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Dr. Jonathan Samet has spent decades researching the health risks of inhaled pollutants, including secondhand smoke and particles in outdoor air such as those in vehicle exhaust. A longtime Fogarty and NIH grantee, he has conducted research around the world, including in China, Latin America and Africa.

A pulmonary physician and epidemiologist, Samet was named dean of the Colorado School of Public Health in 2017. Previously, he was the director of the University of Southern California (USC) Institute for Global Health, and a professor and chair of the department of epidemiology at Johns Hopkins University’s Bloomberg School of Public Health.

What impact has your tobacco research had?

The Fogarty-supported tobacco projects I’ve been involved with have seeded many important things. When I first went to China in 1995, for instance, there was one person doing tobacco control with a tiny budget. There were smoke-free zones in the airport and everyone would be smoking in them. That has changed, and work funded by Fogarty, the Bill and Melinda Gates Foundation and, more recently, the Bloomberg Initiative, has played a big role in bringing about those changes. Today, social norms around secondhand smoke have shifted, and an increasing number of Chinese cities, including Beijing and Shanghai, have restrictions on smoking in public places.

Fogarty support also helped to start the tobacco control program at the National Institute for Public Health of Mexico, which has become a regional leader in tobacco research and training. But there’s still work to do because there’s always a new issue in tobacco control. Who was talking about vaping three years ago? That crept up on us, and today, it’s hugely popular among young people.

What is your current Fogarty project?

As part of the Global Environmental and Occupational Health (GEOHealth) Hubs program, supported by Fogarty, the National Institute of Environmental Health Sciences (NIEHS), CDC and Canada’s International Development Research Centre (IDRC), we're putting in place monitors for airborne particles in the capital cities of Ethiopia, Kenya, Rwanda and Uganda, to try to understand what air pollution levels are.

Our focus is on capacity building and helping to develop scientists in East Africa who do environmental health work and want to advance policy through research. Fogarty’s aim is to develop researchers who can generate the evidence needed to affect policy, and be willing to step in and talk with policymakers about what their evidence shows. We’re giving them the tools to do that.

This project goes back to when I was at the University of Southern California (USC), which holds the training part of the grant. The research part is held by the University of Addis Ababa.

What has this research achieved so far?

In Kampala and Addis Ababa, we’ve completed a complicated assessment of child respiratory health in relation to air pollution. After identifying schools with a range of air pollution levels, we put an air quality monitor in each of 10 schools in both cities. We’ve collected data about respiratory health and measured lung function in about 1,000 children - 100 from each school. We’ve also installed centrally located monitors in each city.

What challenges have you faced?

When we started this work five or six years ago, there were very limited monitoring data available in Africa, there were some people involved in air pollution research and control, but no real enforcement capacity. The sources of air pollution in major cities are themselves complicated - things like trash burning, factories spewing out smoke, diesel vehicles. A lot of the world’s older diesel vehicles - the ones that blast out black smoke when they go down the street - have ended up in Africa. There are the problems that arise from using fuels that pollute indoors and outdoors, whether it’s burning wood or biomass, charcoal or animal dung. While the problem is well recognized, what to do about it is a challenge.

Communication of risk when a threat isn’t immediate is another challenge. With air pollution, people know it’s bad when the levels are extraordinary. Your eyes burn, you can’t see, there’s no question that it’s harming you. But as levels go down, people learn to live with pollution. For the several billion people who burn biomass fuel in their homes, for instance, pollution is a way of life. But getting people to change the fuels they use or how they cook isn’t just a matter of saying, “If you use this new stove, you’ll protect your health.” We’ve talked with our colleagues in East Africa about the need to communicate study results to local media and policymakers, and we’re trying to equip them to do this.

What other areas are you studying?

We’re looking at what will happen to workers in the flower industry, which is growing in East Africa, particularly if we have rising temperatures because of climate change. They work outside and in hot houses, but we don’t know much about what their heat stress levels are. We’re also collecting information on death and hospitalization in all four capital cities to see if we can find a relationship with the air pollution levels we’re measuring.

What can the US learn from this research?

Although the U.S. has made great progress in bringing down air pollution, it remains a global issue. The pollution generated in China, for example, circulates around the world. So when there’s control as a result of research in China or Africa, there are benefits to Americans. Steps that are taken to reduce air pollution locally also are expected to have benefits in terms of greenhouse gas emissions. And there are many US citizens abroad who are exposed to these high levels of air pollution. State Department employees, for example, have legitimate questions about the implications for their health and the health of their families - questions like, can I take my child with asthma to Beijing? Or is it safe to be pregnant in Delhi? There are lots of questions that can be answered by research in this context that will be of value to the U.S.

This interview appeared in the Fogarty International Center Newsletter.