A number of people have asked me to talk about some of the lessons for working in global health that I have gathered from my own long career in global health and development.
Before beginning, I should remind you that I come at this as a practitioner and not as an academic. Let me also remind you that most of my focus has been on policies and programs and not on science. Nonetheless, unless you are going to focus on narrow scientific issue and little else, I hope that my comments will be still be relevant.
In some respects, my comments below will describe the attributes of the “perfect” colleague I would have recruited in my non-academic jobs!!
Will There Be Jobs in Global Health?
We should probably start by asking: will there be jobs for people from high-income countries to work in “global health”? After all: the US is withdrawing from the world in some ways and attacking the world of global health in others. In addition, more and more people from low- and middle-income countries are being trained in public health and the needs of these countries for “technical help” is quite different than it was 30, 20, or even 10 years ago. Moreover, the health of women and children is improving and deaths and disability from infectious cases is going down, as well.
So, in this light … will there be a role for you?
The most thoughtful response I heard to this question was given by Srinath Reddy, the head of the Public Health Foundation of India. Srinath suggested there would continue to be work in global health but that the way in which that work gets carried out would continue to move more and more toward collaborative cross-country efforts, rather than “high-income countries helping low-income countries.”
In addition, while the US Centers for Disease Control and Prevention might suffer budget cuts, it won’t disappear. Neither will WHO or UNICEF. Some foreign assistance will still go to global health and some foundations will still be involved in the field. In addition, I believe that some collective global health efforts will also continue, such as the search for drugs, diagnostics vaccines, and medical devices to address a number of key health conditions. There will also still be research and policy work on global health.
So, if I am right and there is still a place for you in global health .. let’s talk about some of the skills and competencies that I would want you to have to make the maximum contribution possible to global health efforts.
Public health and global health relate to a range of technical, economic, social, and cultural issues. The origins of many health problems and the solutions to them are largely outside the health sector. Thus, I want to encourage everyone to think broadly about global health issues. In many ways, I would suggest you think like a Minister of Finance and not like a Minister of Health. I would also like you to see global health problems through their social determinants, and always ask about the “causes of the causes.” All of you should know something of economics and about tools for ethical priority setting in health.
Understand the places you are working on
Related to your ability to think broadly, you also need to understand the “way countries work”. Everything is political. Everything is historical. Everything is cultural. In addition, people within countries won’t take you seriously if you don’t show a profound respect and appreciation for their country, history, and culture. You will never “know them like a local” but you need to immerse yourself in the countries on which you work if you want to be respected and effective. Of course, this requires living in and working in a range of “global health settings”.
Think like an anthropologist
Knowing a country and thinking broadly about its health issues also requires you to have a deep understanding of the cultural groups with which you are working. The polio vaccine works. Nonetheless, there were groups in Nigeria and India that refused to take it. This was not a “scientific” issue but a cultural one. There are many issues like this and you need to learn to think at least like a “lay anthropologist”.
Develop a high level of technical skills
Whatever your field, it is essential that you develop and be seen to possess a high level of technical skills. Ideally, you will work with a team of people who also possess high level technical skills and who are also able to think and act broadly. People won’t take you seriously if you don’t possess a high level of technical skills.
Have a few areas of special expertise but be able to work across issues
The world of global health is vast and it is difficult to master many key areas in detail. I recommend you find a few niches for yourself that excite you and at which you can be quite expert. However, I also recommend that you keep up a broad understanding of the field and be able to place your work in context. You also need to have a certain degree of fungibility. Most organizations cannot use people who can only do one thing on a small number of countries, when the organization is dealing with a changing world.
You need to be able to work effectively in a cross-disciplinary team
Health and development work are cross-disciplinary. The best teams that I have seen have harnessed the work of each team member in effective, efficient, and respectful ways. They function like a sports team, with each person having different skills and a different position, but which can only win when they are working together in the best possible manner. You need to be expert at your position but also be able to play on a team.
You also need to able to work effectively, efficiently, and in harmony with others on a team. Managers hate having to attend to “personnel problems”, especially concerning “staff that don’t get along”. If YOU can’t work effectively and harmoniously on a team, you should find work that allows you to work alone or in a small group.
Be an expert in all forms of articulation/communication
Communicating effectively and efficiently within your team and with your “clients” is essential. You need to be expert at it. You need to be able to state things in clear, precise, and concise ways. There is nothing a manager likes less than spending time “cleaning up” the written work of his or her team. There is nothing clients like less than not understanding what you are talking about.
You DON’T need to know today .. or ever… exactly what you will do with your life and career
Many undergraduate students believe that they need to know the day they enter university what they will do with every minute of their future lives. This is a sad waste of time and energy. Most of what I worked on in my professional life did not exist when I was a student. There was no HIV, no campaign against NTDs, no polio eradication program, not much thinking about health systems or the quest for universal health coverage, and no discussion of climate change and health. Many of the organizations we worked with also did not exist. There was no UNAIDS, IAVI, Global Fund, STOP TB, or public-private partnerships. You need to master frameworks and concepts for thinking about global health that work now AND in that will work in a future world that could be very different from the one we live in now.
Find ways to keep up … which is not easy
You also need to find ways to keep up with your own field and the broad outlines of global health more generally. There is so much going on in the field that this is almost impossible to “keep up”. I recommend efficient ways of your regularly getting the basics, through selected alerts and newsletters.
Don’t be ideological and find ways to be creative and “disruptive”
Lastly, I want to encourage people to reject ideology, base your work on facts and evidence, and learn to ask the right open and broad questions. Otherwise, you are almost certainly destined to come up regularly with the “wrong answers”.
I hope you can also find ways to be “constructively disruptive”. Don’t accept things the way they are but do ask what it would take to make them better. I would also encourage you to harness a range of opportunities for solutions and don’t be fixated on one single approach. There is an enormous array of global health issues that still need to be addressed more effectively, efficiently, and fairly. It would be wonderful if you could be involved in creating a solution to them.
This blog is based on remarks given in February 2018 to participants in the Global Health Concentration at the Yale School of Public Health.
Richard Skolnik has worked over 40 years in international development and global health. After 25 years at the World Bank, he spent 8 years teaching global health at The George Washington University. He recently retired from five years at Yale University, where he taught global health courses in Yale College, the Yale School of Public Health, and the Yale School of Management. Richard is the author of Global Health 101, Third Edition.