For decades, millions of children in developing countries died every year from diarrhea, a preventable and treatable illness that turns fatal because of contaminated water, lack of food and few treatment resources. But that changed after Robert Black, a U.S. researcher who has lived in some of the world's poorest countries, discovered that simple supplements of the mineral zinc could not only treat it, but prevent recurrence.
Now, zinc supplements are recommended by the World Health Organization and other international health units as a front-line aid to deal with diarrhea. Dr. Black's discovery is credited with helping reduce childhood diarrhea deaths in developing countries to about one million in 2010 from 4.5 million as recently as 1990.
In Toronto on Thursday, Dr. Black, chair of the department of international health at Johns Hopkins Bloomberg School of Public Health, will accept the Canada Gairdner Award, one of the world's top medical honours, for his achievements.
Although he is best known for his breakthrough with zinc and diarrhea, Dr. Black, who shunned the comfort of scientific work in the United States to live in countries as far afield as Bangladesh and Peru, has also shone a light on the suffering of children in the developing world and dedicated his life to preventing deaths from pneumonia, malnutrition, diarrhea and other problems that still kill millions every year.
"I think there's been huge progress," Dr. Black said in an interview. "I hope I've contributed … to it."
Leading international health experts say Dr. Black's contributions and ability to bring attention to the problems of children in developing countries have had a monumental impact.
"Dr. Black has been a giant in the area of not just looking at diarrhea but pneumonia [and childhood]mortality in general," said Charles Larson, clinical professor in the department of pediatrics at the University of British Columbia and director of the Centre for International Child Health at B.C. Children's Hospital. "[His contributions]have been huge."
The Canada Gairdner Awards, which come with a $100,000 cash prize and are given annually to acknowledge outstanding achievements in medicine, will also honour Jules Hoffmann, who won this year's Nobel Prize in medicine for work on understanding innate immunity, and five other scientists from around the world.
In an interview, Dr. Black said he began trials looking at the impact of supplementation in children with diarrhea about 20 years ago, driven by previous research on the effects of a zinc deficiency.
"It was clear that zinc deficiency compromises the immune system," he said. "Individuals who are zinc deficient have higher rates of infectious diseases."
Dr. Black has also dedicated a significant amount of work to evaluating vaccine effectiveness, encouraging breastfeeding and promoting hand-washing to prevent diarrhea.
He said he is humbled by the award because colleagues also deserve credit. But many in the field say Dr. Black's commitment to drawing attention to childhood mortality has had a significant impact on health issues in the developing world.
For instance, Dr. Black played a role in the publication of a major series on maternal and child under-nutrition in The Lancet in 2008.
"He's just outstanding in the field in that regard," said Alvin Zipursky, chairman and scientific director of the Programme for Global Paediatric Research based at Toronto's Hospital for Sick Children. "Right from the beginning, there is that major commitment he has carried through."
Despite gains in recent years, chronic under-nutrition and related developmental and cognitive problems continue in many countries, such as India, Dr. Black said. While many are focused on the famine in the Horn of Africa, that crisis is the "tip of the iceberg" in terms of the potential scope of malnutrition and famine around the world, he said. Instead of waiting for a crisis, he advocates a co-ordinated strategy to prevent future famines and disease outbreaks.
"[Children]are damaged because of under-nutrition in early childhood and that has lifelong consequences for the individual and the society," Dr. Black said. "I think we need a much broader approach to dealing with under-nutrition than just responding to crisis."
Getting a Gairdner
The Canada Gairdner Awards will be handed out in Toronto on Thursday night to seven researchers from around the world for outstanding contributions to medicine. They comprise five Canada Gairdner International Awards for original research that may help find a cure for disease or alleviate human suffering, the Canada Gairdner Global Health Award for achievements in improving health outcomes in developing countries and the Canada Gairdner Wightman Award, given to a Canadian for outstanding leadership in medicine and medical science.
Canada Gairdner International Awards
- Shizuo Akira, director and professor at the World Premier International Immunology Frontier Research Center, Osaka, Japan; and Jules Hoffmann, professor, Institut de Biologie Moléculaire et Cellulaire at the University of Strasbourg, France, for discoveries about innate immunity
- Adrian Peter Bird, Buchanan chair of genetics at the University of Edinburgh, director of the Wellcome Trust Centre for Cell Biology; Howard Cedar, chair, department of developmental biology and cancer research at Hebrew University in Jerusalem; and Aharon Razin, professor, department of developmental biology and cancer research at Hebrew University, for discoveries in DNA methylation and its role in gene expression
Canada Gairdner Global Health Award
- Robert Black, chair of the department of international health at Johns Hopkins Bloomberg School of Public Health, for discoveries that have helped improve health outcomes and reduce childhood deaths from diarrhea
Canada Gairdner Wightman Award
- Michael Hayden, Canada research chair in human genetics and molecular medicine at the University of British Columbia, for leadership in genetics, entrepreneurship and humanitarianism