Next up!

After three years, I'm done with grad school! I finished my MSPH (Global Disease Epidemiology and Control focus) at Hopkins in late May, and my MPA (Economics and Public Policy focus) at Princeton in early June. It's been a lot of work: 10 months of internships, 3 comprehensive qualifying exams, and a Masters thesis; plus 4 quarters of Hopkins classwork and 3 semesters of Princeton classwork for a total of 33 graduate classes. I loved being in school again -- not all my classmates did -- but I'm also happy to have wrapped things up. One consequence of studying applied subjects like public health and public policy is that you're rarely delving into a subject just for kicks (at least for long); the goal is always to get out and do good work with the knowledge and skills you've acquired. This week I started a job I'm really excited about: working with the Clinton Health Access Initiative (CHAI)'s Applied Analytics Team. If you're curious about CHAI here's their about page, and this profile of Elizabeth McCarthy tells a bit more about the Applied Analytics Team (which she runs). We're also hiring. As with my previous internships and work, I won't be writing directly about what I'm doing much at all, but I'll still be writing more broadly about global health and development policy. (And this is probably a good time to reiterate that the views here are just my own.) I'll be working on projects throughout sub-Saharan Africa -- I'm headed to Nigeria for a couple months on Saturday! More on that soon.

Now, back to my (ir)regular blogging...

Still #1

Pop quiz: what's the leading killer of children under five? Before I answer, some background: my impression is that many if not most public health students and professionals don't really get politics. And specifically, they don't get how an issue being unsexy or just boring politics can results in lousy public policy. I was discussing this shortcoming recently over dinner in Addis with someone who used to work in public health but wasn't formally trained in it. I observed, and they concurred, that students who go to public health schools (or at least Hopkins, where this shortcoming may be more pronounced) are mostly there to get technical training so that they can work within the public health industry, and that more politically astute students probably go for some other sort of graduate training, rather than concentrating on epidemiology or the like.

The end result is that you get cadres of folks with lots of knowledge about relative disease burden and how to implement disease control programs, but who don't really get why that knowledge isn't acted upon. On the other hand, a lot of the more politically savvy folks who are in a position to, say, set the relative priority of diseases in global health programming -- may not know much about the diseases themselves. Or, maybe more likely, they do the best job they can to get the most money possible for programs that are both good for public health and politically popular.  But if not all diseases are equally "popular" this can result in skewed policy priorities.

Now, the answer to that pop quiz: the leading killer of kids under 5 is.... [drumroll]...  pneumonia!

If you already knew the answer to that question, I bet you either a) have public health training, or b) learned it due to recent, concerted efforts to raise pneumonia's public profile. On this blog the former is probably true (after all I have a post category called "methodological quibbles"), but today I want to highlight the latter efforts.

To date, most of the political class and policymakers get the pop quiz wrong, and badly so. At Hopkins' school of public health I took and enjoyed Orin Levine's vaccine policy class. (Incidentally, Orin just started a new gig with the Gates Foundation -- congrats!) In that class and elsewhere I've heard Orin tell the story of quizzing folks on Capitol Hill and elsewhere in DC about the top three causes of death for children under five and time and again getting the answer "AIDS, TB and malaria."

Those three diseases likely pop to mind because of the Global Fund, and because a lot of US funding for global health has been directed at them. And, to be fair, they're huge public health problems and the metric of under-five mortality isn't where AIDS hits hardest. But the real answer is pneumonia, diarrhea, and malnutrition. (Or malaria for #3 -- it depends in part on whether you count malnutrition as a separate cause  or a contributor to other causes). The end result of this lack of awareness -- and the prior lack of a domestic lobby -- of pneumonia is that it gets underfunded in US global health efforts.

So, how to improve pneumonia's profile? Today, November 12th, is the 4th annual World Pneumonia Day, and I think that's a great start. I'm not normally one to celebrate every national or international "Day" for some causes, but for the aforementioned reasons I think this one is extremely important. You can follow the #WPD2012 hashtag on Twitter, or find other ways to participate on WPD's act page. While they do encourage donations to the GAVI Alliance, you'll notice that most of the actions are centered around raising awareness. I think that makes a lot of sense. In fact, just by reading this blog post you've already participated -- though of course I hope you'll do more.

I think politically-savvy efforts like World Pneumonia Day are especially important because they bridge a gap between the technical and policy experts. Precisely because so many people on both sides (the somewhat-false-but-still-helpful dichotomy of public health technical experts vs. political operatives) mostly interact with like-minded folks, we badly need campaigns like this to popularize simple facts within policy circles.

If your reaction to this post -- and to another day dedicated to a good cause -- is to feel a bit jaded, please recognize that you and your friends are exactly the sorts of people the World Pneumonia Day organizers are hoping to reach. At the very least, mention pneumonia today on Twitter or Facebook, or with your policy friends the next time health comes up.

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Full disclosure: while at Hopkins I did a (very small) bit of paid work for IVAC, one of the WPD organizers, re: social media strategies for World Pneumonia Day, but I'm no longer formally involved. 

Busy

In lieu of observations about Ethiopia, notes from my work here, or discussion of recent news/articles/links, here's a picture of the books currently occupying my time at work (fascinating, I know):

Tomorrow I'm off to Mek'ele, the capital of Tigray region in northern Ethiopia, for work for about a week. If you have blog withdrawal in the meantime, I share links to maybe 5-10 articles or blog posts each day on Twitter.

Ethiopia bleg

Bleg: n. An entry in a blog requesting information or contributions. (via Wiktionary)

Finals are over, and I just have a few things to finish up before moving to Addis Ababa, Ethiopia on June 1. I'll be there for almost eight months, working as a monitoring and evaluation intern on a large health project; this work will fulfill internship requirements for my MPA and MSPH degrees, and then I'll have just one semester left at Princeton before graduating. After two years of "book-learning" I'm quite excited to apply what I've been learning a bit.

One thing I learned from doing (too many?) short stints abroad is that it's easy to show up with good intentions and get in the way; I'm hopeful that eight months is long enough that I can be a net benefit to the team I'll be working with, rather than a drain as I get up to speed. I plan to get an Amharic tutor after I arrive -- unfortunately I figured out my internship recently enough that I wasn't able to plan ahead and study the language before going.

I'm especially excited to live in Ethiopia. I have not been before -- this will be my first visit to East Africa / the Horn of Africa at all. I'll mostly be in Addis, but should also spend some time in rural areas where the project is being implemented. I've already talked with several friends who briefly lived in Addis to get tips on what to read, what to do, who to meet, and what to pack. That said I'm always open for more suggestions.

So, I'll share what I've already, or definitely plan to read, and let you help fill in the gaps. Do you have book recommendations? Web or blog links? RSS suggestions? What-to-eat (or not eat) tips? Here's what I've dug up so far:

  • Owen Barder has several informative pages on living and working in Ethiopia here.
  • Chris Blattman's post on What to Read About Ethiopia has lots of tips, some of which I draw on below. His advice for working in a developing country is also helpful, along with lists of what to pack (parts one and two), though they're obviously not tailored to life in Addis. Blattman also links to Stefan Dercon's page with extensive readings on Ethiopian agriculture, and helpfully organizes relevant posts under tags, including posts tagged Ethiopia.
  • As for a general history, I've started Harold Marcus' academic History of Ethiopia, and it's good so far.
  • Books that have gotten multiple recommendations from friends -- and thus got bumped to the top of my list -- include The Emperor, Cutting for Stone, Chains of Heaven, and The Sign and the Seal. Other books I've seen mentioned here and there include Sweetness in the Belly, Waugh in Abyssinia, Notes from the Hyena's Belly, Scoop, and A Year in the Death of Africa. If you rave about one of these enough it might move higher up the priority list. But I'm sure there are others worth reading too.
  • For regular information flow I have a Google Alert for Ethiopia, the RSS feed for AllAfrica.com's Ethiopia page, and two blogs found so far:  Addis Journal and Expat in Addis. (Blog recommendations welcome, especially more by Ethiopians.) There's also a Google group called Addis Diplo List.
  • One of my favorite novels is The Beautiful Things That Heaven Bears -- the story of an Ethiopian immigrant in Washington, DC's Logan Circle neighborhood in the 1980s. It's as much about gentrification as it is about the immigrant experience, and I first read it as a new arrival in DC's Petworth neighborhood -- which is in some ways at a similar 'stage' of gentrification to Logan Circle in the 80s.
  • I've started How to Work in Someone Else's Country, which is aimed more at short-term consultants but has been helpful so far.
  • Also not specific to Ethiopia, but I'm finally getting around to reading the much-recommended Anti-Politics Machine, on the development industry in Lesotho, and it seems relevant.

Let me know what I've missed in the comments. And happy 200th blog post to me.

(Note: links to books are Amazon Affiliates links, which means I get a tiny cut of the sales value if you buy something after clicking a link.)

Halfway!

I've been remiss in blogging lately, but my excuses are excellent for once. Princeton has an odd academic schedule with finals after the winter / Christmas holidays. So after spending a couple weeks in Arkansas visiting family it was back to cold (but not as cold as usual) New Jersey to study for finals, write papers, and take exams, all in the middle of January. For normal students -- i.e., those who are used to finishing final exams before Christmas and actually having a mental break over the holidays -- this schedule is unpleasant. But it has one upside: last week was intersession, a one-week break where the fall semester is completely done and the spring semester and its obligations have yet to begin, and Woodrow Wilson students (in the vernacular, "Woos") traditionally plan group vacations.

One group went to Colombia for the week, another to the Dominican Republic, and various individuals and small groups jaunted off to exotic locales like Paris and Florida. I opted for the low-cost, low-energy Puerto Rico group. Sixteen of us rented a condo and this house (which I highly recommended) in Luquillo Beach and enjoyed this for a week:

Needless to say the stress of finals was washed away and we Woos are both more tanned and less loathe to start the spring semester. Today was our first day of classes so I'm still figuring out which classes I'll be taking, but this seems like a good moment to pause and celebrate:

I'm officially halfway through grad school! 1.5 years down, 1.5 to go. So far I've done:

  • 4 quarters of coursework at Hopkins (9 months)
  • a summer interning with the NYC Dept of Health (3 months)
  • and the fall semester at Princeton (6 months)

Still to go:

  • this spring semester at Princeton (4 months)
  • June through January: a yet-to-be-determined internship abroad to fulfill internship requirements for Princeton and practicum and remaining degree requirements for Hopkins (8 months)
  • and a final semester at Princeton in the spring of 2013 (4 months)

I'm happy with my course of study so far, and have largely concentrated on the comparative advantage of each school and program: epidemiology, infectious disease, and other public health courses at Hopkins and economics and more general public policy courses at Princeton. For more details on the two programs (for instance, if you're considering programs like these) click below the fold...

I don't typically blog much about my classes because a) it is difficult and awkward to comment on a class in progress, and b) you might be quite bored since one of several reasons formal education exists is to force students to learn subjects more systematically and in-depth then we might otherwise care to pursue in the course of regular pleasure reading. So I avoid writing about the minutiae of classes -- but am happy to talk if you're considering either of the programs I'm in. One major difference I've mentioned before is that Hopkins is on the quarter system (four terms between August and May) whereas Princeton does semesters (two terms between August and May).

Now that I've finished a semester at Princeton I can say that by comparison the quarter classes aren't exactly a whole semester's worth of material crammed into half the time, but they're definitely more than half. I'd say on average (a very rough approximation!) I learned about two-thirds as much material in a quarter-length class as in a semester one.

As for what classes I've taken, I think they're fairly illustrative of the focus of both programs. As my interests continue to solidify around the implementation and evaluation of large-ish health programs, I think I'll end up using a lot of tools and knowledge from both programs. My course load has also been fairly typical for both programs:

Hopkins MSPH (Global Disease Epidemiology and Control)

I took 16 quarter-length classes for credit, five seminars for credit, and was a teaching assistant in one course:

  • Biostatistics (4 terms)
  • Large-scale Effectiveness Evaluations of Health Interventions
  • Design and Conduct of Community Trials
  • Global Disease Control Programs and Policies
  • Vaccine Policy Issues
  • Vaccine Development and Application
  • Epidemiologic Methods (2 terms)
  • Professional Epidemiology Methods
  • Epidemiology and Public Health Impact of HIV/AIDS
  • Infection, Immunity and Undernutrition (as a teaching assistant)
  • Introduction to International Health
  • Environmental and Population Health in Emergencies
  • Health Behavior Change at the Individual, Household and Community Levels
  • along with one term of a vaccine seminar and four terms of a seminar for my track

Princeton Woodrow Wilson School MPA (Economics and Public Policy track):

Students typically take 4-5 classes per semester, but as a dual degree student I'll do three semesters instead of four. Classes I've completed or must take because they're required:

  • Microeconomics*
  • Macroeconomics*
  • Econometrics*
  • Generalized Linear Statistical Models**
  • Politics of Public Policy
  • Psychology of Public Policy
  • Comparative Political Economy of Development

Others I might take this spring or next spring (my final semester) to complete requirements:

  • Health and Inequality in the World
  • Financial Management
  • Economic Analysis of Development
  • Microeconomic Analysis of Government Activity
  • International Trade
  • and so forth...

Footnotes: * - these core courses, along with a first-semester stats course, are offered at varying levels for students with different math backgrounds ** - most students take an introductory statistics/quantitative course followed by econometrics, while some students opt in to the linear models course instead.

About grad school

Mr. Epidemiology, a PhD student who blogs at mrepid.wordpress.com, has put together a great round-table where he asks open-ended questions about grad school and collects answers from a variety of Masters and PhD students from across mostly related fields. A little about the roundtable and its respondents is here. Questions covered so far include:

I thought the piece on impostor syndrome was particularly helpful. Although not exactly the impostor syndrome (which also hits me often), this is somewhat related: While blogging and going to school concurrently I've had difficulty writing about certain subjects that I've studied more intensively. The more I study, the more I realize my lack of expertise and hesitate to say anything definitive without endless qualifiers and references. For instance, I TA'ed a class on on malnutrition, infection, and immunity, and spent a summer researching lead poisoning in New York City -- but those are two of the more difficult subjects for me to write about for a popular audience. I know PhD students and true scholars must feel this more intensely, but at the same time it's probably even more important for those with more time invested in a subject to weigh in on it.

Update: the latest addition to the series is What has surprised you the most so far?

Grad school advice from bloggers

If you want to take advice from bloggers, they're generally happy to give it. I've written a bit about my own motivation in selecting programs. I think the best advice comes from people who know you, your interests, and aspirations well. That means family and friends, especially if your friends work in similar fields. It's also invaluable to talk to both experienced mentor figures who have some perspective and recent graduates of the programs you're interested in (programs do change over time). Over the past year I've come across a number of resources written by bloggers that I think are worth highlighting: Dave Algoso, a recent graduate of the MPA program at NYU's Wagner School, wrote a grad student’s guide to the international development blogosphere which answers these questions:

1. Why should I read blogs? I do plenty of reading for class/work already… 2. Blogs can be overwhelming. How do I manage the information flow? 3. Okay, I’m sold. What should I be reading?

From Chris Blattman (everyone's favorite development blogger at Yale):

Dani Rodrik responds to Blattman on graduate programs in development.

From Greg Mankiw's blog:

Let me know if you think of something I'm missing. There does seem to be more advice out there about economics programs than those in public health. Personally I'd love to see a similar set of posts from Karen Grepin, Alanna Shaikh, and Elizabeth Pisani, amongst others.

Update: Dave Algoso suggested these posts by Amanda Taub of Wronging Rights, which I missed since I never seriously considered law school:

Grad School Buffet

My program only requires one full academic year of coursework. The second year is a mix of a field practicum, work on a masters paper, and additional courses for those who choose to take some (and many do). But most students complete the core requirements for the degree in the first academic year, which is composed of four quarters. So far I've completed the first two quarters, which included 10 classes and 3 additional seminars for a total of 43 credits. Now I have to decide which classes to take in the 3rd and 4th quarters (January through May), when I have fewer required classes and more electives are offered. Fellow Hopkins GDEC (global disease epidemiology and control) student Kriti at EpiTales describes the selection of public health courses at Hopkins as a buffet. Quite true. I've been trying to narrow down my courses for the 3rd and 4th terms and have come up with a preliminary list, excluding many classes that are redundant, don't fit my interests, or have prerequisites that I haven't taken. After narrowing it down a bit, I'm down a list of a mere 42 courses, or which I'll be able to take 10-11 at most:

Armed Conflict and Health Assessing Epidemiologic Impact of Human Rights Violations Clinical and Epidemiologic Aspects of Tropical Diseases* Clinical Vaccine Trials and Good Clinical Practice* Comparative Evaluation for Health Policy in International Health Current Issues In Public Health Data Management Methods in Health Research Studies Demographic Estimation for Developing Countries Demographic Methods for Public Health Design and Conduct of Community Trials* Econometric Methods for Evaluation of Health Programs Emerging Infections Epidemiologic Inference in Outbreak Investigations Ethics of Public Health Practice in Developing Countries Ethnographic Fieldwork Fundamentals of Budgeting and Financial Management* Fundamentals of Program Evaluation GDEC seminar (required) Global Disease Control Programs and Policies (required) Global Sustainability and Health Seminar Global Tobacco Control History of International Health and Development History of Public Health Infectious Diseases and Child Survival* Intro to SAS Statistical Package Introduction to Urban Health Large-scale Effectiveness Evaluations of Health Programs Nutrition in Disease Treatment and Prevention Pandemics of the 20th Century Poverty, Economic Development, and Heath Professional Epi Methods I Professional Epi Methods II Project Development for Primary Health Care in Developing Countries Public Health Practice* Scientific Grant Writing Spatial Analysis and GIS I Statistical Methods for Sample Surveys Statistical Methods in Public Health III (required) Statistical Methods in Public Health IV (required) Systematic Reviews and Meta-Analysis Vaccine Policy Issues

*Classes noted in bold are required, while those in italics meet some other requirements (I have to choose one from a cluster of courses on a subject area -- it's a bit too complicated to explain here).

Obviously I'll have to narrow it down a bit more. While I would probably enjoy most everything on the list, my strategy is to concentrate on coursework in epidemiology, biostatistics, and statistical software (we use Stata in the required biostatistics series, and I would also like to be familiar with SAS and ArcGIS). Then I'll prioritize courses that provide additional skills in program evaluation and trial design and execution. If I have time left in my schedule I'll get to take the other things -- but it looks like I would need to go back for a second plate at the buffet to be able to take even half of these.

(If you're a prospective student and want to browse for yourself, the JHSPH course search feature is here).

Reading room

The fourth floor of my school has two beautiful reading rooms with natural lighting. This week is midterms (the term system moves fast - midterms after just four weeks) and I already have my first paper (for Intro to International Health) and midterm (Biostats) out of the way. Tomorrow is a test for Epidemiology of HIV/AIDS, and Friday is the Epidemiologic Methods midterm. So I've been spending a lot of time enjoying the reading rooms, and not much blogging... Looking up from inside one of the rooms:

And students learning stuff:

Thanks Uncle Mike.

Grad school is...

Grad school is a battle between curiosity and productivity. Coursework can be conducive to learning -- and especially to skill acquisition. Most students in international health programs -- and all in my GDEC program -- are currently taking Introduction to International Health with Prof. James Tielsch. The class has been excellent so far, with compelling (if sometimes controversial) lectures offering a broad overview of everything in global health. The grades for the course come exclusively from two papers, which are described in an exquisitely detailed 29-page section of the syllabus. The more I work on my paper, which focused on the Guatemalan health system, the more convinced I am that it's excellent preparation for working on grant proposals. That doesn't mean it's fun -- fitting your ideas into someone else's boxes never quite approaches that level of enjoyment -- but it's a great skill to have. But even the best considered assignment pails in comparison to the learning that occurs outside of class, and it feels like the requirement to be productive is always digging into my ability to actively feed my curiosity. During orientation, several professors said that they wished Hopkins would do abolish grades entirely; that worrying about grades was a detriment to their education, and it doesn't really predict who will do well in public health. I can see how this would be true, as the times that I've felt that I'm absorbing the most have been when reading something inspired -- but not required by -- a class, usually something that grew out of a discussion question or a casual aside in a lecture. That, and the conversations and debates we're having amongst ourselves...

Should male circumcision be the default in the US? In Africa? Is it OK to make different policy recommendations for different countries?  If so, how do you explain it to the shafted? Why do people care about maternal mortality more than other types of mortality? How do we think about causality? Are some lives worth more than other? Can a sense of humor survive in a morbid (and mortal) field like public health?