“Global Health is an attitude. It is about the universal nature of our human predicament. It is a statement about our commitment to health as a fundamental quality of liberty and equity.” – Richard Horton, Editor of The Lancet
Whenever I mention my work overseas, I get met with skepticism nearly as often as curiosity. To say that I work in “global health” typically solicits blank stares from most audiences, requiring me to give a brief explanation of what exactly that means. More pernicious, perhaps, is the frequency with which my career choice is looked at as some sort of phase, a temporary bump in the path to a real job. The attitude is not always intentional or aggressive, but even so it remains deeply engrained in many people. Many of us in global health have heard lines like these before:
“Sounds fun, but when are you coming home?”
“Isn’t it dangerous?”
“Don’t you wish you made more money?”
We hear them before we leave on a plane. We hear them when we work for non-profits at home. We hear them when we return and start planning for the next rotation abroad. Underlying all of it is the assumption, whether consciously acknowledged or not, that “global health” does not count as a legitimate field of work and study.
To a certain degree, they might be right. To quote Dr. Paul Farmer and his colleagues in their book Reimagining Global Health, “global health remains a collection of problems rather than a discipline.” My colleagues are doctors, social workers, biostatisticians, economists, and engineers. How can global health stand as a discipline on its own when its practitioners come from such varied backgrounds?
As a Global Health Corps Fellow, I am part of a movement helping to forge global health into a new discipline, one united not by the training required to participate in it, but by its goals and the philosophy behind its methods. We who work in this field believe fervently that health is a human right and that inequalities in health outcomes and access to healthcare are unjust and unsustainable. But we recognize that inequalities result from deeply embedded social, political, and economic factors. If global health limited itself to one training path, one set of knowledge, it would lose out on the immense potential impact of other fields.
As a Monitoring and Evaluation Officer in rural Rwanda, I can describe in exquisite detail the importance of good data quality and how to measure a program’s progress, but all of that knowledge is useless without an understanding of the context that it will operate in. I have to join my knowledge of monitoring and evaluation systems with an understanding of what will and will not be feasible for a particular program. On my own, I achieve very little without the input and collaboration of my colleagues.
Ours is thus the careful work of establishing connections within the collection of problems, of building bridges between the doctor and the economist, the biostatistician and the engineer. The complexity of health inequalities, both in the United States and overseas in developing countries, requires this collaboration. We cannot continue to myopically peer at each individual problem through the lens of a single discipline. Global health must combine disciplines to gain deeper insight into the complex systems that create and sustain inequality if it is to have any hope of dismantling them.
Global Health is the career I choose. It is not a phase or a speed bump on the road to something else. It will not pay well, and it may even send me to difficult or dangerous environments, but ultimately it is a career in service of a greater goal: health for all, no exceptions.