PROVIDENCE – In the upper corner of the group photo capturing the participants in the gathering on April 21 at the private Hope Club at 6 Benevolent St., a conversation between the top echelon of public health researchers from China and the leadership of Brown University’s School of Public Health, the Watson Institute for International Studies, and the Institute at Brown for Environment and Society, is an oil painting of an American clipper ship, once the epitome of speedy commercial enterprise between China and the world, before it was supplanted by steam ships.

[It is one of two such paintings of clipper ships that hang on the stately walls of the Hope Club dining room, the second partially hidden behind a display screen in the photograph, that also speaks, indirectly, to the uncomfortable fact that the heritage of wealth in Rhode Island was built in part upon slavery and exploitation.]

The conversation begun last week has the potential to serve as an important catalyst in transforming the 21st century relationship between China and the U.S., much the way the clipper ship once transformed commerce between the countries, in a new kind of scientific and research collaboration, focused on public health.

The conference, the first of its kind in the U.S., focused first on a discussion on China’s efforts to respond to a wave of challenging infectious and chronic diseases, such as cancer, heart disease, obesity and diabetes – that have followed in the path of China’s rapid economic development.

It then explored the potential for collaboration with Brown University’s scientists in epidemiology, biostatistics, and medicine.

Dr. Tongzhang Zheng, who joined the Brown University Department of Epidemiology earlier this year, recruited from Yale University, spoke with ConvergenceRI right before the conference began.

The conference, titled “The China Forum on Public Health, Environment and Health Policy, was one in which Zheng played a key role in arranging the participation of the Chinese scientists. They included: Dr. Yinlong Jin, president of the National Association of Environmental Health Sciences, Dr. Jianguo Xu, director general of the National Institute for Communicable Disease Control and Prevention, Dr. Jie He, director, China National Cancer Center, and Dr. Dongfeng Gu, vice president, Chinese Academy of Medical Sciences.

It’s no trade secret that China has been beset by many of the ills of pollution and disease as a result of rapid industrialization – and that China has also now been willing to partner with the U.S. in developing new policies to address global warming and climate change.

Zheng, who has been doing collaborative research and training workshops in China, told ConvergenceRI that the conference was an opportunity to extend the collaborative research in China.

As a scientist from Brown, Zheng explained, the conference served as “a wonderful opportunity to extend this collaboration.

“Brown University is setting the standard for collaboration around China’s public and environmental health,” Zheng said. “The conference will explore the issues [now facing] China, and it will also [showcase] what Brown University scientists are doing and capable of doing.”

The public health issues confronting China are many, according to Zheng, including cancer, cardiovascular disease, diabetes, and children’s health. “So, what are the reasons?” he asked rhetorically, and also, what are the potential solutions.

Zheng pointed to the fact that China was “the largest producer and consumer of metals in the world,” talking about the effects of industrial pollution on public health from smelting and coal-burning facilities.

Beyond the statistics
The gargantuan dimensions of the public health crises in China are sometimes hard to grasp within the framework of the American perspective. Jin, in his presentation, attempted to provide a sense of those dimensions – where burning coal is responsible for 70 percent of the energy production, smoking is a prevalent habit for more than 50 percent of the population, and indoor air pollution from open fires without chimneys is a high-risk factor.

There are 127,000 new cases each year of respiratory illnesses, 44,000 new cases each year of lung cancer, 118,000 new cases each year of malignant tumors, and 205,000 new cases of cardiovascular disease, and the rates are increasing. In addition, the body burden of heavy metals found in the neonatal cord keeps rising, and about one out of 25 children die a premature death before the age of five, according to Jin.

To counter that, the Chinese ministry of health is promoting a public health campaign focused on “Blue Sky, Clean Water and Green Mountains,” Jin said.

Countering infectious diseases
Xu talked about China’s capability to control emerging infectious diseases in relationship to behavior and ecology, which he translated into the problem of “more meat, more money, more disease.”

He talked about the Chinese response to outbreaks of Lyme disease, cholera, H5N1 flu, SARS, the threat of Ebola, H7N9 flu, Dengue fever and E-coli, often tied to unhealthy animals and unhealthy food animal production, by culling the animals, according to Xu.

Cancer prevention and control
He, director of the China National Cancer Center, talked about cancer prevention and control, focused on new efforts to limit where smoking of cigarettes was allowed, such as tobacco-free hospitals and tobacco-free schools.

He also pointed to the rapid growth of hypertension in China, from 5 percent in 1959 to 26.5 percent in 2010.

He said that there were 14.35 million patients discharged from hospitals with the diagnosis of cardiovascular disease in 2012, with an expected 290 million cases of cardiovascular disease predicted in China in the next decade.

A world perspective
Dr. Peter Boyle, president of the International Prevention Research Institute, begin his presentation with a bit of wry humor, saying: “Life is a sexually transmitted disease which is inevitably fatal.” He also apologized if, because of his Scottish accent, his English was not readily understood.

Boyle put the focus on global changes in life expectancy, “where chronic diseases become a significant problem” for people who are over 65.

Boyle also said that poverty was the major cause, with “10 percent of children under the age of five” dying from preventable causes. “The major cause of death in the world is poverty,” he said.

Cigarette smoking, Boyle continued, was directly responsible for about 1 billion deaths a year.

“Death is inevitable,” Boyle said. “But premature death between [from birth] to the age of 69 is largely avoidable.”

The importance of physical exercise
Dr. Gu, vice president of the Chinese Academy of Medical Sciences, talked about the importance of re-introducing regular physical exercise into Chinese life in combating “cardiometabolic” diseases, where the ubiquity of bicycles has been replaced by the dominating presence of cars. 

Gu also stressed educational programs talking about limited salt intake, sugar intake, and sweet beverage consumption.

Questions and answers
Dr. Simin Liu, professor Epidemiology and Medicine at Brown, asked the participants to talk about the relationship and interaction between the Ministries of Health and Energy, and the nature of top-down change in China being very much a product of necessary collaboration between the two agencies.

Xu responded, without directly answering the question, by saying: “I think we have to change,” adding that the focus needed to be on institutional collaboration and research.”

ConvergenceRI asked, given the rapid rise of diabetes, with more than 100 million Chinese diagnosed with the chronic disease in just the last few decades, was there any research into the potential role that endocrine disruptors might be playing, beyond the changes in lifestyle and diet?

Boyle answered by pushing back against the idea that endocrine disruptors might bear responsibility, saying: “It’s all about the calories.” He talked about the pending release of a new study in September that put the focus on calories and not sugar in relationship to the epidemic of diabetes.

At lunchtime, Dr. Joseph Braun, an assistant professor in Epidemiology at Brown, engaged with Boyle in further conversation about endocrine disruptors, a focus of Braun’s current research, including soy as an endocrine disruptor. Braun also wondered about measuring and documenting the potential content of glyphosate, a key ingredient in the herbicide, Roundup, in genetically engineered foods.

ConvergenceRI could not attend the full day’s events, but left feeling energized by the level of conversation and dialogue and convergence at the event – and the promise of new frontiers in collaborative research in public health between China and the U.S.

It was clearly a work in progress; it was another example of the emerging health innovation network in Rhode Island as part of the research engine, within a global context.

As Brown President Christina Paxson said in her introductory remarks: “This is a time to be courageous; I say it is a time be bold.” The investment in creating a School of Public Health and investing in the collaborative research platform on public health between the U.S. and China certainly marks a nodal point of convergence in Rhode Island’s innovation ecosystem.