Leapfrogging challenges in the US… and abroad
January/February 2025 | Volume 24 Number 1
Photo courtesy of NHLBIDr. George Mensah
Dr. George A. Mensah, a clinician-scientist, is director of the Center for Translation Research and Implementation Science (CTRIS) at the National Heart, Lung, and Blood Institute (NHLBI). His professional experience includes nearly 30 years of public service at the U.S. Department of Veterans Affairs (VA), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health. Previously, Mensah spent 10 years providing direct patient care, teaching, and conducting research at Vanderbilt University and the Medical College of Georgia (MCG), where he was a professor with tenure, and director of its medical specialties practice. He also served as department head of cardiovascular care at the VA Medical Center in Augusta, Georgia. Mensah has authored nearly 500 manuscripts, abstracts, book chapters, and an atlas on heart disease and stroke published by the World Health Organization and CDC. Recently, he was named Principal Collaborator with the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study.
What inspired you to become a doctor and why specialize in cardiology?
I was born in a very small village in West Africa. We were fortunate to have a clinic in our village and there was a doctor who staffed the clinic. What was most impressive was how much he knew about every disease. He was invaluable to everyone, from children and their mothers to young adults and the elderly. I knew then I wanted to be like him—to know as much about every disease and be of value to everyone. A real eye opener came when I was doing my training as an intern and resident. Someone could come in dead-on-arrival because of a heart attack or cardiac arrest, but in many cases, we could treat that person and later they would walk out of the hospital – thanks to the remarkable research advances in diseases of the heart and blood vessels! Needless to say, I became a heart disease specialist and have loved it ever since.
Tell us about the Center for Translational Research and Implementation Science (CTRIS).
CTRIS supports research that helps turn discoveries into real-world health impact. At the core of our Center’s work is dissemination and implementation research. This work is important because you can have major fundamental science discoveries, but unless we turn the discoveries into clinical and public health applications, the vast majority of people who could benefit from this cutting-edge science never really do. As a field, translational science has an early stage, which is where you go from basic science to first in-human studies, and a late-stage, for example, phase 3 clinical trials, where the safety and effectiveness of a new treatment is compared against the current standard treatment.
Implementation science addresses dissemination and adoption of a new treatment. There may be technical and regulatory hurdles, economic and funding challenges, and even social and environmental barriers to the sustained adoption of effective treatments or behaviors. Overcoming these requires a very coordinated effort among multiple disciplines, but there can also be human behavioral and lifestyle challenges. What’s needed then is to engage with communities in meaningful ways, so that people develop a trust in science and use science-based information to make decisions for themselves and their families. This trust is essential to the co-creation of healthy, thriving communities.
Can international research help NHLBI achieve its agenda?
NHLBI is the third largest Institute at NIH, and the vast majority of our work is through researchers we support here in the U.S. Still, supporting research abroad helps our Institute fulfill its mission as a global leader in research. There are times when other countries, especially low- and middle-income countries (LMICs), provide special opportunities for furthering research through the use of unique populations, non-traditional resources, or environmental conditions that are not readily available in the United States. By working with a unique population abroad, we can advance science that often has relevance in the U.S. Take sickle cell disease (SCD) as an example. An estimated 1,000 – 2,000 African American children are born with SCD each year in the US; however, there are more than 150,000 children born with SCD in Nigeria alone. So if you're designing a study that requires thousands of patients, working in Nigeria would enable you to conduct your research and address an important public health challenge in Nigeria that could also have practical implications here in the U.S.
While most of CTRIS work is done in the U.S., we often partner with Fogarty so that the limited resources we have to spend outside our country can go a long way in supporting investigators working abroad, including in low- and middle-income countries (LMICs), which often bear a disproportionate burden of the diseases in NHLBI’s portfolio and can therefore uniquely inform the research mandated by its mission.
Tell us about the Global Burden of Disease study.
I've been very fortunate to work with the GBD study, which is spearheaded by the Institute for Health Metrics and Evaluation at the University of Washington. If you look at 20 to 30 years of data in any region or country, you can have a deep appreciation of how the disease and its risk factors change over time based on changes in policies, lifestyles, behaviors, and in the social and environmental conditions. The global view also reveals regions in the world where a particular disease is low or causes fewer deaths and other regions where that same disease causes a lot of death and disability. From there, we can discover important associations that inform clinical and public health practice and policy for the prevention and control of specific diseases and their risks. We also gain important knowledge about how to raise awareness and provide education for action about each disease.
What we've learned, unfortunately, about cardiovascular disease is that we haven't conquered it yet. It remains the leading cause of death worldwide; in the vast majority of places, including the U.S., it’s also a major contributor to rising healthcare costs and to rising number of years people live with disability. Currently, about 75-80% of the burden of cardiovascular disease is found in LMICs—that’s a huge challenge. When you look at LMICs, what you see is cardiovascular disease rising rapidly in some areas. This has been termed the epidemiologic transition. In some regions where many people were dying in infancy and young adulthood from infectious diseases, people are now living longer—thanks to effective antibiotics and highly-effective antivirals—and they are now succumbing to major chronic conditions such as cardiovascular disease.
What’s important...what’s ahead?
The real value of science and data science!
As you know, NIH just released the 2025 to 2030 strategic plan for data science and a lot of what is addressed has many implications for LMICs. Fogarty is leading the NIH’s Data Science for Health Discovery and Innovation in Africa program, yet similar programs need to happen in Latin America and Southeast Asia. Data science, machine learning, artificial intelligence can be a way for U.S. communities as well as the global health community to leapfrog challenges that we've faced for a long time.
When I was growing up, there was one telephone in my village; a copper wire ran from the capital city all the way to that one phone in the post office. As you can imagine, often there would be problems with that wire, and we’d lose phone access. We used to say, “It will take too many years for enough copper wires to be laid so that every household can have a telephone.” But then mobile phones became available and all of a sudden you didn't need copper wires. Now, almost everyone in sub-Saharan Africa has access to a mobile telephone. Imagine the huge benefits that could accrue if we leveraged mobile phones effectively to provide mobile health in sub-Saharan Africa!
Today, we need to think creatively: How can data science advances, including AI, help us leapfrog challenges, so that we can improve health for the vast majority of people in the world?
More information
Updated February 12, 2025
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