The University of Cape Town invites you to an inaugural lecture by Professor Diane Gray.

Strengthening respiratory health across the life course: Lessons from African children

This lecture argues that the lessons learnt from African led child-health research are important, not only for strengthening health in Africa, but for the benefit of populations globally. This will be demonstrated through our understanding of lifetime health risk and the insights learnt from South African child cohorts. This centers around the growing evidence that an individual’s lung function is a key marker for long-term health and all-cause mortality risk, a frame shift in health screening and preventive care. Lung development continues after birth through childhood to adulthood and is both vulnerable to insult with life-long consequence during this time; but also capable of recovery with appropriately timed intervention. Hence, understanding the determinants of lung development becomes critical for preventing chronic disease in adulthood and reducing early death from all cause. 

Africa, being home to over a third of the world’s children and having a disproportionate burden of respiratory disease and risk factors for respiratory disease, hosts a powerful context to answer these questions. The lecture will present some of the evidence on early determinants of lung health in African children with a focus on those amenable to public health intervention. In addition, developing basic tools to monitor lung development from early life through adulthood has become an important goal.  This lecture will further highlight initial steps taken to improve access to appropriate diagnostic and management tools in low resourced settings. 

This lecture is both a reflection on what it means to be a ‘good doctor’ in South Africa when the science to inform practice remains so heavily influenced by data from minority contexts, as well as a celebration of collaboration in changing the story.

About the speaker:

Prof Diane Gray is a paediatric respiratory physician at the Red Cross War Memorial Children’s Hospital, Department of Paediatrics and Child Health, and full professor of Paediatrics, University of Cape Town, South Africa. Her work has focussed on the determinants, diagnosis and prevention of lung disease in African children, producing a coherent body of high-quality, internationally recognized research in the field of paediatric respiratory health. Notably her work in infant and preschool lung function (LF) has contributed novel data to international efforts to strengthen respiratory diagnostics, understand LF trajectories across the life course (in particular the early life contribution); has prioritised underrepresented child populations and focussed on global high burden respiratory conditions. Beyond this research, Prof Gray is a committed clinician, youth advocate and teacher, dedicated to helping capacitate the next generation of impactful, African clinician scientists.

She and team established the first infant and preschool lung function in Africa, providing the first data from low and middle income (LMIC) context and plays an active role in international efforts to develop these tools globally. She has been integral in developing national and regional respiratory physiology training programs, meaningfully increasing much needed access to spirometry and other LF across Africa. Both through paediatric respiratory training within the African Paediatric Fellowship Program (APFP) program at University of Cape Town (UCT) and as founder/Co-Chair of the Pan African Thoracic Society (PATS) African Paediatric Lung Function working group, she has participated in facilitating a network of active respiratory researchers and clinicians across the African continent.

She has broad collaborations that include local, regional and international groups, all with the express goal to strengthen the health of the African child. These include the international clinical research collaborations including  INCIRCLE: International Collaboration to Improve Respiratory Health in Children, Child-BEAR-NET: Children’s bronchiectasis education, advocacy and research network and PELICAN: Preterm effect on the lungs in children and adults network, the latter of which she is co-chair. Her research has focused on ensuring that African children and African led research are kept firmly embedded in global efforts to strengthen respiratory health. To that end she has contributed to the clinical research environment through editorial work: Associate Editor Respirology; is a regular reviewer for leading respiratory journals and advisory group membership: Lancet Child and Adolescent Health global board, FIRS Lung Health Task Force, GLI Advisory Committee.  She is regularly invited to present at national and international congresses including as keynote speaker; and has been on conference organising committees for national and international societies. She has obtained a number of competitive and substantive grants and is active in trying to develop a healthier, more equitable research culture. Awards for her work have included the South African MRC Silver Research Award, 2021 and European Respiratory Society Gold Medal for Midcareer researcher, 2025. Her priority is equitable capacity building, and she greatly values her role as teacher and mentor.

About the topic:

As a young paediatrician caring for sick children in South Africa, Professor Graywas overwhelmed by the burden of chronic respiratory disease and the lack of evidence to inform appropriate prevention and care. This started the journey of investigating the determinants of respiratory health in South African children, children with many risk factors for poor health. Although current evidence highlights the importance of lung health on long-term all cause morbidity and mortality, evidence to inform prevention and management strategies has remained grossly skewed towards high income, lower burden settings. Further, tools to measure lung health have until recently been largely inaccessible to those most at need of them. These factors have meant the impact of many of the high burden risks for health in Africa and other low- middle-income settings (by far the global majority) have not been known. 

Further, lung health screening as key for lifelong health risk assessment, is an important message to highlight and informs future system and research planning. Fortunately, through many regional and international collaborations, key insights into lung development for those most at risk have been identified, and African researchers and data are now contributing to the global efforts to strengthen health. There remain considerable challenges to addressing inequity, but the story is changing, and this will be a key message of the lecture.