Ten Lessons in Public Health: Inspiration for Tomorrow's Leaders

Preface

Research is formalized curiosity. zora neale hurston “Global health” now attracts the interest of the press, the World Economic Forum, and young people everywhere— undergraduate and graduate students, physicians, nurses, health managers, and public health professionals of every stripe. It has become the destination major of many applicants to university schools of arts and sciences, medicine, nursing, and public health, especially the Bloomberg School of Public Health at Johns Hopkins. Undergraduates on campuses across America (and in many other countries around the world) are editing and publishing slick magazines devoted to the subject, while every major academic institution worth its salt has established programs, departments, or institutes of “global health.” Yet the term itself is barely a decade old. How did this suddenly happen? It wasn’t sudden. Many people have been laboring in these fields for half a century or more. We’ve been tackling diseases, new and old, by identifying their causes and determinants, devising and testing programs for their control, and attempting to convince policymakers of the importance of vigorous, evidence-based interventions . What has changed, for a multiplicity of reasons, is the attention these pursuits now receive, the importance they are Preface x PREFACE accorded, and the passion with which a new generation has embraced their cause. What’s now called “global health” is traditional “public health” writ large: public health explicitly played out, as it always has been, on the global stage. But the new terminology graphically reminds us that no population can feel smugly safe while others are ill, whether from infectious diseases like SARS, influenza, tuberculosis, or HIV/ AIDS, or from chronic (often behaviorally “communicable”) diseases like obesity, stroke, and chronic obstructive pulmonary disease. While genes are important, they don’t explain, nor are they responsible for, the epidemics of lung cancer, diabetes, and asthma that are now sweeping the globe. Many disciplines contribute to the design and conduct of successful global health interventions, but success almost always begins with the classic epidemiologic triangulation of a disease by time, place, and person. Why this person and not the person next door; why now and not last week or next year? Epidemiologic investigations and insights provide the evidence behind good medical practice and global (public) health policy. We epidemiologists have been handed powerful new tools to assist our work, from laboratory tests that identify new infectious agents to powerful computers that can quickly carry out complex analyses. But nothing can replace epidemiology’s core underpinnings: the rigorous collection of data and their thoughtful, innovative interrogation. “Connecting the dots” is what matters most. I’ve had the good fortune of being able to follow my interests (and enhance my ability to connect the dots) by chasing down a diverse array of global health threats. Sometimes these efforts led to insights that were not particularly relevant —until they were, urgently, forty years later. At other times they led to discoveries that launched global programs that now save the sight and lives of millions of people. In one PREFACE xi instance, my own work, in a small way, helped to establish a new nation. Any significant involvement in global health demands a willingness to stray from the traditional path—on your part and that of your spouse or partner. I’ve known few instances in which a global (public) health career wasn’t supported by a joint interest in experiencing other environments and engaging with other cultures. This small treatise tells of my immersion in a world where data mattered mightily but persistence, powers of persuasion, and luck mattered nearly as much. It is my hope that these personal stories will help those considering careers in global health to better appreciate—through my successes and failures, frustrations and celebrations, plans and accidents—how interesting and unpredictable epidemiology and a life immersed in global health can be, and how much our individual contributions can matter. I hope that this brief retelling of moments along my personal journey will help you in yours. My own journey was influenced by many marvelously supportive mentors and role models, among them, Howard Hiatt, George Comstock, Abe Lilienfeld, Helen Abbey, Ed Maumenee, Arnall Patz, Alex Languire, and Bill Foege— all luminaries in the annals of medicine and global public health. I am grateful to them all. Those eager to make a difference in the world will do well to read about these mentors . (But more important, find your own.) My immediate...