Translating Scientific Evidence Into Global Health Policy TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. Senior Scholar Health Care Innovation and Policy Research The George Washington University School Medicine and School of Public Health

TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. OUTLINE Introduction Health: Definition & Determinants Scientific Knowledge: Generation, Translation, Implementation Global Health Policy & Advocacy Global Mental Health Action Plan 2013 – 2020 Health, Illness, & Economic Consequences TOTAL Health: Integrating Primary Care, Mental Health, Public Health 21st Century Challenges, Opportunities for Innovation Acceleration

TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. INTRODUCTION Brain, neurosciences, health systems performance – research rapidly evolving Brain, genome, immune system, microbiome Social determinants, global burden of disease (GBD) Non-communicable diseases & comorbidity – GBD & disability (GBDD) Cardio-vascular disorders (CVDs), depression, & diabetes comorbidity More than 30% in the GBD and more than 50% of GBDD, in aggregate Health systems’ fragmentation, need for integration TOTAL health integrated model & its translation into global health policy

HEALTH: DEFINITION & DETERMINANTS TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. HEALTH: DEFINITION & DETERMINANTS Health is a complete state of physical, mental, and social well-being Not just the absence of disease and/or infirmity Multifactorially determined Biologic, genetic, psycho-social, economic, cultural, & environmental Complexity of health, illness, & disabilities Responsive, integrated health systems responding on a timely basis Integrating primary, secondary, & tertiary prevention Accessible, of quality, and sustainable

SCIENTIFIC KNOWLEDGE: GENERATION, TRANSLATION, IMPLEMENTATION TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. SCIENTIFIC KNOWLEDGE: GENERATION, TRANSLATION, IMPLEMENTATION UN General Assembly on Non-Communicable Diseases (NCDs), September 2011 Mental disorders among most prevalent NCDs, excluded from the agenda Also excluded from the Millennium Development Goals (MDGs) There is no health without mental health High levels of comorbidity with other NCDs Total health systems integration – primary care, mental health, public health Domenici-Wellstone parity law 2008 Affordable Care Act – collaborative care, 2009

GLOBAL HEALTH POLICY & ADVOCACY TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. GLOBAL HEALTH POLICY & ADVOCACY WHO Executive Committee letters 2011, 2012 Dr. David Satcher, U.S. 16th Surgeon General Dr. Pedro Ruiz, President, World Psychiatric Association (WPA) Dr. Eliot Sorel, The George Washington University Dr. Jeff Lieberman, Columbia University College of Physicians & Surgeons Dr. Patricia Newton, President, Black Psychiatrists of America WHO Executive Committee Agenda WHO Assembly, Geneva, Switzerland, May 2012 WHO Global Mental Health Action Plan 2013-2020

GLOBAL MENTAL HEALTH ACTION PLAN 2013 – 2020 TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. GLOBAL MENTAL HEALTH ACTION PLAN 2013 – 2020 WHO Assembly ratifies global mental health action plan, May 2012 Mental health included on the global health agenda with other NCDs Strengthening effective leadership & governance Comprehensive, integrated, & responsive, community-based care Promotion & prevention for mental health Strengthen information systems, evidence, & research

HEALTH, ILLNESS, & ECONOMIC CONSEQUENCES TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. HEALTH, ILLNESS, & ECONOMIC CONSEQUENCES Health begins in the perinatal period, with lifelong consequences Perinatal TOTAL health essential for individuals’, families’, & populations’ health Attachment, nutrition, fitness, adverse childhood experiences (ACE) 50% of mental disorders by age 14 75% by age 24 Severely & persistently mentally ill, CVDs, & diabetes, 25-year premature deaths 4% of GDP of OECD countries

INTEGRATING PRIMARY CARE, MENTAL HEALTH, PUBLIC HEALTH TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. TOTAL HEALTH: INTEGRATING PRIMARY CARE, MENTAL HEALTH, PUBLIC HEALTH TOTAL health model Integrating primary care, mental health, & public health Health protection, promotion, & illness prevention Beginning with perinatal period and continuing throughout lifecycle Enhances access, quality, outcomes Diminishes costs, shame, stigma, & discrimination Integrating brain, body, & mind

INTEGRATING PRIMARY CARE, MENTAL HEALTH, PUBLIC HEALTH TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. TOTAL HEALTH: INTEGRATING PRIMARY CARE, MENTAL HEALTH, PUBLIC HEALTH Core Principles of Integrated Care Team-based, patient-centered, primary care (PC) P C provider, behavioral care managers, psychiatric consultants Populations-based, defined, screened, triaged & tracked registries Regularly reviewed, adherence and responsive treatment

INTEGRATING PRIMARY CARE, MENTAL HEALTH, PUBLIC HEALTH TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. TOTAL HEALTH: INTEGRATING PRIMARY CARE, MENTAL HEALTH, PUBLIC HEALTH Core Principles of Integrated Care, continued Measurement-based standardized outcomes measures Tools & treatment adjustments made when no progress Evidence-based pharmacotherapy, psycho-social interventions Accountability & quality improvement Track quality of care & outcomes continuously

TOTAL HEALTH: INTEGRATING PRIMARY CARE, TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. TOTAL HEALTH: INTEGRATING PRIMARY CARE, MENTAL HEALTH, PUBLIC HEALTH, continued New scientific evidence for TOTAL health and systems integration Innovative information nanotechnology & artificial intelligence applications Brain Project in the US, Human Brain Project in Europe Brain/heart, brain/immune system, & brain/microbiome interactions Enhancing primary, secondary prevention strategies Access, quality, & sustainability Buttressing translation of scientific evidence into global health policy

21ST CENTURY CHALLENGES & OPPORTUNITIES FOR INNOVATION ACCELERATION TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. 21ST CENTURY CHALLENGES & OPPORTUNITIES FOR INNOVATION ACCELERATION World Bank/WHO high-level meeting, Washington, D.C., April 2016 Making mental health a global development priority Global Innovators’ Fair, innovations across economies TOTAL health screening for integrated care Depression & comorbidity in primary care in China, India, Iran, & Romania Professional education services, research, & policy innovations Integrative role: IT/AI innovations across systems

TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. REFERENCES Kessler, KC, Ustun, TB, editors. The WHO Mental Health Surveys. Geneva: Cambridge University Press, 2008 OECD, Making Mental Health Count: the Social and Economic Costs of Neglecting Mental Health Care. OECD Health Policy Studies, Paris: OECD Publishing, doi:10.1787/978964208445-en. Sorel, E, Satcher, D. “The UN’s Unfortunate Exclusion.” Psychiatric News, October 7, 2011, page 8. Sorel, E. “TOTAL Health for All in the 21st Century.” Dignity in Mental Health, pp. 16-17. World Federation for Mental health, Occoquan, VA, 2015, http://www.gwu.edu/-ieresgwu/assets/WMHD_2015.pdf

TOTAL Health: Translating Scientific Evidence Into Global Health Policy Eliot Sorel, M.D., D.L.F.A.P.A. REFERENCES, continued WHO. The WHO Global Mental Health Action Plan 2013-2020. Geneva: WHO, 2013. The Brain Initiative, www.brainintiative.nih.gov; www.humanbrainproject.eu (last accessed August 7, 2016. World Bank Group. http://documents.worldbank.org/curated/en/2016/04/26281016/out- shadows-making-mental-health-global-development-priority. Washington, D.C.: World Bank, 2016 (last accessed August 7, 2016) Sorel, E, et al. “Depression and Comorbidity in Primary Care in China, India, Iran, and Romania.” Int Med J 2016; 23:2 118-131 Sorel, E., Raney, L., “Integrated Care,” American Psychiatric Association, Board of Trustees Position Statement, July 2016 Human Rights Council, United Nations General Assembly. Promotion and protection of all human rights. HRC 32, 29 June 2016