Redefining Global Health: Dr. Nils Daulaire on Global Health for the 21st Century
By Kajal Mehta
Dr. Nils Daulaire, Former Assistant Secretary for Global Affairs at the U.S. Department of Health and Human Services, United States Representative on the World Health Organization Executive Board and current Menschel Fellow at the Harvard T. H. Chan School of Public Health, proposes that we are transitioning into a new era of global health. In his Voices in Leadership interview on January 28th at the School of Public Health, he highlighted interconnectedness as a crucial framework for the upcoming global health agenda.
To Daulaire, global health is in “Act Three” of its evolution as a discipline. Looking back on its place in history, he says in Act One, global health was a field “focused on the individual” and often associated with missionary endeavors. Act Two intended to improve the infrastructure, health, and capacity of other nations. However, there was a clear sense of otherness — an innate delineation between them and us. How does Act Three differ and why has it garnered so much interest? Daulaire posits that the current climate of global health embraces a significantly more holistic outlook. This time, health is “a common good and a common endeavor.” As the world has swiftly globalized in terms of trade, migration, travel and culture, the us versus them distinction in health has crumbled.
What are the implications of this transition? In Daulaire’s opinion, this affords the international community an opportunity to better understand and respond to the challenges that this century will bring. Recent events such as the Ebola virus outbreak and ISIS-linked terrorist attacks have roused attention worldwide. One global response to these events has been fear and a tendency to return to the separateness of previous eras in global health, but Daulaire describes how he chooses to view these events as an opportunity. He insists that in the realities of the current global context, no wall is sufficient to keep out the world, and global events impact local contexts making it essential to embrace opportunities to improve and protect health.
The reality of global interconnectedness is an important consideration for U.S. policymakers as the world will look to our nation for leadership. From his experience with the Department of Health and Human Services, Daulaire shared his initial surprise with the interrelatedness of arenas like environment, trade and media with health: “One of the things that struck me…was the degree to which I had to deal with parts of the US government, parts of the way we deal with the world, that are entirely outside, by traditional standards, the health arena.” His advocacy for health and consideration of non-communicable diseases required him to work closely with the office of the U.S. Trade Representative once he saw the strong impact of trade on health. These interactions spurred him to learn the language of trade regulation to fight for public health principles.
Given his extensive experience in global health working in over 50 countries, did he feel prepared for the tasks at hand as Assistant Secretary for Global Affairs? Daulaire laughed,
“Well first of all, I don’t think you’re ever well-prepared. The best you can hope for is not to be so shocked that you can’t act.”
For him, a valuable skill was earnestly listening when working in an interdisciplinary environment to understand the different perspectives at the table. Additionally, he emphasizes that mistakes are part of the learning process, and we should commit ourselves to learning from them.
Moving forward in the face of formidable crises, Dr. Daulaire’s lessons are poignant considerations as polarized sentiments echo around the nation — there are cries to build walls, to keep outsiders and their diseases and issues out. However, as the interviewer Dr. Jha pointed out, there is no human pathogen with an incubation time shorter than the longest human flight. Therefore, it is impossible to ignore how health in one population affects the rest of the world. No longer is global health limited to healthcare professionals, but is relevant in all disciplines. Daulaire pushes that as leaders in global health, residents in nations, and members of the global community — we must step up, push for consideration of health in all policies, and utilize the synergy of our interconnectedness as we take global health into the 21st century.
For more from the Voices in Leadership (@VoicesHSPH) series at the Harvard T.H. Chan School of Public Health (@HarvardHSPH), visit www.hsph.harvard.edu/voices.
Story edited by Esther Velasquez
