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.”
IH CONNECT 
This article is the truth, Jessica! I can relate to the struggle of trying to break into the global health field. One of my professors who had worked in CDC kind of warned me but I thought that with the passion I have for global health, my grades and my overseas experience, I would be able to land a job upon graduation. It seemed impossible to land even an internship in the field without the years of experience and technical knowledge that most of the positions demanded. Plus I am not in the “area” and it was not financially feasible to just up and move. I also do not know people on the “inside” and the amount of networking I did up to that point did not help. I am certainly interested in learning more about the global health jobs analysis and hopefully land my dream job. I look forward to reading the final part of these series!
Thank you for your comment, Olatoyosi! Your experience is unfortunately extremely common and has been a major motivator for myself and my analysis colleagues (all unpaid!) to keep the project moving. We are incredibly excited about the results and optimistic about getting them published this year. We also plan to share them with IH Secton members. I hope you are among them – if not, I encourage you to join!
Thoughtful, smart. Just what I’d expect from you.