Global News Round Up

Politics & Policies

William “Bill” Steiger, a global health official under former President George W. Bush who crossed swords with many scientists, is now advising President Donald Trump.

After the Trump’s administration submitted a budget to cut foreign aid, the world’s wealthiest man and co-founder of Microsoft Bill Gates met with President Donald Trump to discuss progress in programs for global health and development as well as domestic education.

In President Trump’s proposed budget, there’s a $54 billion bump in military spending. U.S. foreign aid would be cut by 28 percent. Global health spending beyond AIDS, malaria and vaccines will suffer.

The American Society of Clinical Oncology (ASCO) today issued a clinical practice guideline on human papillomavirus (HPV) vaccination for the prevention of cervical cancer. This is the first guideline in primary prevention of cervical cancer that is tailored to multiple regions of the world with different levels of socio-economic and structural resource settings, offering evidence-based guidance to healthcare providers worldwide.

Programs, Grants & Awards

March 21 was World Down Syndrome Day.  The need to receive proper education, to get a job, to live with independence, to catch up with friends, to play sport, to fully exercise our rights as equal citizens are important aspects of life for each of us and needs that no one would dream of defining as “special”. Yet for people with Down syndrome, the label of “special needs” is often used to describe them and their needs.

The Golisano Foundation and Special Olympics, the largest public health organization for people with intellectual disabilities (ID), honored the Beijing Tongren Eye Hospital, Capital Medical University in Beijing, China for coordinating medical professionals throughout China and ensuring sustainable eye health and treatment access are available to Special Olympics athletes.

Research

Assess the prevalance of metabolic syndrome (MetS) among patients in rural Lesotho who are taking first-line anti-retroviral therapy (ART) containing either zidovudine or tenofovir disoproxil.

In this analysis, we examine the effect of wages on obesity by constructing pseudo-panels to conduct a dynamic estimation of Grossman’s human capital model. The results indicate that wages have an increasing effect on obesity status.

To examine county-level geographic variation in treatment admissions among opioid treatment programs (OTPs) that accept Medicaid in the continental United States.

We analyze the evolution of mortality-based health indicators in 27 European countries before and after the start of the Great Recession. We find that in the countries where the crisis has been particularly severe, mortality reductions in 2007–2010 were considerably bigger than in 2004–2007.

Over the next 20 years, there will be 49 million new cases of HIV, a mathematical model has indicated.  This number, however, could be drastically reduced if current interventions are acted upon and a vaccine is introduced in the next four years.

Diseases & Disasters

A small but growing number of pain doctors and addiction specialists are overseeing the use of marijuana as a substitute for more potent and dangerous drugs. Dr. Mark Wallace, chairman of the division of pain medicine in the department of anesthesia at the University of California, San Diego, said over the last five years he has used marijuana to help several hundred patients transition off opiates.

People who wake at night with an urge to go to the bathroom may need to cut back on salt in their diets, doctors from Japan are suggesting.

Technology

The National University of Singapore (NUS) and Holmusk, a digital health and data analytics company, signed a Memorandum of Understanding (MOU) recently to explore collaborations for improving healthcare delivery in the region.

A new diagnostic tool to test for up to 7 micronutrients using a single serum sample has been developed by Quansys in collaboration with PATH. This multiplex tool can help gather national data on micronutrient status and use these data to implement appropriate interventions.

Environmental Health

Hydraulic fracturing, more commonly known as fracking, has the potential to affect drinking water resources in the U.S., the Environmental Protection Agency announced in December.

Equity & Disparities

Health and health care disparities, which are differences between groups in their health status and their ability to obtain care, remain a persistent issue in the United States. This brief describes health and healthcare disparities today, highlights recent advancements in reducing disparities under the Affordable Care Act (ACA), and discusses how the American Health Care Act (AHCA) and proposed reductions in discretionary funding may affect ongoing efforts to address disparities.

Niger’s population is set to double in about 17 years and high birth rates have contributed to this population growth. Already 80% of Nigeriens live in poverty and there is growing concern that such population expansions could lead to famines, political instability and violence in this landlocked nation.

The UN has warned that due to climate change about one in four children will be living in areas with extremely limited water resources by 2040.

Hundreds of thousands of people in India could be left without essential government services and benefits – including free school meals and uniforms, food subsidies and pensions – under new rules that make access to more than three dozen state-funded schemes conditional on showing identification.

Maternal, Neonatal & Children’s Health

China has achieved a substantial reduction in maternal mortality over the past three decades, from 88.8 deaths per 100 000 live births in 1990 to 21.7 deaths per 100 000 live births in 2014, down by 75.6%. The Article by Yanqiu Gao and colleagues in The Lancet Global Health is a valuable and welcome opportunity to present progress and discuss how maternal health can be improved in developing countries.

An UNFPA representative has urged Nigeria to invest more in maternal health since it has the potential to save Nigeria nearly $1.5 billion annually.

What happens when both mothers and newborns weigh significantly more than they did just several decades ago? The question occupies one of the most active areas of obesity research.

Future of Conflict Minerals murky under Trump administration

You’ve likely heard the term “blood diamonds.”  Also known as “conflict diamonds,” these precious stones have helped fund civil wars and contributed to some 3.7 million deaths in Angola, Sierra Leone, and the Democratic Republic of Congo (DRC) according to an Amnesty International report.

The term “conflict minerals” doesn’t have quite the same ring, nor a titular film starring Leonardo DiCaprio, but they are at the center of a recently leaked memo from the White House.  The memo seeks to dismantle the Conflict Minerals Rule in the 2010 Dodd-Frank Wall Street Reform and Protection Act.  Under Dodd-Frank, companies had to disclose whether or not their products contain minerals mined in the Democratic Republic of Congo or a neighboring country.  The reason to withdraw this clause that valued human life over electronics?  Perceived job loss and costs to American companies, estimated at $3-4 billion in upfront compliance costs and $200 million annually thereafter.

What is life like for the miners of conflict minerals – tin, tantalum, tungsten, and gold ore – in the Democratic Republic of Congo and neighboring countries?  The Guardian reports a systematic web of sexual violence, kidnapping, child labor, and modern-day slavery.

An overwhelming abundance of human suffering all so we can play Bejeweled on an almost dizzying array of devices.  Tech giants, Apple and Intel, have spoken out against the repeal of the Conflict Minerals Rule, but fear that enforcement will be difficult without written law.  Human rights groups representing some 100 organizations in and around DRC have also spoken out against repeal of the Rule:

Thanks to the Dodd-Frank Act, Eastern DRC has to date more than 220 certified green mining sites, more than 300 mining police officers trained and deployed to secure mining sites,an independent audit mechanism, and a regional certification system. These advances undoubtedly contribute to reducing the rate of crime and human rights violations, including rape of women and exploitation of children in mining areas. All these efforts and progress will be destroyed if the US Government decides to contradict itself by repealing the Dodd-Frank Act.

It isn’t just Big Business that has taken a hit under the Conflict Minerals Rule.  A healthy dose of criticism cites that the Rule has actually made miners and their families in DRC poorer.  In many ways, the implementation of the Rule slowed down, or stopped, mining due to implementation issues of the government and business variety.  Millions, out of work, were left between the proverbial rock and the hard place: either face starvation or join the militias that the very Rule were designed to protect them against.  Closing of mines is felt throughout communities:

With less money flowing in, shops in Luntukulu have closed. Many people struggle to feed their families through farming. “If Obama’s law wasn’t signed, the ban would not have existed,” said Waso Mutiki, 41, president of the miners’ co-operative in Luntukulu. “It destroyed everything.

Others who contest the Rule say that the it does not acknowledge or alleviate deeply systemic issues afflicting the region, such as in this open letter signed by academics, politicians, and civil society professionals:

First, while the minerals help perpetuate the conflict, they are not its cause. National and regional political struggles over power and influence as well as issues such as access to land and questions of citizenship and identity are just some of the more structural drivers of conflict. The ability to exploit and profit from minerals is often a means to finance military operations to address these issues, rather than an end in itself.

The authors of the open letter above offer some alternative strategies which seek to buoy the economy by incentivising better practice and fair competition for international and Congolese businesses. Dollar for dollar, the Democratic Republic of the Congo is one of the richest countries in the world when it comes to untapped mineral resources.  The people who seek to own that wealth and exploit its potential are many, and unfortunately, Congolese citizens and their communities are not among those to first reap those benefits.

So, what is the bottom line?   Some might say the Conflict Minerals Rule sees the forest but not the trees, doing significant damage to local economies and livelihoods despite the progress made by eliminating a driver of local conflict.  It serves as yet another example of the need for policies to be developed and refined with community feedback. A globally engaged U.S. administration might attempt to build on the successes of the Rule with foreign and trade policy that takes such feedback into account. But the current administration seems to have different priorities. Rather than approaching policymaking in a way that benefits the communities most heavily impacted, or even that takes into account the expectations of American consumers, President Trump fights for the common man…the average, American CEO:

Government and community collaboration are key in achieving meaningful reform. Whether or not the U.S. Administration will take part in that exchange remains to be seen.

Call for Papers: AJPH Special Edition on Climate Change and Health

This announcement is posted on behalf of Rose Schneider, the IH Section’s Climate Change and Health Working Group Chair.


The American Journal of Public Health (AJPH) intends to publish a supplement issue on the topic of Climate Change and Health: Research, Translation, Policy, and Practice. Climate change is widely considered the greatest challenge to the public’s health. This issue will showcase scientific research that evaluates the degree to which climate change is a present-day and future threat to population health and health equity and highlight emerging and innovative evidence, strategies, solutions, and policies to address the health and equity consequences of climate change. Original research articles, briefs, systematic reviews, commentaries, editorials, as well as analytic, photographic, and historic essays on the health and equity impacts of climate change are invited. Papers that highlight translational practices as well as evaluation or policies that demonstrate advancement of health and equity are encouraged. Topics of interest include, but are not limited to, best-practice models, co-impacts of climate change and other policies, economic evaluation, climate literacy and communication, and gaps in research, policy, and practice implications related to climate change adaptation, community resilience, and mitigation.

Potential authors should visit the AJPH website (www.ajph.org) to review the Instructions for Authors and specific guidelines for the various types of manuscripts. All manuscripts will undergo standard peer review by the AJPH editors and peer referees as defined by AJPH policy. Manuscripts must be submitted April 1, 2017, via the online submission system at http://editorialmanager.com/ajph.

Global News Round Up

Politics & Policies

UN estimates that five months after Hurricane Matthew made landfall, nearly 280,000 Haitians are highly food insecure. This is largely due to failed policies and failure to provide much-needed support.

The word health resonates across borders and cultures.  That lesson was made clear during a recent trip by Military Health System leaders to three African nations, underscoring the enduring commitment of the MHS to help partners build enhanced capabilities to respond to infectious disease and other public health threats around the world.

Major associations representing physicians, hospitals, insurers and seniors all leveled sharp attacks against the House GOP’s plan to rewrite the Affordable Care Act on Wednesday, as some Republicans publicly questioned whether the measure can clear the House of Representatives.

Republicans in the House of Representatives unveiled their long-awaited draft healthcare bill on Monday night, amid hopes this was the first step on a road to keeping a key election promise.

The administration of U.S. President Donald Trump has issued the first official guidance for implementation of the Mexico City Policy, also known as the “global gag rule.”

Secretary of State Rex Tillerson has agreed in principle to a White House proposal to slash foreign aid and diplomatic spending by 37 percent, but wants to spread it out over three years rather than in one dramatic cut.

China is facing the biggest and deadliest outbreak of H7N9 bird flu in human history.  The virus causes pneumonia and death in most of its victims, which is why it tops the list of global flu pandemic threats.

Programs, Grants & Awards

Thirty percent of all freshwater is ground water.  National Ground Water Awareness Week, an annual observance sponsored by the National Ground Water Association (NGWA), is March 5–11, 2017. This observance highlights how important ground water is to people’s health and the environment.

Research

She was only 21 at the time, but the event helped to inspire the fledgling scientist to crack how the brain is repaired.  The discovery reported today could potentially help millions of people with multiple sclerosis who have the opposite problem, a rogue immune system attacking part of the brain.

A 2016 study found the overall rate for stroke was 8% higher in the two days after daylight saving time. Losing an hour of sleep has also been associated with a higher risk of heart attacks and injuries.

A study published in The Lancet Global Health shows that community resource center model for women and children’s health incurred low-cost in informal settlements and is feasible and potentially replicable. This study was conducted in informal settings in Mumbai, India.

Diseases & Disasters

For the first time, doctors have tied infection with the Zika virus to possible new heart problems in adults. The evidence so far is only in eight people in Venezuela, and is not enough to prove a link. It’s also too soon to know how often this might be happening.

Arthritis costs at least $81 billion in direct medical costs annually.  The most common types are osteoarthritis, rheumatoid arthritis, gout, lupus, and fibromyalgia. It is a leading cause of disability, and causes pain, aching, stiffness and swelling and is not a normal part of aging.

Top infectious disease experts are warning about a rapidly spreading outbreak of deadly yellow fever in Brazil that could hit parts of the United States. The danger would be most acute if the virus starts spreading by the same mosquito that transmits Zika.

A Save the Children study charts an increase in self-harm and suicides among children as young as 12 and reports that Syrian children are suffering from toxic stress that has the potential to cause long-term damage.

Technology

The pharmaceutical companies GlaxoSmithKline and Sanofi sell the most vaccines and earn the most money doing so, while the Serum Institute of India sells the most vaccines at a discount, according to the first Access to Vaccines Index, which was released last week.

Environmental Health

According to two new WHO reports, nearly 1.7 million children under the age of 5 die due to environmental hazards every year.

According to a new study making small changes to our diets can mitigate effects of climate change in addition to impacting the health care system.

Equity & Disparities

Supreme Court of India has called for policies to prevent the epidemic of suicides among Indian farmers rather than providing compensation after the fact.

Maternal, Neonatal & Children’s Health

The pharmaceutical company Cipla cited non-payment of dues by the government and has therefore, stopped manufacturing Lopinavir syrup, life saving drug for children living with HIV/AIDS.

Given the risks posed by shifting global environment to women’s and children’s health, research on why some global health campaigns succeed can help turn this crisis into an opportunity.

Dr. Georges Benjamin responds to APHA members and Section Leaders

Read Dr. Georges Benjamin’s response to our open letter and learn how you can be involved in public health advocacy efforts:

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Five practical career development suggestions to position yourself for the global health profession

This is the final installment of a three-part series the IH Blog will feature this week called Global health career insights: Lessons on the job market, how to crack it, and what to do once you’re in.


Jessica’s post on the results of the Section’s analysis of the global health job market speaks a lot to the harsh realities of the global health field, and development more broadly. Much like her, I did not start out working in global health – in fact, I entered it 10 years after my public health career already started. I worked for free (well, academic credit) to fulfill my (200 hour minimum) MPH practicum requirement (which I did while working basically full-time and continuing to take classes) on a global health project with my current organization, whom I now work for full-time. When I started my practicum, I already had a very robust set of specialized knowledge and like so many other global health professionals of my generation, I was lucky enough to be introduced to my organization through someone in my public health network.

Throughout my public health career, it has been disheartening for me to see how limited the opportunities are for entry-level public health professionals. In the short three years I’ve spent working in global health now, I’ve learned that for many employers, both big and small, it is the nature of our projects and our funding cycles that often prevents us from taking big risks (and this applies beyond just hiring decisions). It’s not that we don’t want to hire entry level folks! Unfortunately, grants and projects are often done in short to very short cycles, which puts employers in the tough position of needing someone who can really hit the ground running – and running really, really hard.

While the field is admittedly tough to crack, it is not impossible. Global health will always need dedicated professionals who will bring their passion, persistence, and innovative thinking to their “dream job,” whether it is managing projects, analyzing data, or filling that elusive technical advisor role. The goal of the global health jobs analysis project isn’t to discourage our Section’s students and aspiring professionals from entering the global health field completely. Rather, it’s meant to provide a roadmap on how to enter the field. With that in mind, here are five practical strategies you can integrate into your career development:

1. Find a way to live abroad and learn another language. This is more essential for some technical areas than others, but it never hurts – and for many employers, it can make your application stand out even if the position you are vying for doesn’t explicitly require it. Experience living overseas in particular demonstrates that you are adaptable to challenging environments and able to work with individuals with different cultural backgrounds. You don’t even necessarily have to be doing global health work. Even teaching English or a working holiday doing manual labor can showcase your resilience as a job candidate.

2. Build a robust set of technical skills. From my perspective, the toughest job search reality for public health generalists trying to enter this field is the shift favoring the hiring of candidates with more technical skill sets. I work in the mHealth sector of development where there is a huge need for talent. However even if the position isn’t that of a computer programmer, these job descriptions often still look for technical knowledge. So regardless of if you have a degree in anthropology or in engineering, employers seeking candidates need someone who has more than just a passion for global health and good communication skills. They need employees with technical know-how and in my field that’s either knowing project management standards, how to write and debug code, develop databases, write technical reports, run statistical analyses, or create data visualizations. Find out what technical skill set is needed for your “dream job” and work on perfecting your craft. This will help your resume stand out from the crowd greatly.

3. Work somewhere else first. A growing number of entry-level jobs in global health are going to people in country, and this isn’t a bad thing. In fact, it’s absolutely essential for country ownership. However, there is still significant need for trained professionals in a wide variety of fields who know how to function in a professional environment and work well with a wide variety of colleagues. Sure some basic soft skills are essential – flexibility, open-mindedness, and a willingness to learn from others can take you far. But many more can be learned on the job. If you really want to make an impact in global health, find a professional vocation you are passionate about, get really good at it, and hone in on your ability to teach and be taught. Whether you’re a nurse, a project manager, an architect, a 5th grade teacher, or a data scientist, there is a need for your know-how somewhere in development.

4. Find alternative ways to work for free that don’t break the bank. I know many of us young professionals are shouldering what feels like a mountain of student loan debt, but if you can find a way to swing this and be practical about it, this is still one of the best ways to get your foot in the door. You don’t have to forego a day job, either. For those of you currently pursuing a Master in Public Health, find an organization that does work in an area you are interested in and ask if you can do a practicum, internship, or fellowship with them. If you’re already out in the workforce, volunteer your professional skill set to global health professional societies (like the IH Section!) or other professional volunteer organizations (like Engineers Without Borders, DataKind, or Teachers without Borders). Even a Google or LinkedIn search of organizations you’re interested in volunteering for should do. If you’re cold contacting an organization, make clear to them what value proposition you can offer and don’t be afraid to be persistent. While it can be a hustle, it is a good way to get experience that will give you a leg up and help you build a professional network. Which leads to…

5. Build a professional network. This advice is true in any field, but it is especially true in development. While requesting email and phone informational interviews can be helpful, getting out and meeting people one-on-one is still the best way to network. Attend relevant lectures at your local university or find a local organization that does (World Affairs and Commonwealth Club offer lectures for those living in my home base in the San Francisco Bay Area) and meet other like-minded folks. You never know who you could be sitting next to. Sign-up for list-servs like Global Health Delivery Online to connect virtually with the global health community. Attend professional society meetings with a global health focus or track like APHA’s Annual Meeting. Talk to the presenters or the person sitting next to you. These meetings are a networking gold mine!

It will take some time for the incoming generation of global health professionals to transform this field. Shifting from short-term funding cycles to long-term ones is only one way to facilitate more attainable entry points into a global health career. Until then, those of us already working in the field must make sure that we invest in aspiring global health professionals, encouraging them to take on leadership roles, and fostering their talents and ambitions through mentorship. Global health and development needs young people and their fresh perspectives in order to keep up with this rapidly changing world.


Now we want to hear from you! Please share your stories and insights on how you crafted your career and positioned yourself to enter the global health field. Get in touch with us at ihsection.communications@gmail.com.

Five sobering job search lessons I learned from analyzing the global health job market

This is the second part of a three-part series the IH Blog will feature this week called Global health career insights: Lessons on the job market, how to crack it, and what to do once you’re in.


One “global health career beginnings” story that has stuck with me over the years was one that was shared at the International Health Careers panel discussion put on by the Section at APHA’s 2011 Annual Meeting. The panelist explained that he got his start in global health because he and his wife were hopeless idealists who wanted to provide health care to the poorest. In true 60s hippie spirit, the two of them climbed into their Volkswagen after he finished medical school and drove from Germany to Morocco by way of the Bosphorus to volunteer their services through an order of nuns who were providing care and support to the locals. “Of course,” he chuckled, “you can’t do that anymore.”

Nearly every career path story I hear from the global health professionals that are now approaching retirement is woven with the same frustrating thread.

You might say I failed at landing my “dream job” in global health. Unlike many well-established and highly experienced global health professionals of the Baby Boomer generation, I have wanted a career in global health since I was earning my MPH back in 2007. However, despite being the child of a first-generation immigration, being fluent in both Portuguese and French, having top-notch grades, and slowly working my way through increasingly advanced public health jobs in the U.S. over the years, dozens (if not hundreds) of applications for positions with global health and international development government agencies, government contractors, and non-profits have gone unanswered. An application to the Peace Corps went nowhere. After a while, I gave up. I taught English in South Korea to gain international work experience and started doing consulting and freelancing instead. That turned out to be a much more fruitful avenue: I have since been able to work with DAWNS Digest and on a climate change mitigation project in China, which turned into a book. Eight years after getting my MPH, I love what I do, but I’ve never actually occupied a “typical” global health job.

It’s possible that my job profile is worthless from an international perspective and I am simply unaware of that fact, but I doubt it. (In fact, I’ve been assured otherwise by multiple global health professionals and recruiters.) I began to suspect that the rosy picture being painted for me and other aspiring global health professionals by seasoned global health experts – that all that is needed for a career in global health besides some technical public health knowledge is an adventurous spirit and basic cross-cultural adaptability – was missing the mark. Out of hundreds of global health job vacancies I have scrolled through over nearly a decade, many call for a career’s worth of highly specialized technical knowledge. I began to wonder what the job market for global health graduates really looked like, and whether a simple willingness to “establish trust,” “practice humility,” and “respect the culture” were enough to break into that elusive technical advisor role. That was why we launched the Global Health Jobs Analysis project last year. We are finalizing the results for a manuscript this spring, but we presented initial findings at last year’s APHA meeting – results that pose a sobering counterpoint to the typical career advice presented to aspiring global health professionals.

1. The current global health job market looks completely different now than it did 25 years ago. Of the 1,007 distinct private-sector jobs captured by the analysis over six months, 75% were at the manager (median 5 years of relevant experience required), technical expert (6 years), or director level (8 years). Only 10% of jobs were considered entry-level. For overseas positions, that number is even smaller (6%). The difference on the supply side is staggering as well. Graduate training programs in global health have exploded in the last ten years, right along with the cost of university tuition. Now the applicant pool doesn’t just consist of anyone who happens to walk through the door – managers have their pick of tens of thousands of job applicants who can submit their resumes online. Valuable career advice should start with tips on how to get your resume through the screening software and in front of a pair of human eyes.

2. Front-door entry to global health jobs in the US government is all but impossible. At the Global Health Diplomacy session at last year’s APHA meeting, James Kolker, Assistant Secretary at the US Office of Global Affairs, admitted that no DHHS agencies had an entry mechanism or career path for global health professionals. Our analysis of federal jobs corroborates this: of the 123 global health-related jobs posted by the federal government during data collection for the analysis, none were open to master’s-level graduates (GS-9). 81% were GS-13 level or higher; for USAID, that figure went up to 85%. Anything higher than a GS-11 essentially requires at least a year of previous experience in a government agency, which means that these jobs are only accessible to those already on the inside. Also, many federal public health agencies rely on highly competitive fellowship programs as recruiting mechanisms and entry points. GHFP serves as one such mechanism for USAID. Of the 25 fellowship positions the program posted during data collection, all but 3 were for technical experts, with a median of 10 years of relevant professional experience required.

3. You have to be in the area and know someone on the inside. One hiring manager for Chemonics, USAID’s largest contractor (who, incidentally, got fined for discriminatory hiring practices last year), told me that he and most of the other managers in his division would not bother looking at submitted resumes that did not have a local address. Virtually all CDC recruiters I have talked to are reluctant to even interview someone outside of Atlanta. USAID and CDC in particular are increasingly turning to contractors to manage global health projects (which are typically short-term) and find technical experts to lead them. As with most other sectors, the best way to get in is to know somebody on the inside. Recruiters for these contractors tend to hire people they have previously worked with, many of whom are retired agency employees, which creates a “revolving door” with a limited group of professionals. Put another way by AidLeap:

Sadly, a lot falls down to who you know and/or luck. Many colleagues have told me they were in the right place at the right time, or that someone they knew from a previous job had helped them out. It’s wrong and I find it a very difficult pill to swallow, however, it is the reality.

4. The international development field, including global health, rewards unpaid work – and thus favors the wealthy. A lot has already been written about this by Gen-X development professionals who tend to be more forthcoming about the difficulties in breaking into this kind of career. Alanna Shaikh has touched on this issue in her own experience, explaining, “International development is a brutally competitive field to get into…If your heart is set on [it], then be prepared for a lot of unpaid jobs before you find one with a salary.” Similarly, Chris Blattman admits, “Be prepared to volunteer your first couple of jobs. The paid opportunities will come in droves, but only after you distinguish yourself from the mass of inexperienced undergraduates who want to work abroad. Offer to work for free, and consider paying your own airfare over to look for opportunities.” The trouble with this reality is that it favors people who have outside financial support (read: wealthy parents) and/or no student loan debt. An intense spotlight was shone on this fact with the story of the UN intern who found himself living in a tent on Lake Geneva. There is a tragic irony in the fact that careers in a field devoted to helping the poorest are largely inaccessible to those who are not wealthy.

5. We’re supposed to be putting ourselves out of business, anyway. There is a good reason that the number of entry- and mid-level jobs in global health and development projects is shrinking – those jobs are now occupied by citizens of the countries those projects are meant to benefit. Frankly, this is how it should be. We want low- and middle-income countries to take the lead on their own development. Unfortunately, this leads to a natural “aging” of the global health professional in demand, as the spots remaining to be filled are those requiring many years of targeted technical experience for a given project. All this has combined to make global health a murderously competitive field for American MPH grads.

Cultural competency and playing well with others are incredibly important in global health, and any career advice should emphasize those skills. But those lessons learned come in handy after you land the global health job. The student and ECP members of the IH Section, who make up nearly half of our total membership, will need more than just cultural competency and a listening ear to be able to land work as global health technical advisors. My hope is that the results and insights from the Global Health Jobs Analysis will help them to build careers that will eventually land one of those elusive, increasingly competitive “dream jobs.”


These are difficult realities to confront, and may make entry into the global health profession seem out of reach. Don’t despair! There is still room in this field for dedicated professionals, but cracking that “dream job” takes some strategic planning. Please stay tuned for the final part of this series, “Five practical career development suggestions to position yourself for the global health profession.”