Is there a global health bubble? (Or: should you get an MPH?)

There's a LinkedIn group for Global Public Health that occasionally has good discussion. One example, albeit a sobering one, is the current discussion of employment opportunities after MPH. I've been meaning to write about jobs for a while because now that I'm on the other side of the picture -- an employed professional with a job at a reputable organization, rather than a grad student -- I find myself doing an increasing number of informational interviews, and saying much the same thing each time.

[First, some caveats on the generalizability of the advice below: first, folks with an MPH from another country often have less debt burden than Americans, so may find it easier to do long unpaid or underpaid internships. Second, folks from low- to middle-income countries are and should be more employable, especially in their own countries. Why? Because they have incredibly valuable linguistic and cultural talents (see Alanna Shaikh's recent post on this), so much so that an organization choosing between an outsider and a local with the same technical skills, communication skills, etc, should almost always choose the local. If they don't, that's generally a sign of a dysfunctional or discriminatory organizations.]

The problem is that there is something of an MPH bubble, especially in global health. The size of MPH classes has increased and - more importantly - the number of schools granting degrees has risen rapidly. Degrees focusing on global health also seem to be growing faster than the rest of the field.  (I'd welcome data on class size and jobs in the industry if anyone knows where to find it.) This is happening in part because public health attracts a lot of idealists who are interested in the field because they want to make a difference, rather than rationally choosing between the best paying jobs, and global health has gotten a lot of good press over the last decade. Call this the Mountains Beyond Mountains Effect if you like.

If you know this, and still go into the field, and don't have an MD or PhD that qualifies you for a different sort of job altogether, then you need to distinguish yourself from the crowd to be employable. I'm assuming your goal is to get a good job in global health, where "good job" is defined as a full-time professional position with a good (not necessarily big-name) organization, working on fulfilling projects and being paid well enough to live comfortably while paying off the loans that most American MPH grads will have. For some, though not all, a good job might also mean one that's either based abroad or involves frequent international travel. If that's the goal, then there are several ways to distinguish yourself:

  1. get some sort of hard, transferable skills. This can be research or M&E skills, especially quantitative data crunching ability, or it can be management/coordination experience with serious responsibility. Or other things. The key point is that your skillset should match jobs that are out there, and be something that not everyone has. A lot of MPH programs feature concentrations -- or the lack thereof -- that are more appealing to students than they are to employers. A biostatistics concentration will likely serve you better than a global health concentration, for instance, and with some exceptions.
  2. get solid international experience, preferably a year or more. Professional experience in public health -- even with a lesser-known organization -- is much more valuable than experience teaching, or studying abroad. Travel doesn't count much, and it's better to have experience in the region you're interested in working in. There's a huge catch-22 here, as you need international experience to get it, so that many global health folks start off doing work they're critical of later in their careers.
  3. relatedly, speak an in-demand language, though this will only help you to work in the region where it's spoken.
  4. have professional work experience. Even if it's not in global health, having worked an office job for a year or two makes you more desirable to employers. No one wants to be your first employer, so folks who go straight to an MPH may find themselves less employable than peers who worked for a bit first.
  5. go to a top school, which signals that you're smarter or better qualified than others (this often isn't true, the key part is the signalling, and the networks you acquire). Also, graduates of top schools often get good jobs in part because those schools select people with good work experience, skills, and connections to begin with, so that a superior candidate at a school that's perceived to be a second or third-tier school can do just fine.
  6. avoid debt (which often conflicts with 'go to a top school') to give yourself the flexibility to work for less or for nothing at first, until you can do the above.

Any one or two items from this list probably won't cut it: you need to acquire several.  For example, I've known peers with a solid technical degree from a top school and some international experience who still struggled to get jobs at first because they had never had a regular office job before grad school. Also, the relative importance of each will vary according to the subfield of global health you're interested in. For instance, learning languages might be more important for an implementation person (program coordinator or manager) or a qualitative researcher than it is for a data cruncher.

I used to be pre-med, until I realized I was more interested in policy and did not want to be a clinician, and the path to doing so in the US is long and expensive. Like many former pre-med students who decided not to go to medical school, it took me a while to figure out what I wanted to do, and how to do that without an MD. A couple years post-undergrad I found myself working a job that was interesting enough but not what I ultimately wanted to do, and unable to get a first job in global health without the requisite skills or longer international experience, and I didn't have the resources to just up and move abroad on my own. So, I went to go to grad school with a technical focus (epidemiology) at a top school, and then used the practicum requirement to build more international experience (Ethiopia). The combination of school and work experience gave me solid quantitative skills because I chose to focus on that each step of the way. But, it also meant taking on quite a bit of debt, and the international practicum would have required even more had I not had generous funding from the econ/policy degree I did. This has worked out well for me, though that same path won't necessarily work for everyone -- especially if you have different interests from mine! -- and I think it's instructive enough to share.

The upside of this bubble is that organizations often hire well-educated, experienced people for even entry level position. The downside is that people from less privileged educational or financial backgrounds often get blocked out of the sector, given that you might have to volunteer for an extended period of time to get the requisite experience, or take on a lot of debt to get a good graduate degree.

In conclusion, getting an MPH -- and trying to break into global health -- is a personal decision that might work out differently depending on your personal goals, the lifestyle you're looking for, and your financial background. But if you do get one, be aware that the job market is not the easiest to navigate, and many MPH grads end up unemployed or underemployed for a stretch. Focus on acquiring the skills and experience that will make organizations want to hire you.

NYC and London from the air

My recent New York to London flight featured both good approach paths and nice weather, so I snapped a few shots. Here's New York, taking off:

And London:

I was going to include a quote here from Gotham, an epic and impressively readable history of New York City, regarding how communication and travel times between London and New York decreased during the 17th and 18th centuries, but can't find the quote readily now... So, short version: things got faster.

Next up!

After three years, I'm done with grad school! I finished my MSPH (Global Disease Epidemiology and Control focus) at Hopkins in late May, and my MPA (Economics and Public Policy focus) at Princeton in early June. It's been a lot of work: 10 months of internships, 3 comprehensive qualifying exams, and a Masters thesis; plus 4 quarters of Hopkins classwork and 3 semesters of Princeton classwork for a total of 33 graduate classes. I loved being in school again -- not all my classmates did -- but I'm also happy to have wrapped things up. One consequence of studying applied subjects like public health and public policy is that you're rarely delving into a subject just for kicks (at least for long); the goal is always to get out and do good work with the knowledge and skills you've acquired. This week I started a job I'm really excited about: working with the Clinton Health Access Initiative (CHAI)'s Applied Analytics Team. If you're curious about CHAI here's their about page, and this profile of Elizabeth McCarthy tells a bit more about the Applied Analytics Team (which she runs). We're also hiring. As with my previous internships and work, I won't be writing directly about what I'm doing much at all, but I'll still be writing more broadly about global health and development policy. (And this is probably a good time to reiterate that the views here are just my own.) I'll be working on projects throughout sub-Saharan Africa -- I'm headed to Nigeria for a couple months on Saturday! More on that soon.

Now, back to my (ir)regular blogging...

Housekeeping

I recently updated the post categories on this blog, trying to clean things up a bit. Since a lot of my posts are link roundups, shorter commentary, or photography, I added a category called "prose" that includes all the slightly longer, more substantive things I've written. You can browse that category here.

Ethiopia bleg

Bleg: n. An entry in a blog requesting information or contributions. (via Wiktionary)

Finals are over, and I just have a few things to finish up before moving to Addis Ababa, Ethiopia on June 1. I'll be there for almost eight months, working as a monitoring and evaluation intern on a large health project; this work will fulfill internship requirements for my MPA and MSPH degrees, and then I'll have just one semester left at Princeton before graduating. After two years of "book-learning" I'm quite excited to apply what I've been learning a bit.

One thing I learned from doing (too many?) short stints abroad is that it's easy to show up with good intentions and get in the way; I'm hopeful that eight months is long enough that I can be a net benefit to the team I'll be working with, rather than a drain as I get up to speed. I plan to get an Amharic tutor after I arrive -- unfortunately I figured out my internship recently enough that I wasn't able to plan ahead and study the language before going.

I'm especially excited to live in Ethiopia. I have not been before -- this will be my first visit to East Africa / the Horn of Africa at all. I'll mostly be in Addis, but should also spend some time in rural areas where the project is being implemented. I've already talked with several friends who briefly lived in Addis to get tips on what to read, what to do, who to meet, and what to pack. That said I'm always open for more suggestions.

So, I'll share what I've already, or definitely plan to read, and let you help fill in the gaps. Do you have book recommendations? Web or blog links? RSS suggestions? What-to-eat (or not eat) tips? Here's what I've dug up so far:

  • Owen Barder has several informative pages on living and working in Ethiopia here.
  • Chris Blattman's post on What to Read About Ethiopia has lots of tips, some of which I draw on below. His advice for working in a developing country is also helpful, along with lists of what to pack (parts one and two), though they're obviously not tailored to life in Addis. Blattman also links to Stefan Dercon's page with extensive readings on Ethiopian agriculture, and helpfully organizes relevant posts under tags, including posts tagged Ethiopia.
  • As for a general history, I've started Harold Marcus' academic History of Ethiopia, and it's good so far.
  • Books that have gotten multiple recommendations from friends -- and thus got bumped to the top of my list -- include The EmperorCutting for StoneChains of Heaven, and The Sign and the Seal. Other books I've seen mentioned here and there include Sweetness in the BellyWaugh in AbyssiniaNotes from the Hyena's BellyScoop, and A Year in the Death of Africa. If you rave about one of these enough it might move higher up the priority list. But I'm sure there are others worth reading too.
  • For regular information flow I have a Google Alert for Ethiopia, the RSS feed for AllAfrica.com's Ethiopia page, and two blogs found so far:  Addis Journal and Expat in Addis. (Blog recommendations welcome, especially more by Ethiopians.) There's also a Google group called Addis Diplo List.
  • One of my favorite novels is The Beautiful Things That Heaven Bears -- the story of an Ethiopian immigrant in Washington, DC's Logan Circle neighborhood in the 1980s. It's as much about gentrification as it is about the immigrant experience, and I first read it as a new arrival in DC's Petworth neighborhood -- which is in some ways at a similar 'stage' of gentrification to Logan Circle in the 80s.
  • I've started How to Work in Someone Else's Country, which is aimed more at short-term consultants but has been helpful so far.
  • Also not specific to Ethiopia, but I'm finally getting around to reading the much-recommended Anti-Politics Machine, on the development industry in Lesotho, and it seems relevant.

Let me know what I've missed in the comments. And happy 200th blog post to me.

(Note: links to books are Amazon Affiliates links, which means I get a tiny cut of the sales value if you buy something after clicking a link.)

What happened?

What happened during the 2007-8 financial crisis? Here's a reading from my classes that I think may be of interest to a broader audience: "Getting up to Speed on the Financial Crisis: A One-Weekend-Reader's Guide" by Gary B. Gorton and Andrew Metrick, writing in January 2012 (PDF from NBER). Covering 16 sources (academic papers, a few reports by institutions, and Congressional testimony by Bernanke) Gorton and Metrick provide a timeline of the crisis, some historical perspective on past banking crises, the build-up to this crisis, phases of the crisis itself, and government responses.

It's just 34 pages and interesting throughout -- the only shortcoming is that the PDF is rendered in Calibri.

A related article is Andrew Lo's "Reading About the Financial Crisis: A 21-Book Review" (PDF), which includes this:

No single narrative emerges from this broad and often contradictory collection of interpretations, but the sheer variety of conclusions is informative, and underscores the desperate need for the economics profession to establish a single set of facts from which more accurate inferences and narratives can be constructed.

Discussions of causes are difficult when you don't agree on the simpler matters of what actually happened -- which speaks to the importance of trying to simply get at (as Gorton and Metrick are trying to do) an account of what happened.

Name that quote

I'm reading Evolving Economics, a highly-regarded history of economic thought by Agnar Sandmo. I thought one tidbit early on was quite interesting: it comes in the course of a discussion of a once-common method of charging tolls based on the weight of carriages. Sandmo quotes an economist who recommended different rates for luxury versus other transport.

Thus, "...the indolence and vanity of the rich is made to contribute in a very easy manner to the relief of the poor, by rendering cheaper the transportation of heavy goods to all the different parts of the country."

Who said that? Answer below the fold...

Adam Smith, the patron saint of laissez-faire economists everywhere, in The Wealth of Nations no less. Sandmo comments, "This formulation is notable both for its substantial content and for the tone of its language, which leaves one with no doubt as to the author's sympathy and social concerns."

Monday Miscellany

  • Erin Fletcher reviews Matt Yglesias' new book, The Rent is Too Damn High, and summarizes it nicely along the way.
  • What does transportation legislation have to do with public health? More than you might think: which systems our government chooses to subsidize have a huge though indirect impact on decisions we make on where to live and how to get around, which in turn impact exercise and obesity. The Pump Handle - a public health blog - talks about the current transportation bill here.
  • A fascinating controversy is unfolding in experimental psychology (specifically on priming effects) after researchers attempted to replicate a seminal finding and came up short. Discussion here.
  • Andrew Gelman's blog is read by social scientists of many stripes -- from statisticians to political scientists and economists -- so when he titles a post "Economics now = Freudian psychology in the 1950s..." you know the comments will be good.
  • "How sure are you that your models are correct?" asks Observational Epidemiology: "This is not to say that we should be reckless. But policies like austerity in a time of high unemployment have immediate and real costs." Read the rest here.

Princeton epidemiology: norovirus edition

Princeton is in the midst of an outbreak of norovirus! What's norovirus, you ask? Well, it looks like this:

Not helpful? Here's the CDC fact sheet:

Noroviruses (genus Norovirus, family Caliciviridae) are a group of related, single-stranded RNA, non-enveloped viruses that cause acute gastroenteritis in humans. The most common symptoms of acute gastroenteritis are diarrhea, vomiting, and stomach pain. Norovirus is the official genus name for the group of viruses previously described as “Norwalk-like viruses” (NLV).

Noroviruses spread from person to person, through contaminated food or water, and by touching contaminated surfaces. Norovirus is recognized as the leading cause of foodborne-disease outbreaks in the United States. Outbreaks can happen to people of all ages and in a variety of settings. Read more about it using the following links.

My shorter translation: "Got an epidemic of nasty stomach problems in an institutional setting (like a nursing home or university)? It's probably norovirus. Wash your hands a lot."

The all-campus email I received earlier today is included below. Think of this as a real-time, less-sexy version of the CDC's MMWR. Emphasis added:

To: Princeton University community

Date: Feb. 6, 2012

From: University Health Services and Environmental Health and Safety

Re: Update: Campus Hygiene Advisory

In light of continuing cases of gastroenteritis on campus, University Health Services and the Office of Environmental Health and Safety want to remind faculty, staff and students about increased attentiveness to personal hygienic practices.

A few of the recent cases have tested positive for norovirus, which is a common virus that causes gastroenteritis.  While it is usually not serious and most people recover in a few days, gastroenteritis can cause periods of severe sickness and can be highly contagious. You can prevent the spread of illness by practicing good hygiene, such as frequent hand washing, and limiting contact with others if sick.

Gastroenteritis includes symptoms of diarrhea, vomiting and abdominal cramps. Please take the following steps if you are experiencing symptoms:

--Ill students should refrain from close contact with others and contact University Health Services at 609-258-3129 or visit McCosh Health Center on Washington Road. Ill employees are encouraged to stay home and contact their personal physicians for medical assistance.

--Wash your hands frequently and carefully with soap and warm water, and always after using the bathroom.

--Refrain from close contact with others until symptoms have subsided, or as advised by medical staff.

--Do not handle or prepare food for others while experiencing symptoms and for two-to-three days after symptoms subside.

--Increase your intake of fluids, such as tea, water, sports drinks and soup broth, to prevent dehydration.

--Avoid sharing towels, beverage bottles, food, and eating utensils and containers.

--Clean and disinfect soiled surfaces with bleach-based cleaning products. Students and others on campus who need assistance with cleaning and disinfecting soiled surfaces may call Building Services at 609-258-8000. Building Services also will be increasing disinfection of frequent touch points, such as doorknobs and restroom fixtures.

--Clean all soiled clothes and linen. Soiled linen should be washed and dried in the hottest temperature recommended by the linen manufacturer.

In the past week, University Health Services has seen more than the usual number of students experiencing symptoms of acute gastroenteritis. The New Jersey Department of Health and Senior Services tested samples from a few of the cases, which were later found positive for norovirus. Because norovirus has been identified as the chief cause of gastroenteritis currently on campus, further testing is not planned at this time, but the University is urging community members to take steps to prevent the further spread of illness.

Noroviruses are the most common causes of gastroenteritis in the United States, according to the Center for Disease Control and Prevention. Anyone can become infected with gastroenteritis and presence of the illness may sometimes increase during winter months. While most people get better in a few days, gastroenteritis can be serious in young children, the elderly and people with other health conditions. Frequent hand washing with soap and warm water is your best defense against most communicable disease.

I bolded a few passages because I think the very last sentence (wash your hands) is actually the most important single part of the message and is much clearer than encouraging someone to increase "attentiveness to personal hygienic practices." But still a good message overall. At least one friend has come down with this and it sounds unpleasant...

Halfway!

I've been remiss in blogging lately, but my excuses are excellent for once. Princeton has an odd academic schedule with finals after the winter / Christmas holidays. So after spending a couple weeks in Arkansas visiting family it was back to cold (but not as cold as usual) New Jersey to study for finals, write papers, and take exams, all in the middle of January. For normal students -- i.e., those who are used to finishing final exams before Christmas and actually having a mental break over the holidays -- this schedule is unpleasant. But it has one upside: last week was intersession, a one-week break where the fall semester is completely done and the spring semester and its obligations have yet to begin, and Woodrow Wilson students (in the vernacular, "Woos") traditionally plan group vacations.

One group went to Colombia for the week, another to the Dominican Republic, and various individuals and small groups jaunted off to exotic locales like Paris and Florida. I opted for the low-cost, low-energy Puerto Rico group. Sixteen of us rented a condo and this house (which I highly recommended) in Luquillo Beach and enjoyed this for a week:

Needless to say the stress of finals was washed away and we Woos are both more tanned and less loathe to start the spring semester. Today was our first day of classes so I'm still figuring out which classes I'll be taking, but this seems like a good moment to pause and celebrate:

I'm officially halfway through grad school! 1.5 years down, 1.5 to go. So far I've done:

  • 4 quarters of coursework at Hopkins (9 months)
  • a summer interning with the NYC Dept of Health (3 months)
  • and the fall semester at Princeton (6 months)

Still to go:

  • this spring semester at Princeton (4 months)
  • June through January: a yet-to-be-determined internship abroad to fulfill internship requirements for Princeton and practicum and remaining degree requirements for Hopkins (8 months)
  • and a final semester at Princeton in the spring of 2013 (4 months)

I'm happy with my course of study so far, and have largely concentrated on the comparative advantage of each school and program: epidemiology, infectious disease, and other public health courses at Hopkins and economics and more general public policy courses at Princeton. For more details on the two programs (for instance, if you're considering programs like these) click below the fold...

I don't typically blog much about my classes because a) it is difficult and awkward to comment on a class in progress, and b) you might be quite bored since one of several reasons formal education exists is to force students to learn subjects more systematically and in-depth then we might otherwise care to pursue in the course of regular pleasure reading. So I avoid writing about the minutiae of classes -- but am happy to talk if you're considering either of the programs I'm in. One major difference I've mentioned before is that Hopkins is on the quarter system (four terms between August and May) whereas Princeton does semesters (two terms between August and May).

Now that I've finished a semester at Princeton I can say that by comparison the quarter classes aren't exactly a whole semester's worth of material crammed into half the time, but they're definitely more than half. I'd say on average (a very rough approximation!) I learned about two-thirds as much material in a quarter-length class as in a semester one.

As for what classes I've taken, I think they're fairly illustrative of the focus of both programs. As my interests continue to solidify around the implementation and evaluation of large-ish health programs, I think I'll end up using a lot of tools and knowledge from both programs. My course load has also been fairly typical for both programs:

Hopkins MSPH (Global Disease Epidemiology and Control)

I took 16 quarter-length classes for credit, five seminars for credit, and was a teaching assistant in one course:

  • Biostatistics (4 terms)
  • Large-scale Effectiveness Evaluations of Health Interventions
  • Design and Conduct of Community Trials
  • Global Disease Control Programs and Policies
  • Vaccine Policy Issues
  • Vaccine Development and Application
  • Epidemiologic Methods (2 terms)
  • Professional Epidemiology Methods
  • Epidemiology and Public Health Impact of HIV/AIDS
  • Infection, Immunity and Undernutrition (as a teaching assistant)
  • Introduction to International Health
  • Environmental and Population Health in Emergencies
  • Health Behavior Change at the Individual, Household and Community Levels
  • along with one term of a vaccine seminar and four terms of a seminar for my track

Princeton Woodrow Wilson School MPA (Economics and Public Policy track):

Students typically take 4-5 classes per semester, but as a dual degree student I'll do three semesters instead of four. Classes I've completed or must take because they're required:

  • Microeconomics*
  • Macroeconomics*
  • Econometrics*
  • Generalized Linear Statistical Models**
  • Politics of Public Policy
  • Psychology of Public Policy
  • Comparative Political Economy of Development

Others I might take this spring or next spring (my final semester) to complete requirements:

  • Health and Inequality in the World
  • Financial Management
  • Economic Analysis of Development
  • Microeconomic Analysis of Government Activity
  • International Trade
  • and so forth...

Footnotes: * - these core courses, along with a first-semester stats course, are offered at varying levels for students with different math backgrounds ** - most students take an introductory statistics/quantitative course followed by econometrics, while some students opt in to the linear models course instead.

Monday Miscellany

Generalized linear models resource

The lectures are over, the problem sets are submitted -- all that's left for the fall semester are finals in a couple weeks. One of the courses I'm taking is Germán Rodríguez's "Generalized Linear Statistical Models" and it occurred to me that I should highlight the course website for blog readers. Princeton does not have a school of public health (nor a medical school, business school, or law school, amongst other things) but it does have a program in demography and population research, and Professor Rodríguez teaches in that program.

The course website includes Stata logs, exams, datasets, and problem sets based on those data sets. The lectures have closely followed the lecture notes on the website, covering the following models: linear models (continuous data), logit models (binary data), Poisson models (count data), overdispersed count data, log-linear models (contingency tables), multinomial responses, survival analysis, and panel data, along with some appendices on likelihood and GLM theory. Enjoy.

Does grad school make you liberal?

In short, no, liberals are just more likely to select themselves into grad school attendance (PDF). The abstract:

This paper analyzes longitudinal data to evaluate three claims that are key to a recently developed theory of professorial politics. The theory explains the liberalism of the American professoriate as a function of reputation-based self-selection: because academia has a reputation for liberalism, liberals are more likely to pursue graduate degrees and academic careers. We examine whether in fact young Americans who identify as liberal are more likely to enroll in graduate programs with the intention of completing a doctorate; the proposition that such a tendency cannot be explained away by variables unrelated to occupational reputation; and the claim, also made by the theory, that exposure to many years of higher education is not a major cause of the liberalism of graduate students. We find support for all three claims, with ambiguity only on the question of whether the greater propensity of those on the left to attend graduate school results from personality differences.

Within the particular fields I'm studying this is even more true. For public policy -- speaking very broadly -- if you're conservative and mostly want to cut government then why study how to do government better? Why not study business or law instead? And public health has traditionally been a field that  favors a lot of government intervention too.

About grad school

Mr. Epidemiology, a PhD student who blogs at mrepid.wordpress.com, has put together a great round-table where he asks open-ended questions about grad school and collects answers from a variety of Masters and PhD students from across mostly related fields. A little about the roundtable and its respondents is here. Questions covered so far include:

I thought the piece on impostor syndrome was particularly helpful. Although not exactly the impostor syndrome (which also hits me often), this is somewhat related: While blogging and going to school concurrently I've had difficulty writing about certain subjects that I've studied more intensively. The more I study, the more I realize my lack of expertise and hesitate to say anything definitive without endless qualifiers and references. For instance, I TA'ed a class on on malnutrition, infection, and immunity, and spent a summer researching lead poisoning in New York City -- but those are two of the more difficult subjects for me to write about for a popular audience. I know PhD students and true scholars must feel this more intensely, but at the same time it's probably even more important for those with more time invested in a subject to weigh in on it.

Update: the latest addition to the series is What has surprised you the most so far?

Math Camp!

Two weeks ago I wrapped up my work as an Epi Scholar with the NYC Department of Health, where I was researching childhood lead poisoning (on which I should be writing more soon). I had a few days off to enjoy the city, and then last weekend I moved to Princeton, NJ. I'm in Princeton to work on an Master in Public Affairs in 'Economics and Public Policy' at the Woodrow Wilson School. The other Woo students (as the school and its denizens are called) and I moved to Princeton three weeks before our "real" classes begin to enjoy a Woo ritual known as Math Camp. We spend a good chunk of each day in classes that teach or review basic concepts in mathematics and economics. There are four math tracks; the one I'm in has already covered some advanced algebra, univariate and multivariate calculus, and some basic linear algebra. We'll spend the next two weeks doing more calculus and focusing on optimization problems, and touch briefly on some concepts in probability. The Math Camp classes have homework and tests and grades, but their main purpose is to help place us in the most appropriate 'track' in our microeconomics, macroeconomics, and quantititative analysis coursework.

I'm sure I'll end up writing more about Math Camp and the Woo in general, as well as my amazing classmates. I am looking forward to being able to make some comparisons as time goes by -- looking at epidemiology and economics, large schools and small schools, public health and public policy, and so forth. But generally I'll try and keep my writing here about the subject matter I encounter rather than the mechanics of how grad school works.

I'm sorry (for technical reasons only)

If you have a lot of RSS feeds for infrequently-updated personal blogs in your feed reader of choice* then you can't avoid seeing posts that follow this format:

"I'm so sorry I haven't posted in [length of time which is generally a short period in analog world but forever in the blogosphere]. I really planned on posting more and committed to doing so for [New Year's, my blogoversary, Ramadan, etc]. But then my [work commitments, school schedule, real research projects] got in the way. I'm really sorry, dear readers, but I'll try to do better in the future.

I think this genre of post is fascinating because it speaks to our expectations for the frequency with which a good blog should be updated, and our almost universal failure to live up to that ideal. Also, if you're reading a feed via RSS, you wouldn't necessarily have noticed the gap in posting without the "I'm sorry" post.

My posting isn't always as frequent as I'd like it to be, but I was sure I'd never write one of those posts because I find them irksome. However, I've encountered an entirely new reason for not posting and thought it was novel enough to share.

I moved to Princeton, NJ a week ago and found that my blog (and the back-end that I access to edit it) are completely blocked on all the Princeton wireless networks. This is disheartening as without such a blockage my musings would likely have a much stronger impact on the elite policy-making world (just kidding). It's also surprising since I would expect this more at my undergrad alma mater than at Princeton, and I have yet to write anything critical about Reunions. Oddly enough you don't get any indication that the site has been blocked -- no Websense notice -- but rather the site just never loads. It took me quite a while to realize it wasn't me, and for the moment it looks like I've been blocked because this site was the source of a phishing attack. I hope to get it resolved and resume my regular posting schedule soon, but I wanted to clarify that this particular gap in my posting is actually due to technical problems and not due to any deficiencies in my work ethic or personal character. And, dear reader, thanks for reading.

*Aside: if you're reading this via a web browser, you're old fashioned and should start using Google Reader today. Exceptions granted if you found this link via social media such as Facebook and Twitter.

Grad school advice from bloggers

If you want to take advice from bloggers, they're generally happy to give it. I've written a bit about my own motivation in selecting programs. I think the best advice comes from people who know you, your interests, and aspirations well. That means family and friends, especially if your friends work in similar fields. It's also invaluable to talk to both experienced mentor figures who have some perspective and recent graduates of the programs you're interested in (programs do change over time). Over the past year I've come across a number of resources written by bloggers that I think are worth highlighting: Dave Algoso, a recent graduate of the MPA program at NYU's Wagner School, wrote a grad student’s guide to the international development blogosphere which answers these questions:

1. Why should I read blogs? I do plenty of reading for class/work already… 2. Blogs can be overwhelming. How do I manage the information flow? 3. Okay, I’m sold. What should I be reading?

From Chris Blattman (everyone's favorite development blogger at Yale):

Dani Rodrik responds to Blattman on graduate programs in development.

From Greg Mankiw's blog:

Let me know if you think of something I'm missing. There does seem to be more advice out there about economics programs than those in public health. Personally I'd love to see a similar set of posts from Karen Grepin, Alanna Shaikh, and Elizabeth Pisani, amongst others.

Update: Dave Algoso suggested these posts by Amanda Taub of Wronging Rights, which I missed since I never seriously considered law school:

The battle for hearts and minds

A major difference between the public health approach and the beliefs and strategies underlying fields such as human rights or medicine is that public health concerns the prioritization of limited resources. There is a limited pie. Even if you believe that pie can be expanded (it can, at times), it cannot be expanded infinitely, and so at some point in the policy process someone has to make a decision about how to prioritize the resources at hand. This traditional public health approach overlaps with and gets blurred into human rights and medicine and politics such that the value judgments underlying different claims aren't always apparent. We have a certain number of interventions that are known to work -- they save lives and reduce suffering -- but we don't have enough resources to do all of those things in every place that needs them. If we choose option A, some people will be saved or helped, and some will die. If we choose option B, a different number of people will be saved or helped, and some other group of people will die. The discussion of who will be saved is often explicit, while the discussion of the opportunity cost, those who will not be saved is almost always lacking. Both groups are abstract, but the opportunity cost group is usually more abstract than the people you're trying to help. These are generalities of course, and in reality there is uncertainty built into the claims about just how many lives could be saved or improved with any one approach.

The problem is this: pretty much everything we do in global health is good. Sure, we can argue specifics and there are glaring examples to the contrary, but for the most part we all want to save lives, prevent suffering, and improve health. No one is seriously against successful interventions when they stand alone: no one thinks people with HIV shouldn't get antiretrovirals, or children with diarrhea shouldn't get oral rehydration therapy. Rather, they may oppose spending money on HIV instead of on childhood diarrhea (or in reality, vice versa). Who is comfortable with making an argument against preventing childhood burns? Being against treating horrific cancers? Any takers? So we all argue for something that is good, and avoid the messy discussions of trade-offs.

Thus, much of the conflict in the global health fields is about spending money on X intervention versus intervention or approach Y. Or, better yet, traditional and known intervention A versus new and sexy and unproven-at-scale approach B. I don't think I'd want to live in a world where all health decisions are made entirely by cost-benefit analysis, nor would I want to live in a world where all decisions on care and policy are made from a rights-based approach -- both approaches result in absurdities when taken to their extremes and to the neglect of each other. My impression is that most professionals in global health draw insight from both poles, so that individuals fall somewhere on a continuum and disagree more with others who are furthest away. The tension exists not just between differing camps but within all of us who feel torn by hard choices.

So the differences between the mostly utilitarian public health old-guard and the more recent crop of rights-driven global health advocates aren't always clear-cut, and they often talk right past each other ... or they just work at different organizations, teach at different schools and attend different conferences so they won't have to talk to each other. To some extent they're fundraising from different audiences, but they also end up advocating that the same resources -- often a slice of the US global health budget -- get spent on their priorities. These tensions usually simmer under the surface or get coated in academic-speak, but sometimes they come out. Which brings me to an anecdote to leaven my generalities:

A few months ago I was having a private conversation with a professor, one who leans a bit towards the cost-benefit side of the continuum with a dose of contrarianism thrown in for good measure. Paul Farmer came up -- I don't remember how. I paraphrase:

Resource allocation is the central dilemma in public health. Period. If people don't get that, they're not public health. Paul Farmer? Fuck Paul Farmer. He just doesn't get it.

You won't hear that in a lecture or in a public speech, but it's there. I've heard similar sentiments from the other side of the spectrum, those who see the number-crunching cost-benefiteers as soulless automatons who block the poor from getting the care they need.

These dilemmas are not going away any time soon. But I think being conscious of them and striving to be explicit about how our own values and biases shape our research and advocacy will help us to collectively reach a balance of heart and mind that makes more sense to everyone.

HIV/AIDS is one of the areas of global health where the raw passion of the heart most conflicts with the terrible dearth of resources we have to fight the demon. Decisions have ugly consequences either way you choose, and, rightly or wrongly, dispassionate research is often anything but. The recent news that pre-exposure prophylaxis (PrEP) can prevent HIV acquisition in sero-discordant heterosexual couples is huge in the news right now. Elizabeth Pisani (epidemiologist and author of The Wisdom of Whores) hits the nail on the head in this recent blog post. She notes that there are voices clamoring for widespread scale-up of PrEP -- treating the HIV negative partner -- but that PrEP prevents infection in 60% of cases while treating the HIV-positive partner cuts infection by 96%. Continuing:

That leaves us with the question: who should get PReP? Right now, there are not enough antiretrovirals to go around to treat all the sick people who need treatment. If we’re going to use them selectively for prevention, we should start with the most effective use, which appears to be early treatment of the infected partner in discordant couples. We could also give them to people who aren’t in a couple but who know that they’re likely to get around a bit and might want to stay safe without using condoms. That’s potentially a lot of people; it will stretch our purses. But more than that, it will stretch our political will.

So who is PReP for? We’ve got a better option for discordant couples. We’re not going to want to give it to randy adolescents. We know it works for gay men, but some of the countries where the trials took place would rather thump or jail gay men than protect their sexual health.[...] But I think we would be unwise to rush around talking about massive roll-out of PReP before we actually figure out who it works for in the real world.

Treating people with HIV is good. Preventing infection via treatment is good. Prevention infection via PrEP is good (assuming it doesn't breed more drug resistant strains and make it harder to treat everyone... but that's another story). But most voices in the debate have an agenda and are pushing for one thing above the rest. One of them -- or a balance of them -- is right, but you have to understand their values before that can be discerned. And I think many people in global health don't even think explicitly about their own values, such as the mix of cost-benefit and rights-based approaches they find most appealing. Rather, we all want to promote whatever we're working on that the moment. After all, it's all good.