Reproductive, maternal, newborn and child health continue to be prominent public health issues in low and middle-income countries. These are two of the main priorities in Sustainable Development Goal 3 of the United Nations, which aims to ensure the health and well-being for people of all ages by 2030. In addition to maternal health, reproductive health covers an array of topics including safe pregnancy and childbirth, fertility, access to regulation of fertility and family planning, sexually transmitted diseases, and rights to reproductive health (services). Child health includes the well-being, and physical, emotional, mental, and social health of children and adolescents. Julius Global Health combines clinical and public health-based research to improve maternal, neonatal, and child health.  

Current projects in Ghana, Indonesia, Nigeria, South Africa, Tanzania, and Suriname facilitate the application of best practice in clinical care and public health. They involve the strengthening of basic health systems directed at health care providers to enhance clinical decision-making skills through leadership development activities and mobile health e.g. smartphone application support. They also aim to prevent pregnancy-related complications, such as hypertensive disorders of pregnancy and other non-communicable diseases. Projects offer emotional support during pregnancy through text messaging and counseling on breastfeeding, which contributes to understanding of optimal maternal and infant feeding, and thereby promotes child and adult health. The Carry Care Booklet  compiles experiences from pregnant women, their close contacts and professionals on maternal health and our work in Ghana.

Cancer is a major leading cause of death, with the majority of cancer occurring in low and middle-income countries. The number of people diagnosed with cancer is increasing considerably due to growing and aging populations, changes in lifestyle factors, and improved diagnostic facilities.  

Malaysia and multi-ethnic Singapore, where Chinese, Malay, and Indian are the main ethnic groups, have well-organized research environments. Recent work by Julius Global Health researchers in Singapore and Malaysia showed that Asian women with breast cancer express different symptoms and disease outcomes compared to Caucasian women. Research from Julius Global Health is combined with expertise from the National University of Singapore (NUS) and hospitals in Kuala Lumpur (Malaysia) to perform outstanding global health research in order to improve breast cancer outcomes

Dr. Peter Schielen, RIVM Center of Population Screening does focus on the development of cancer screening programs on the Dutch Caribbean islands with the aim to have screening programs for breast, cervix and colon cancer implemented by 2025. In May 2021, the RIVM Center of Population commenced with implementing a breast screening program on Bonaire, Saba and Statia, followed by introduction of cervix cancer screening in 2022. Introduction of colon cancer screening is expected for 2024. The programs are shaped along criteria developed for the programs in the Netherlands in Europe, and are adapted to accommodate for cultural differences or infrastructural limitations requesting alternative approaches. For the realization of these programs, Dr. Schielen and colleagues work closely with a network of stakeholders, both curative and public health professionals (GPs, GP-nurses, clinical specialists, laboratory specialists etc.) at local hospitals and GP practices, while being strongly connected to screening organisations in the Netherlands that lend support. In addition, he and colleagues have initiated  the development of a cancer registry in the Caribbean Netherlands in collaboration with research institutions, such as the Global Oncology workgroup of the Julius Center, UMC Utrecht.

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, accounting for 18 million deaths annually and increasingly affecting populations in low and middle-income countries. This increase has been attributed to population aging and trends towards unhealthy diets, smoking and sedentary lifestyles, in part related to increasing urbanization and globalization.  

Julius Global Health is involved in multi-center international studies on common cardiovascular risk factors and disease outcomes and clinical trials to test the effectiveness and impact of low-cost medication for primary and secondary prevention of cardiovascular diseases. Further research aims to develop primary and secondary prevention models that are optimally cost-effective when reducing the burden of cardiovascular diseases and diabetes. Research takes place in partnership with academic healthcare organizations in Malaysia, Indonesia, India, China, South Africa, Ghana, and Kenya and with international research consortia, such as SCUBY (Scale-Up Diabetes and Hypertension Care) and SURF (Survey of Risk Factors).

Most low and middle-income countries face a double burden of disease: non-communicable diseases are on the rise, while communicable diseases, particularly malaria, tuberculosis and HIV, remain prevalant. For those infected with HIV, the use of effective antiviral treatment has resulted in increased life expectancy, almost up to the level of non-infected people. However, there is evidence that constant activation of the (successfully treated) HIV patients’ immune system leads to a higher risk of developing cardiovascular diseases (CVD), chronic diseases such as diabetes, or diseases of the nervous system. The regular use of antivirals might also play a role in this increased risk. In addition to research which primarily addresses HIV treatment and long-term prevention of chronic diseases in HIV-infected populations, recent Julius Global Health activities embrace addressing childhood infections beyond HIV through healthcare innovations.  

Julius Global Health researchers are investigating the interaction of HIV and non-communicable diseases – particularly cardiometabolic disease in children and adults – for better prevention of non-communicable disease and better treatment of HIV. This is mainly being done in Africa, one of the regions with the highest HIV burden in the world, with research being conducted primarily in South Africa. In addition, work has been undertaken in Jakarta, Indonesia, to address cardiovascular health and cognitive function in infants and children infected through HIV transmission from mother to child.

More than 50% of the world’s population currently lives in urban areas and it is estimated that this number will rise to 80% by 2025, particularly in Africa and Asia. Not only will this result in more megacities, but the estimated 1 billion people currently living in slum-like conditions could double by 2030. It is commonly assumed that economic growth and demographic changes result in better health outcomes. However, increasing urbanization poses major challenges, including clean water supply, sanitation, and environmental pollution, and has been linked to profound lifestyle changes and unfavorable outcomes. Furthermore, the double burden of disease largely affects the growing lower socioeconomic population of cities. Through collaboration with the Institute for Risk Assessment Sciences and the Faculty of Geosciences at Utrecht University, Julius Global Health conducts research on the human health risks associated with exposure to potentially harmful agents in the environment. 

Exposome research 

Environmental Health research has long been limited by fragmentation and compartmentalization of environmental stressors, which has made it difficult to get a full understanding of the crucial impact of the environment on health. Julius Global Health is involved in exposome research, which recognizes the totality of environmental exposures over the life course. Through partnerships between Utrecht University, the Chinese University of Hong Kong and the University of Toronto, researchers aim to contribute to the development and implementation of new technologies to study the single and combined effects of environmental stressors.

Global Geo Data and Health Centre 

The Global Geo Health Data Center (GGHDC) is a shared data infrastructure of Utrecht University (UU) and the University Medical Center Utrecht (UMC Utrecht). GGHDC studies the role of the physical and social environment on health by providing a web service capable of linking personal environmental exposure data to health outcomes.

With the advanced geocomputing framework, our scientists link high-quality environmental data sets to large global healthcare cohort studies. The research results can assist urban planners, designers, and policy makers in working toward healthier cities.

Planetary health

The University Medical Center Utrecht (UMC Utrecht) is one of the eight academic hospitals in the Netherlands. UMC Utrecht aims to contribute to a healthy life and a healthy society, not only for ourselves, but also for all future generations, by providing care, education and research that is future-proof, both ecologically and economically as well as socially.

Examples of our work are the Exposome research hub, our Planetary Health educational vision and interdisciplinary courses, the ePlanet consortium (international collaboration to create educational platform on planetary health for the medical curriculum), our close collaboration with other science institutes in the country on this subject (www.ewuu.nl) and our research work with partners in low- and middle income countries.  For more information, please see: https://www.umcutrecht.nl/en/sustainability.

Global health ethics is a relatively young discipline, which focuses on issues of justice and fairness in relation to global health. Although the scope of this discipline is broad, in the Julius Center we currently focus on the ethics of international research, the ethics of health systems research in low-resource settings and the ethics of innovative techniques to promote global health, such as the ethics of gene drives.

Gene drives could, amongst others, be used to decrease the burden of vector borne diseases such as malaria, or to control invasive species or agricultural pests. The ethics groups at the Julius Center actively contributes to the dissemination of the 2016 CIOMS International Ethical Guidelines for Health-Related Research Involving Human beings including dissemination through an e-course.