Our mission:

Our mission is to improve the health of millions of people worldwide. We will achieve this by: Providing the best evidence to guide critical health decisions Engaging with decision makers to enact real change Targeting global epidemics, particularly of chronic diseases and injury Focusing on vulnerable populations in both rich and poor countries Our values Our humanitarian commitment will spur us to tackle the health issues affecting high-risk and disadvantaged people worldwide. Our focus on excellence will produce scientific evidence that is ethical and of the highest quality. Our creativity will challenge traditional thinking and provide an impetus for new and innovative solutions to the worlds leading health problems. Our integrity will underpin all our work and interactions, including our collaborations with partner organisations worldwide. Our can do approach will produce timely, effective action, even in the face of adversity or other barriers to implementation. Our emphasis on impact will ensure our work has real consequences for those who are most vulnerable to disease and injury.

History:
Over the last decade, the Institute has delivered high-impact evidence from a large program of research and innovation that has influenced health policy and healthcare practice worldwide. From modest beginnings, the founders have built a team of more than 300 staff across centres in Australia, India, China and the United Kingdom. The Institutes projects now span more than 40 countries worldwide. Over the last decade, the Institute has delivered high-impact evidence from a large program of research and innovation that has influenced health policy and healthcare practice worldwide. From modest beginnings, the founders have built a team of more than 300 staff across centres in Australia, India, China and the United Kingdom. The Institutes projects now span more than 40 countries worldwide.

In India
The George Institute has been active in India for much of the past decade. An initial focus was the State of Andhra Pradesh, where in 2002 the Institute launched the Andhra Pradesh Rural Health Initiative in partnership with the Centre for Chronic Disease Control in New Delhi. Subsequently, The George Institute, India was formally established in Hyderabad in 2007. The Institute now employs about 50 staff memebers and manages a range of clinical trials and population health studies throughout India. The Institute works closely with the Indian Council of Medical Research and the Public Health Foundation on India.

In Australia
In 1999, with the support of the University of Sydney Medical School, The George Institute was established in Australia with the aim of creating a world-class centre for research in global health. The George Institute, Australia has now grown to comprise 150 staff, six research divisions, several research centres and a number of strategic enterprises across two major metropolitan sites in Sydney. Australia remains the global headquarters for the Institute.

In China
The China-Australia Partnership for Health was established in 2004 as a collaboration between The George Institute and Peking University Health Science Centre (PUHSC). The George Institute, China was officially launched in 2007 and continues to build and coordinate a broad alliance between governments, universities, hospitals and other research organisations across China. Based in the Haidian District of Beijing, the Institute recently launched the International Centre for the Prevention of Chronic Diseases in association with Chinese, Australian, US and British partners. The institute employs around 50 staff in China.

In the United Kingdom

The George Institute established an office in London in 2004 to house a research group analysing investment trends in the development of new treatments for neglected diseases. In 2008, the group received a major award from the Bill & Melinda Gates Foundation which now underpins their research program. In 2010, the Institute, in partnership with the University of Oxford, will launch The George Centre for Healthcare Innovation, a major new initiative focussed on essential health care, affordable health technologies and evidence-based health policy.

10 ways in which weve made an impact on global health

Provided global evidence to reduce heart attack, stroke and kidney disease in diabetes patients Led global research that has changed practice in the treatment of high blood pressure and stroke Identified cost-effective treatments to save lives in intensive care patients globally Developed a program to address high rates of chronic disease in Indigenous communities Created a world-first survey tracking global investment in the development of new treatments for neglected diseases Determined that chronic diseases and injuries are the major causes of death in rural India Identified risks and strategies to reduce the high death and injury rates among young drivers Designed an intervention in China that dramatically increased use of seat belts to improve road safety. Demonstrated how lower blood pressure helps save dialysis patients lives Provided vital evidence to improve outcomes for millions of patients with recurring low back pain Organisation structure: Support us

Together, we can improve the health of millions of Indian people. As a nation, we must not forget that millions of people in India have limited, if any, access to good health care. At The George Institute, India our humanitarian commitment means we tackle the health issues affecting high-risk and disadvantaged people in our country. Your contribution helps us honour that commitment. Philanthropy plays an important role in medical research, often providing crucial support for new, innovative projects. Each persons reason for giving is different. By following your own passion, you can direct your philanthropic support to a specific area of interest and help us:

Improve access to essential health services, particularly for Indias urban poor Tackle some of the leading causes of death in India diabetes, heart disease and kidney disease Improve Indian peoples overall health and wellbeing through simple behavioural changes Reduce road traffic injuries and deaths Address mental health and depression, particularly for adolescents Advance the best in Indian scientific discovery by supporting young researchers
Corporate Support. A healthy workforce is vital to Indias economic prosperity. Conversely, long-term health problems and injuries put tremendous strain on economic and social development. Research at The George Institute, India plays key role in health policy formulation and as such, helps ensure people continue to stay engaged in the workforce and lead more productive lives for longer. Whether part of a corporate social responsibility strategy, a community engagement initiative or marketing sponsorship, our team will work closely with you to develop a partnership that achieves your goals and maximises the possibilities for positive exposure. By partnering with The George Institute, your company will play an active role in helping to improve Indian society. To learn more about philanthropy, corporate support and donations, please contact Chris Ostendorf on costendorf@georgeinstitute.org.au or +61 2 8238 2402.

Our Global Partners:

Global partnerships with institutions, organisations and individuals sharing our vision, allow us to extend our reach in rich and poor countries alike. Through these partnerships, we draw on a wide range of expertise to develop and implement activities to address global and regional health issues. If you or your organisation would like to collaborate with us on any of the work that we do, please contact us.

Collaborators Funders Strategic enterprise-George Clinical

George Clinical is an enterprise established by The George Institute to design and manage large-scale clinical trials both for the Institute itself and for pharmaceutical and medical research organisations worldwide. George Clinical offers all the essential elements required to conduct high-quality international clinical trials, including world-class scientific expertise, sophisticated project management, comprehensive study monitoring services, state-of-the-art data management facilities and biostatistics expertise. George Clinical has staff and faciilities throughout the Asia-Pacific region and has established partnerships with leading Academic Research Organisations (AROs) in North America and Europe. In this way George Clinical provides a comprehensive service with truly global reach. Current clients of George Clinical include several major pharmaceutical companies from Europe and the United States. George Clinical is wholly owned by The George Institute, and many Institute staff members work on George Clinical projects. Any profits generated by George Clinical are returned to The George Institute to support its work around the world. For more details or to contact George Clinical, please visit the George Clinical website.

Our Work: Preventing and managing chronic conditions

Chronic disease is the leading cause of death in India, and our research program looks to address this rise in conditions such as cardiovascular disease, diabetes and stroke. Our aim is to make a significant contribution towards improving the health landscape in India, by better understanding important causes of illness and death and their prevention.

Our current projects

Four in one polypill: the use of a multidrug pill in reducing cardiovascular events The UMPIRE project aims to investigate a polypill strategy, by testing adherence compared to usual care in patients at high-risk of cardiovascular events. Detail: Four in one polypill: the use of a multidrug pill in reducing cardiovascular events (UMPIRE Cardiovascular diseases are a leading cause of deaths globally and in India. Effective preventative treatments are available for patients at highrisk of heart attack and stroke, but optimal therapy is often not prescribed and many patients find it difficult to adhere to complex drug regimens, particularly when they have no symptoms. The UMPIRE project is a European Commission funded, randomised controlled trial to ascertain if a strategy based on using a fixed-dose combination medication (containing low-dose aspirin, a cholesterol lowering drug - statin and two blood pressure lowering drugs) improves adherence compared to usual care in patients at high-risk of cardiovascular events Aims To assess whether provision of a fixed-dose polypill, compared to usual care, leads to better adherence and thus lower blood pressure and cholesterol levels. Secondary aims will assess barriers to adherence, quality of life, safety and cardiovascular outcomes. Method A total of 2000 patients (1000 patients from India in addition to 1000 patients from the UK, Netherlands, and Ireland) will be randomised to receive either the polypill or usual care, and adherence to treatment will be monitored over an average of 18 months follow-up. In India, 30 clinical centres will participate, jointly managed by The George Institute India and the Centre for Chronic Disease Control (CCDC), New Delhi. Collaboration This is a collaborative multi-country project involving representatives from India (The George Institute India and CCDC), UK (Imperial College London), Netherlands (Universitair Medisch Centrum Utrecht), and Ireland (Royal College of Surgeons Ireland), with overall coordination

provided by Imperial College London. Other collaborators include the Public Health Foundation of India and Dr Reddys Laboratories, with data management provided by The George Institute in Australia. UMPIRE is a member of the SPACE (Single Pill to Avert Cardiovascular Events) Collaboration, along with another George Institute study, Kanyini-GAP a study investigating the impact of the polypill among non-Indigenous and Indigenous Australians. Funding Agencies

This study is funded by the European Commission and a National Health and Medical Research Council(NHMRC) Grant .
2) Support for cardiovascular disease prevention in primary healthcare A feasibility study of a simple tool for health workers to evaluate cardiovascular disease risk in patients. The system also provides prevention advice, and has been developed for use at primary healthcare centres in low and middle-income countries. Electronic decision support forCVD prevention for primary health care: The George Institute India is conducting a feasibility study of incorporation of a simple algorithm for cardiovascular disease prevention into an electronic decision support system that has been developed for use at primary healthcare centres in low- and middle-income countries. The system has been particularly developed for use by non-physician health workers.

Aim
Our aim is to ascertain whether a pre-existing paper-based protocol for cardiovascular risk screening can be integrated into a pre-existing electronic decision support tool (Early Diagnosis and Prevention System) developed for use in primary healthcare centres. In particular, we are interested in determining whether the software can accurately triage patients over the age of 35 through a cardiovascular risk assessment; whether data relating to those visits can be collated for analysis; and whether physicians and other health care workers in lowresource settings in India find this tool of assistance in the provision of care to their patients.

Methodology
The intervention will be field tested at six clinical sites. All patients visiting these clinics will be triaged by non-physician health care workers immediately prior to a formal visit with a doctor. For all patients aged thirty-five (35) years and over, the questions and protocols relating to cardiovascular risk will be applied. That visit and the responses to the protocol (both before and after the consultation with the doctor) will become a unique, searchable and interrogatable event for future analysis.

Collaboration
The George Foundation, Bangalore St. Johns Research Institute, Bangalore 3) ADVANCE: the worlds largest study of treatments for type 2 diabetes Following the release of the results from the ADVANCE study, ADVANCE ON will provide important information about the potential long-term effects of blood pressure lowering and glucose control on vascular outcomes in patients with type 2 diabetes. Detail: Action in diabetes and vascular disease study: advance and advance on

ADVANCE: the worlds largest study of treatments for type 2 diabetes

Globally, there are approximately 250 million people with diabetes, most of whom will eventually be killed or disabled by the complications of their condition. The most common cause of death in people with diabetes is heart disease, however kidney disease also affects a large proportion. Against this backdrop, experts at The George Institute conducted the largest-ever study of treatments designed to prevent these complications of diabetes. Over six years, researchers studied more than 11,000 patients from 20 countries, in a project focused on two key treatment targets for people with type 2 diabetes lowering levels of blood pressure and blood glucose. ADVANCE was a factorial randomised clinical trial of routine blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes from 20 countries worldwide. In India, over 400 patients were recruited from 4 major centres. The trial was completed in 2008, with main results published in the Lancet and New England Journal of Medicine. From January 2010, observational follow-up of trial participants commenced. This phase of the study,ADVANCE-ON, will provide important information about the potential long-term effects on blood pressure lowering and glucose control on vascular outcomes in patients with type 2 diabetes. 4) Prevention of type 2 diabetes in women with gestational diabetes in urban India This study aims to evaluate the effectiveness of a lifestyle intervention for the prevention of type 2 diabetes in women with gestational diabetes in India Detail: Gestational diabetes mellitus (GDM) is a strong risk factor for developing future chronic or Type 2 diabetes. It is common among Indian women. Limited information about lifestyle programs to prevent or delay Type 2 diabetes in women with gestational diabetes mellitus is available from other countries, but their applicability in India is unknown.

Aim
The overall aim of this project is to inform the design and conduct of a large-scale cluster randomised study to reliably evaluate the effectiveness of a lifestyle intervention for the prevention of type 2 diabetes in women with gestational diabetes in India.

Method
Phase 1 In two public urban Indian hospitals, 500 consecutively-identified women with GDM will have an oral glucose tolerance test administered 6 or more weeks following delivery. Proportions with normal glucose tolerance, abnormal glucose tolerance and established type 2 diabetes will be estimated. Phase 2 Around 60 of these patients without type 2 diabetes will be invited to undergo a group lifestyle intervention, comprised of six 2-hour sessions delivered over an 8 month period. The intervention, based on a program currently being deployed in Australia, will be adapted for delivery in the Indian context by specifically-trained facilitators. Feasibility will be evaluated by measurement of attendance and completion, and qualitatively, through semi-structured interviews of patients and facilitators. Baseline and follow-up measurement of selected clinical variables will help inform sample size calculations for a subsequent controlled evaluation of the programs effectiveness.

Collaboration

All India Institute of Medical Sciences, New Delhi Centre for Chronic Disease Control (CCDC), New Delhi Flinders University Faculty of Health Sciences

5) Investigating sleep apnea and cardiovascular disease The SAVE trial will determine the effects of nasal continuous positive airway pressure (CPAP) in preventing cardiovascular disease in high risk patients with moderate-severe obstructive sleep apnea. Detail: SAVE (Sleep apnea cardiovascular endpoints study) is an investigator-initiated and collaborative, phase III, international, multi-centre, open label, randomised, controlled trial to determine the effects of nasal continuous positive airway pressure (CPAP) in preventing cardiovascular disease in high risk patients with moderate-severe obstructive sleep apnea (OSA).

SAVE in India
More than 20 private and government hospitals across India will aim to recruit 500 patients (10% of the total randomised participants) for this important trial. Patient recruitment in India will commence in the second half of 2009. Collaborators SAVE Country Principal Investigator: Dr.N.Ramakrishnan Nithra Institute of Sleep Sciences 6) Improving chances of recovery after stroke The landmark INTERACT project is studying the effects of blood pressure lowering following a stroke.

Detail:
INTERACT2 (Intensive Blood Pressure Reduction In Acute Cerebral Haemorrhage Trial) is the main phase of an academic led and conducted, international, multi-centre, open label, blinded endpoint, randomised controlled trial to establish the balance of benefits and risks of a treatment strategy of early intensive lowering of blood pressure (BP) compared to a conservative BP lowering policy in patients with acute primary intracerebral haemorrhage (ICH) and co-existing elevated BP without any definite indication or contraindication to treatment.

INTERACT2 in India
Approximately 20 participating private and government hospitals will aim to recruit 600 patients (20% of the total randomised participants) to this important trial. Patient recruitment in India will start in the second half of 2009. Collaborators INTERACT2 Country Principal Investigator: Dr K Subash Nizams Institute of Medical sciences

Measurement of population health:

Key to India addressing the rise of disease and improving health outcomes is understanding the size and impact of different health problems in the population. The Institute is engaged and managing a number of projects that harness new ways of measuring population health. With this knowledge, India will be well placed to tackle the rise of key issues including chronic disease and injury.

Our projects focused in this area include

Response to Gates Grand Challenge #13 The Population Health Metrics Research Consortium Project (GC13) is part of the response to Gates Grand Challenge which seeks to develop new technologies that permit better quantitative assessment of population health. Andhra Pradesh Rural Health Initiative commencing in 2003, this significant initiative has helped to determine the major causes of mortality in this part of rural India. It continues to establish the prevalence of major health risk factors.