Over the past year - during my time at Yale School of Public Health and following graduation - I have been fortunate to engage in discussions with numerous individuals interested in the subject of 'Public Health'. To many, preventative medicine immediately springs to mind; smoking cessation, healthy eating and increasing levels of exercise. As noble as these interventions are however, they alone do not encompass the breadth that is the subject of Public Health, therefore limiting the scope possible for those keen to contribute to this burgeoning field of endeavour.
The term 'public health' can be applied to any implementation that aims to improve the health of a given population, be that in a village of ten people or a city of one million. Access to efficacious medication falls under the umbrella of the discipline just as much as do water sanitation strategies, bringing us onto a cursory exploration of the pharmaceutical industry, which for a long time has been the object of less than favourable representation:
When I was 9 months old, I fell ill and rapidly deteriorated. I refused to feed, groaned in pain and from what my parents tell me, shied away from interacting with them, despite having previously been boisterous and sprightly. My parents, growing increasingly concerned and unable to find a physician in Cameroon who could diagnose my ailing condition, decided - in panic - to send me to France for treatment. Before we left home for the flight however, an astute friend of theirs, a young and sharp-witted medical doctor proposed meningitis as the culprit. Guided by his medical training and honed intuition, he administered the antibiotics that led to my rapid recovery and saved my life. All that remains from that episode is residual sensorineural deafness in my left ear, but I am otherwise healthy and well with intact cognitive faculties and a robust physical constitution.
The discovery and mass distribution of antibiotics sparked a revolution in healthcare that continues to transform the lives of millions as it did mine. However, in many parts of the world, access to medications that actually work continues to be an issue. We in the United Kingdom take for granted the fact that for just under $10 USD, we can have access to tried-and-tested drugs that will restore the level of health to which we have become accustomed and feel entitled. But inasmuch as accurate diagnosis is vital, so too is access to the medications required to address the clinical issues identified. This is particularly true in emerging nations where communicable disease poses a greater threat to human life than it does in ‘the West’.
As a young doctor, I remember struggling with the British National Formulary (the dictionary of medicinal drugs) and confused by its seemingly endless lists of 'interactions' and 'contraindications', regularly turned to Pharmacists for guidance. Whenever I had a query, or was uncertain about a dosage or metric, pharmacists pointed me in the right direction. In fact, it was in the hospital setting that I learned the inestimable value of the 'multidisciplinary team' and by extension, the necessity to forge partnerships that promote a multifaceted approach to problems. Truth be told, Public Health was a subject that bored me in medical school. But as my desire to impact as many people as possible grew, so too did my pursuit of avenues to effect population-level change. At Yale, I met with students in different concentrations of Public Health, from Social and Behavioural Sciences (i.e. Social Epidemiology) and Health Policy (the track I chose), to Epidemiology of Microbial disease, challenging my view of what exactly Public Health is.
I learned much during my time abroad. In particular, I became aware of the danger of corralling disciplines into limiting, myopic definitions. That is, the definitions we choose to adopt based on cursory analysis alone will determine the opportunities that we utilise to effect change. For example, if my view of Public Health is limited to health prevention strategies because I have not done my research, I will not think to reach out to teachers, politicians, pharmacists and private industry to forge relationships that will permit me to have a large-scale impact or find solutions from different vantage points.
My advice to those keen on pursuing Public Health, is to think first about the impact you wish to make, and if it is indeed related to health, explore the avenues and relationships by and through which it can be achieved. The goal (i.e. improved health of populations) is the primary objective, and with collaboration, reflection and determination, we can work to create novel avenues by which it is more effectively accomplished. As medical advancements and technology proceed, so too will this field about which I remain passionate. In this connection, and in light of the above, even the emergence of Artificial Intelligence applied correctly can be seen to have Public Health applications and in the future may very well develop into a subset of Public Health in its own right.
My own personal journey has brought me to effecting population level change through clinical research, in collaboration with key pharmaceutical players spearheading research into Alzheimer’s disease. The journey continues and so too do the collaborative relationships I forge, with the end (described above) in mind.
I do hope that this short article will at least spark inside your being, what my time at Yale lit ablaze in mine; a burning desire (pun intended) to make a positive difference to the health of populations that we will all one day serve.
This article was written by Dr. John FW Ndikum BSc MBBS (London) MPH (Yale)