Global health career paths: learn, mentor, practice, repeat

Global Health Matters is the monthly podcast from TDR, please subscribe.  GHMs brings you topical subjects and insightful discussions with health experts from across the globe, including a focus on low-to middle-income countries.

Are you a professional looking to progress further or perhaps a global health student at the early stage of your career? There are so many routes to get into a career in global health, so this podcast episode discussion is with two career professionals sharing their knowledge of how they chose their path and giving clear guidance on ways to get the support needed to increase opportunities to make a difference in the ever pressing global health challenges.
 
Global Health Matters host Garry Aslanyan speaks with the following guests: 

• Stephanie Topp: Associate Professor, Global Health and Development, College of Public Health, James Cook University
• Renzo Guinto: Chief Planetary Health Scientist, Sunway Centre for Planetary Health and Director, Planetary and Global Health, St. Luke's Medical Center 

Stephanie Topp looks at how global health can support the next generation of thinkers and leaders, and suggests that networked capacity building and an emerging voices model is a critical example. Renzo Guinto wants to listen to different voices and challenge power structures to address the inequities that global health is trying to address.

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Disclaimer: The views, information, or opinions expressed during the Global Health Matters podcast series are solely those of the individuals involved and do not necessarily represent those of TDR or the World Health Organization 

Transcript

Garry Aslanyan [00:00:09] Welcome to Global Health Matters, a podcast discussing topics and key issues influencing global health, with perspectives from low- and middle-income countries. I'm your host, Garry Aslanyan. Thank you for joining me again. Before we dive into today's discussion topic, as you know, we are always excited to hear feedback from our listeners. Let's hear one latest message.

 Peter Kilmarx [00:00:40] I'm Peter Kilmarx of the Fogarty International Center. My favourite episode of the Global Health Matters podcast was when Garry Aslanyan interviewed Catherine Kyobutungi and Agnes Binagwaho about their views as powerful female leaders on decolonizing global health.

 Garry Aslanyan [00:01:00] Thank you, Peter. The conversation on decolonizing global health is ongoing, and I trust that this episode will further contribute to this important discussion. As many of our listeners are enjoying their summer break, we wanted to bring you an episode that would inspire and stimulate you to reflect on your own global health career path. There is a great diversity of professionals engaged in global health. From 21 to 91 they bring richness to this field. For this episode, I spoke to two emerging global health leaders, Stephanie Topp and Renzo Guinto, who shared how their views and approach to career and global health evolved over time. Steph and Renzo are both reflective thinkers, not merely accepting the status quo, but deeply questioning their own role in and their contribution to global health. Stephanie or Steph, as she's better known, is an Associate Professor in Global Health and development at James Cook University in northern Queensland, Australia. Steph has been advancing in her global health career for the past 15 years, focusing on health systems both in low- and middle-income countries, as well as more locally in Australia. She's been recognized for her research contributions to health systems and policy. Steph started her career in a non-health disciplinary field, but quickly saw the value it could bring to deepening her understanding of global health challenges.

 Stephanie Topp [00:02:52] One of the reasons I sort of have been attracted to global health as an area of work because I think one of its distinguishing features is a concern for inequity. I am not clinically trained, I am not a health professional by background, I'm a historian by background. And it is the inequity in health outcomes and specifically then access to health care that is why I feel motivated to work in this area.

 Garry Aslanyan [00:03:29] Renzo Guinto is Chief Planetary Health Scientist at the Sunway Centre for Planetary Health in Malaysia. He's also the Director of the Planetary and Global Health Program at the St. Luke's Medical Center at the College of Medicine in the Philippines. In 2020, Renzo was recognized by Tatler magazine's GenT list as one of 400 leaders of tomorrow who are shaping Asia's future. Renzo's career focus has been on determinants of health and in particular environmental challenges facing island nations like the Philippines.

 Renzo Guinto [00:04:11] I'm from the Philippines, which is at the heart of the climate crisis, one of the most climate vulnerable countries in the world. The disproportionate impact of climate change, especially on the health of the poor, the vulnerable, the children of today and in the future, this, I think, is a global health injustice that keeps me awake at night, that really animates my work even until today.

 Garry Aslanyan [00:04:38] Steph's formative exposure to global health policy and practice occurred in Zambia, where she worked for eight years. She began her career as an intern and progressed to a project management role. During this time, Steph became acutely aware of the danger associated with positions of decision-making without local accountability. This awareness was the catalyst for a career iteration. She became impassioned to contribute to global health, not as a decision-maker, but rather to inform local decisions by generating trustworthy evidence.

 Stephanie Topp [00:05:16] A Zambian internship I think was the start of recognizing or coming to terms with the discomfort with an aspect of global health that places outsiders in a position of responsibility, but without a great deal of downwards accountability for the consequences of their actions. And that experience resulted in a much more deliberate set of decisions later in my career about the sort of work that I wanted to engage in. Work where I was accountable, not just to those who were funding or managing my work, but also to those for whom there were consequences of the work. And so that was one of the reasons that I decided to pursue a Ph.D., because I could see opportunities, again, sort of drawing on those big picture skills, on my skills for abstraction, to think about ways to produce knowledge or curate existing knowledge in ways that will be useful for those in a position of responsibility to be able to make informed decisions or more rapid decisions, given the options.

 Garry Aslanyan [00:06:41] The term global health has come under significant scrutiny lately for carrying a connotation of, and I quote, "public health somewhere else". However, Renzo and Steph had to confront the tension between the global versus local and make a decision as to when is the right time to contribute to each sphere. They have been able to reframe their global health careers in a more inclusive manner by focusing on national issues with international relevance and applicability.

Renzo Guinto [00:07:18] I guess one important crossroad that I've encountered is tension on whether I stay in the Philippines and, for example, receive my education here, gain more exposure in domestic public health, versus gain experiences from abroad, for instance, pursue advanced education overseas, and really trying to strike a balance between the two. And I guess that's a major challenge for us emerging global health practitioners, scholars and leaders from the "Global South", because, yes, we have pressing global health challenges that we certainly can contribute in in terms of solving them, but also we still have the baggage of the local health problems. You know, tuberculosis is still a major challenge in the Philippines. Universal health care is still not yet a reality for many Filipinos. And so I guess that's always a tension and a dilemma that I always encounter in my young career so far, so I focus more my energies on international work versus domestic priorities.

 Garry Aslanyan [00:08:40] I personally found a lot of parallels with my own choices between national or global careers. I found that global experiences gained at TDR enriched our approach to national issues in Canada. Following a rewarding career chapter in Zambia, Steph made the decision to return with her family to Australia. This was a critical career juncture for her.

 Stephanie Topp [00:09:08] Another came right on the cusp of having my first child, a daughter. When I saw a job, I was at that stage still based in Zambia, and I saw a job advertisement for my current role, which is at James Cook University in North Queensland in Australia. And there the role was very attractive in the sense that it was at a level that I felt I was competent, but it would have meant, it did mean, a huge move for me and my partner from Zambia to northern Australia, from an NGO work arrangement to an academic university appointment, and there were lots of factors that contributed to that decision. But a really important one was this desire to reengage with the Australian health system and the inequities that I knew were manifest in the Australian setting and to be accountable as a citizen in my country for contributing to knowledge and research production that helped to address that.

 Garry Aslanyan [00:10:23] The experiences Steph gained in Zambia gave her a new outlook on the health inequities present in the Australian health system. It further made her aware that self-reflexivity is a critical competency required by all working in global health. Decolonizing global health thinking is as much an individual as a systemic necessity.

 Stephanie Topp [00:10:50] I think in global health there is still a lot of us and them thinking and a lot of bipolar positioning of global north experts and global south recipients of expertise. And I think that it stems from many, many things, but a lack of reflexivity on the part of global north institutions and individuals about the way their own society and their own health systems also producing profound inequities is a contributing factor to that. I think one of the reasons they are not so reflexive is because global health, if you trace it, I mean the antecedents of global health, are a colonial set-up that had colonial powers sending medical doctors to colonized states to deliver expertise for various reasons in order to prop up extractive trade regimes. And it's an uncomfortable history to reckon with in an industry that fashions itself as benevolent in its modern day iteration.

 Garry Aslanyan [00:12:20] Is there an aspect of the indigenous groups and how they feel about this?

 Stephanie Topp [00:12:26] I shouldn't speak on their behalf. I know that historically First Nations groups have not been particularly engaged in global health work. That may stem from a recognition on their part, positionality on their part that they do not wish to engage in what is potentially perceived as neo-colonial practices. But I think another potential factor is that they are so engaged with what is for them a day-to-day fight with the institutions of power in their own nations, that that's enough, that there's nothing left after they've done that.

 Garry Aslanyan [00:13:18] In this response Steph gave me, it was evident that she practices the values and principles that she has written about in her research outputs. Each global health conversation is an opportunity to reshape power dynamics, such that marginalized communities can have an opportunity to speak for themselves.

 Garry Aslanyan [00:13:39] As we strive for equity in global health, it is as important for global health education become equitable. In my conversation with Renzo, he highlighted the opportunities he gained from pursuing his doctorate at Harvard. He's very conscious that this is not a privilege afforded to all. Acquiring an education from a leading institution plays an influencing role in future career positioning, networks and opportunities.

 Renzo Guinto [00:14:26] Education that transcends borders is really essential. But surely, unfortunately, this is something that is not within the reach of many. And what we need to really think about is how to make these educational opportunities more accessible and equitable and even democratic, right? And I guess the COVID-19 pandemic is now giving us some windows of opportunity, for instance, for online learning and bilateral exchanges. So those are some of my thoughts when it comes to global health education. There's still definitely a lot of inequalities, but certainly also emerging opportunities moving forward.

 Garry Aslanyan [00:15:14] Steph reflected on the influence of one's primary education experience and how different disciplinary fields shape global health practice. Global health education, underpinned by biomedical approaches and side-lining social sciences, was a contributing factor to health inequity for Steph.

 Stephanie Topp [00:15:37] Biomedical knowledge is the foundation of addressing health inequities, which I would challenge. I think probably, if you look at the root causes of health inequities, they are not going to be solved with biomedical knowledge. Biomedical knowledge delivers more sophisticated and better health care. It does not solve the root causes of health inequity, which lie often outside of the health sector itself. And so an understanding and an education that is more equitable in its spread of disciplinary capabilities that produces global health experts who can operate in urban planning, in environmental planning, in social service spaces, and who can inform decisions and work with decision-makers in those different sectors in ways that have profound impact(influences?) on those health outcomes are just as important as those in the global health domain who are operating in the formal health system to try to improve the quality of care for those who do become sick.  In the end, I think that global health education lacks sufficient investment in competencies that derive from the social sciences. My foundational training was in history and in between my public health and my Masters of Public Health, my global public health Ph.D., I did a Masters in Development Studies, and the competencies that I derived from those two social sciences degrees are what I bring into play in my work on a daily basis. Competencies relating to thinking about management structures, systems thinking, political analysis, critical studies. I think if global health as a field, even partially, is interested in improving equity, then understanding the social and the political and the cultural landscapes in which those inequities thrive is absolutely fundamental.

 Garry Aslanyan [00:17:57] In season one of the podcast, we explored the topic of science communication. My discussion with guests Natalia Pasternak, Imogen Foulkes and Sonia Lowman, highlighted the need for global health professionals to be strong communicators. You may want to check out that episode. As two excellent communicators, I wanted to gain Steph and Renzos' views on whether communication should be a standard competency in global health education.

 Stephanie Topp [00:18:29] Communication is absolutely key but is slightly different to the communication that goes into thinking about what this podcast is producing. For example, the kinds of competencies that enable people to be good communicators in different domains would be another capability, another area of global health education that I would advocate for. I think it's essential and I think it is often a side thought or a belated career add-on when if it were embedded from the get-go, it could be hugely productive and serve both those involved in the healthcare delivery as well as the more upstream components of global health that I was talking about would benefit from.

 Garry Aslanyan [00:19:28] Renzo has been drawing on a range of communication tools to raise awareness of climate change and its impact on local populations. Renzo's research reached both professional and lay audiences as he believes only through collective awareness and action can the health of the planet and people be safeguarded.

Renzo Guinto [00:19:52] In this era of not just misinformation but a lot of noise and chaos and dissonance, I think the best communicators in global health are the ones that will triumph because communication is what will influence policy-makers, will raise awareness among the public and hopefully will effect lasting change in policy and practice in our field. There are a lot of new tools and platforms for global health communication, but there are also different styles of communicating. So, for instance, I love the power of storytelling in public health, in medicine, we've been trained to discuss public health matters, medical matters, in a very jargon filled way. And I think now, we need to take advantage of new ways of communicating like storytelling because stories do not just educate the brain, they also touch on the heart of audiences, of listeners. So storytelling, films that do not just paint a gloom and doom picture, but really convey a message of optimism and hope that these challenges, whether it's the climate emergency or the COVID-19 pandemic, they can be addressed, they are not totally insurmountable. We just need to work together and to really harness the innovativeness of the human spirit. Those are the kinds of stories that I want to tell more in more, moving forward, either through film or song. As you know, Garry, I'm Filipino. We love karaoke singing and I think we should have more music, in short, the sky's the limit in terms of the creative ways of communicating about global health, not just about the problems, but also the solutions.

Garry Aslanyan [00:21:47] For most of us working in global health, mentors have played an important role in our careers. I myself am not an exception. I've had various mentors throughout my career and actually continue to draw on the wisdom of mentors. While I now often find myself playing a mentor role. I came to Public Health originally being trained as a dentist. One of my early mentors, who was in a senior leadership position at a Municipal Public Health Unit, helped me build on my training and recognize the policy and political dimensions of health. I doubt I would have realized so early on the importance of the political in public health without that kind of timely guidance I received. Supporting global health careers, especially those of researchers in low- and middle-income countries, is a main focus of work we do at TDR. I've heard so many times from researchers who have been supported by us, the impact mentorship has had in advancing their global health career in addition to their formal education. Significant investments that are being made each year in new mentorship programmes for global health professionals, but their impact is not always clear. Renzo and Steph shared with me the difficulties in quantifying the value of mentorship relationships, which often extend far beyond pure professional gain.

Renzo Guinto [00:23:13] I think mentorship can go in all directions. I remember I had a colleague from the Philippine Department of Health and he is more than a decade older than me, but he always tells me, Renzo, you are actually my mentor, I've learned a lot from you. And so mentorship definitely transcends the boundaries of age. Another thing that I had the pleasure of having is what I call an informal council of advisors. Because mentorship is quite intensive, right, and it requires long term and sustained relationship building between the mentor and the mentee. But I think it's also important to know and to have a pool of people, colleagues, senior leaders, etc., who you can easily send a WhatsApp to or ring their phones if you have a question that perhaps is of particular interest and expertise to that person. And so I think over time, through the years, I have created that "circle of advisors". That's my encouragement. Find your mentors, but also create an informal circle of advisors that is diverse, from different fields and disciplines, international, coming from your country but also elsewhere, and from all ages,  from the young to the young apart.

Stephanie Topp [00:24:51] It's played a huge role on both sides of the coin, if you will, both as a mentor and as a mentee. And it's come from expected in unexpected places.  The friendship with my Zambian colleague and I would consider her one of my most important mentors, primarily as a cultural mentor, but also as a professional mentor operating in, especially in those early days in Zambia, in clinical spaces with which I didn't have a great deal of familiarity, and so watching her, emulating her, seeking advice from her in terms of understanding how to communicate, when not to communicate and so forth, was really important. I would also say though that being a mentor has been really important in my career, especially for helping me think through where my strengths are and what it is that I'm trying to achieve with my work. So when you're in this position of providing advice to people, whether it be academic or professional or otherwise, it's an exercise in reflexivity in the sense you're trying to abstract your own experience and explain what was useful about that for someone else and why it was important to you. And I've certainly come to know myself and my own decisions better, I think, through conversations that were catalysed in a mentorship role to others. On a very basic level too, I think taking on mentor roles has helped me grow into my career and just be more confident in myself and feel less like an imposter, which is something I fight on a daily basis.

Garry Aslanyan [00:26:39] Steph highlighted a very important structure for mentorship, that of network capacity building. Her experience of being part of a mentoring network such as the Emerging Voices for Global Health Programme, gave her the courage to challenge the prevailing power dynamics and rhetoric in global health. This programme went beyond building the capacity of young global professionals within their institutional setting, to rather build their capacity for system level change.

Stephanie Topp [00:27:13] Global health, it's not a thing, it is a series of challenges that sort of revolve around these ideas of health inequities and health service or health system inequities. And this is an age old strategy and support of addressing those types of inequities that are always related to power, is collective action. And from the perspective of how we can support a next generation of thinkers and leaders, then I think that networked capacity building, the emerging voices models, is an absolutely critical example. I continue to be so grateful for having an opportunity to participate in emerging voices originally as a fellow, and then in subsequent editions as a facilitator or in a planning role. We can't just support individuals in isolation. We need networks of emerging leaders. We need to provide them with proving grounds for discussion and debate that, and I think this is really important, that are not trapped or tamed by the logic and the vested interests of universities or even single institutions, which is where you typically get individual leaders emerging. Right? So if you're only supporting the individual within a single institution, then the vested interest of that institution tends to shape the opportunities for that leader. In a networked capacity building opportunity, those individuals are taken outside of their institutional home, their organizational home, and given opportunities to think and act outside of that in ways that create collective strength, but which, like a university cohort, and there are strengths of a university cohort, can establish lifelong relationships that inform each other's decisions and give each other strength and enabling them to draw on each other at different points in their career. So it replicates the cohort model, but it takes them outside of the vested interests of existing institutions that often have very specific priorities themselves. And I think without a strong network of leaders who's thinking has had an opportunity to develop beyond the priorities of their individual institutions, it's very difficult to achieve change, whether incrementally or more radically, because we need that change to happen concurrently in different places, in different ways that require people to be able to draw on these networks in flexible ways.

Garry Aslanyan [00:30:19] Steph and Renzos' journeys have a common thread; they are each highly motivated to address a key global health challenge and committed to gaining the breadth and depth of education required to alleviate these challenges. Their careers have consisted of multiple iterations and decisions made at critical junctures. With each, their approach to global health practice has been refined and defined. 

Garry Aslanyan [00:30:47] The final question I posed to Renzo and Steph was to inquire about their vision for global health. These two emerging leaders jargoned humility, diversity and justice as three core guiding values by which global health can be reimagined. If we, as a broader global health community, can embrace these, the possibility of equitable global health systems becomes an achievable reality in our lifetime. I will let Renzo and Steph explain it in their own words.

Stephanie Topp [00:31:27] I don't have a vision for global health. I don't think global health is a thing to be imagined so much as a collective effort to improve health and well-being and the equity or inequities that influence health and well-being in so many distinctive contexts. And I think recognition of those distinct contexts requires humility as much as hubris of a unified goal, so in the sense that we have to be able to admit what we don't know as well as what we do know. So I think I want global health to be more reflective of the way it is ensnared with so many broader power structures that shape the way things are done in the field, both in terms of global health practice as well as global health research, and I want for global health to become a field where people are emboldened to challenge those power structures, because those power structures are equally the cause of the inequities that global health claims to be trying to address. So I want it to be a place where people are bold and a place where people go to challenge the root causes of inequities rather than a place where they become entrapped by those same structures that are causing the inequities.

Renzo Guinto [00:33:07] Systems are creating disease and widening inequalities that if we do not address them and even transform them, we are facing a very high risk of just perpetuating them rather than reaching this "new normal" that we want. In terms of global health, of course, we want it to be more inclusive and diverse in terms not only of the people that work in it, but also the ideas and the solutions that are being advocated and spread and implemented. Especially now in this pandemic we're seeing lots of innovations from different corners of the world. We always thought that the north or the west are the only places for new ideas, new knowledge, and now you see countries in Asia, communities in Africa, that are able to address local problems without perhaps external help, but also taking advantage of local knowledge, even indigenous knowledge as well. And so I think global health has to become humbler as well in the process, listening to different voices, bringing in a lot of different perspectives and people, especially young people. So these are just some of my initial ideas when it comes to not just decolonizing but reimagining global health. Humbler, more diverse, more inclusive, more just.

Garry Aslanyan [00:34:56] Thank you for listening to this episode of the Global Health Matters podcast. On our web page, you can find more information about each episode, including suggested readings by our guests, show notes and translations. We would like to invite you, our listeners, to share your own career reflections with us. How has a mentor supported you in your journey? What were the key moments that defined your career? And for our younger listeners, how can we as a global health community better support you in your own career? Get in touch with us on social media, via email or by sharing a voice message with us. Tune in next month when we continue the conversation on yet another important issue in global health. Subscribe and share this episode with your colleagues and friends and sign up for the Global Health Matters newsletter. We will ensure to let you know when the next episode is available.

Elisabetta Dessi [00:36:03] Global Health Matters is produced by TDR, an infectious diseases research programme based at the World Health Organization. Gary Aslanyan, Lyndi Van Niekerk and Maki Kitamura are the content producers and Obadiah George is the Technical Producer. This podcast was also made possible with the support of Chris Coze, Elisabetta Dessi, Iza Suder-Dayao, Noreen O'Gallagher and Chembe Collaborative. The goal of Global Health Matters is to produce a forum for sharing perspectives on key issues affecting global health research. Send us your comments and suggestions by email or voice message to TDRpod@who.int, and be sure to download and subscribe wherever you get your podcasts. Thank you for listening.