Your Future In Public Health: What You Need to Know and What You Don’t

Richard Skolnik, BA Yale College 1972, is a Lecturer at the Yale School of Public Health who has been deeply involved in health and development work for almost 40 years. From 1976-2001, he worked at the World Bank where his focus was on health systems development, family planning and reproductive health, child health, the control of communicable diseases, and nutrition in low-income countries. He has served on advisory groups for organizations such as the WHO, the Harvard Humanitarian Initiative, the Global Health Leadership Institute at Yale University, and the Global Fund. Skolnik has peer reviewed numerous books, reports, and articles on global health issues and is the author of the undergraduate textbook on Global Health, Global Health 101.

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Students regularly come to me asking what they need to know to work in Global Health. They also frequently ask what I wish I had known when I was their age (which was almost too long ago to remember, of course)! At the invitation of the editors, let me offer some comments below on “what I would want to know (and not know) if I were you.” Hopefully, this will help answer at least some of the questions that are on students’ minds, as they think about pursuing Global Health.

Let me start by saying that most of you should stop trying to plan every minute of your life and stop believing that you lack worth if you are not sure exactly what you want to do professionally. As my friend Robert Hecht, of the Results for Development Institute, says so well, most of what we worked on professionally in our long careers in Global Health did not exist when we were at Yale. There was no AIDS. There was no cry for Universal Health Coverage. There was no GAVI Alliance, Global Fund, or Global Program for the Eradication of Polio. Thus, it is important to have a strong understanding of Global Health issues, the kinds of problems that might arise in the future, and the questions one needs to raise to help understand them. However, it is not possible to “know all the answers now.”

A similar point holds true in terms of your knowledge of both health and development. Some of you may wish to specialize in particular topics and on particular regions of the world. However, your career will be best served if you get a broad understanding now of critical issues in health and development, as they play out across a range of countries, and couple that with the beginning of technical specialization. First, this will allow you to put your specialized interests in context. Second, it will help ensure you are learning the lessons of experience from different places and are able to apply them in a range of settings. Third, it will prepare you to work on different parts of the world as needs change. I “lived and died” for Southeast Asia when I was at Yale and the needs there were vast at the time. Yet, I worked largely on Africa and South Asia at the World Bank, at a time when much of Southeast Asia saw very rapid economic growth and a widespread reduction of poverty.

I cannot stress enough how important it is for you to find “role models” as you develop a better sense of what you might wish to do professionally. When I came to Yale, I wanted to be a physician. Then, after spending a year in the Philippines on the Experimental Five-Year BA, I decided I should work in the new field of “development” instead, with a focus on health and education. Yet, I had no idea what people did in this field, who the key players were, or how they got where they were professionally. I might have heard of the US Centers for Disease Control and Prevention (CDC) and smallpox, but I certainly knew nothing of the great and more silent heroes of Global Health and development. You can learn an enormous amount from looking for such people, learning about their lives, and seeing if you can attach yourselves to them or their work.

In fact, I cannot stress enough the importance of mentors. I realized a little too late in my career how exceptionally important it is to have people from whom one can learn. A huge share of my personal and professional growth is the result of having had a number of exceptional mentors. Those who know me will be amused (but not surprised!) that I was told not to speak while on field visits in my first year at the World Bank. So, I listened carefully that year both to the masterful diplomatic French of my mentors and the well thought out content in their words. From other mentors I learned to speak slowly and take breaths between my words; ensure that ethical issues were paramount in all of our work, even in environments where they were not so explicitly mentioned; to think and act more strategically; and, to understand the emergence of HIV, just as it began. Among many other things, I also learned the centrality of nutrition to all matters health and development. I also learned much about how to manage and motivate people and work diplomatically but rigorously with a wide array of country partners. In the courses you take, the internships you undertake, the summer employment you get, and in your long-run career, you want to identify people from whom you can learn and then learn all you can from them.

You should also understand that if you want to work in Global Health, with a focus on the poor in poor countries, then you must spend time living and working in low-and middle countries. Unfortunately, this is an area to which Yale students need to pay much more attention. A summer is NOT the same as living in a country for a year or two. Nor are two summers. The best understanding of health and development issues comes from extended periods of time in countries, living as close to local families, as possible. I was fortunate that Yale had both a five-year program in my day and that I could also participate in the Yale-China program when I graduated. I would encourage many more Yale students to take a semester or longer abroad and to do so in places where one can get first-hand experience with health and development problems among the poor. Perhaps Yale can refine its fellowship programs a bit to facilitate and encourage more students to do this. Many students also fail to realize that spending a semester studying in Senegal, or doing a project there on community-based insurance for the poor can actually enhance medical school applications, rather than doom them.

As always, there is much more I can say. However, these are the few points with which I would begin to offer some thoughts on what I wished I had known when I was in college and what I would want YOU to know, and not know, as you consider a career in Global Health.