1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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: / 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 World Federation for Mental health, Occoquan, VA, 2015,

15. 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 Geneva: WHO, 2013.
The Brain Initiative, (last accessed August 7, 2016.
World Bank Group. 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:
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