The DrPH as a Toolkit for an Engaged Academic Path

As Harvard’s DrPH consolidates its global standing as a unique academic experience geared towards producing highly qualified public health professionals, I would like to reflect on how it can also turn out to be a step towards an academic career engaged with the practice of public health. The DrPH was created to bridge the gap between the usual output of doctoral academic programs -researchers- and an unmet need in the public health field: public health practitioners with doctoral-level training in both scientific methods and the exercise of leadership. Proficiency in scientific methods is needed due to their key role in the public health decision-making processes, as well as to utilize them purposefully and innovatively to improve our understanding of health needs and our ability to meet them. Dexterity in the exercise of leadership is required at many levels: from influencing public discourse and funding decisions to shaping the concrete manner in which health services are offered by providers, teams, programs, and systems. Many doctoral programs appear decoupled from the constantly changing perceived needs of the population and, in many cases, this may be exactly what is needed: the rigorous and patient pursuit of a research question, at a safe distance from the madding crowd, may be an effective and justified safeguard against fads, distractions, or the status quo’s expectations. However, a different type of doctoral program emerged to address the dynamic challenges of implementation, as evidence of the delay in the uptake of scientific breakthroughs mounted, and as it became clear that implementing and scaling up evidence-based interventions seemed to require a science unto itself. I will sidestep the discussion about the purported differences between basic and applied science, but whatever your position on that discussion is, there is a need of people who focus -with the same level of rigor- on (a) the fundamental knowledge and methods that shape our understanding of a given condition and/or practice; (b) the reality of how that condition or practice exists in a specific place and time; and (c), designing a plan to improve (b) with the tools provided by (a).

I view Harvard’s DrPH as a program purposefully –and successfully– designed to do just that through a strong common methodological core, a flexible elective component, intensive field engagements, and an integrative DELTA project. Of course, the DrPH offers the context, and each doctoral student needs to find the way in which that promise may be fulfilled. In hindsight, if I had to pinpoint the key elements that allowed me to maximize my experience at Harvard, I would say that they are all related to a couple of straightforward facts: I already had significant professional experience in my field, and entered the DrPH with a broad but clear idea of what I wanted to do within it. I did not know many of the details, but my field of choice was clear, and I had an acceptable awareness of my strengths and weaknesses in terms of personal skills and characteristics. My goal was –from the beginning– to approach mental disorders with a public health perspective in order to improve mental health services. My roadmap included: identifying a key conceptual issue to which I believed I could contribute; recruiting academic mentors that would help me produce and advance that contribution; and identifying the specific context (including time and place) in which I intended to disembark after graduation. Nothing was set in stone –indeed, at many points, I re-assessed my choices and re-directed as needed–, but I had a default pathway that I found personally engaging and potentially impactful. In my DrPH application’s Statement of Purpose I had identified the field I wanted to work in -global mental health- and two specific exemplars of the challenges I would want to address after graduation: the mental health policy failure in Argentina -resulting from the botched implementation of a mental health law-; and the public health crisis in Vancouver’s Downtown East Side due to the mounting challenge of comorbidity between severe substance use, mental illness, and brain damage, in the context of poverty and poorly prepared services. I wrote then “My goal is to become proficient at creating scientifically informed, ethically sound and politically viable solutions to public health crises like those affecting Vancouver and Buenos Aires”. Throughout my DrPH, I sought to do just that: grasp the underpinnings of, and be able to offer answers to the global mental health challenge and its local manifestations. Within this broad scope, I explored my concrete possibilities and gradually homed in on the Vancouver option. I identified and applied for specific funding that would allow me to do my DELTA partially in Vancouver and partially in Boston, thus consolidating my insertion in the global mental health field –through the DGHSM at Harvard Medical School-, and in Vancouver. Also, and very importantly, my DELTA was structured along the lines of a classic dissertation model -a succession of publishable peer-reviewed papers-, which I expected would allow me to keep a foot in the academic world. I was becoming increasingly aware of academia’s impact in shaping real-world health systems, and of the creative autonomy it can afford. I also identified organizations -NGOs, multilaterals, research centers, hospitals- that could find my work of value to their specific goals, and I did not hesitate to adapt to their needs, be it through regional needs-assessments, national mental health strategy evaluations, organizational strategic planning, or organizational supervision, all the while maintaining the focus on mental health and substance use.

This all led -quite organically- to establishing close working relationships with mentors -Rifat Atun, Arthur Kleinman, Anne Becker, Graham Thornicroft, Vikram Patel, Elliot Goldner, Dost Ongur, and Bepi Raviola-, as well as with organizations such as PAHO, PIH, the Department of Global Health and Social Medicine at HMS, and Simon Fraser University/Centre for Applied Research in Mental Health and Addictions. This network allowed me to focus my DELTA on the epidemiological and health systems issues that I wanted to pursue but also forced me to do it in a way that was meaningful and impactful enough for existing organizations, so that they were willing to sustain it. After graduation, I transitioned to a similar role, but from a position of higher autonomy and responsibility: grounded in academic positions, my current work is still closely aligned with multilateral organizations, provincial and federal Ministries of Health, as well as with health systems and organizations such as NGOs, hospitals or community centers. As PI of the Needs-Based Planning For Mental And Substance Use Disorder Services in BC project, I am working closely with the Health Authorities and the Ministry of Health to design a blueprint for the ideal suite and size of services for the province. As part of my clinical and research role at UBC/St. Paul’s Hospital, I am co-designing a protocol to improve the care of the most complex patients in Vancouver’s Downtown East Side, and studying how social capital impacts mental health outcomes and shapes the need for health services. I am also teaching and preparing courses on the key conceptual and implementation issues pertaining to global mental health.

In short: each DrPH trajectory is unique, and this only reflects my personal circumstances. My DrPH experience was highly demanding but incredibly rewarding, which I attribute to the fact that: a) I was at a point in my career that allowed me to rapidly identify feasible goals and pathways to achieve them; b) I was able to structure everything –courses, written products, field placements, network- so that it built on my previous expertise to become an attractive portfolio from a public mental health perspective; and c), I always kept the academic option open by structuring my deliverables accordingly.