Q&A with Rohit Ramaswamy, PhD, MPH
Morghen Philippi, MPH global health concentration student and graduate research assistant for Research, Innovation and Global Solutions, interviewed Rohit about his global health work, systems thinking, and the changing global health landscape.
What roles do you play at Gillings?
I have a joint appointment in two departments; I am in public health leadership and also in the maternal and child health departments… I teach in the public health leadership program; I teach in the leadership and practice concentration. I teach a course in systems thinking and design thinking that has students from multiple concentrations, including from global health. In maternal and child health, I work with several masters and doctoral students on some of my global projects. I also have global health students, of course, in these projects. My second major role is the co-lead of the global health concentration – working with the other leads from the other departments. I think it really is a model for working together and comes with both its rewards and its challenges. Additionally, I am on various committees. I am on the Appointment Promotions and Tenure Committee, so I serve at the school level. Then at the university level, I am on the Faculty Council and on the Chancellor’s advisory committee. I work with the Chancellor on issues of relevance to the university as a whole. I am also the director on the UNC side for the UNC-RTI Consortium for Implementation Science.
What does “global health” mean to you?
I’ve been giving it a lot of thought. What does that mean to me right now, especially as we are seeing global work slow down because of the pandemic? Before March of this year, I was spending a large amount of time on planes. The way a lot of the global health work is typically done, I had – during the course of the year – multiple visits to the multiple sites where I have projects. The work that I do is very much at the intersection of research, teaching and practice, so a lot of the components that I work on involve partnering with local organizations. The need for us to be in these countries with our partners is valuable from the perspective of building relationships, but I have become less convinced that we need to be there to move the projects along. The last time I was on an international flight was on the 19th of March. It’s been six months since I’ve been on a plane. And as I’ve been seeing how our projects are working well without our physical presence, I’m becoming more and more convinced that this model, where somehow we need to be there all the time in order to be working with our partners may or may not be critically necessary.
In Ghana and in South Africa, our partners are doing extremely, extremely well on their own, perhaps in some cases even better without our interference… As we look at how the health systems of countries such as Ghana have reacted to the pandemic relative to what we have done, it is apparent that the capacity in these countries to do what is right certainly exists. In some cases it feels like it surpasses ours, not necessarily in terms of resources, say, but in but in terms of the ability to mobilize leadership – in terms of having the political will to be proactive around keeping the population safe and basically sticking to a course without having that kind of swinging pendulum from one intervention to another…
All of this is part of the conversation about decolonizing global health which I am glad we are engaging in right now. This conversation has been around for 20 years… What is the role of international NGOs that collect US government funds that come from our surplus farm products and go, you know, monetize them in other countries and use that to run programs? What is the value of that, especially if, you know, there’s no real focus on local capacity building and there’s no focus on sustainability?… The discussion has been taking place for a long time, and it’s certainly been brought back into focus right now with global health… We have talked in our school about local is global. And I think we’ve stuck to that idea quite strongly. I think people take it seriously. But I wonder whether we should be promoting [it] even more amongst our faculty, amongst our students. How do you begin to kind of put that into practice in a way that better brings together the faculty in our school who are doing exceptionally good local work – where the focus is on anti-racism, with focus on equity? How do use of some of their skills and knowledge to be part of our overall global health portfolio? How can we be honest in telling current and future students that while we recognize and acknowledge their global interest, we will advocate with equal vigor for them to direct their energies and talents to the deep inequities that exist at our doorstep, and that as inhabitants of this planet, these enterprises are as important as working in locations abroad?… I actually have been thinking about these topics a bit more deeply, you know not having to rush to the airport immediately gives you some time to reflect, and so that’s kind of where my thinking is right now.
Before entering the public health field, you earned degrees in mechanical and civil engineering. How does your engineering background influence the way you view and engage with global health?
As we begin to think about public health 3.0, the idea is that public health leaders ultimately are not necessarily just program implementers but public health strategists able to build and convene multisectoral partnerships and bring about complex change or able to facilitate change in complex systems. I am completely, completely convinced that is the only way we as public health professionals can survive… The more we are able to bring together different stakeholders with different perspectives and different skills to engage around systemic problem solving, the more successful we will be. Engineering as a field emphasizes that kind of thinking… Ultimately, your role as an engineer is not to just build a building, but understand that a building exists within an environment and that by placing a footprint on the environment you are affecting the environment in certain ways – the building itself is part of a larger collection of buildings which is a built environment which is part of a larger ecosystem… That is one area where I do think the engineering education helps, and I hope I am able to bring that engineering perspective to students in the school.
Second, engineers are also trained to be entrepreneurs – to be tinkerers and experimenters. We, as the [Gillings] school and UNC are emphasizing innovation, social entrepreneurship and social innovation. How do we do better experimentation – not necessarily experimentation tied to five-year RCTs, but how we can actually do meaningful and thoughtful experimentation on the ground that actually allows us to work with communities and test out solutions? How do we do that in a way that is still scientific and systematic but is done with the goal of inclusive problem solving in mind and the goal of innovation in mind? Those are some of the things that are intrinsic to engineering thinking and I think have always been important in public health… At place like Gillings, where we do have this kind of interdisciplinarity and practical focus, I think we are right for that kind of work… We have a dedication to practice and to equity and justice that runs through a lot of the faculty. We also have much more of an interdisciplinary, collaborative culture that lends itself well to an engineering approach.
What attracted you to the field of global health?
I fell into the field of global health quite by chance… A lot of the work after my PhD in Engineering was in the private sector. A lot of the work I was doing is much of the same work I do today but with a focus on service delivery strategies for large corporations – working with their international teams in developing processes for whatever they did… In the early 2000s, there was a period in my life when my parents were both ill in India, and I needed to take some time off work to go spend time with them. I had a year which was kind of a gap year for me… I had already done a lot of global work, not necessarily global health work, but through my consulting, I had a global portfolio, mostly in high income countries, a lot of it in Europe and some of it in Latin America. The year I spent in India, I was looking for things to occupy my time. I had always been interested in international development. I just didn’t always have a sense of how what I brought to the table would contribute to that field. So, I reached out to a half a dozen organizations and NGOs – the World Health Organization and World Bank and others and said, “Here’s my CV. Here are the things I do. Are there any things of interest where my skills could be useful?” It turns out that I happened to be at the right place at the right time. India was transitioning from being a low-income-country to being a middle-income-country. The entrepreneurial economy was doing extremely well… India had basically told international NGOs, “You can come do nutrition programming or reproductive health or HIV-work, but we don’t need you to bring your food from the US.” And so, a lot of the NGOs were beginning to think, “How do we redesign our service program delivery platforms to accommodate this new environment?” CARE, the international NGO based out of Atlanta, happened to call me and said, “Looks like you do a lot of systems design and process design work. Can you help us with our processes and help us improve the quality of what we deliver – given that we need to be doing something different?” And so, I had a year with them working on much of the same kinds of things I worked on in the corporate world but in the nonprofit world.
It became apparent to me that not only were my skills useful in public health and global health, but especially in that time – this was 2005, 2006 – these skills were not part of the overall public health body of knowledge. So, I came back to the US and looked around for online MPH programs, and Gillings had the Public Health Leadership program. I got my MPH from there. Then, after I graduated, this is when the school was developing its online global health certificate. Once again, I happened to be at the right place at the right time, and they offered me that. Then, I moved into faculty here. I think [all this] came from a realization, as I mentioned earlier, that many of the things I have been trained to do have real value. For me, the transition moving away from doing things for the service of for-profit companies to the doing things for service of the betterment of humanity fit my mental model a lot better, too.
If you could travel anywhere in the world, where would you go and why?
I go to South Africa a lot, and the people that I work with in South Africa have always said, “You have to go to Lesotho.” It is supposed to be truly, truly beautiful. Black Panther was filmed there! Every time I have gone to South Africa, I have said I wanted to make the site trip to Lesotho, but I have not quite made it yet.