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Elizabeth H. Bradley

Elizabeth H. Bradley

Posted: June 29, 2009 12:54 PM

Paradox and Strategy in Global Health Leadership


Written with Lauren Taylor

From June 15-19, Yale University's new Global Health Leadership Institute (GHLI) held its inaugural conference, bringing together top leaders in global health to inspire leadership and new approaches to strengthening health systems. To many ears, what they heard at the conference may have sounded like contradictions. One speaker said "humility is key" while the other espoused the value of boldness. One spoke of the importance of prioritization, while another implored the audience to work simultaneously in multiple directions. And then, a single person demanded both leadership and followership of the health officials in the room. Together, the speakers collectively had demonstrated an unfortunate but important reality of global health: even in the words of global health experts, there are no easy answers. With some reflection, what seemed to be outright contradictions emerged as unexpected secrets to modern global health leadership: balancing paradox.

First, there was this issue of boldness and humility. Yale Professor of Medicine Harlan Krumholz provided what may well become one of the most memorable taglines of the conference (borrowed from Adidas): "Impossible is Nothing." This sentiment was echoed by Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, TB and Malaria and Ariel Pablos-Mendez, Managing Director of the Rockefeller Foundation, both of whom reflected on how far public health had come since the dawn of their respective careers. But this message of boldness was tempered by a pervasive discussion of humility. Kazatchkine recalled for the audience that some of his greatest leadership successes in medicine were achieved when he, as a young physician, let his patients lead. That, he said, was unheard of, and bold.

Then there was the issue of prioritization. Its necessity was an implicit theme of several talks, and an explicit message of Sir Richard Feachem, Founder and Director of the Global Health Group at UCSF. "Prioritize," read his final slide. And yet, he also said that no global health problem is an island unto itself. Yale scholars John Gaddis and Paul Kennedy echoed this sentiment, saying that successful grand strategy in any endeavor must accept the interrelatedness and "ecology" of all strategies. The need to work on several interrelated issues and in many directions simultaneously was equally palpable. On the question of horizontal versus vertical interventions, for example, no one would choose. Kazatchkine responded that the best way to approach the issue was to "raise funds vertically and spend horizontally." Pablos-Mendez similarly eschewed prioritization all together -- saying "I don't believe in the horizontal and the vertical. I believe in the whole."

Lastly, and perhaps most momentously, there was the paradoxical discussion of leadership and followership by Yale Professor David Berg and Elizabeth Bradley, Professor and Director of the Yale Global Health Initiative. Both depicted leadership as a role rather than a quality, and banished the thought of a checklist of "leadership characteristics" that would ensure success. Instead, Berg suggested that exceptional leaders lead where they are able and follow where they are not. Furthermore, he posited that no trait was necessary in the leader if it were present in the relationship between the person in the leadership role and the people in followership roles. In this way, leadership is all about relationships, with cognitive and emotional "give and take" between leaders and followers -- no matter how reluctant or dissonant a follower may be.

So, where are the answers that everyone traveled so far for?

They're still out there waiting to be thought, discussed, challenged, and tested. And this is no accident. If delivering "answers" had been the goal, a webinar or chatroom forum would have sufficed for one side of the World to relay facts and formulas to the other. It is precisely because simple answers are ineffective in global health that the Global Health Leadership Institute holds such promise. Rather than answers, conference attendees returned home with new relationships through which to further explore the strategies and paradoxes first presented by GHLI's speakers. These relationships, while young, dynamic and necessarily long-distance, were born strong as a result of the delegates' shared stake in global health.

In a week brimming with impressive facts, figures, and individuals, the most impressive aspect of all may have been this: at a conference in which no speaker knew the others' agenda, the speakers and delegates had collectively lived the message of leadership as beautifully as Berg articulated it. Each had moments in which they had enthusiastically led at the podium, as well as moments in which they inconspicuously followed from a conference room armchair. The "answers" lay only in their shared discussions and debate. Together, the speakers at Global Health Leadership Institute had painted an honest picture of what it means to effectively lead in tackling the global health challenges of the twenty first century.