| Thanks so much, Pierre, for the generous introduction. When you first asked me to speak on this occasion, I jumped at the opportunity to address this Tulane audience on this special graduation day. I was particularly honored to be celebrating such an accomplished group of students and their families. Moreover, having been in the field of public health for nearly four decades, I took the occasion to learn even more about Tulane University in general and the School of Public Health and Tropical Medicine in particular. Yesterday’s whirlwind tour with Pierre provided a unique insight at the current status of your school and its pioneering role in global health. We are in a golden era where global health has become a burgeoning field. One of my epidemiologic colleagues referred to the situation as an “outbreak of global health on U.S. campuses.” At last count, at least half of the 130 American medical schools have formed unique units to address the need for and interest in global health. We do indeed have an epidemic of global health opportunities. Why is global health so popular today? Three reasons: - Number 1, the tools continue to multiply. We already take measles, polio, and hepatitis B vaccine for granted. The recent human papilloma virus vaccine can change the history of cervical cancer. We also have an increasing number of medicines that are sufficiently safe to be distributed by rural community workers. And we now know that these advances represent only the beginning of more sophisticated prevention, treatment, and diagnosis tools.
- Number 2, the resources. The explosion of funds directed to global health allows us to apply these tools to vulnerable populations. Even in today’s tough economic times, new resources from governments, foundations, corporations, and individuals are flowing into global health. A decade ago, we were grateful for any resources; we measured our budgets in units of millions. Now we demand continually increasing resources; our budgets are measured in tens of billions.
- Number 3, the interest. Global health used to engender so little interest that everyone in the field knew each other. But times have changed. More and more students are interested in global health careers. For example, student membership in the Global Health Council increased 60% in just the last year. Leading researchers are turning to the health problems of low income countries. Universities are expanding their global capacity. Movie stars, rock idols and high visibility politicians provide further publicity to the field. The golden years have begun.
As you may know, Tulane is a farm system for my organization, Family Health International. However, as hardly any of you know, we have an “FHI Office” (of one) here in New Orleans, married to a faculty member. To prepare for this talk, I canvassed my FHI Tulane colleagues about their student experience. Their comments were both glowing and genuine. They loved the Tulane network. When I asked them what to convey to you, these statements from three different Tulane alumni capture their emotion: - “The people sitting here, graduating with you, before you and after you, are your greatest strength. They will help guide you, support you, motivate you and they are your team. While you are going off today on your own, carving your path in your career, remember that you are connected by what brought you here in the first place.”
- “My best piece of advice – it was an advantage to go to Tulane, and it is important to keep the network. Connections and relationships are everything. Nurture them.”
- “(You) guys are graduating with some amazing people, like many who have gone before (you). The Tulane network runs wide, high and even deep into the jungles of Africa. (In my work at FHI, I met) a Congolese medical doctor with a doctorate in tropical medicine from Tulane. She could have gotten so many cushy jobs, but she decided to return to her country to help her fellow countrymen and women…. She has so little to work in terms of government stability, infrastructure like running water, and access to knowledge or resources, but she perseveres. She is truly an inspiration to me.”
Every responder had something similar to say about Tulane. No wonder I consider it such a privilege to be part of this celebration. Today’s talk will have three parts. - First, to set the scene, I’ll provide a little personal background on how I got to be here with you today….to include a bit about Family Health International;
- Second, I’ll provide several additional hints from your Tulane-alumni colleagues at FHI on what they wish they’d heard from their commencement speaker; and
- Finally, I’ll add a few extra words on what a possible vision for the future may look like – the world Pierre and I envision two decades from now.
A Personal Odyssey to Public Health As you can tell from my accent, I am not a native Southerner although I married one! I was raised in the New York City area, and my formal educational years were spent largely at Yale in New Haven, Connecticut during the decade of the 60s – save for two years in Cambridge, England separating undergraduate and medical school. The timing of these two years changed the course of my life. The British system of education is far different than what American undergraduates experience. No intervening tests, lots of discussions. I portray my different American and British educational experiences by confessing “in America I had so much work to do I did not have time to think, while in England, I had so much thinking to do I did not have time to work.” This contemplative lifestyle led to a personal transformation where I evolved from being a libertarian individualist to a more socially concerned, population-level thinker. I also decided to go into medicine, based on a wonderful experience I had with the British National Health System after being knocked unconscious playing intramural rugby. This was my first of 3 experiences with the serendipities of life. Now let’s fast forward how I got into my scientific discipline – sexual health. Just like my choice of medicine, it was largely chance, a testimony to the ways in which life’s unplanned vicissitudes can have a happy ending. In 1974, after my clinical training in internal medicine, I joined CDC in hopes of both furthering a career in preventive medicine and learning its basic science of epidemiology. I listed a variety of positions, any of which I thought would allow optimal development of my epidemiologic skills. At the time, most of us went into infectious disease slots. However, when the match was announced, I had been assigned to the newly-formed Abortion Surveillance Branch in the Family Planning Evaluation Division. Though somewhat surprised – since I could not distinguish a curette from a toaster – nonetheless, this act of fate provided an amazing career opportunity. At the time, the Roe v. Wade Supreme Court decision had just been announced, and the public health impact of legalizing abortion was becoming recognized. During the 1970s, our CDC data helped establish the safety of legal abortion. However, our scientific inferences did not sit well with those opposed to allowing American women this choice. With the change of political administrations in 1980, from Jimmy Carter to Ronald Reagan, so came still another career “opportunity”. In the fall of 1981, the Director of CDC called me into his office. He had been told I needed to change jobs. The new Task Force for Kaposi Sarcoma/Opportunistic Infections was seeking epidemiologic help in its fledging months. KS/OI became AIDS, and the rest is history as they say. HIV/AIDS became the global health issue of our lifetime. So three acts of fate – a concussion, a job match, and an election – none of my own choosing – directed my career into the field of sexual health, with its components of medicine, reproductive health, and sexually transmitted infections. Over the next decade, the virus infected nearly a million Americans. The increasing availability of the test for HIV allowed persons to know their infection status, and increasing new antiretroviral therapies provided hope for those who are infected that their fatal prognosis would be improved. However, during this interval, HIV ramped up its international pace even faster. The generalized HIV destruction in Africa became recognized, a concentrated HIV fortress in Asia was built, and the merging HIV foothold in Eastern Europe was established. By the mid-1990s, it became time for me to venture outside of the confines of Atlanta’s Interstate 285. I moved to Family Health International, located in North Carolina’s Triangle region. FHI allowed a merging of my career fields at CDC, and also provided a wonderful chance to become involved at the global level with both the reproductive health and the HIV agendas. FHI’s organizational history matched my own – it began in the 1970s as a reproductive health center – to investigate contraceptive safety. During the 1980s, FHI evolved into providing global HIV prevention services. During the last 15 years, it has grown remarkably in its sources of funding, its number of staff, and its research-to-practice services. When I first got to FHI in 1994, we had 350 staff in North Carolina, 150 in Washington, DC, and 50 in our 13 country offices – a total of about 550 persons. Today, in 2009, we have over 2400 staff, with 400 in North Carolina and 100 in DC, but nearly 2000 in our 35 country offices. All – repeat all – of the growth during the 15 years since I arrived at FHI has been in our field offices. So the explosion of global health in American universities became a palpable reality in my own organization. Pearls From Your Tulane Alumni Enough about personal history, what else did your fellow Tulane alumni tell me they wish they had heard at the time of their commencement? I received advice from 22 colleagues and collapsed their responses into seven unifying themes. Many of these are self evident, even platitudinous, but we all need regular reminders of life’s simple lessons. - Find your professional passion – If you do nothing else, you should find something in public health about which you hold a personal passion, since this topic will drive your days and many of your nights. Whatever the field of public health – environmental health, behavioral health, sexual health, public health evaluation, whatever – make sure you follow your heart. I frequently tell people that I am so excited about what I do that I cannot drive fast enough to get to work in the morning. One of your colleagues put it this way - “Do what you love, happiness is priceless.”
- Be a team player – Public health, and especially global health, is not made for prima donnas. The “global village” metaphor says it all. Much of what goes on in the “village” environments today is multidisciplinary. As such, look for ways to be part of highly effective groups. Emphasize team results more than individual rewards. Public health is by definition public – namely a community-oriented, population-level discipline.
- Build on your strengths, rather than trying to overcome weaknesses – My favorite book on management is entitled, “First Break All the Rules”, largely because its evidence-based conclusions support my intuitive management experience. The book presents 25 years of data from in-depth studies of successful managers across a wide variety of situations. One common trait predominated: the most outstanding managers did not hesitate to break virtually every rule held sacred by conventional managerial wisdom. For example, they selected employees for talent rather than for skills and experience – what I call “the best protoplasm.” They then set clear expectations for these talented employees by defining the outcomes they wanted to achieve rather than the processes by which to achieve them. Then, they built on each person’s unique strengths, rather than trying to fix any underlying weaknesses. Finally, they based career staff development on a mentoring approach, more typical of universities like Tulane than commercial businesses. So focus on your strengths.
- Be collaborative rather than competitive – In public health, as in other parts of life, partnerships are essential to optimize both personal and organizational goals. Within partnerships, trust begets trust. Everything you do presents an opportunity to build on this foundation. Another of my favorite books, “Forces for Good,” describes characteristics of the most effective nonprofit organizations. The data showed the best leaders are those that don’t just build organizations – they build movements. They are obsessed with advancing their cause, rather than their company. The best nonprofits find points of leverage outside their organization to achieve their mission. In my career I have found that sharing pre-publication scientific ideas and data leads to increased collaboration with my peers. Our overall pursuit of knowledge is advanced. Placing ideas in a scientific commons allows them to be molded through iterative exchange well before they appear in print. So in the long run, collaboration, transparency, and sharing generate a much stronger public health and scientific product than competition and secrecy.
- Stay positive – Think about how great it is to be around positive people. They don’t spend a lot of time criticizing others. They bring energy to the workplace. A psychologist at UNC, Barbara Fredrickson, has demonstrated that when people are feeling positive emotions, they work better. She found the really successful, high performing teams have about a six-to-one ratio of positive to negative statements. Conversely, low performing teams had ratios of less than one-to-one, meaning that more than half of what was said was negative. So start now counting your positive statements…make sure they dominate the negatives by at least 6:1.
- Be flexible – As one of your Tulane alumni stated, “The path that you will take after graduation is nothing like what you envision now. You have to learn lessons that no one can teach you.” Another described studying M&E at Tulane, but ultimately being hired by FHI to conduct clinical studies. She now trains colleagues in operational aspects of clinical research. Finally, my own unique personal odyssey shows the role of serendipity in crafting the key elements of one’s career. So still another FHI-Tulane colleague says “Bend like bamboo. People who succeed are typically both strong and flexible.” Special words of wisdom.
- Stay on message – Graduating today with a degree in public health is a great first (or for some, second) step. However, you’re in public health for the long haul. Perseverance and staying on message – and on your life’s passions – will be rewarded. No one is a better advertisement for this than our current President, who achieved his success by staying “on message” in the midst of the hourly crises. My current message is that “contraception is the best kept secret in HIV prevention.” Every presentation I give – including this one – I emphasize how more infants are spared HIV infection by HIV-infected women who do not currently wish to become pregnant using effective contraception to prevent unintended pregnancies, than by antiretrovirals for pregnant HIV-infected women at the time of delivery. We need both approaches – contraception and antiretrovirals - to prevent the most maternal-to-child transmission. OK, for now, I have delivered my “signature” message.
Vision For The Future Armed with these collective insights, let’s fantasize about the future of global health? As with most social movements, a long incubation period usually precedes sudden change: e.g. the ending of slavery, the vote for women, or the election of an African-American President. So it is with the field of global health. As Bill Foege reminds us, two decades from now the disparities in health between high and low income countries will be narrowed substantially. In the next 20 years, the technological pace of change will accelerate well beyond what we now think is remotely possible. Children will get 20 routine vaccinations regardless of where in the world they are born. Those living in African villages will have their iris read by a handheld computer and their immunization record will come up on screen no matter how many clinics have given them vaccines in the past. The vaccines they need right now will be highlighted on the screen. The same handheld computer will read the vaccine vial, and instantaneously their electronic medical record will be updated by the wireless system covering all of Africa. Star Trek here we come! The majority of women everywhere will know the full range of life’s options available to them. Most will have the power to make important decisions in their lives – social, sexual, economic – even if born in a rural village. They will have wide access to protection against a number of diseases, as well as against unintended pregnancy. And for their planned pregnancies, they will have access to safer deliveries. These women of the future will describe to their daughters a past world that existed only two decades earlier, way back in 2009. Those mothers will tell stories about the people who changed their lives – those who motivated, who sacrificed, who cared, who inspired. Most of the pioneers will be women, but a few good men will have also contributed, among them your Dean, Pierre Buekens. So in conclusion, many congratulations. You’re graduating today at the most exciting time in global health with a wealth of opportunities available to you. The field has achieved a critical mass. As your Tulane colleagues have suggested….find your passion, join a winning team, build on your strengths, be collaborative, stay positive, be flexible, and never give up. Thank you again for allowing me to share these exciting times with you. Read the 2008 Commencement Speech by Ian Rawson |
