Vision, according to Mark Dybul, is the biggest problem in public health.
Dybul, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and former head of the President’s Emergency Plan for AIDS Relief (PEPFAR), appeared at Duke on Sept. 16 for the Sanford School of Public Policy’s Egan lecture. The event was co-sponsored by the Duke Global Health Institute and the Kenan Institute for Ethics.
The format was like a meeting of the minds as Michael Gerson, Washington Post columnist, former speechwriter for George W. Bush, and Pamela and Jack Egan Visiting Professor at Duke, interviewed Dybul.
Gerson and Dybul probed fundamental questions such as how to effectively empower health efforts, socioeconomic disparity in health aid efforts, the role of science in public health, and trends in AIDS treatment methods.
Dybul opened by painting a picture of the landscape of AIDS in Africa in the epoch before serious AIDS efforts. He described the streets of Uganda “clogged with coffins,” an atmosphere thick with the expectation of imminent death. He said the implications of this desolate psychology spread far beyond the human body, decreasing motivation for education or investment.
Dybul stressed that a program focused on vision, methods, and results is necessary in order to alleviate the AIDS epidemic, rather than a paternalistic approach gauged only by the sheer amount of money given to an issue and the amount of aid distributed.
He said that bilateral aid organizations, many of which are based in the U.S., are necessarily attached to governments across oceans and thus inspire a certain degree of distrust with local communities. Global Fund, for example, serves as a mechanism for countries to organize anti-AIDS efforts, rather than the directing organization.
The reasons for the measured success of Global Fund, Dybul admitted, are unclear, largely due to the inability of separating variables in live populations. “Public health is art,” he added. The positive impact of Global Fund is indisputable, with decreased numbers of casual sex partners and increased use of condoms contributing to the reduced spread of AIDS in African nations.
When Gerson asked about the future of public health, Dybul predicted a relative increase in the prevalence of non-communicable disease; however, he forecasted that the more important question will be: “Who pays [for treatment]?”
Dybul also projected a vision of a worldwide, cohesive data management system to provide surveillance as a preventative measure in communities — “being smart” about epidemics. Dybul emphasized that public health extends deep into the community and suggested that the term “global health” may evolve into “country health” as relief efforts become more locally-based.
Dybul advised aspiring students to focus on what excites you, yet be open to new opportunities.
View a video of the entire talk (1:18) —