SPH in India: Partnering for Progress on Disease, Climate, and Sanitation.
SPH in India: Partnering for Progress on Disease, Climate, and Sanitation
Researchers at the School of Public Health collaborate with partners across India to combat tuberculosis, improve maternal and child health, map air pollution and heat risk, and expand access to water, sanitation, and hygiene.
As India launches its first national census in 15 years following a COVID-related postponement from 2021, researchers at the School of Public Health and their Indian collaborators foresee opportunities to strengthen and scale their existing portfolios of work on air pollution, sanitation access, tuberculosis, and maternal and child health in the world’s most populous country.
Over the course of the 2026 – 2027 year, India will attempt to gather information on the household characteristics and living conditions of an estimated 1.4 billion people—data SPH researchers rely on for contextualizing their findings but may not currently reflect the true realities facing the population.
“It’s a massive effort,” says Akshay Gupte, an assistant professor in the Department of Global Health, who grew up in Pune, India and trained as a physician before coming to the U.S. to build a research career focused on infectious and chronic lung diseases in low- and middle-income settings, including tuberculosis (TB) in India.
Tuberculosis Prevention & Treatment
“In a country as diverse and spread out as India, getting a good census is an incredible feat of logistics,” says Gupte. “[But] those data are valuable because we often compare characteristics of TB patients with expectations from the general population. The census collects valuable data on socioeconomic status and standard-of-living indices, so we can geo-map cases and get a sense of the communities they’re coming from.”
While TB is “curable,” eliminating the disease has proven challenging, says Gupte.
“TB is inherently linked with socioeconomic status and poverty. That doesn’t mean it can’t affect someone with higher [socioeconomic status], but it’s more prevalent in vulnerable populations who don’t have access to good care, are malnourished, and so on,” he says. “In terms of progress, we’ve made good progress in diagnosis—we have diagnostic tools that can pick up disease quickly. The challenge is finding everyone who needs to be diagnosed—a vast number still go undiagnosed.”
The longer a patient’s disease is left untreated, says Gupte, the greater the patient’s risk of treatment failure, relapse, and worse long-term health outcomes, as well as the higher the likelihood that they spread the infection.
Gupte’s work on lung injury after TB infection is one of a variety TB-related research efforts under the umbrella of Regional Prospective Observational Research for Tuberculosis (RePORT) India, a multi-organizational, collaborative consortium funded bilaterally by the National Institutes of Health (NIH) and the Government of India and the largest of six regional TB consortia worldwide (China, Brazil, Indonesia, Philippines, and South Africa). Fellow physician-scientist and professor of global health Robert Horsburgh is BU’s principal investigator for RePORT India and sits on the executive committee.
Horsburgh has studied TB for decades, producing evidence that can inform clinical guidelines (dosing of rifampin to treat TB during pregnancy, for example), support targeted public health interventions (such as nutrition and alcohol misuse programs), and strengthen the evidence base for stigma‑reduction and screening strategies.
Maternal and Child Health
Like her colleagues, Patricia Hibberd, chair and professor of global health, also has extensive clinical training and expertise in infectious disease to complement a long legacy of research activities in India. Hibberd recalls first beginning work in the country in 1996 when the World Health Organization (WHO) invited her to help design a clinical trial investigating ways to better treat childhood pneumonia. At a meeting with the other investigators on the project, she met her Indian counterpart, Archana Patel, program director of the Lata Medical Research Foundation in Nagpur, India.
Over the next thirty years, the two women would go on to become close collaborators, as they spearheaded maternal and child health (MCH) research collaborations through the Global Network, a sprawling NIH‑coordinated research consortium with partner sites worldwide. Hibberd and Patel have collaborated to pilot and test a variety of sustainable, low-cost MCH interventions that have gone on to inform WHO guidance and global practice; examples of their contributions include the early recognition of severe hypoxemia and the use of oxygen to treat children with pneumonia in resource-constrained settings and the development of novel, point-of-care diagnostics for neonatal sepsis.
“To summarize our three decades of work and friendship in a comment or two is difficult but easy in one word: ‘extraordinary!’” says Patel. “Dr. Hibberd and I began our research collaboration in India prior to the turn of the century […] with both of us serving as pediatric epidemiologists, a role relatively uncommon at the time. Since then, our research has continued successfully through numerous grants, studies, and publications encompassing intervention trials and observational studies aimed at improving maternal, neonatal, and child health in India and other resource-limited settings worldwide.”
Air Pollution and Heat Risks
To better understand the geographic distribution of air quality and other environmental health risks in India, Kevin Lane, associate professor of environmental health, collaborated with partners in India to build fine‑scale exposure maps that can be paired with on‑the‑ground health data and program footprints. As a member of the Consortium for Climate, Health and Air pollution Research in India (CHAIR-India), Lane helped to assemble satellite, ground monitoring, meteorologic, and land‑use data to produce daily PM2.5 and temperature estimates at 1‑kilometer resolution for the entire country for the 12-year period between 2008 and 2020.
Analyses using the CHAIR models, conducted collaboratively with Indian investigators and public health agencies, have shown that both long‑term and short‑term particulate pollution are linked to increases in mortality, and that extreme heat and poor air quality interact to amplify risk. For example, a 2024 study coauthored by Lane and Gregory Wellenius, professor of environmental health and director of SPH’s Center for Climate & Health, and published in Lancet Planetary Health found that long-term exposure to air pollution consisting of particles smaller than 2.5 micrometers in diameter (PM2.5) increased mortality by 1.5 million deaths per year in India over the period of ten years between 2009 and 2019.
Researchers on the project also mapped consistent and emerging pollution hotspots, including many districts and cities not previously flagged under national non‑attainment lists as exceeding legal pollution limits. CHAIR’s work has concluded and the outputs of the consortium’s investigations are now publicly available on the BUSPH-HSPH CAFÉ Research Coordinating Center’s dataverse so Indian researchers, state health departments, and national programs can download the exposure layers to guide policy and program development.
Lane emphasizes that the project’s value lies not only in the models and publications, but in the shared tools and local collaborations that allowed the exposure data to be shared publicly for India’s public health professionals and others to reference.
Water, Sanitation, and Hygiene
Since 2010, Anoop Jain, assistant professor of environmental health, has operated a nonprofit called Sanitation and Health Rights in India (SHRI) that both provides community toilet facilities to some of India’s densest, most impoverished areas and serves as a platform for SPH research. The model yields immediate health benefits for users—including private stalls, functioning toilets, clean water, and a rigorous cleaning and maintenance protocol—as well as a steady flow of evidence and proof of concept in support of shared toilets to India’s government.
Because WHO’s joint monitoring program does not consider shared sanitation facilities like SHRI’s to be “improved” due to concerns that poorly maintained facilities might exacerbate the spread of disease, Jain is leveraging pilot funding from SPH to test a new method of evaluating the cleanliness of shared surfaces using adenosine triphosphate swabs—the more organic matter present, the more ATP that is detected. He is also collaborating with another organization based in India and the Centers for Disease Control and Prevention to better understand the types of bacterial and viral material on these surfaces and whether it is pathogenic.
Jain has also been busy rapidly scaling the SHRI Foundation’s facilities, growing from 18 community sanitation facilities in April 2024 to 32 facilities across several states in April 2026. Thanks to a recent influx of new funding from the nonprofit foundation Rippleworks, Jain also plans to extend the SHRI model into schools and government health centers, and he hopes to secure an additional grant to launch a menstrual‑friendly schools initiative.
For Jain, a quality experience is paramount.
“I’m really interested in how sanitation shapes mental health outcomes,” he says. “Over the last 15 – 16 years, I’ve heard people describe the stress, anxiety, and shame of having to defecate in the open and how inadequate access shapes those outcomes.”
Installing functioning doors, for example, is a simple fix, he says. “You don’t need new technology, but you need a system to make sure the door gets put up, stays there, and is maintained so people feel comfortable using the facility. Otherwise, the work is wasted.”
With the support of a K01 award from the National Institute on Aging, Jain is currently investigating how sanitation shapes mental health outcomes among older and aging populations. He sees his research as sitting on either side of his mission to provide sanitation. On the one side, he is studying how to make sanitation high quality and on the other, he is studying how that high-quality sanitation might shape physical and mental health.
Jain also views his work in India as a living expression of SPH’s mission: Think. Teach. Do. For the Health of All.
“The organization allows me to apply social epidemiology theory—think, use material in my teaching—teach, and bring real-world implementation to life—do,” he says.
But none of it is possible without the right partners on the ground.
“Since day one, I’ve relied heavily on partnerships in India,” he says. “You can’t work in India in this field without local partners — [for] practical reasons like IRB, designing surveys in local languages, and so on. Substantively, it’s critical to have the right partners.”
