Moving on up

Dr Alessandro Demaio is about to take a big step up in his career, joining the World Health Organization to continue his global health quest to prevent non-communicable diseases

TWO years ago Dr Alessandro Demaio was about to launch a global social movement called NCDFree.

His life at the time was already busy — he was teaching global health at the University of Copenhagen, the University of Melbourne, and the Charité-Universitätsmedizin in Berlin. He had just moved to Boston to do postdoctoral work at Harvard Medical School.

If he didn’t have enough frequent flyer miles on the clock already, NCDFree was about to launch him into platinum membership status, as he crisscrossed the globe inspiring young doctors and the generation coming through to raise awareness of the importance of prevention of non-communicable diseases (NCDs) such as obesity, diabetes, and chronic heart disease.1

Now the 30-year-old Monash University alumnus is about to take another leap onto the global health stage.

On 2 November, Dr Demaio began a new fulltime appointment with the World Health Organization in Geneva, Switzerland — working in the Evidence and Policy Guidance Unit in the Department of Nutrition, Health and Development.

“I’ll be developing new global guidelines on the treatment and prevention of NCDs using nutrition, particularly in vulnerable populations, specifically maternal, child, and early infant nutrition”, Dr Demaio tells the MJA.

Any thoughts that being based at the WHO in Geneva will turn him into a one-town man are far from Dr Demaio’s mind, however, as his role also includes being a technical advisor on nutrition and NCDs to governments in regions such as Africa and South America.

“I’ll also be commissioning and collating research and then turning it into WHO policies”, he says.

“It’s very exciting, and frankly, a bit scary.”

It’s also an amazing career opportunity for a young doctor who has never shied from taking big steps.

He and his father Pietro, a general practitioner, travelled to Sri Lanka in the aftermath of the 2004 Boxing Day tsunami to help the relief effort. It was there that the impact of untreated NCDs really impacted on Dr Demaio, who was still a student at the time.

“I expected to see a lot of trauma, but in fact most of what we saw were the side effects from untreated hypertension, angina, diabetic ulcers — all because of disruption in access to medications and treatment.

“NCD treatments weren’t seen as part of essential medicines so they got none of the focus. In a sense they were seen as one step beyond humanitarian aid.”2

Taking up a position with a global organisation as influential and respected as the WHO has come a little earlier than Dr Demaio expected.

“This was something I was expecting to do when I was, maybe, 50”, he says. “But it’s an amazing opportunity and just shows that you never know where life can take you.”

After spending the last 5 years as more or less his own boss, working within the WHO’s confines will be a big change of environment.

“I have been a bit of a free agent. I’m really looking forward to having an office and some structure and a fulltime boss/mentor”, he says.

“It will also stop me from taking on too many crazy international projects.”

One of those projects is festival21, a free one-day “celebration of community, food and future” being held at the Melbourne Convention and Exhibition Centre on 11 December this year, to coincide with the last day of COP21 — the United Nations climate conference in Paris.3

Speakers at the event include barrister and human rights advocate Julian Burnside; cook and founder of the Kitchen Garden Program, Stephanie Alexander; chef, architect and founder Joost Bakker; Kaitlin Yarnall, the executive editor of National Geographic magazine; and cook and author, Stefano de Pieri.

Late in September, Dr Demaio was invited to give the keynote speech at GP15, the annual conference of the Royal Australian College of General Practitioners.4

“We’re at a crossroads in history at the moment”, he says.

“Whether it’s the fact that two-thirds of Australians are either overweight or obese and [the same is true for] one in four of our children; or whether it’s that 35% of Australians are now living with an NCD — one in 50 live with four or more comorbidities; whether it’s the fact that what and how we eat are a major driver of NCDs; [whether it’s that] about 70% of the burden is preventable and 91% of deaths in Australia are caused by NCDs.

“We now have a situation where one million Australians are living with type 2 diabetes and another half million are living with it but are unaware.

“At the same time, though, we’re spending less than 2% of our current health expenditure (which is 9% of our GDP) on public health prevention.

“We have a health system designed for 20th century problems.

“We have a rising burden of preventable disease and we have no strong, unified voice to question it and to address it and to bring change.

“I think 30 000 powerful, intellectual, health leaders in their community … have such an opportunity to reframe and move the debate.

“Primary care has to be the centre of any future sustainable health care system.

“These are discussions [that GPs] can and must lead, because when doctors talk, people listen, politicians listen, business listens. People trust doctors. People look to doctors.”

It was a lesson from his father that has stuck with Dr Demaio.

“He put it really well — you can be a GP that takes care of your patients, or you can be a GP that takes responsibility for your patients.

“All GPs take great care of their patients, but some also take responsibility for the health and future of their patients.”

However long he spends travelling the world spreading the message about NCDs, nutrition and preventative global health care, Dr Demaio also still nurtures the dream he had as a much younger man.

“Growing up it was actually my dream to be a GP, to be a country GP and who knows? Maybe some day I’ll end up living my dream”, he says.

“I’m not putting it to rest just yet. There’s something wonderful about being a clinician, about having that daily influence, impact on people’s lives and being able to tangibly bring health to individuals.”

But in the meantime, Dr Alessandro has a big job to do changing the world.

“We’re all changing the world”, he says.