During a family trip to southern India nearly 14 years ago, an influential mentor of mine and I both came down with a severe case of malaria. I survived my encounter with the disease, but my mentor did not. The reason? I had access to the world’s premier health resources once I returned to the United States, while my mentor had access to comparatively little.
In 2005, I began an MD-PhD program at Weill Cornell/Rockefeller/Sloan-Kettering working on how malaria parasites evade our immune systems. At the same time, I started to organize students globally to tackle neglected diseases of poverty. I worked on access to medicines and healthcare for an international student-run NGO called Universities Allied for Essential Medicines (UAEM), which seeks to make university-derived medicines and vaccines available in poor countries. My enduring vision – my ‘why’ – was access: increasing access to the ability to live a healthy, productive life.
Along the way, I began to see the rise of chronic, non-communicable diseases (NCDs) in developing countries. These diseases – and not malaria or HIV alone – will be the leading drivers of sickness and death by 2030. Meanwhile, our systems are not yet ready to cope with the explosion of heart disease, cancers, lung disease, diabetes, and mental illness. Following the pioneering work of HIV advocates, my initial reaction was to petition the WHO to include statins – a blockbuster cholesterol-lowering drug – on its essential medicine list. I had hoped that that would help control heart disease worldwide.
My colleagues in public health, however, pushed back. They asked, what is driving heart disease? What about tobacco? Fatty foods? Inadequate physical activity? Overuse of alcohol? I realized I didn’t know much about these – the causes of the causes. As I studied the data, I found that of the 30 years of life expectancy gains in America over the past century, only 5 are directly attributable to medical care. The rest were driven by tackling the causes of the causes – in particular sanitation and hygiene. I began to wonder what the 21st century equivalent of sanitation was. Was it food? Was it engaging the next generation of emerging leaders in universities to think of new solutions? Our current paradigm in health is adapted from germ theory, with a focus on curative approaches. For the modern era, we need new mental models. We will not solve depression with the same curative paradigm we used for malaria or smallpox.
This craving for a new perspective combined with a bottom-up approach led to the founding of the Young Professionals Chronic Disease Network (YP-CDN). To focus on this effort, I took some time off to serve as a Fellow at the Dalai Lama Center for Ethics & Transformative Values and a Fellow at Harvard Medical School’s Department of Global Health & Social Medicine.
The network serves as an incubator for nearly 2000 leaders under 40 from over 100 countries in disciplines ranging from urban planning to anthropology to clinical medicine. Many are students, NGO leaders, and young faculty keen to focus on new campaigns. One such campaign led by a member is the NCD Free project; another is work with the Institute of Medicine to help re-engineer transdisciplinary curricula in universities to give credit and incentives to out-of-the-box thinkers and problem solvers. On the third Thursday of each month, 10-12 emerging leaders meet in over 25 cities globally to re-imagine and then work towards a different world. Our guiding mantra is to develop thermostats (to change the state of injustice) rather than develop thermostats (those that provide mere descriptions of injustice).
I share Tenzin’s passion for engaging the next generation – especially university students. I taught a course via the Dalai Lama Center at MIT on re-imagining the world in 2050 for MIT’s Independent Activities Period; and in India, I worked with Tenzin to deliver a lecture on ethics and public health to over 300 medical students at Osmania Medical College in Hyderabad (which also happens to be where my parents’ went to medical school).
The problems we face in 21st century global health are immense; and a transdisciplinary, creative approach is needed from the next generation. You can see more about what animates me at this TEDMED talk and read about my interests in what human social movements can learn from microbes at this global health blog.