Karnataka state, resulting in a historical reduction in number of wild polio cases (highest in the world at that time) from 36 in 2003 to only 1 in 2004. The enthusiasm from polio program resulted in my instrumental work towards sending a proposal from the state Government to initiate Measles surveillance in Karnataka. This initiative resulted in the Union Government’s initiation of its Multi Year Plan for Measles elimination in India. As a result of the ensuing activities, I was offered to head India’s Measles program at W.H.O as national measles coordinator. However, continuing the pursuit of answers for numerous questions in my mind, I made a momentous decision by choosing to pursue the career in public health research.
I was accepted into the masters in public health and subsequently into the doctoral program in Epidemiology at University of California Los Angeles (UCLA). I was fortunate to have Professor Roger Detels as my advisor, an internationally acclaimed epidemiologist, who transformed the rest of the career through the considerate mentorship he provided over 5 years. The academic and research pursuit was facilitated by graduate student scholarship and NIH Fogarty fellowship for doctoral studies. At UCLA, I worked as special academic reader, which involved teaching epidemiology to graduate students, and was rated outstanding for my teaching skills by being nominated to the prestigious best teaching assistant award. I also worked as research associate in the multi centre AIDS cohort study. As I was set out to return to India, Dr. Roger Detels wrote: “I predict that you will make many important contributions to the health of India.” In all humility, these words guide my work in the path ahead.
Hypertension is a major contributor to the worldwide epidemic of cardiovascular diseases (CVD). Workplace settings provide perfect locale for testing interventions of modifiable factors. I led a study (N = 1071) of software professionals exploring the association of Job stress and Hypertension. The study was done in 27 different companies and showed higher prevalence of hypertension at younger age, affecting 31% professionals. If untreated, these young professionals would go on to develop CVD at an early age. In addition, our meta-analysis established independent effect of Job Stress in the development of hypertension. Subsequent to this study in software professionals, we have now conducted the study among schoolteachers and employees of the government health department. These studies have helped us to collate evidence on worksite-based burden of Non Communicable Diseases (NCDs) and are helpful in designing the appropriate interventions. These studies suggested that the onset of NCDs in Indians occurs very early and it is essential to tackle the determinants of these diseases at very early age.
With the focus to continue the work on life course epidemiology by identifying the early markers of NCDs, and thereby contribute in prevention and their judicious management. Currently, efforts are underway to collate evidence from all over the world including expanding the birth cohort to multiple centres in understanding the role played by parenteral milieu on infants and subsequent development of NCDs. Dr.Jørn Olsen, my teacher of epidemiology trained me on the methods and results from Danish National Birth Cohort (DNBC) during my stay at UCLA. I was enthusiastic to discuss about the DNBC and epidemiologic methods with Prof.Olsen, as he continued to shape my plans of starting a cohort study in India. In pursuit of the goal of setting up birth cohort, I was fortunate to be awarded Wellcome trust strategic grant for setting up a birth cohort in Bengaluru. The aim of the study is to estimate the effect of glucose levels in pregnant women on skinfold thickness (adiposity), as a marker of chronic diseases (Diabetes and Heart disease) in early childhood. The study also aimed to identify other predictors of hyperglycaemia and obesity. Exploring the plausible association between glucose metabolism and future risk of diabetes in offspring will provide deeper insights into the etiology of Type 2 Diabetes Mellitus (T2DM). The study has currently enrolled over 950 pregnant women at two public health facilities in Bengaluru. With the WT-DBT India alliance fellowship, the cohort will be expanded to other health facilities in the city.
My future research plan is dedicated to understand the impact of early life determinants in prevention of NCDs. A life course epidemiological approach can provide useful perspectives in endeavoring promotion of positive health in populations through appropriate interventions. The following objectives guide my research.
a) Understanding about parental and psychosocial environment of NCDs
b) Explore the appropriate interventions through pilot projects
c) Ensuring evidence based public health policy planning and implementation
Objectives (a) and (b) help in validated identification and prioritization of parental determinants of childhood obesity (and subsequent risk of diabetes and hypertension). The evidence available in the next three years, will aid in generation of rigorous, feasible and contextually specific population based pilot interventions. The objective (c) will be achieved through pilot interventions based on objectives (a) & (b). The three objectives together will contribute to logical and empirically grounded choices of public health interventions. My long-term goal is to ensure healthy populations are sustained through integrated technical and advocacy efforts. My track record of working in public health over 15 years has provided a clear resolve for the achieving the objectives listed above.
Most of my work outside the research is dedicated to prevention of non-communicable diseases (NCDs). As an illustration, I worked as the lead editor in framing guidelines for health professionals for prevention and management of NCDs in primary health care settings on the invitation of the Government of Karnataka. In addition to the research, I engage in several public health advocacy and technical support initiatives. Some of such works include my role as the only public health professional in a committee constituted by the Karnataka government to initiate public health cadre in the state. I also worked on developing the action plan for implementation of the National Urban Health Mission (NUHM) and Universal Health Coverage (UHC) for Karnataka state.
I am able to pursue my dream career and research only due to the transformational platform of PHFI crafted by the futuristic vision of Prof.Srinath Reddy and other great public health leaders of this world. As my supervisor and immediate mentor, Prof.GVS Murthy Vice president (south) and Director IIPH have considerable influence on the meticulous design and success of the research in Indian settings. To implement the earlier pilot and current study, I am fortunate to have Prof.Sanjay Kinra as a collaborator and mentor, who has immense experience of establishing several birth cohorts. I am blessed to have a wonderful team at Bangalore with Dr. Suresh Shapeti taking care of all the administrative matters and logistics required for the study and makes the lives of researchers easy. I have found a great supporting wife in Sangeetha. The soul of my being and excelling is consequential upon my elder daughter, Spoorthi, who is the inspiration for all that I do. With second daughter entering our lives, Maanvi has brought us lot of joy and energy. Drawing from the encouragement and strength provided by my family, collaborators, mentors, and the opportunities provided by the research I do, I hope to realize my original quest of contributing to the improvement of the health and well being of people.