“…If you really want a job in global health policy, it’s really about getting actual global health experience through practicums, advanced trainings, or doing work on the ground. “

Professor Timothy Mackey, Ph.D is the instructor of the new Fall 2017 course offered by the UC San Diego (UCSD) Global Health Program, GLBH 160. Global Health Policy.  In this interview he shares his insights and background to enlighten us on this booming area in the field, which has been an area of increased interest by the student population at UCSD.

Interviewed by Anh Vo and Julius Solbes-Moran

What led you here to become an associate professor at UC San Diego (UCSD), specifically? 

Pure chance! I have no intention of getting into academia. I actually did my bachelors here and went into the legal and compliance field. Then I just decided to get a Master’s degree in health policy and law, because I want better versatility, and that’s pretty much it.

What motivated to pursue a career in global health, specifically in global health policy?

So I was born in the US and lived here for about a year, and then we moved to the Phillipines. So the Phillipines were my first exposure to the less developed countries, this was in the 1980s. And I remember vividly in my childhood, there were Fillipino kids that were scaling the walls. And then we moved back to California for a year or two, and then we moved to Greece and Germany, and then I lived in Japan and I lived in few other countries. But one of the things you’d see regardless of what country you go to, whether it’d be high income or low income, is that you see that people has a lot of health inequalities. And so that kind of carry forward with me throughout my life. And obviously the international experience was one of the reasons i got into global health. And then when I came back to the states, I came back to a neighborhood that were impoverished, Moreno Valley, which is an area in Riverside; and not just Moreno Valley, but a “ghetto” area of Moreno Valley. There, I saw a kid in my middle school with no dental coverage, living his life with yellowed, coming out teeth, just no healthcare and stuffs like that. That got me really passionate about health, and then of course, looking at it from a global context, I thought I had a unique perspective, so that’s what got me into it.

Why policy, specifically?

Policy has always been my area because, One, as you guys can probably notice, nobody teaches global health policy, there’s no curriculum or practitioners. AS much as we talk about interdisciplinary in global health, most of it is in specific domains. And policy is very fascinating because you can kind of cross over everything: Infectious diseases, non-communicable diseases, Econ,… Policy touches everything, so that’s why its such a fascinating area of study for me, and a lot of my experience in this field is based upon my of course legal training, and also a lot of my research is geared towards that. But also a lot of that is influenced by my work when I was working with the WHO (World Health Organization), in their Intellectual Property and Public Health Group. [Policy] is a very neglected area in global health, and yet policy impacts a lot of the downstream interventions that we tried use in global health. If the policy framework is good, you’re going to have a better global health outcome. And a lot of times policy doesn’t follow global health objectives; It follows other things like foreign policy objectives, economics goals, etc… So there is a huge need to interject global health as a very fundamental and important principle in policy and foreign diplomacy. So knowing that there’s not a lot of people doing it, and not a lot of research into any topics I want, is really the reason why I like it so much.

What do you hope that your class would become? What do you hope your students to take away from it?

I have high hopes for this class, because a lot of what we’re doing is experimentation. Essentially, it’s a very mixed method approach and a blended learning environment, which include these workshops. Unfortunately, this class is kind of a test case for it. And as we go, we’ll refine the process a little bit better. Some workshops may work out better than another, some will be harder than others. I’ve already done this with my graduate students, but that’s a much smaller group, usually 13-14 people so it’s a lot easier to manage. But what really happens in this class is, you learn some didactic, fundamental principles, then you apply them in these discrete workshops, but you don’t really get the real policy experience until you get into true simulations. And what simulation is, is that students take ownership over debate, taking the perspective of a stakeholder, understanding the policy mechanism that they would support or not support, and then debating it, with of course the support from a lecturer or a professor. My thing for this is hoping this would become a broader portfolio for classes that really encompass all of global health policy, not just the very fundamental stuffs. The mixed learning method is going to be hard, but I really think it’s going to be the future of education. If you just lecture people, they’re not going to really learn anything. Especially given the attention span of people today with social media, as well as other data sources that you have to navigate. So you have to be innovative with education

But I think one of the things we don’t do well here, is incentivizing excellence in education. At UCSD, we’re an R1, we’re mainly a research institution. So i’m hoping this will be the case that more students will get into global health policy, and that also people will think: “oh well this is a learning experience I should have,” which can create institutional changes.

What advice do you have for global health students that are policy-inclined?

That’s a very important question to ask. So there’s currently nothing in San Diego, we’re in this policy-dead zone. But that doesn’t mean policy can’t have implications on many different levels. A lot of people think about policy within the context of, how can you influence a legislator, or a UN representatives of something like that. But policy can also happen at the advocacy level, the grassroots level. What students can think about is how policy can translate into advocacy, that I can do more from the perspective of an NGO, a civil society organization, patient safety organization,etc…And then having a global context allows you to coalesce around all these different stakeholders that are available for the topics, instead of just relying on domestic people to work on it.

But if you really want a job in global health policy, it’s really about getting actual global health experience through practicums, advanced trainings, or doing work on the ground. Most of my work is informed by my time working in WHO and with other groups. There are jobs in DC that are specific to global health. Global health is a space where, because the Gates Foundation is there, there’s a lot of money pumping through the system. So even in Washington, there’s a lot of policy analyst jobs specific to global health that people can tap into. And again, it’s not something that people are usually trained on, so that’s kind of the advantage. But you need to have some applied experiences as well.

With regards to San Diego being a bit of a policy dead zone, what makes you say that, and what areas are policy rich?

DC, or Geneva’s another. Geneva is huge, Geneva’s amazing. 6 months in Geneva is like a 2 year internship. You’re exposed to as much experience as you can get. When I was in Geneva I got to go to WTO meetings, I got to go to treaty negotiations. The exposure you get is absolutely amazing. All the UN special agencies are clustered there. So if you want to get into global health policy, I wouldn’t even say it’s DC, I’d say it’s Geneva. Geneva’s like the most expensive place in the world; a Big Mac costs, I think, $30 dollars. Yeah, it’s expensive. But if You have the opportunity to go there, even for a week or two, it just will change your life. So the reason why San Diego is kind of dead is primarily because we’re translational science driven. There’s a lot of biotech firms here; there are firms like Illumina that are on the sequencing side that do have policy angles to them as well, though most of them are focused on promoting their industry sector, less on kind of the global health policy space overall, and more on the regulation space, so You could say that San Diego has a regulatory affairs kind of feel to it, but I wouldn’t say that it has a policy feel to it. People at UCSD may object to that, since there are a lot of policy programs here, but there’s not much You can do to influence policy within this environment because you only really have your state legislature here, and Sacramento is pretty far anyway. And here, it’s about translational science, mainly, which is not the endpoint, which is policy.

What challenges do you forsee for global health? Are there things that give you hope? What do you think will be the most pressing challenge for global health within the next ten to twenty years?

I think I’ll start with the first question, what opportunities do I see. One is, You know, I am a technologist, so I see that, if used the right way, certain emerging technologies can really address a lot of the problems that we already have. Mobile technology is a big impetus in all developing countries. There’s a lot of microfinancing that goes on that’s disrupting that sector. There’s things I’m working on called blockchain technology that’s going to be used to unify data frameworks and provide information that’s trustworthy

So technology is, I think it can be agnostic, so like technology is technology, so it doesn’t necessarily have underpinnings of religious connotations or political connotations so it can form a framework for supporting a lot of, but it can also be used the wrong way, and it can also be implemented the wrong way across populations that either don’t have access to that technology, or don’t understand how to interface with that technology, so it’s a two way street. So for me, that’s an important thing that is a solution and, of course, I think there is, one of the things I think that’s important is economies are very interdependent now, and global health is one of those things that’s seen as something that impacts economies. So if You have a disease outbreak, it’s not just, you know, it’s unfortunate that lots of people, of course, die from a disease outbreak, but a lot of policy makers are more worried about the economic impact that a disease outbreak will have on multiple trading partners, so just because you have an outbreak in East Africa doesn’t mean that it doesn’t impact an economy otherwise, because we’re such closely related trading partners. And then of course, because diseases can just jump on a plane and be somewhere in two weeks or so, or even a day or two. So I think those are pressing concerns, but I think they exhibit greater recognition of global health as being important; and then, I think the biggest component for me and a lot of people will probably disagree with this is, and for me, maternal child health is really important, and that’s when we’re talking about family planning, and we’re talking about, of course, good outcomes in child birth, and the reason why is because it directly related to population, and as we grow as a human population, we demand more resources, and it impacts a lot of other sectors. It impacts planetary health, it impacts social determinants (of health) because people get more crowded, and then there’s more conflict. So I think family planning, maternal-child health is a really, it’s not neglected, but the linkage to population is less clear, and it’s really important because if people can have healthy babies and have good, you know, birthing outcomes, then they’re likely going to have less children. So it’s really important that we take those economies that are still having those issues, and we raise them up in that fashion.

What do you think global health policy is leaning towards?

I think global health policy is an open term, to begin with. I think, again I’m more of a governance scholar, and what I think is that, as you see global health growing as a field, and becoming more important, and becoming more recognized, then you’ll see policy frameworks start to harmonize. What that means is we’ll agree on policy, health policy in one country, and then we’ll harmonize with the health policy in another country. And there won’t be so much division with how one country approaches health policy.

So would you say that’s like globalization of health policy?

To a certain extent. But the globalization component is mostly within the context of economics, it’s less within the context of policy. So, you know, one way that you, kind of, harmonize legal frameworks it through treaty mechanisms, and the literature doesn’t support that we’re going to have more treaties. We’re probably not, you know because they’re very hard to negotiate, but the idea that countries would kind of self-elect to agree on policy frameworks that were similar, so that we could address a common issue. So for example, infectious disease outbreaks, it makes a lot of sense for everyone to report infectious disease outbreaks the same way. And that we all agree on a framework for, you know, if we need to address travel a certain way, or trade a certain way when there’s an infectious disease outbreak, we all agree; because if certain countries don’t do it in a good way, then we have a hole in our security blanket. So those type of global health issues that unify a lot of policy frameworks is where I see it going, I’m not sure if we’ll get there, because the politics is so divisive, especially in this country, but that’s the hope, that these policy frameworks don’t become so domestic focused; they become more regional focused.

Out of the many organizations that you’ve worked with, which was your favorite and why (excluding UCSD)?

The organization that was the most interesting to work for was definitely WHO. It’s such a dynamic organization, and it’s such a flawed organization at the same time. It’s the only organization that has the power to do things that other organizations don’t. They can erect treaties, they can issue technical guidance that crosses all countries. And yet, they’re completely underfunded. Humans are human beings. There’s people at WHO when I was there that they’d worked at WHO their whole career and they were being let go, and they had to go back to their home country, and they hadn’t been back to their home country for twenty years, because their visa is only applicable to UN agencies, not to all of Switzerland. So the future of WHO is really important. And at the same time, it’s a very disabled organization at this point. When you go there, and you see it first-hand, it reinforces the urgency to reform the WHO. So for me, that’s informed so much of my research moving forward. And the bottom line is there’s great people at WHO. There’s people that care. There’s people that really want to make an impact, but you know, governance is one of those things that can enable or limit progress. And it’s real. That’s why I think a lot of people dismiss policy and governance as these more social science concepts when people are arguing about what organization does what. But they actually very much impact the full environment. And that’s what I think. A lot of people may be doing an intervention in a country, and they don’t know why it doesn’t work. It’s probably because of some macro-policy issue that’s inhibiting that progress.

What kind of research are you currently working on, in terms of your personal academia path?

I’m kind of all over the place. But one of the area that we do a lot of work in is social listening, or social surveillance. One of the big projects we have going on is mining social media to detect prescription drug abuse. That involves a lot of big data and machine learning, I also have a lot of projects that are policy focused. We have a project going on about tobacco, looking at some determinants in the digital space and also the traditional survey space.

Again, because policy kind of cuts into everything, you can research anything you want. I have a real passion for infectious disease governance, which is about how do we ensure legal frameworks appropriately incentivize countries to report infectious diseases. I think there’s a lot of lessons from Ebola that we haven’t learned correctly, and I think that’s one of the most pressing needs. Because I don’t think we are more prepared after Ebola than we were before it.

Governance is my core research area, and people care about governance. But organizing the complexities of all the different stakeholders that are involved, and all the interests that are involved, it’s an amazingly complex science. So for me, governance is my core area, and other things are in the periphery.

You said before your research is mainly on governance, and you work on the  research of all these different topics, do you have a root cause for what it is you want to do for global health? Do you have a bottom line You’re trying to advocate towards?

No, I mean, the way I approach it is problem solving. Like, there’s a problem in global health. One of the things I do a lot of work in is fake medicines. So how do You address that problem? You can address it through technology, You can address it through governance, You can address it through domestic policy, through enforcement, through patient advocacy, and so, I just try to look at global health problems as very complex and very dynamic with no single answer. They all have an element of what we talked about in the mind-map; human rights, economics, planetary health, even fake medicines, or more pressing like environmental issue. So I try to approach problems more than I do, you know, the solution. And the reality is that I’ve worked on a lot of different problems in global health and a lot of them are not easy to solve. And the research is one component. The research provides evidence to support policy-making, to support that there is a problem. Sometimes people don’t even know there is a problem. But the translation doesn’t always equate to a good outcome or something that changes the situation. So it’s really important for us to generate evidence, but also as researchers to take the next step and start to look at implementation and translation so that when we talk about something, people understand it in a way they can act upon it. So, that’s a struggle for a lot of us academics, and it’s a place that we’re not always comfortable with, but that’s where we have to go to be relevant because the literature alone is not going to solve a lot of these problems.

Just going back to the WHO and Your time there, if you could reform it however you chose or however you saw fit, how would you change it?

One of the big things about WHO is it’s governed by its member states only. We’re still not sure what the appropriate way to include non-state actors would be. The reality is that WHO gets more of its budget, or a higher percentage of its budget, when you break it down, of course, from the US, but the Gates Foundation is a large donor. And when you don’t have a seat at the table, and you can’t influence what happens with your money and how it’s used, you’re going to go to other funding sources. So how WHO integrates non-state actors into its governance framework is the most important thing. But at the same time, member-states, they all have a vote, they don’t anyone else to have a vote, so it’s very difficult to have inclusion of other actors, unless WHO opens up its membership and we can talk about how that membership would look like, maybe they are not voting members, maybe they just get a seat to talk in a committee or something, which a lot of them do already, then WHO is not going to be relevant anymore, because so much of global health happens outside of those countries. It happens within the NGO space, it happens within the foundation space, it happens within the technology space. And a lot of the high politics, happens beyond the international UN level. It happens in the board meetings, it happens in the meetings between trade associations, and things like that. And right now, WHO just doesn’t have the flexibility to interact with those actors.

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