For public health-global health senior Rohini Achal, public health and public service are inextricably linked. That’s because policies have a direct impact on the health of communities, Achal said.
“[Public health and public service] both work to serve constituents and advocate for policies, programs, and practices that consider the well-being of communities and not individuals,” Achal said.
Achal, who has been pursuing her bachelor’s degree at the University of Washington School of Public Health (UW SPH), had the opportunity to discuss this important connection between health and service with Bizu Gelaye, fellow UW SPH alum (Epidemiology MPH '11 and PhD '13) and Harvard T. H. Chan School of Public Health Associate Professor of Epidemiology and Psychiatry.
Their conversation appeared in the Public Service Review, a publication of the Stennis Center for Public Service, which is a bipartisan legislative branch agency. Achal and Gelaye talked about the social determinants of health, their experiences at the University of Washington School of Public Health, and their hope for future professionals in this field.
Read Achal’s interview with Gelaye while he was in the Mississippi Delta helping lead the Delta Scholars Program.
This interview was first published in the Summer 2023 edition of the Public Service Review. The article is reposted here, with permission.
Rohini Achal: Thank you for meeting with me today as part of the Public Service Review.
Dr. Bizu Gelaye: Thanks, Rohini. My name is Bizu Gelaye. I'm an Associate Professor of Epidemiology and Psychiatry at Harvard School of Public Health and Harvard Medical School, and I do research on various topics, particularly in maternal and child health and psychiatric epidemiology in global settings.
Achal: Thank you for agreeing to this interview which will benefit students interested in public health and public service. Can you tell me about yourself and describe your career path?
Gelaye: I'm one of those people who didn't have a straight path. I grew up in Ethiopia in East Africa and moved to the U.S. about twenty years ago through a program called the Diversity Visa Program. My training background prior to moving to the U.S. was in mechanical engineering, which I worked in for a couple of years. I wanted to be in an academic setting, and I was fortunate enough to get a job at the University of Washington managing a training program. It was in the School of Public Health and the Department of Epidemiology, and my desire was to study mechatronics, an engineering field that combines mechanical and electrical engineering. Little did I know about the public health field, so I wanted to be in academia so I could take free classes. I was working full time, and one summer there was a program that the Department of Epidemiology put together in collaboration with the Seattle Department of Veterans Affairs teaching them epidemiology. I decided during the summer, because I had nothing better to do, to sit in those classes. I immediately fell in love with epidemiology, and I saw the kind of contribution I could make if I studied public health. And that was how I got into public health.
Achal: You already led me into my next question which is what drew you to public health, and what are your public health passions?
Gelaye: I wasn't aware at the beginning what public health is. I had participated in it in undergrad and some research activities, but I didn't make the connection. As I started to learn more about epidemiology, I started to see the analogy between engineering and epidemiology because engineering is about solving problems, and so is epidemiology but in the public health space. So, I saw engineering as the most applied part in the same way that epidemiology is the most applied part of public health, and it just goes beyond the beauty of the science. It's an applied field of public health. I also believed I could make a greater impact to the communities I came from by studying epidemiology where you can understand the burden of disease at a global scale and a population scale to try to understand the causes, risk factors, or drivers of health outcomes which you wouldn't be able to do by studying mechatronics. Its application would be limited. It would be self-fulfilling. But in terms of impact, I saw that public health could do greater work.
Achal: That’s why I got into public health, seeing the bigger systems and trying to understand the social determinants of health. How do you see anti-racism work fit in with your passion and career goals? Do you see it in your work? Do you see public health leaning more toward that in the future, and how can it improve that lens?
Gelaye: I love the discipline, epidemiology. It's a great discipline. It is about who's getting a disease or a particular outcome, what factors give rise to those outcomes, and how we address them. That is, in a nutshell, the definition of epidemiology, and it is very solution oriented. Unfortunately, the majority of public health research has largely focused on individual risk factors, not going deeper into understanding the structural factors or root causes that give rise to some of the outcomes we observe. Its definition includes those structural factors, including factors that give rise to the kind of policies that drive those outcomes. It's inherently in the discipline, but the field hasn't done the work that it should do. There is a growing recognition in the general field of epidemiology and public health in terms of addressing not only the research but also its teaching and mentoring to have an anti-racist lens, but we still have more to do. In the last few years, we have seen a more renowned commitment through academic institutions and even funding agencies, including the National Institutes of Health, investing more money to address the root causes of public health problems. So, there is definitely more attention being paid. But I think we have more to do, and I'm hoping that you young people could do even more.
Achal: It’s definitely my hope, too, and I agree that we're slowly but surely getting there, but there's a lot more emphasis that needs to be placed on facts, justice, and equity. Both of us have had the pleasure of attending University of Washington Seattle. I'm currently there, and you are a former Husky, so I was hoping you could tell me a little bit more about your experience at UW. Why did you decide to get an M.P.H. and Ph.D. at UW, and what was your experience like?
Gelaye: Initially, I didn't see myself getting a master's degree or a Ph.D. degree. I was the first in my family to complete high school, so that was a big accomplishment. Getting an engineering degree was the biggest accomplishment I could see for myself, so my horizon was artificially low. It is just through God-sent mentors that I met at the University of Washington that I started to see myself in a different light. One of the mentors I had was a brilliant epidemiologist, Dr. Michelle Williams, who was the Dean of the School of Public Health until recently. She has touched the lives of so many people, including my own, and allowed me to start to see myself getting an advanced degree. As much as I loved UW, it wasn't the most diverse place at that time, so seeing someone like Dr. Williams was quite inspiring, and I started to take classes one at a time after that summer course. By the time I fully matriculated in the graduate program, I had already taken all the required courses, so it was an easy switch. I decided to matriculate in epidemiology then took additional classes which were easy to take because I love the discipline, and I can see its application in the field.
Achal: After UW, you moved to teach and conduct research on the east coast at Harvard. What research are you working on currently?
Gelaye: My experience at UW helps inform what my experience at Harvard is because the training that you get at UW is a solid epidemiology training. Some of our professors at UW were public health giants. And the training was an applied one. We had access to state registry records and hospital discharge data to design applied research projects. And in many ways, those experiences shaped what I do in my own teaching and in my own mentoring, and I still go back to my UW training materials to teach, be it in Durban, South Africa, Lima, Peru, or, here, in Mississippi. In many ways, it really helped inform the work that I am currently doing. I'm currently primarily working to address maternal and infant health outcomes. In particular, I'm working on how trauma and adversity affects maternal health across the life course, not only maternal health outcomes but also intergenerational and what we can do to address it because epidemiology is not only about studying but also about addressing. In addition to the research work that I do, I'm heavily involved in training programs. There's so much inequity when you look at the workforce domestically and globally. I believe one way to address some of the health disparities is by expanding training opportunities for members of our community that have been historically underrepresented. I work with a training program that tries to address and expand psychiatric genetics research capacity in low-income countries, particularly in Sub-Saharan Africa. As part of the work that the Stennis Center supports, I have the pleasure of being a part of the Delta Scholars Program leadership. The main goal there is when enough people have a seat at the table, they can design studies that benefit their own communities, and they can address the inequalities that we see in many of the health outcomes.
Achal: That’s something that we really place emphasis on at UW, especially in the School of Public Health—the life course approach but also community. What is the most fulfilling part of your career?
Gelaye: I've been an academic for almost 19 years, and one of the greatest joys that I still get is working with the students and mentoring. I had the good fortune to be mentored by amazing faculty members throughout my career, and I'm trying to pay it forward. But it gives me greater joy mentoring and creating opportunities for students whose profiles and backgrounds are not represented in places like Harvard. It is really important to do this work because we still have a long way to go. If a person like me who's from Africa can make it, many, many, many well deserving students can make it in places like Harvard.
Achal: What challenges do you face daily and long term in your career in research? What do you think is the hardest thing about the research and work that you do?
Gelaye: That's a million-dollar question, right? At a more general level, the greatest challenge I see in research is the credibility of science and research is constantly under attack. In recent months, work related to addressing historical inequities is increasingly political. Scientific responses are codified in political responses. That makes it challenging, but on the flip side, the resolve, commitment, and advocacy I see in young people gives me hope. The other challenge is the funding structure we have in academia. It is not the best designed to address some of the core issues. Those are some of the challenges that we have, but you get joy in working with communities, collaborators, and students, so it's a balancing act.
Achal: I appreciate you mentioning the funding structure but also ending it on a positive note that there is hope for the future. People are still moving the needle. It's not a lost cause. Public health is a developing field, but a lot of people are interested in it, which brings me to my next question. Many students reading this are probably looking for advice in pursuing a career in public health. What advice do you have for students interested in public health, and do you have any specific tips for succeeding in the field?
Gelaye: We have seen quite an increase in the number of students who apply to the programs we have. Around the beginning of the pandemic, the number was almost double, but still there is a sustained and continued interest which makes me really happy. In terms of advice, I would say to obtain some research experience during undergrad years. Even if you are not in the public health field, there are so many applied summer programs and internships for undergraduate students that provide meaningful research experiences. I highly encourage people to explore those. They are often the defining experiences for people who want to pursue a career in public health. If that is something that you are interested in, the other thing which is increasingly becoming clear to succeed in public health is recognizing that public health is dynamic. It requires dealing with unexpected changes and flexibility to be able to respond to changing circumstances. We've seen it during the COVID-19 pandemic and through other health issues. Having that flexibility mindset is important. The other important skill set I would say is good communication skills. It is increasingly important to be able to have clear communication, not only scientific communication but also communication with policymakers and the lay public. Lastly, I would say cultural competency and cultural humility is an important skill to have which involves understanding, communicating, and effectively interacting with people across different cultures. Public health is not about the individual, it is about collective people, and actions of global communities are going to have an impact on the outcomes people face. Having that cultural competency and humility is really important to understand how we can address the collective challenge we all face. It's not about individual decisions or individual choice, but it is the collective effort that protects all of us from traits that we face in public health.
Achal: From that, I would like to highlight the cultural humility and competency, and, to your point, I believe everything has a health implication. I'm in policy right now, and we have seen that policy always has a direct influence on health, so, for me, public health is inextricably linked to public service. They both work to serve constituents and advocate for policies, programs, and practices that consider the well-being of communities and not individuals, like you echoed. Do you see an overlap between public health and public service, and, if so, where?
Gelaye: Absolutely. If you think of many of the public health issues, they have their root causes, or underlying risk factors, in social justice, which is intricately tied to public service. A few years ago, the Centers for Disease Control came out with the 10 Essential Public Health Services framework that clearly articulated how public health is about public service, because public health is about protecting and promoting health for all people in all communities. Public service is inherently tied with public health, but there's this idea sometimes in academic environments that you have to stay objective, avoid advocacy, and do research. I think it's a false dichotomy. The two go together hand in hand. I highly encourage you to read about the genesis of community health workers. It started out in Mound Bayou, Mississippi. When John Hatch and Jack Geiger started the Delta Health Center, some of the issues they were addressing were not medical issues. They were addressing the social determinants of health, and it required advocacy and public service. In many ways, the two are overlapping, particularly with underlying social determinants of health.
Achal: The social justice piece is something that overlaps in both public health and public service. As you said before, public health is uniquely suited to protect and promote the health of populations and communities through its intersectional, multidisciplinary approach to societal issues. This is something that deeply excites me about the future of public health. What excites you most about the future of public health and public service and the new generation of students pursuing both public health and public service?
Gelaye: There is increasingly more focus on understanding and addressing not only the individual risk factors but also the structural and systemic barriers that result in health inequities. Those include homelessness, poverty, racism, gender discrimination, and all forms of oppression. I hope this is going to be a sustainable focus. Federal funding is increasingly focusing on those factors which gives me hope. The other thing is research has historically stayed within the walls of academia and in academic journals. You don't necessarily see it, in the past, outside those. But the young people, the students, and you all are bringing research into mainstream. We had a session a couple of months ago with social media influencers on TikTok and other social medias trying to get public health messaging to them, because communities listen to the influencers. Communicating our research in ways that we have not historically communicated, outside the research context, is important. That gives me hope that the next generation has pushed us to refine our communication beyond academic journals. I hope this continues. And, as I mentioned, I hope that the politicizing of public health issues becomes less of a concern with the next generation. That gives me hope.
Achal: That all comes back to what we talked about. Public health is dynamic. Public service is dynamic. Both are constantly changing and interconnected. Those are all the questions I have for you. Thank you so much for taking the time to be a part of the Public Service Review and be interviewed by me. I have enjoyed listening to your eloquent answers and being able to pick your brain.
Gelaye: Thank you for the great questions. It makes me really happy that UW has continued the legacy of providing training to young people who are choosing a career in public health. Including public service is going to be important for addressing the challenge that we face domestically and globally, so thank you.
See the full publication of the Summer 2023 Public Service Review, where this article first appeared.
Learn more about the interviewees
Rohini Achal is an East Coast native who moved to the West Coast to beautiful, rainy Washington at age five. She is an aspiring public health practitioner, lawyer hopeful, and currently a senior at the University of Washington (UW). At UW, Rohini is pursuing a bachelor’s degree with honors in public health – global health from the renowned University of Washington School of Public Health and a minor in public policy from the Evans School of Public Policy and Governance. Rohini was raised in a multigenerational household and got her professional start in childcare with her local school district, both of which spurred her interest in public health. Rohini is particularly passionate about creating and implementing evidence-based anti-racist public health policies focusing on inequities in long term health, reproductive health, environmental/climate justice, and education. Rohini was a nature and health policy intern at UW’s EarthLab, a climate research lab, and is a current civil division student trainee at the United States Attorney’s Office for the Western District of Washington. She also currently serves as one of two student representatives on the UW School of Public Health’s Public Health-Global Health Major Steering Committee, working with faculty and students to shape the direction of the School of Public Health’s #1 Undergraduate Major. Next year, Rohini will continue serving the major as a student resource coordinator. In her spare time, Rohini enjoys reading non-fiction and realistic fiction books as well as memoirs. You can also find her playing with her three-year-old French water dog, Hugo.
Dr. Bizu Gelaye is an Associate Professor of Epidemiology and Psychiatry at the Harvard T. H. Chan School of Public Health, Harvard Medical School and The Chester M. Pierce, MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital. He is an associate member of the Broad Institute’s Stanley Center for Psychiatric Research Program and Teaching Faculty at the Center for Bioethics in the Department of Global Health and Social Medicine at Harvard Medical School. Dr. Gelaye’s research makes innovative use of population-based data and biomarkers to understand resilience and risk factors for neuropsychiatric disorders. His work, in collaboration with multidisciplinary researchers, focuses on how trauma affects health across the life course and intergenerationally. Dr. Gelaye’s research also includes a focus on the application of psychometric methods in cross-cultural settings. In addition to research, Dr. Gelaye is a highly regarded mentor preparing outstanding, diverse public health scientists and leaders. He served as program director of the Multidisciplinary International Research Training (MIRT) program for more than 10 years. Currently, he is the program director of the Harvard T. H. Chan School of Public Health Mississippi Delta Partnership in Public Health Program and the associate director of the Global Initiative for Neuropsychiatric Genetics Education in Research (GINGER) Program.