Upon graduating high school, Dr. Yiliang Zhu knew he would most likely be assigned to work in the countryside.
He would return to China in 2012 to continue working among the land, but this time as a Fulbright Fellow.
“I was a farmer in a rural area for two years,” he said. “That made me really connected to the land. I care about what’s happening to those rural people.”
During his one year Fulbright Research Fellowship, Dr. Zhu evaluated China’s cooperative medical insurance program, where he examined the health care given to villagers.
He noted that the rural village clinics in northwestern China would be what most Westerners would consider primitive, with some doctors not even being able to read. He also noted technical training was very limited, trust levels were low and government restrictions on the types of services that could be provided were high.
This motivated him to develop the Loess Health Project in 2013.
The project, a multidisciplinary and international study of health and development on the Loess Plateau, follows households for 18-years and focuses on health policy and system research with interventions to the interplay of health, health care systems, the environment and education.
“When we do this long-term follow up study, the goal is to truly reflect what’s going on the ground, how people’s life and their view is being affected, and how the total environment really is unfolding to impact people’s health,” Zhu said.
The project at the baseline has surveyed a clustered random sample of 12 townships and 36 villages, covering 4,000 households and about 20,000 individuals.
Zhu and his team have implemented two interventions as a result of the Loess Plateau project.
The first focusing on waste management and protecting local watershed. The second focusing on the quality management of village clinics.
“Water is very scarce, very precious,” he said. “We realized waste management is not existent, even though there is strict government regulation. There is little enforcement. There is garbage everywhere, medical waste is untreated, and so we wanted to do something about that.”
The Loess Plateau climate is very arid, with only about 350 millimeters of precipitation per year, according to Zhu.
Through a grant from the National Geographic Society, Zhu is piloting a program in two villages where the watershed is still existent.
“We try to think in this stereotypical Chinese society where everything is coming from government, can we let the villager think or act on their own to clean up their own backyard, is it possible?” he said. “We wanted to test that hypothesis.”
Zhu plans to return this summer to wrap up the research and then apply for the next phase of funding.
He is also focusing on the quality management of village clinics.
“The Chinese government actually has nice policy on paper, that is, if you are 65 or older, you should have a free physical once a year, and if you have chronic disease such as hypertension or diabetes, you should have free monitoring,” Zhu said. “The village doctor is supposed to provide these types of services.”
However, Zhu noticed that township hospitals were withholding money, not purchasing those services to be provided by village clinics, and the village clinics won’t provide the services if they are not paid.
Because lack of trust in the village clinic is already low, Zhu wanted to focus on developing quality management tools to let the village clinics identify their deficiencies and to create a self-intervention to build up their own capacity to better provide clinic care and more importantly public health services.
“In theory they can provide more services and, therefore, make more money financially,” he said.
Through the 18-year follow up, Zhu will examine farming activities, the environment, general health conditions of the family, family structure, education, nutrition, maternity and child health among others.
“When we have the funding, we will implement the interventions in selected villages to see how as a whole we may be able to change the course of rural development and improve the health of rural people,” Zhu said.
From China, Zhu embarked for Washington, D.C. to become a Science and Technology Policy Fellow of the American Association for the Advancement of Science with U.S. Environmental Protection Agency.
The fellowship sends about 350 PhD level scientists and engineers to different areas of the federal government in the hopes of increasing more of a science-based approach to policy, program, and legislation, according to Zhu.
He served as a fellow with the U.S. EPA from 2013 to 2015.
In this capacity, he conducted research regarding the health hazards of indoor exposures to help generate guidelines on indoor air standards.
“We used asthma exacerbation as a health outcome to see how it’s related to indoor molds, second hand smoking, rodents, and cockroaches, to see how the presence of these biological stressors exacerbate asthma,” Zhu said.
He then moved on to examine chemicals that could potentially disrupt the human endocrine systems, a mandate resulting from several legislatures including the Clean Water Act.
Zhu said the screening and testing process of chemicals is extremely cumbersome, with only 53 chemicals making it through phase one of the process in a period of 20 years.
“At this speed, it will take more than 200 years and 100 billion dollars to run through all 10,000 chemicals,” Zhu said.
Zhu is working with a new data analytic process to help with systemic analysis of a series of assays that EPA has developed to speed up the screening of the chemicals.
“Adverse outcome pathways,” he said. “It’s a brand new idea proposed by the EPA, but the OECD [Organization for Economic Cooperation and Development] is embracing this idea to try to come up with a new way of screening chemicals. If it works, it will guide you to gather data in a cascading fashion from an upstream target A to a downstream target Z, combining high throughput experiments at molecular level, in vitro, in vivo, and human data into sort of a single ecosystem. There is an intense screening-testing iteration evolving alongside the pathway to determine how far the tests of a chemical will go. If this process works, we can do the screening of 10,000 chemicals in maybe 20 years instead of 200 years.”
Zhu is working front and center with the EPA and American Chemical Council to advance this government, academic and industry partnership.
“Although every partner has its focus, there is common overlapping, that is where science can play a positive role in shaping our policy and making society better in a way,” he said. “It’s very interesting and very rewarding experience.”
Zhu plans to continue his research in China and plans to have academic papers published from his fellowship experiences.
He’s also working with government and industry collaborators, sharing summaries of his reports and writing grant proposals to continue research efforts.
Zhu said his past fellowship experiences have provided him another outlet to show his students how public health impacts the lives of people.
He said one of the most important take-away points he leaves his students is to not forget their potential to have a lasting impact.
“The reason I do this is because my research interests have expanded to include how science informs policy and why we should use science to inform policy, rather than policy without any scientific basis,” he said. “I really think while we are doing academic work, to think it could be related to enabling change in people’s behavior or lives is really cool,” he said.
One of the important catalysts in that process of changing lives is the importance of solid data, according to Zhu.
“Data is something I recognize that would be really impactful for practice, research and policy. Who is going to do that? It would take generations,” he said. “I want to do work that I can feel has the potential to change people’s lives or behaviors, whatever that takes.”
Story by Anna Mayor, USF College of Public Health
Tags: air quality, American Association for the Advancement of Science, asthma, China, community health, Department of Epidemiology and Biostatistics, Fulbright, National Geographic, U.S. Environmental Protection Agency, waste management, water quality, Yiliang Zhu