Academe and public health

Life in the academe at first glance can be just like any other job; like in all other careers, one gets involved in a rat race with the aim to climb up the career ladder, to gain both reputation and higher remuneration. Not to mention the privilege to brandish one’s fancy academic attire year after year during commencement.

This was my first impression of the academe, when I chose it as an alternative career track after finishing a stint in government. I intended to do research to supply evidence that will support health policy in my country. Also part of this motivation was to share my experiences to students and fellow faculty.

I soon realized that this was not just what the academe is all about. Now, almost four years since I chose this career track, I now fathom the immense importance of the academe in pushing further the boundaries of knowledge, and defining what it means to be in public health. Cliche as this may sound, accomplishing such a duty entails finding new approaches and concepts to teach to my students, making sense of current and emerging trends in my field of endeavor, and catalyzing discussion on how to solve the problems of the world today. 

All these sound like mammoth tasks to achieve, but what I find deeply consoling in the academe is that all these starts with the stroke of pen and ink. In an attempt to respond to real world needs, we academics write the ideas brought forth by deep introspection and analysis of the problems set before us. 

Pragmatic thinking may dismiss academic publishing as non-productive; indeed, matters discussed for the sake of discussion with action as mere afterthought are often deridingly deemed moot and “academic.” But my experiences in the field taught me that academic writing serves a uniquely important purpose: it serves to challenge norms and paradigms, allowing us to zoom out of conventional ways of solving problems, and propose suitable solutions. 

In my past work in public service, I aimed to solve public health problems while looking at the context of my clientele: their culture, their socio-economic concerns, and their collective aspirations. I believed that using this approach would result in interventions that are acceptable, affordable and appropriate. 

However, many public health programs were implemented by following checklists and monitoring success indicators that were determined by program managers and policy implementors who were marginally aware of the context of the target population. I couldn’t blame them, as this was the only way to ensure well-monitored progress of health improvement for a budding health system such as ours. 

In this system, these interventions started with a written plan, which usually followed a certain template set by legal and bureaucratic protocols. Though there was room to propose adjustments applicable to the local setting, due to the sheer volume of work, health officers would just stick to accomplishing bare minimums. 

In this system, many an implementor would be wont to say: As long as our scorecard wasn’t red in this indicator, I’m OK. As long as I’m not rock bottom in my province, I’m OK. As long as I don’t have any maternal or neonatal death in my jurisdiction, I’m OK.

Indeed, it’s OK. But does this lead to achieving the “best possible state of health?”

Back in medical school, I was introduced to the concept of working towards the “best possible state of health for all,” a principle upheld by the WHO Alma-Ata Declaration on Primary Health Care in 1978. Despite its battlecry for community-managed health care and “health in the hands of the people,” due to various practical reasons, health care became fragmented, compartmentalized, and indicator-driven, both in government and private sector health management; what, with the emphasis on financial accountability and the need to prioritize interventions that generate the greatest apparent return of investment.

Clinging to my belief in providing the best possible health care for all while being aware of the current practical difficulties in implementing the Alma-Ata Declaration, I felt that approaching health problems from an academic standpoint would enable me to zoom out from this state of affairs, and investigate approaches that would truly produce the best possible health. 

This is why I chose to be in the academe. I still believe in health for all, and I want to be at the forefront of how it is to truly achieve it.