Friday, March 28, 2014

Week 2: Leaders in Public Health and their Views on Moving Forward

The world faces more challenges than anyone can count when it comes to global health.  From corrupt governments to struggling economies, poorly allocated resources and the double burden of communicable and non-communicable diseases in developing countries organizations and countries definitely have their hands full trying to improve the state of health of most people on the planet.  But how to go about undertaking this overwhelming task?  Where to even start?

Well, it's difficult to say as there are so many differing views, even among experts.

This post will explore the opinions expressed by leaders from very different backgrounds about how the global community should proceed as far as addressing public health concerns and social inequalities, particularly in the developing world.

Amartya Sen (Sen)

This first video clip is an interview with Amartya Sen, who won the Nobel Memorial Prize in Economic Sciences in 1998 and works as a professor of economics and philosophy at Harvard University.  Here a few of the key points that Sen believes will be integral to furthering health and development in the world:
  • Freedom, people having control over their own lives
  • Entrusting decisions and judgements to public reasoning and scrutiny
  • Focusing on developing human capabilities so people can change their communities themselves, so they can be in a position to help other people (enabling people)
  • Countries, organizations and other entities should be working together in the world to achieve common goals
  • Communication is crucial to development
I have to say that for the most part, I agree with Sen's views on several levels.  I believe that individual freedom and equality are pivotal to health and development.  I also, agree that in general, the majority of a well-educated population will make the correct judgements for its people.  However, in reality, the latter does have the potential to compromise the former in uneducated populations that can be easily swayed by overzealous individuals and ideologies. But there is no question in my mind that developing people's capabilities so that they can take care of themselves and help others when necessary is the way forward. 

David E. Bloom (Bloom)

David E. Bloom also works at Harvard University as a professor of economics and demography in the Harvard School of Public Health.  However, his views focus a great deal more on the privatization of health services and product delivery.  In his interview he discusses:
  • Utilizing privatization to get public health messages and services to everyone, even the unreachable communities (if Coca Cola can reach just about everyone, why can't health services?)
  • Employing the marketing techniques that private businesses use to sell ideas instead of telling people what to do. 
  • Using private businesses to produce and widely distribute medical supplies, nutrition supplements, etc, as was done with penicillin.  
Julio Frenk (Frenk) 

Julio Frenk is a medical doctor from Mexico who is currently the Dean of the Faculty at the Harvard School of Public Health and T & G Angelopoulos Professor of Public Health and International Development.  His approach centers around establishing health as a human right, here are some of his key points:
  • Countries (and their people) need to have the conversation to make the decision of whether they believe health is a right or a reward.   
  • Once they have arrived at a conclusion in that regard, they can then go from there and discuss how health care can be distributed and provided to the people.
Having grown up in a society that decided health was a human right long ago, it has always been difficult for me to see it in any other light.  I do agree that a decision must be made before a country can proceed in a meaningful way.  The way that I see it, being unable to decide results in an inefficient distribution and use of resources and therefore, care that is not as good as it could be for the majority of people.  

Lately I have heard that one of the reasons people want the option of private health care is that they do not trust in the government to provide adequate services.  So I suppose they want options, they do not want to place all of their eggs in one basket, instead hedging their bets on both sides.  But what if that means that neither one will ever reach its fullest potential, to be as great as it could be if it had every available resource behind it?

Take for example, a scenario where a service is available both for free (through taxes, i.e. public) by one system or at a cost (for real or perceived superior service, i.e. private).  For starters, the private system becomes reliant on a number of things, including a decent amount of disposable income for a good portion of people in the population.  This is only possible with a strong economy and solid job market.  If people are struggling financially, why would they choose to pay for a service that they could get for free?  There is thus a strange one-sided relationship that develops between the public and private systems, favoring success for the private entities.  The private system is more likely to be successful if the public system is struggling to provide quality service in a timely manner.  The public system itself will be strained if too many people use its services instead of paying for private care, but its funding is often tied to the estimated demand for services, and reduced if that demand starts to fall.  So in essence, the private system relies on failures in the public system pushing people to pay for better and faster care, while the public system depends on the success of the private sector to alleviate some of the workload - but not too much of the workload.  The demand and supply for both of these systems would have to be perfectly balanced for both to work well.

Jeffrey Sachs

Jeffrey Sachs is a highly respected economist, a tenured professor at Harvard University and Director of the Earth Institute at Columbia University.  He has been instrumental in the creation of the Millennium Development Goals (Sachs) (Sachs)
  • It is entirely possible to fund universal primary health care for everyone in the world, for a very small comparative cost to the western countries (o.1 of 1% of GDP or 35 billion dollars).
  • Sachs admits that funds have been and are often mismanaged, but also states that rich countries have used that as an excuse to cut foreign aid, especially when the world was hit with the recession in 2007 and 2008.  But Sachs insists that poor management does not mean that the amount of foreign aid that he has proposed will save millions of lives and dramatically improve the state of health systems in developing countries.
I do not agree with a great deal of his points and arguments about simply giving aid and that solving all of the third world's problems.  Yes, he did touch on the mismanagement of funds, but there are so many more issues.  Simply handing money over does not motivate people or developing countries to change, to grow, to progress.  I believe aid money can actually be very detrimental if it creates the expectation that it will always be there.  I believe in small loans and microfinancing investment avenues that can help motivate people to be productive without charging them interest or punishing them if they cannot pay the loan back.  There are several organizations that oversee those sorts of transactions.  Looking at the impact that microfinancing has had on Bangladesh I would say that investments in growth and development are going to make the difference for third world countries, while outright aid has yet to be effective should not be relied on.

I agree much more with the views of Dambisa Moyo.

Dambisa Moyo (Moyo)

Developing countries, no matter where they are, need to be treated like equal partners in their own development and on the world stage.  Change will need to happen from the ground up, not from the top down or by dropping money in blindly without an infrastructure for countries and their people to sustain themselves in the long term.

Young Leaders (young leaders) 
  • Focusing on preventative measures needs to be the way forward to improve health rather than curative medicine as illnesses become more lifestyle-related: empowering people through microfinance, encouraging people to grow and buy local produce with minimal pesticides, promoting healthy and balanced lifestyles (physical activity and healthy eating), education. 
  • Healthy people are productive people.  Health and development are interlinked, it’s difficult to have one without the other.  In the same respect, when you do invest in one, the other is often improved as well.
It's impossible for me to disagree with preventative health measures to address the burden of disease.  Healthy people are more productive, happier and contribute actively to society.  However, it's very difficult to concentrate on preventative health when an overwhelming amount of people are already sick or when healthy people are still getting sick (from communicable diseases, particularly in developing countries).  Initiatives to treat and cure then become the focus because they are more urgently needed and provide more immediate, tangible and satisfying results.

This exercise highlighted different strategies, different ways to address public health issues around the world moving forward.  Some believe the answer is in the privatization of products, messages and services by utilizing the channels of distribution and marketing strategies that private businesses do to obtain results.  Others believe that it is in promoting preventative health strategies instead of relying on curative measures, as healthy people are more productive and able to take care of themselves and contribute to their communities.  Others still believe that the developed world could easily and should therefore simply pay to give everyone in the world access to primary health care.  However, I do not believe that it is as simple as that.  

Programs take time to implement and people take time to be educated properly.  Health programs should be run and operated by locals for many reasons, including sustainability, the trust of the community and knowledge of language and cultural customs.  Money wouldn’t simply have to go into healthcare, but also infrastructure, education and the promotion of human rights and freedoms, all of which should be developed by the people, they should be the ones making the decisions, not rich foreigners (although some guidance and consulting would probably be very beneficial).  I appreciated Sen’s view that we should work together to achieve our goals and that important matters should be presented to the public for scrutiny so that they can take part in decision-making and therefore their own development.  Mistakes will be made, but valuable lessons will also be learned from the experiences and will guide future development.


Wednesday, March 26, 2014

Week 2: Leadership

Leadership was the main focus of our second health and development class this semester.  So, what qualities make a good leader? What is the difference between leadership and management or are they the same thing? Am I a leader and if so, what kind?

I always believed that a leader was someone who always remained calm and who felt comfortable taking the reins and steering a group safely and purposefully to their shared goal.  They were people who were good at coming up with a plan, who could delegate tasks accordingly but also adapt their strategies appropriately when circumstances changed.  They knew how to best utilize the strengths of those around them and had great social skills, motivating people and getting them to work together.  They knew how to make people feel valued and important to the success of the group and/or endeavor.

As it turns out, I was not entirely off target, but I did mistake some skills for leadership that are should actually be attributed to good management.  Leadership and management are not the same thing but do go hand in hand.  Here are the actions, behaviors and skills of a leader versus management, as described in class:

  • Create the vision
  • Align and inspire people
  • Collaborate
  • Create and build process
  • Keep values visible
  • Motivate
  • Communicate, communicate and communicate
  • Look to the future
  • Challenge the status quo
  • Implement the vision
  • Plan, budget and organize the team
  • Maintain order and system
  • Manage the impact of change
  • Measure day to day
  • Control and problem solve
  • Seek step by step improvement
Where I went wrong was considering the planning and every day adaptations to keep everyone on track part of leadership when it is more a part of management.

To be fair, the best leaders and managers that I have worked with had one foot in both worlds.  They had a vision and were able to motivate people, they had great communication and social skills but they were also involved in the day to day undertakings of realizing their end goal.  They were understanding towards the people working with and under them, hearing their concerns and helping them work through any difficulties they were having.

I have only experienced being in a leadership position a few times as captain and coach of sport teams, vice president of student council at university, shift lead at a fast food restaurant.   All of these positions have required both leadership and management skills.  I have often wondered what kind of leader I was on those occasions and what kind I would be in the future.  

(Cartoon by Penwill, R, retrieved from

So I was pretty keen to take the leadership style inventory quiz at to see what my results would be.

In the end, my leadership style result was:

Participative Leadership
Participative leaders accept input from one or more group members when making decisions and solving problems, but the leader retains the final say when choices are made. Group members tend to be encouraged and motivated by this style of leadership. This style of leadership often leads to more effective and accurate decisions, since no leader can be an expert in all areas. Input from group members with specialized knowledge and expertise creates a more complete basis for decision-making.

If my result from the quiz was accurate, I am very happy with my style of leadership.  I want to be the kind of leader who is actively involved, who motivates people and takes the views of others into consideration.  But when I am in charge, I know that I also enjoy making the final decision myself.  After having read Goffee and Jones' article "Why should anyone be led by you?", I realized that I have another quality to bring to the table: vulnerability.  I noticed at a very early age that if I wanted people to open up to me, it was easier if I opened up to them first.  I have no problem openly admitting to my own limitations and weaknesses and have found that doing so not only helps me to work on them, but also helps people to feel more comfortable around me.  It helps to build trust.  I want those who work with me to feel understood and appreciated, I do not want them to be too nervous to tell me if they need help, more time or even a bit of a break.  Of course, I will have to be conscious of not becoming a pushover. 

Overall, I think that this style will help to make me an effective leader in the field of public health by being inclusive and empowering but also by providing structure and direction to ensure that goals are accomplished without the confusion of having too many cooks in the kitchen.

One thing that I know I should work on is confidence in my own capabilities, believing that I have it in me to inspire people to do their best work individually, but also to guide them to collaborate successfully.  I should also learn to trust my intuition, which Goffee and Jones mentioned was another shared characteristic among great leaders.  About a year ago at the end of a year's research contract, a supervisor re-wrote my work without even looking at it and my confidence was quite shaken.  I knew that it should not have been, everyone has their own preferred writing style and researchers can be quite pedantic about it.  Still, it took a lot for me to summon up the courage to write again in the following months for my new job, despite the encouragement and praise that I received from my new supervisor.  Hopefully as I gain experience in the public health sector my self-confidence will grow and I will have more faith in myself to steer the course of projects, research or otherwise.


Monday, March 24, 2014

Week 1: Health as a Human Right

After only two classes, my perceptions of health and development have already started to evolve and this post is just a personal reflection of my views on access to healthcare.  While discussing the various definitions of health, one of the concepts that was brought up was health as a human right.  I am a Canadian and though there is not much that we are willing to boast about openly, we do have a few things that bolster national pride.  Among them are hockey, maple syrup and our universal health care system.  Our system is far from perfect in many ways with long wait lists and an ever-growing need for more medical practionners, nurses and other health professionals.  However, it does give all of our residents equal access to primary health care services, emergency and specialists (outside of elective procedures), regardless of income.  Patients are first treated based on urgency and then in order of arrival/registration.  The overwhelming majority of Canadians strongly support the system, myself included.  In truth, there has never been any question in my mind that health is a human right.

It was always difficult for me to understand why a society or government would choose to have a private system or a joined public and private system.   Why divide up resources (health professionals, equipment, etc) in that fashion instead of based on need?  The only answer that I kept arriving at was that privatization could increase efficiency to optimize revenue and create competition between providers that may (and I emphasize may) benefit consumers.  But, I often felt that those systems were put in place at the demand of those in the higher echelons of society who want to be able to use their wealth to pay for superior care without the wait.  It was not until attending the first health and development class this semester that I was introduced to another reason for privately funded health care.  On a per individual basis, those who are wealthy and gainfully employed generally bring more money into a society through increased spending, higher taxes, investment and the work that they do.  Therefore, prioritizing the health of these individuals so they can continue to bring more wealth into their society and further fuel its economy could ultimately be considered as a more profitable use of health services.   

My personal preference for publicly funded systems instead of private ones will probably never change as I believe the true worth of an individual and therefore the value of keeping them healthy cannot be measured solely in output dollars.  Those in lower socioeconomic groups are already at a disadvantage when it comes to keeping in good health (due to the cost of gym memberships and healthy food, etc) and therefore are actually in greater need of support through health services.  I simply do not agree that society benefits more from keeping the wealthy healthy, everyone should have the opportunity to live their lives to the fullest and realize their goals.  However, I do feel that I have a more comprehensive understanding of the potential incentives behind privately funded health systems.  I have also come to realize through the class discussion that I will have to be careful of my own bias towards entirely publicly funded systems when working abroad as every country and society has different values.


Sunday, March 23, 2014

Week 1: The Washing Machine Dividends

Time for post number two...

The following is a video of Hans Rosling giving a talk about the divisions between the socioeconomic groups in the world and how industrialization and access to so many amenities have made life easier for those in the developed world.  It is entitled: "Hans Rosling and the Magic Washing Machine".

Okay, so the washing machine is obviously a wonderful piece of technology that can and has already transformed lives.  Anyone who has experienced life without one, had theirs break or run out of money at the laundromat and had to do a load of washing by hand can attest to that.  But what is Hans Rosling really trying to say?  What does the washing machine represent and how does it relate back to public health? 

Rosling utilizes wood fire, light bulb, washing machine and airplane as symbols to compare the lifestyles of people living in the different economic echelons of the world (generally between countries but also within) by highlighting what type of resources they have at their disposal.

In short, the wealthier populations have access to more technology and amenities like washing machines, which make their lives easier and save them time so that they can focus on other activities.  Those without however, toil arduously just to get through daily tasks and have little time to devote to things like education, teaching their children, fun and recreational activities, working to make money, etc.  This relates to public health through a number of ways, one of which is education.  Education is associated with higher standards of living through greater employment opportunities, better access to health and family planning services (resulting in more manageable family sizes) and increased knowledge of health and safety.  In fact, maternal education has been identified as the most influential factor impacting child survival.  Amenities also relate to health in a more direct fashion through easy access to clean and safe water in the house instead of having to spend time fetching the water and boiling it over a fire.  In addition to being time consuming, boiling water comes with its own set of risks, including an increased number of burns in the household, smoke inhalation if there is not good ventilation and the risk of musculoskeletal injuries from carrying the water over long distances.

As the old adage goes "time is money", but money can also buy time, time that can be spent doing other things.  The washing machine had an enormous impact on Rosling's mother's everyday life and as a result, his own as well.  It enabled his mother to spend more time teaching her children and to further her own education.  She was able to take her children to the library where they could develop a love of reading, which likely set Rosling on the path to higher education, eventually leading him to the successful life he has now.  The washing machine triggered the beginning of a virtuous cycle for his family from which future generations will likely continue to benefit.
Now I have to say that we do have a washing machine, so I can hardly imagine what it would be like to only ever wash garments by hand.  However, I can relate in some respects.  Coming from a low income family, I had to work all the way through my university degree in order to afford things like tuition, books and residence.  Towards the end of my degree when I was applying for graduate programs, I wondered how much higher my marks could have been if I had more time to study instead of working.  I realized that the real advantage that my fellow students from wealthy families had was an abundance of time and energy to spend reading, exercising, volunteering and enjoying themselves.  That extra time could certainly have been translated into higher marks, thereby giving them an advantage in the graduate program selection process over myself.  Essentially, the rich have a greater chance of staying rich and even accruing more wealth, while those with less must work even harder to try and get further ahead, to overcome those socioeconomic divides.

The video also discusses the environmental impacts and costs of making life easier for more people around the world by increasing access to technology and electronics based on current energy use figures.  By projecting the development of population, Rosling highlights the need for greener and more efficient energy use to curb climate change, which would certainly impact health (as it has already started to do so).  Finally, he exposes a double standard that is often present when it comes to the green movement and developmentEnvironmental activists are often opposed to the spread of mass energy and fuel consumption in the developing world because they are concerned with how the planet will be affected.  Yet the amount of energy individuals and even families in the third world use compared to the west is truly negligible.  

We in the developed world had the opportunity to expand our industries without restrictions and we have been reaping the socioeconomic benefits for quite some time despite the damage it has caused to the environment.  If we won't stop consuming the way that we do, why shouldn't low and middle income countries have the same opportunities that we had to grow their economies and infrastructure?  It is incredibly hypocritical to place restrictions that prevent disadvantaged societies from enjoying the benefits of having washing machines when wealthier populations with far more leisurely lifestyles refuse to cease using their vast numbers of machines.

I like consider myself to be an environmentally conscious individual (I do not drive, I ride my bicycle or take public transit, use reusable grocery bags and coffee cups, etc), but I have to admit that there are days when I would do anything to have a dishwasher.

(Our little 30 x 35 cm sink)

The dishes can pile up very quickly in our tiny kitchen sink and during the semester when I am busy with so many other things, the truth is that I would much rather spend those twenty or thirty minutes a day reading or even relaxing instead of washing plates.  With that in mind, I can hardly imagine how much more difficult it would be to do everything that I need to do without my washing machine.


Wednesday, March 19, 2014

Week 1: Defining Health and Development

Welcome to my first health and development blog post.  I've heard that the beginning is a very good place to start and that's exactly where our course led off, with one our first activities consisting of defining "health" and "development" as individual concepts.  They both have several potential definitions, depending on the context.  My own personal perspectives are heavily influenced by my past experiences and education, starting with health.

Throughout my undergraduate degree courses, health was described as having seven dimensions: physical, emotional, spiritual, occupational, economic, psychological and social (or cultural) wellness, all of which contribute to an overall state of wellbeing.  Having spent over a year as a climate change researcher, I have since added environmental health to the mix.  It was also explained to us that health did not simply refer to the lack of illness or condition, but actual wellness in all respects.  Those two notions of health have stayed with me and shaped the way that I think of health. 

(Modified from the "Seven Dimensions of Wellness" from North Dakota State University

Compared to the formal definitions outlined in class, mine is closest to that which has been put forth by the World Health Organization (WHO): “health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmary. A resource for everyday life, not the object of living. Emphasizes social and personal resources as well as physical capabilities – health is a complex outcome”.

Development on the other hand, was not something that we touched on even remotely in my first four years of university.  As a result, my definition has arisen solely from the education I've received during my masters here at the University of Queensland and how that knowledge has made me look at my own experiences and the world around me.  To begin with, I define development as a change or evolution from one state of being to another.  In the context of countries, I see it as encompassing a number of factors including infrastructure, economic stability, growth and GDP, security, the distribution of wealth, standard of living, freedom, respect for human rights, social security and all that those entail.

This definition is likely closest to development as a “multi-dimensional process involving reorganization and reorientation of entire economic AND social system”.

So what do my opinions on health and development say about me?  Hopefully they speak to a broad understanding of these terms far beyond the narrow labels of "sick" or "not sick" and "developed" or "not developed".   I've lived, been ill and gone to school/worked in four very different countries, three of them developed (Canada, Italy and Australia) and one not (Uganda).  Comparing those experiences has helped me to recognize that health and development are just general concepts that are actually made up of many smaller factors, most of which we don't notice until circumstances change.  For example, I don't often think about how nice it is to breathe in and out through my nose until I get a head cold.  Then suddenly accomplishing even the easiest of tasks become more difficult, all because of that one small problem.

Health and development are also very subjective states.  For instance, someone with a particular condition may feel well despite being viewed as unwell by others and society (and vice versa).  In a similar respect, low income countries are often at comparatively different stages of development.  So at which point is a country considered developed?  What does it mean to be truly healthy?  How are these things measured and who decides at what point the scale tips?  Those designations are largely given out by bodies such as the United Nations, the World Health Organization (WHO) and the World Bank.  But, in many ways, health and development are in the eyes of the beholder.

As if health and development weren't complex enough on their own, they also have a very complicated interdependent relationship.  I'm truly looking forward to delving deeper into these issues throughout the course of this semester and documenting what I learn in these posts.