Health Care Crisis Can't Be Solved by Outsiders Alone

Written with Lauren Taylor

It used to be the case that global health work mandated spending enormous sums of money on disease-focused outcomes. The money went towards supplying anti-retroviral treatment for the HIV, DOTS for those stricken by tuberculosis, and artemisinin combination therapy for the millions who contract malaria each year. Such disease-specific treatments are meant to restore health to the already sick.

More recently, recognition that prevention is often more effective than treatment has meant more money and attention for condoms, vaccines and malarial bed nets. These efforts are aimed at decreasing the number of people who fall sick in the first place. Choices between treatment and prevention efforts often require making complex decisions about resource allocation, but prevention has saved both money and lives -- simple solutions such as vitamin A supplementation of vitamin A-deficient populations can reduce child mortality by as much as 23-24% and costs as little as $1 per child.

Still, the work of improving global health remains costly and complicated. Decision-making and priority setting frequently rest with academics and agency staff on the "outside" of the affected community. The ability of these people to affect change is real, but limited. I know, because I am one. We outsiders are at once powerful and powerless. We may provide an objective perspective and a variety of resources to mobilize, but we lack crucial bits of knowledge gained only from time spent on the "inside" of the affected community. Real, lasting change must be born from within. Where this is not the case, significant challenges still remain.

Thus, global health finds itself on the brink of yet another necessary transition. It's a transition that aims to deliver us to a place in time where our conception of global health expands beyond either treatment or prevention -- beyond disease-based definitions of health -- to include health systems strengthening. To achieve this new vision, courageous leaders need be trained to make strategic decisions about how scarce resources should be allocated. Sometimes this will require treatment; other times this will require prevention. But it will be up to these local leaders to evaluate such tradeoffs. In this way, these leaders can become dynamic agents of change and sources of strength within their systems.

Here at Yale, the Global Health Leadership Institute is working to usher in this new era of global health work. From June 14-19, healthcare leaders from five countries will come together to learn with academic leaders in health management and grand strategy about what it means to be a part of this new generation of global healthcare leadership. Each delegation will arrive with a specific health system challenge that is a current priority for the country. The Conference design features include team-based learning, community-building using principles from organizational psychology and experiential problem-solving, and adequate time for group reflection. If successful, all delegations will leave with a clearer plan for addressing their countries' challenges and a new understanding about "what works" and what doesn't in developing effective leadership.

In his June 11 Huffington Post blog, my colleague, Josh Ruxin, referenced a term that we hope to explore this week at GHLI. The term was "global citizenship" and it is an idea that rests on broadened understandings of the body politic to which we each belong. We call attention to the term here because we think it holds the potential to breathe new life into the traditional vocabulary of leadership.

Prior to this most recent wave of globalization, individuals identified most closely with membership in some combination of towns, states, geographic regions and/or nations. More recently, many individuals have embraced their membership in the still larger global community. In doing so, these individuals feel a new sense of civic responsibility to maintaining a covenant with people and communities on the other side of the world. In the context of health, true global citizens remind us all that where one is ill, we all suffer.

So how does this relate to leadership? With this new conception of global citizenship in place, an increasingly diverse group of stakeholders are participating in global health problem solving. A commitment to humility, flexibility, and teamwork on the part of all involved is of even greater importance than ever before. The new generation of healthcare leaders need not only know how to lead, but also how and when to follow. Such leaders could be poised to respond intelligently and compassionately to the complex and ever-changing problems of global health in a way no vaccine or medication ever could.