The Road Ahead: Public Health Beyond the University

Excerpts from the Graduate Forum address of Jon Rohde, 19 January 2012

What a remarkable group you are! Men and women from ten countries spread across the world; nurses, doctors, dentists, social workers, nutritionists, community organizers, health program managers, demographers, researchers, economist – all professionals; all brought together by a concern for the health and well-being of the poor. Together with your teachers, drawn from over 8 Universities and Schools of Public Health, you have helped us to advance this unique educational experience designed to prepare you to be catalytic actors on the world stage of public health. Together we have given substance to the old Chinese adage: “Go to the people, live with them, learn from them” – for we, like our mentor James Grant, fervently believe that Experience is the Best Teacher. No other school in the world offers public health education situated in the midst of needy rural and urban communities. None provides a daily contact with the very problems which public health must address. None draws faculty and experience from a nation-wide health and development effort like BRAC. And, none offers such an exposure to modern scientific technology applied directly to solving the most pressing health problems in a wide range of applied public health research that you have experienced at icddr,b.

If you carry away but one lesson, let it be that of learning from experience in the field. BRAC has made its mark in global health by its openness to new approaches learned from the people it serves:

  • In Bangladesh, treating diarrhoea with salt and sugar water has become part of the culture – women pass it on and practice it as a matter of routine, in stark contrast to the old tradition of withholding fluid during illness – child mortality has plummeted, Bangladesh is the country with the highest use rate of home oral rehydration in the world today.
  •  Infant mortality and fertility in BD have fallen substantially lower than neighbouring India – through women’s groups, girls education, jobs and microcredit for women, women have taken on the best practices of family and child rearing, even within their severely limited means.
  • You have seen how BRAC Shasta Shevikas have accomplished over a 90% cure rate for TB – in South Africa, where I live, we are yet to reach 70% cure; you have seen urban traditional midwives deliver babies in clean simple huts in the slums– by early referral maternal mortality has dropped by 2/3 and neonatal mortality by ¾ in only 4 years
  • Jim Grant, though an UN Undersecretary General, insisted on going to the villages in every country he visited, for only there did he learn what really works, what is possible for everyone.

The icddr,b has been on the forefront of applying the very best world science to understanding and meeting the needs of the poorest. In a world where some 90% of resources go to research on the diseases of the rich, you have seen how modern technology and world science can be applied with such benefit to those far more solvable needs in the bottom 80% of the world. But while icddr,b did indeed invent the cure for diarrhoea deaths, it took a BRAC and the women of Bangladesh to apply ORT universally to realize its potential benefits. Your education has shown you the value and the means to marry science with the community’s needs.

I challenge you to carry the inspiration of Jim Grant with you in your work. Born in China in a day where life expectancy had not yet reached 40 years Grant, a Harvard trained lawyer, was seized with the idea that, one could reach everyone in the world with modern life saving interventions – immunization, oral rehydration, bed nets, antibiotics, contraception and good nutrition. Grant saw freedoms as fundamental rights: freedom from illness, freedom from hunger, freedom from ignorance, freedom from exploitation. “Poverty”, said Gandhi, “is the worst form of violence” and Grant believed that basic public health is a fundamental antidote to poverty. Jim believed in a very practical kind of democracy – a world where no one is left behind – you must strive for this freedom in your life work.

When celebrating the eradication of smallpox in 1975, Dr. DA Henderson, who had directed that magnificent global effort, was asked “What is the next challenge to eradicate?” “Bad management!” he replied! You now have learned the skills to manage the tools of public health – the appropriate use of new technologies, building health manpower teams incorporating the best of social as well as health sciences, the linkage between good research and meeting the needs of the poor. It is up to you to use the new communication, “knowledge management”, and other technologies to fast track equity in health.

As you leave, we at BRAC ask but one return: that you share with us, and with each other, the insights, innovations and life experiences that illuminate your careers. You have seen firsthand in BRAC how a ‘learning organization’ thrives on daily interaction from its staff and clients and how modern connectivity links you to the entire world. You are the nidus of a new network of ideas and experience – share with us and with others as we learn together how to make this world a place of decency, of good health, of equity and of peace.

At my graduation, beloved American poet Robert Frost addressed our class and challenged us: “Do not follow where the path may lead.” He said, “Go instead where there is no path, - and leave a trail!” We at BRAC’s James P. Grant School of Public Health anxiously wait to follow you as you break new trails in public health! Jon E. Rohde, MD is Chair of the International Advisory Board of the School. He is a founding member of the School, conceptualizing the idea with BRAC’s Sir Fazle Abed in 2003. He has been affiliated with the Master of Public Health (MPH) programme from its inception, regularly reviewing the MPH curriculum and facilitating the capstone Integration Workshop.