CHAPTER 18
Working in Global Health
LEARNING OBJECTIVES
By the end of this chapter the reader will be able to:
• Discuss the wide variety of professional opportunities available in the global health field
• Appreciate the skills, knowledge, and experience required to take advantage of those opportunities
• Review some of the many different routes to a career in global health
• Make use of key resources for information about careers in global health
• Articulate career goals in the global health field, as appropriate to their own interests
VIGNETTES
Edith was among the best students in her schools in Kenya, and she had a strong desire to become a scientist. After finishing secondary school and university in her home country, Edith won a fellowship to study HIV/AIDS in graduate school in the United States. Edith’s scientific research has focused on people who have contracted HIV but do not develop AIDS. Edith is now working at a research institute in Nairobi, where she focuses her work on nonprogressors, in close collaboration with the International AIDS Vaccine Initiative.1 The findings from these efforts could be instrumental to the eventual development of an HIV vaccine. Edith remains excited by her research efforts, even in the face of immense scientific challenges.
John is a Canadian civil engineer who works with the development of community-based water supply in poor countries. As a secondary school student, John already knew that he wanted to use engineering to provide poor people with better water and sanitation. He was inspired to pursue such a career by videos he saw in social studies class about the terrible impact on health of the lack of access to safe water. During his engineering studies, John spent three summers working in Africa with Engineers Without Borders, where he learned much about applying engineering techniques to poor communities.2 John also learned the importance of working closely with communities in the development and operation of water and sanitation schemes. Through his work as an engineer, John is making important contributions to health.
Vivian is a Filipina. She studied English at the University of the Philippines and then began to work as a journalist for a Manila newspaper. During more than a decade in journalism, Vivian became increasingly familiar with the poor health circumstances of many Filipinos and how they often relate to a lack of knowledge of good health behaviors. As she approached her 35th birthday, Vivian decided to leave journalism and apply her knowledge of communications to working in health. Today, Vivian is the director of communications for a nongovernmental organization (NGO) that focuses on community-based approaches to improving the health of the poor.
Joseph is a graduate of the U.S. Military Academy, a former U.S. Army Ranger, and the former head of logistics for Doctors Without Borders (MSF) in Africa.3 Joseph grew up in a family with a strong sense of social justice and considered for some time how he might help poor people in low-income countries. When he finished his time in the U.S. Army, Joseph looked for jobs with NGOs working in Africa, to see if he could bring to them the organizational and management skills he had learned during military service. Logistics management is of great importance to everyone working in health, and this was an area in which Joseph had considerable expertise. This knowledge served him well as he worked with Doctors Without Borders in the Democratic Republic of the Congo, Liberia, Sierra Leone, and Somalia.
John is a 40 year old from Uganda. He works for UNICEF in Kenya on childhood immunization. John studied anthropology in Uganda and then received a graduate degree in public health from the London School of Hygiene and Tropical Medicine. After a number of years working for the Ministry of Health in his own country, John worked for an international NGO that supported Uganda’s child health efforts. Noting the exceptional quality of his work, UNICEF in Uganda then asked John to work with them. After several years, the regional UNICEF office asked John if he could work on their Kenya program. John provides technical support to that program, assists Kenya in raising the financing needed to improve child health, and assists in ensuring that UNICEF funds provided to Kenya are used wisely.
Sam is a 45-year-old American. He studied international affairs for his first degree and then spent two years in the U.S. Peace Corps in Niger. Sam then earned an advanced degree in public policy, with a focus on development. Sam is the country director in Madagascar for PSI, a U.S.-based not-for-profit consulting firm that supports health services in 60 countries.4 Chuck helps PSI to bid for financing proposals, hire the staff to implement those efforts if they win the bid, and supervise the staff. He also has important inputs into the technical work of his international and Malagasy team, as they work with the public and private sectors to improve the maternal health program, the family planning program, and TB control in Madagascar.
INTRODUCTION
Interest in global health has been growing worldwide. As described earlier, there has been an enormous increase over the last decade in financing for global health, the number of public–private partnerships that address global health issues, and the number of students at all levels who are studying global health. With this expansion of global health activities and studies has come a growing interest in careers in global health.
The purpose of this chapter is to introduce you to those careers; the knowledge, skills, and experience you need to work in global health; and how you can acquire the background you need to become a global health professional. Consistent with the rest of the book, this chapter primarily focuses on careers related to the unfinished agenda—the health issues that confront poor people in poor countries. The chapter is not meant to be a complete guide to job hunting in global health. Rather, it is intended to help you understand whether this is a field in which you would like to work, and if so, how you might pursue such interests. The chapter largely provides the type of information needed by university students who have minimal global health experience.
As you read this chapter, it is important to keep several critical points in mind:
• There is a wide variety of ways to work in global health.
• There are many different areas of global health on which one can work.
• Many organizations, of many different types, work on global health.
• There is a large number of professions that can serve global health needs.
These points may seem trite. However, many people do not understand them and believe that only those people trained in the health professions can work in the field of global health. Of course, you can work in global health as a physician, nurse, or public health graduate; however, you do not need to be trained as a health professional to work in global health. For example, there is also an enormous need for people in global health who understand communications, ecology, economics, engineering, finance, health systems management, law, logistics management, and water and sanitation, as discussed further next.
WHAT KIND OF GLOBAL HEALTH WORK CAN ONE DO?
One can engage in many different types of global health work. Although there is no perfect typology of these efforts, they do fall roughly into several different spheres. These are portrayed in Table 18-1.
TABLE 18-1 Selected Areas of Global Health Work
• Research
• Policy
• Program Design and Implementation
• Program Evaluation
• Advocacy
TABLE 18-2 Selected Functional Areas of Global Health Work
• Ethics
• Nutrition
• Women’s Health
• Reproductive and Sexual Health
• Children’s Health
• Adolescent Health
• Immunization
• Environmental Health
• Communicable Diseases—TB, HIV/AIDS, Malaria, Neglected Tropical Diseases
• Noncommunicable Diseases—Heart Disease, Stroke, Diabetes
• Health Conditions of the Aging
• Mental Health
• Unintentional Injuries
• Complex Humanitarian Emergencies
• Essential Surgery
THE KEY TECHNICAL AREAS FOR GLOBAL HEALTH WORK
Global health is a rich field, with many different areas of effort. The functional areas in which one might work in global health are suggested by Table 18-2.
TYPES OF ORGANIZATIONS WITH WHICH YOU MIGHT ENGAGE IN GLOBAL HEALTH ACTIVITIES
NGOs
Many people want to work with nongovernmental organizations (NGOs) that are engaged in health in low- and middle-income countries. Some of these are local NGOs, such as the Self-Employed Women’s Association of India and the Population Foundation of India. Others are international NGOs, such as Oxfam, CARE, and Save the Children. The largest of these organizations support a wide variety of activities, including the delivery of health services and the strengthening of health systems. They may also engage in research, policy, and advocacy activities.
The largest NGOs tend to recruit people with substantial experience and high-level skills for their fieldwork in low- and middle-income countries. However, at their headquarters, these organizations generally have a broader range of positions, and they recruit staff with a variety of skill sets to carry out this work. These positions range from entry-level program assistants, who coordinate and track program information, to senior technical positions. The latter may include physicians, often with an advanced degree in an area of public health, such as epidemiology. These NGOs also recruit nurses, but usually only those with advanced degrees in public health, as well as experience working in public health in low- or middle-income countries.
In addition, many large NGOs hire public health graduates at the master’s and doctoral level. These public health professionals have expertise in some of the key global health issues, such as maternal and child health, family planning, nutrition, communicable diseases, and health systems development. Most large NGOs will also employ a range of social scientists, including economists and anthropologists. Their staff may also include people with knowledge of behavior change and communication. Technical staff are usually involved in research, policy, or advocacy work, or in the design, implementation, monitoring, and evaluation of health programs.
Organizations Involved in the Delivery of Humanitarian Services
A number of organizations, many of which are NGOs, are involved in the delivery of clinical services in low- and middle-income countries, especially related to complex emergencies or other humanitarian efforts. Such organizations would include, for example, Doctors Without Borders or the International Rescue Corps.3,5 They may also provide services as part of shorter-term medical missions, as in the work of Sightsavers6 or Operation Smile.7 In addition, the largest of these organizations are also involved with research, policy, and advocacy work. Many of the people engaged in these organizations are trained in medicine, nursing, and pharmacy; however, these organizations also have staff members who may be trained, for example, in finance or logistics management to support their clinical work, or economics, policy, and communications to support their other efforts. For their humanitarian work overseas, these organizations tend to hire relatively few junior staff that lack clinical training.
Bilateral Organizations and Government Agencies
The leading bilateral aid organizations, such as those from Australia (AUSAID), the United Kingdom (DFID) and the United States (USAID), also support important health programs in low- and middle-income countries. The profiles of staff members recruited by these organizations are similar to those of the largest NGOs. However, the bilateral agencies may include more people with training in economics and finance on their technical staff than most NGOs. In addition, the NGOs tend to focus on a relatively narrow range of technical areas, whereas the bilateral agencies may be involved in a wide range of health activities and require staff with skills in all of those areas. For example, the largest bilateral organizations may simultaneously work on health systems strengthening, maternal and child health, and infectious diseases, among other things. The staff who work with these organizations may be engaged in advocacy, research, or policy activities. They also work on the design, implementation, and evaluation of health programs in developing countries.
Multilateral Organizations and UN Agencies
The multilateral organizations and United Nations (UN) agencies that work on health tend to hire very seasoned professionals for their technical work. Most of these staff are recruited midcareer, after they have already had distinguished careers in their fields. However, many of these organizations also have programs for junior professionals or young professionals. The junior professionals are generally recent graduates of a first degree or an advanced degree program. Other programs, like the World Bank’s Young Professionals Program, select people who have advanced degrees, outstanding academic and professional records, and substantial experience compared to most people their age.8 In addition, these organizations recruit some relatively recent graduates of both first degree and advanced programs to work as program assistants and research assistants.
Multilateral organizations and UN agencies are also involved in a broad range of health sector activities and need professionals with skills in all of these areas. Similar to the work of the bilateral organizations, this generally includes research, policy, and advocacy, as well as program design, implementation, and evaluation. These organizations, however, often place more emphasis on health systems activities and the work of economists and finance specialists than do other organizations working in global health. The World Health Organization, of course, is the most technical of these organizations, and a large share of its staff are trained as physicians.
Public–Private Partnerships for Health
The number of public–private partnerships for health has grown substantially. These organizations, like AERAS, IAVI, and Medicines for Malaria Venture, tend to be highly technical in nature and employ professionals with high-level technical skills. Because the organizations work in science, research, policy, and health services delivery, they recruit staff members with skills in each of these areas. However, their employment needs are frequently determined by new product development efforts, such as for a TB vaccine or a microbicide that could stem the transmission of HIV. In such cases, the organizations hire professionals with the knowledge and skills needed for these specific projects and for the policy, regulatory, and communications efforts needed to support them.
Consulting Firms
There is a wide range of consulting firms, both for-profit and not-for-profit, that work on global health. Many of the largest for-profit firms, such as McKinsey, engage in global health work. However, there is also a wide range of other firms engaged in global health efforts. These include organizations such as FHI, JSI, and PSI. Many of the consulting firms that work on global health also work in a wide variety of health efforts, including research and policy analysis, as well as program development, implementation, and evaluation. To carry out this work, the consulting firms generally require the same skill sets as the bilateral and multilateral organizations. This includes high-level technical expertise from a select number of domains in which the firm wants to specialize. However, they may also recruit younger staff to serve as research assistants, program assistants, and other entry-level positions.
Foundations
In general, the foundations that work in global health have a relatively small number of employees who tend to be very highly trained in their field. However, they often couple these staff with a small number of junior staff. The largest foundations that work in global health, such as the Bill & Melinda Gates Foundation, are generally staffed in a manner similar to the largest bilateral and multilateral organizations.
Academia
A large number of universities throughout the world are involved in education, training, research, and practice in global health. Universities and their associated research programs are generally staffed by faculty that have doctoral-level degrees in a discipline or degrees in law or medicine, frequently in conjunction with a public health degree. These faculty are in a wide variety of academic departments, most often including anthropology, economics, medicine, political science, public health, and sociology.
Many universities now have global health institutes or global health centers that coordinate and bring together faculty research and practice from across different parts of the university. These centers and institutes are often the university organizations that receive grants or contracts for global health projects and recruit people for work in university-affiliated global health activities. These efforts often engage a range of professionals, as well as more junior research assistants and program assistants. Of course, many universities prefer to hire their own students and graduates for such programs.
Policy and Advocacy Organizations
Policy-oriented organizations, such as think tanks, focus on research and analysis of selected policy matters. They often use the conclusions of their analyses to engage with important stakeholders on how key global health issues can be addressed more effectively and efficiently. Organizations with this type of focus include, for example, the Results for Development Institute, the Center for Global Development, and the Council on Foreign Relations.9–11 For their technical work, they tend to recruit highly skilled and experienced staff.
Advocacy organizations focus on raising awareness and funding for key global health issues. Examples of these types of organizations are RESULTS and ONE.12,13 These organizations tend to recruit relatively young individuals who have some background in health, communications, and/or advocacy. These organizations are generally looking less for high levels of technical expertise and more for people with a deep sense of commitment to their work, the ability to strategize about how to influence policymakers, and exceptional ability to speak and write well on policy matters.
There is a considerable amount of discussion about social entrepreneurship, and organizations that engage in this type of work might also be of interest. Unfortunately, there is no generally accepted definition of social entrepreneurship, and some people believe that organizations that call themselves social entrepreneurs are just another form of NGO. In any case, most definitions of social entrepreneurship suggest that this includes using business skills and innovation to try to create long-term sustainable social impact. Some would suggest, for example, that Unite for Sight’s work on cataract blindness control takes this approach.14 They might also say that PATH takes this approach as it works in public and private partnerships to promote the development of technologies that can better serve the health needs of poor people in poor countries.15 A well-documented case of an organization that most people would identify as social entrepreneurs is the Aravind Eye Care Hospital in India.16 This hospital provides high-quality eye care to people of all social classes and uses fees collected from better-off people to subsidize the cost of its work with less well-off people. In principle, social entrepreneurs who work in health seek to employ creative, innovative staff, who can think out of the box, possess a good knowledge of health, understand a variety of approaches to improving health, and also know something about a range of business practices and how they might be applied to health. Some social entrepreneurs will also employ highly qualified technical staff in a number of areas.
YOUR FUTURE IN GLOBAL HEALTH
Now that you have a better understanding of the broad range of jobs in organizations that work in global health, it is time to establish a framework within which you can consider a possible career in global health. It is also important to provide a basic overview of how you can pursue such a career.
As you begin to think about your professional interests and a possible career in global health, it might be useful to ask yourself the following question: “Ten years from now, what impact do I hope to have on the global health field?” Thinking about this question will help you focus on what you would like to do and the impact you would like to make from doing it.
If you are new to the global health field, it may be difficult to know the different types of global health work in which you could engage. You are probably familiar with some of the clinical work that health professionals, such as physicians, engage in to improve global health. However, you may have had little exposure to the work done by other professions. You may never have heard of work like Vivian’s on health communications, Joseph’s logistics work with Doctors Without Borders, or Edith’s use of science to help develop new diagnostics, drugs, or vaccines that could improve the health of the poor in low- and middle-income countries.
Therefore, as you begin to develop your interest in a global health career, it is very important to:
• Become familiar with the opportunities for working in global health
• Understand the background needed for the type of career you may want to pursue and how much of that background you already possess
• Establish a plan to gain the knowledge, skills, and experience you need for such a career, in a manner consistent with your other personal and professional interests and obligations
• Identify people who can serve as role models to help you understand global health professions and how you can pursue them
More is said about each of these topics in the following sections.
What You Need to Know to Work in Global Health
In many respects, careers in global health are just like other careers. Both require a certain type of background to obtain a job and to carry it out effectively. In global health, as in other fields, specific types of knowledge, skills, and experience are usually necessary to gain employment and to grow in the field professionally. If you want to work in global health, it is also important to have a good understanding of how to work in a variety of settings outside of your own country and culture, with humility and an appreciation of one’s role in such settings.
If you think broadly about work in low- and middle-income countries, you would generally need to have:
• A good understanding of key political, social, and economic issues in the development of low- and middle-income countries, as well as how these issues might be addressed
• An appreciation for and an understanding of different cultures
• Knowledge of one or more languages commonly used in low- and middle-income countries
• Experience living and working in low- and middle-income countries, ideally close to the grassroots level
• Technical skills that can be used to help address global health issues
• An outstanding ability to write and speak simply and clearly for a wide range of audiences
Developing Your Knowledge, Skills, and Experience
Once you have outlined the knowledge, skills, and experience you are likely to need to pursue your global health career, it is important to assess your progress in each of these areas. You can then determine the gap between where you are and where you need to be. This assessment can serve as the foundation upon which you decide how best to fill that gap. Some of the ways of enhancing your readiness for a career in global health are noted in the following sections.
University Studies
The first step to set the foundation for your future career in global health is to get a good education in the field you want to pursue, if that is already defined. As noted earlier, it could be engineering. It could be anthropology. It could be economics. Whatever field you choose, it is important to master the material and take advantage of every opportunity to link your studies with the field of global health. For an engineering student, this could be a focus on water and sanitation. For an economics student, this could be a focus on the relationship between health and development. For an anthropology student, this could be a focus on medical anthropology.
As you pursue your first or later degrees, it is also important that you engage in the study of development. You do not need to become a development economist; however, you do need to have a good understanding and appreciation of the key issues in development, how they play out in low- and middle-income countries, and how those countries might address them. In addition, it is crucial to understand the many links, in both directions, between health and education and health and development.
It is also essential to master as much as you can of English, Spanish, and French. Several other languages can also be very useful for work on health and development, including Portuguese and some languages commonly used in low-income countries, such as Swahili. It is important to note that the more languages in which you can work efficiently and effectively, the greater the opportunities will be for you in the global health field. The inverse is also important; a lack of knowledge of languages other than your own can be a major obstacle to gaining employment in the global health field.
In the end, the best way to learn about other cultures and languages is to live and work with other culture groups. However, until you can do that, it is essential that you take advantage of opportunities to study other cultures, languages, and development.
Internships and Work Study
One excellent way to build the foundation for a career in global health while you are still a student is to engage in internships or work-study opportunities in the global health field. By undertaking a variety of internships throughout your studies, you can learn about numerous aspects of global health. This can also help you understand which parts of the global health field are most interesting to you and best suit your strengths. For example, with good planning and some luck, you might be able to work at different times for an NGO that works on health and human rights, another that focuses on the health of women and children, a third that emphasizes TB, and a fourth that is an advocacy organization. Alternatively, if you develop a specific interest at an early stage in your studies, such as HIV/AIDS, you could use your internships to gain a better understanding of the many aspects of HIV/AIDS work.
Most universities provide considerable information on how to find internships. This information may be available in a career office, on a university job or internship website, or through other forms of communication such as mass informational emails and print brochures. Other ways that students obtain internships include searching for advertisements on specialized websites, having faculty connect them to colleagues in global health, word of mouth from student to student, or asking for internships directly from specific organizations of interest to them.
Of course, finding an internship is easiest if you attend a university in a location with a tradition of internships and a wide array of internship opportunities, such as Washington, DC, in the United States or London, in the United Kingdom. If you study somewhere with ongoing global health efforts, you should have opportunities to learn about various aspects of global health throughout the course of your studies.
On the other hand, if you attend a university in a location with few such global health opportunities, you can still prepare yourself for global health work by pursuing internships in areas of domestic health that focus on marginalized populations, such as lower-income or immigrant communities. People in these communities face many of the same challenges that the poor face in low- and middle-income countries, and much can be learned from working with them.
Study Abroad
Another way you can build a foundation for work in global health is by studying for a semester or two in a low- or middle-income country. An increasing number of opportunities exist to study in low-income countries, such as Kenya, Senegal, or Uganda, as well as middle-income countries, such as Brazil, China, South Africa, and Thailand. In addition, some of these programs specifically focus on health and provide students with opportunities to engage in independent research on health topics of their choice. Moreover, many study abroad programs have homestays, in which students live with a local family. These opportunities can be transformational and extremely enlightening for university students. The chance to live, even for a short time, with a family in a low- or middle-income country is a unique and invaluable experience.
SIT, for example, has a wide range of study abroad opportunities that focus on health. These include programs in Argentina, Brazil, Chile, China, India, Jordan, Kenya, Madagascar, and South Africa. SIT also operates the International Honors Program that gives students a chance over a semester to visit several countries.17 The Alliance for Global Education operates a program on global and public health in Manipal, India. There are many other study abroad programs that focus on global health as well.18
Work Abroad During Vacation
Another outstanding way to develop a foundation for a career in global health is to work on health in a low- or middle-income country during your university vacations. Some students do this over relatively short breaks, such as the winter break or spring break in the United States. However, others undertake such an experience during their long vacation, which is the summer break in the United States.
You can arrange such a work experience abroad in multiple ways. One possibility is to arrange the work through personal contacts. In many countries, university students are a diverse group, and a student may be able to spend time in the home country of a classmate, working, for example, with a health-oriented NGO. Another way to work in low- or middle-income countries over school vacations is to participate in a variety of programs that are arranged by organizations and firms, such as:
• Cross-Cultural Solutions: For more than 15 years, Cross-Cultural Solutions has sent students to volunteer or intern in one of 12 countries in Africa, Asia, Latin America, and Eastern Europe in the fields of education, health, and social service. Trips last anywhere from 1 to 12 weeks.19
• Visions in Action: Also known as Africa Development Corps, Visions in Action has sent students for over 20 years to work on development projects in Liberia, Tanzania, and Uganda on issues of health, food security, and education. Most health projects in which students participate are related to combating HIV/AIDS, and most programs last anywhere from 6 to 12 months.20
• Global Service Corps: Located at SUNY Albany (State University of New York at Albany), Global Service Corps sends students to intern in Cambodia and Tanzania. Internships are related to health care, education, and other community development projects and last anywhere from one week to indefinitely.21
Unfortunately, one generally has to pay for opportunities such as these. However, many students have found them worthwhile.
Many universities and student groups sponsor short humanitarian visits to low- and middle-income countries during school breaks. The visiting groups may help provide needed health services or may engage in broader aspects of community development, such as home building or the installation of water and sanitation systems.
Some universities also have travel fellowships that support student-led research or practice during the university breaks. Although these fellowships tend to be highly competitive, they represent an excellent opportunity for students to explore research and practice topics in another country. For example, a student at Yale University recently used such a fellowship to do research on sex trafficking in Mumbai, India. A George Washington University student used a travel fellowship during her winter break to conduct interviews in Mexico on the impact of the Oportunidades program on reducing maternal mortality among poor women. This research was part of an honors thesis she did during the final year of her bachelor of science degree program. As part of a practicum for her master of public health degree, a student at George Mason University used such a fellowship to work on infection control in a hospital in Swaziland.
Postgraduate Work Overseas
Although it is very valuable to engage in global health efforts during your university studies, there are also opportunities to gain global health experience after completing your first degree. There are a small number of travel fellowships that can support such activities. These fellowships are sometimes offered by foundations, such as the Luce Foundation Fellowship in the United States.22 Some universities also have their own fellowship programs for recent graduates. The United States also has a Fulbright scholars program that supports research and teaching in other countries.23 There are also a large number of teaching fellowships that can help one live and work in a low- or middle-income country. Upon arriving in-country for such teaching fellowships, teachers can find health activities to engage in during their stay. It is possible to conduct valuable global health research or practice through each of these fellowships.
Another popular way of gaining work experience in low- and middle-income countries is through a national overseas volunteer program, such as the U.S. Peace Corps24 or the British Voluntary Service Overseas.25 Although one is not guaranteed to work in health, even if one is trained in that area, many volunteers do work in health or a related field. However, even if volunteers do not work specifically on health issues, they can still gain excellent exposure to critical issues in development that will be valuable throughout their global health career.
The Global Health Corps is similar to the Peace Corps in some respects, but places young professionals in global health organizations in Africa and the United States for one year and pairs them with a young professional from the country of their placement.26 Organizations like the Peace Corps and Global Health Corps have strong alumni networks that can be an excellent resource during job searches. Moreover, many employers place a premium on recruiting ex-volunteers because they believe that such people have personal traits that make them especially productive employees.
Graduate Studies
An important question after completing your first degree is whether you should pursue graduate studies, and if so, in what field. The main point worth reiterating here is that you can work in global health and serve the needs of marginalized people in many ways and with many academic backgrounds. The second point worth repeating is that no matter which field of study you pursue, it is crucial that you bring highlevel professional skills to your future work in global health. A third point is that your future field of graduate study could be different from the field of your first degree. A person who studied science can do graduate work in economics or public policy. In North American educational systems, one could study film or English for the first degree and still attend medical school later, provided one also meets the prerequisites for that field.
Indeed, many people who work in global health both clinically and on policy and program issues are trained as physicians. Many of these people also have graduate degrees in public health. Some of them do global health work that is highly technical and requires clinical training. For example, there are physicians who work abroad clinically through organizations like Doctors Without Borders or the International Rescue Committee. However, many of the physicians who work in global health have stopped practicing clinical medicine and now focus on public health work instead. This is the case, for example, for most physicians who work on TB control with the Global Partnership to Stop TB or on HIV/AIDS control with UNAIDS.
Clearly, if you want to work in global health, there is still considerable merit in studying medicine. Indeed, physicians have led many of the most important contributions to global health. For example, Donald “D.A.” Henderson, who has MD and MPH degrees, led WHO’s Smallpox Eradication Programme. In addition, William Foege, who also has MD and MPH degrees, made substantial contributions to smallpox eradication efforts, directed the U.S. Centers for Disease Control and Prevention (CDC), and has been instrumental in efforts to control neglected tropical diseases. Of course, these comments can also be said of other health professionals, such as nurses, pharmacists, or dentists. It also appears that there will be increasing roles in global health for veterinarians who understand and are trained in public health.
Economists have also made important contributions to global health. They have generally focused their attention on the costs and financing of health systems, the provision of financial protection to the poor, and ways to ensure value for money from health investments. Some economists have made major contributions to research and practice on global health. For example, Dean Jamison, who holds a doctorate in economics, was the main author on a number of global health reports that had a major impact on how low- and middle-income countries invest in health. Ramanan Laxminarayan, who also has a PhD in economics, has conducted important research on cost-effectiveness analysis that is widely used in the global health field. Both Abdo Yazbeck and Rachel Nugent hold PhDs in economics and have had important impacts on global health efforts. Abdo has done seminal work on poverty and health. Among other things, Rachel has done pioneering work on food policy and nutrition and on antimicrobial resistance.
As noted throughout the text, global health issues are inextricably linked with culture. Thus, you might want to study medical anthropology, focusing on selected issues in global health. This might include, for example, the cultural issues that relate to women’s health or nutrition. Many people do not know that Paul Farmer and Jim Kim, who have been so involved with the NGO Partners in Health, are both physicians with PhDs in anthropology.
Many people who work in global health have pursued graduate degrees in international affairs or development studies and built strengths in particular areas of global health around those studies. Similarly, many others have gotten advanced degrees in public policy, focusing their work on development, human resources development, or global health issues. There is a risk that degrees in development studies or public policy may leave one without in-depth expertise in any one discipline. They also leave one without a specific professional title. Yet, many employers appreciate the way that graduates of these programs are trained in policy analysis, development, economics, and finance. Keith Hansen, for example, who headed the health program for Latin America at the World Bank, is a graduate of the Woodrow Wilson School at Princeton University, a public policy school. He also has a law degree. His colleague at the World Bank, Tim Johnston, who headed the World Bank’s health work in Cambodia, is also a Woodrow Wilson School graduate. Many of the staff of organizations that engage in policy and advocacy work are graduates of public policy programs.
It was noted earlier that many students interested in global health have never thought of pursuing an advanced degree in business and may even see business as something contrary to global health. Yet nothing prevents a business school graduate from devoting his or her life to applying those business skills to work on public health issues. For example, Pape Gaye heads an important nonprofit consulting firm that works on global health. One of the ways that he prepared for this was by obtaining an advanced degree in business. In addition, many people who studied marketing are involved in social marketing for health.
Studying engineering to an advanced level can provide one with an excellent basis for work on global health. For example, designing roads to enhance safety and improve access to social services would have a major impact on health in many countries. Moreover, strengthening water and sanitation systems could make a substantial impact on the burden of disease. Yet, most people do not consider engineering when imagining a career in global health. The late John Briscoe, who was on the faculty of the Harvard Schools of Engineering, Public Health, and Government, was an engineer who made major contributions to work on water supply and sanitation.
As you know, a substantial share of the burden of disease is linked with under- or overnutrition. A number of graduate programs, like those at Tufts University and Cornell University, have excellent education programs in nutrition at both the master’s and the PhD level. Proper nutrition is fundamental for the well-being of young children; consistent with this, many UNICEF staff members have obtained a PhD in nutrition.
Those with a strong interest in health and human rights might want to study law or even philosophy. A number of law programs have concentrations in human rights issues, and many staff members who work on health at organizations such as Amnesty International and Human Rights Watch have law degrees. Those who have studied law might also be at the forefront of work on intellectual property issues and trade matters that affect health, such as access to affordable medicines in low- and middle-income countries. Surprising to some people, many of the most distinguished writers on ethical issues in health have a background in philosophy. For example, Norman Daniels, the author of Just Health, which focuses on social justice and health, is a philosopher. Toby Ord27 is a professor of philosophy at Oxford University in the United Kingdom. He established Giving What We Can, a society for charitable giving, and has done research and writing on a number of ethical issues related to global health.28
Many people still fail to consider the important role that journalists, filmmakers, and others in media and communications can have in enhancing interest in global health and efforts to improve it. Despite the apparent decline in newspapers in some countries, a number of newspapers continue to have reporters who regularly write on global health issues. For example, Laurie Garrett, now at the Council on Foreign Relations, is a journalist who became interested in global health and wrote several widely read books on public health issues. Documentary films on global health issues, such as Rx for Survival,29 as well as popular films, such as While the Band Played On or Philadelphia, can have a major impact on popular perceptions of key health issues. Many organizations that are involved in global health are now active users of social media, such as Facebook and Twitter.
One last question that will arise as you consider studies in global health is whether you should get a doctoral degree. There is no perfect answer to this question. However, the simplest answer is that a doctoral degree is essential if you wish to engage in research work. However, if you want to work in policy or practice, you may wish to seek additional practical experience instead of taking a substantial number of years to get a doctoral degree.
This list of areas for possible graduate study could include many more fields, such as those related to mental health, which is also an enormous burden of disease. Although the previous comments are only illustrative, they highlight the importance of considering graduate studies as you complete your first degree. It is also crucial to get a sense of the field of study you wish to pursue, knowing that you do not need to compromise your interests in order to work in global health. By contrast, there are many academic paths that can prepare one for a career in global health.
SELECTED ADDITIONAL RESOURCES ON CAREERS IN GLOBAL HEALTH
In this chapter you have been exposed to a framework for thinking about careers in global health. If you are still interested in considering a career in global health, you may want to pursue some additional information on this topic.
Somewhat surprisingly, given the growth of interest in careers in global health, there is still only a limited number of resources available to help guide those interested in pursuing such a career. Some of these include:
• Building Partnerships in the Americas30
• Caring for the World: A Guidebook to Global Health Opportunities31
• Finding Work in Global Health: A Practical Guide for Jobseekers or Anyone Who Wants to Make the World a Healthier Place32
Another book that might be helpful, although it is not specific to global health, is Idealist Guide to Nonprofit Careers for First-Time Job Seekers.33
In addition, the Consortium of Universities for Global Health has a number of educational modules that touch on careers.34 Unite for Sight has an online course on careers.35 Dr. Greg Martin runs an online channel on global health, which also features a number of videos that relate to careers in the global health field.36
There are also a number of websites that list job postings in global health or fields related to global health and development, including the following:
• DEVEX is an organization that focuses on international aid and development. Its web page lists jobs in global health, among other fields.37
• The Global Health Council operates a clearinghouse for global health careers that is available to those seeking a position in global health, as well as, for a fee, those recruiting people to work in this field.38
• GlobalHealthHub.org has a range of valuable resources on global health broadly and on careers in global health.39
• The International Jobs Center is an online weekly publication of international jobs.40
• Idealist.org is an “interactive site where people and organizations can exchange resources and ideas, locate opportunities and supporters, and take steps toward building a world where all people can lead free and dignified lives.”41 This website has a number of resources related to jobs in the nonprofit field.
• Zebra Jobs is a resource for jobs in Africa.42
• Eldis is a clearinghouse of information on development that has a jobs listing on its website.43
• The U.S. government operates a website with information about U.S. government jobs in global health and some related positions.44
• The U.S. Centers for Disease Control and Prevention has a website that focuses on its jobs overseas.45
• The Public Health Employment Connection is a job clearinghouse operated by the Rollins School of Public Health at Emory University.46
• Public Health Career Mart is a website of the American Public Health Association that focuses on jobs for public health professionals.47
• The Akili Initiative, an online student initiative for global health, offers a database of organizations that offer global health jobs and links to their career pages.48
MAIN MESSAGES
Global health is a growing field, and there are many opportunities to work in it. There are positions, for example, in universities and think tanks, NGOs, social entrepreneurship, bilateral and multilateral aid organizations, and consulting. Although there is a variety of jobs in the global health field for those trained in the health professions, there are also many opportunities for those trained in other areas, including anthropology, communications, economics, engineering, and logistics management.
If you are considering a career in global health, it is valuable to get a sense of the range of such careers that are available. You will then want to understand better the skills, knowledge, and experience this type of career would entail and how you might fill any gaps you have in terms of the required background for such positions. You will also want to approach potential work in global health with a deep sense of humility.
Most jobs in global health will require a good understanding of economic development; an appreciation of other cultures; an ability to write and speak well, both in English and in other languages; and skills in at least one of the areas important to global health. They often require experience living and working in low- and middle-income countries as well.
If you want to pursue a career in global health, it would be valuable to get your first degree in an area related to the one in which you want to work. It is also important to build on that with internships, fellowships, and other opportunities to live and work abroad. Many different graduate programs can build on your studies and experiences and further prepare you for a career in global health. There are many routes to becoming involved in global health. It is always valuable to learn from the career paths of those already involved in the field and mentors with whom one can work directly.
Study Questions
1. What are some of the organizations most involved in global health work?
2. What types of staff carry out their health activities?
3. What types of knowledge and experience are generally essential to working in global health?
4. How can university students get a better understanding of life in low- and middle-income countries?
5. What role might an economist, anthropologist, engineer, or public policy specialist play in global health?
6. What are some of the careers in global health that might be open to physicians?
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