A Private Life in Public Health
The concepts of private and public would certainly appear to be antithetical.
It was on a hillside in Nepal that I had my first very clear recognition of public health as a very personal matter. Throughout my coursework for my MPH degree at New York Medical College and the studies of populations, aggregate data sources, collection and analysis, tests of significance, associations and geographical mapping, and defining population parameters, I was always reminded that “small numbers are a big problem.” (Issel page 141.) “Several statistical techniques exist for addressing the small numbers problem, utilizing counts, rates or proportions .” One set of these techniques is based on comparing the small area (population) with a larger area (population) or a standard. Another set of techniques is based on comparing two small areas. (Issel, 2004.)
I had flown to Nepal all alone. I traveled to Hetauda with a driver I have met 5 days prior while staying at the Park Village hotel in Kathmandu. The staff I met at the MIRA project was small. Over the 5 days I spent with them I got to know them as individuals, especially Kirtiman Tumbahangphe the director of MIRA, who grew up in the far eastern area of Nepal, had studied in London, and returned to Nepal to run MIRA. He is an animist. He is a fascinating individual.
I knew statistically and in public health development and delivery planning that the assessments, planning, implementation and evaluation (APIE) phases of a program had to reach populations and at the heart of public health programming is the behavior changes of populations. This is the very public aspect of public health: mass population (“the people”) in association with some matter of common interest.
One of the most enlightening books I read during my public health education was Better by Atul Gawande, MD. In fact, I keep a quote from the book rather unceremoniously but accessibly taped to the rolled back roll top of my desk in my home office. Better was not an assigned book in any of my classes. My dear friend Heller An who lives in Chevy Chase lent it to me when I was staying with her during the National Children’s Alliance conference in Washington, DC, in the spring of 2007. I started reading it in the comfy guest room of her house to the background voices of her two children Eleanor and Alex, with whom I became extremely attached when we were all in Bogota, Colombia together in January 2006. I was afforded this honor of joining them most likely because I was the person Heller An knew would be crazy enough to say yes when she asked if I could come to Bogota for a week or so to keep her company while the adoption process dragged on with a “slow judge.” The week we all spent together was one of the best trips of my life. So back to Dr. Gawande who would totally respect that little digression into my personal past. What I loved about Better and what kept me so attached to it that Heller An let me take it with me when I left Chevy Chase (and it is still in my possession,) is everything in that book is about Atul Gawande. Yes, the book is about making medical care “better.” But he writes about the betterment from a very personal perspective. It is his private thoughts, assessments, ideas, and advice that make the book engaging . Even beyond engaging, the book is about change, change for the better. The quote on the now ragged piece of paper taped to my desk says:
“Write something. I do not mean this to be an intimidating suggestion. It makes no difference whether you write five paragraphs for a blog, a paper for a professional journal, or a poem for a reading group. Just write. What you write need not achieve perfection. It needs only to add some small observation to your world.”
The front end flap of Better bears the statement, “the struggle to perform well is universal,” i.e., it is population based, it is public. But the five suggestions Dr. Gawande recommends to his students and the readers of Better are very individual, personal, private. One of them is the quote above about writing, another is don’t complain….it doesn’t get more personal than that. It is the very small number of one that can make health care services better by not complaining. Another suggestion is for health care providers to ask questions when talking to patients: “Where did you grow up?” “What made you move to Boston?” “Did you watch the Red Sox game last night?” (OK, New Yorkers. do the cultural translation to “Did you watch the Yankee game last night?”)
So I was on that hillside in Nepal, not really thinking about Atul Gawande, really just “being there” in a very Zen way. I was absorbing the sunlight, the clear smell of the air with the faint touch of wood burning fires, watching the women in their colorful saris and kurtas walking from their mountain village homes. I was entranced by how beautiful these women were, how adorable their children were. I forgot about the MIRA cluster-randomized controlled trial documented in the article in The Lancet that had brought me there I wasn’t thinking that the study included almost 30,000 women whose birth outcomes were monitored. I wasn’t thinking about public health APIE or the classes I had taken to achieve my MPH or the thesis I wrote about global maternal mortality and the impact of birthing kits. I was just being myself: a woman in Nepal, sitting on a hillside, meeting other women, sitting beside the staff of MIRA. We were a very small number of individuals who had made personal decisions to be together that day in November 2010. Nothing that happened that day changed the world. That meeting of a small number wasn’t documented in a peer reviewed journal article. If it generated any statistical data, it was very small and possibly even outlier data. But lives were changed. I know because my life was changed. This was public health and it was my private life close up and personal with the lives of the women I sat with, their personal stories, and the clothing we shared, my Tshirts and their scarves that we ended up exchanging.
“Write something,” wrote Dr. Gawande. I have procrastinated for a long time about setting up this blog. Lots of really important things interfered with my sitting down at my computer, learning how to use Word Press, deciding what I would include, who would be my audience, would in fact I have an audience? Let’s see I had to do laundry. It was the holidays and I had to shop, set up the Christmas tree, knit scarves for just about everyone. I had to organize my CD’s and learn how to use my new IPad. I had to go out for dinner with friends. I actually had to go to work every day. But finally as 2011 slipped into 2012 I had another realization to go along with the realizing that public health was indeed personal. A public health blog that would include my personal thoughts and feelings and experiences would also be an opportunity for participants to share their private lives in public health.
All of us working in public health are private individuals with our individual goals and passions and personal as well as professional reasons for working in public health. We all have our moments of inspiration, our relationships with people who have inspired us: family, clients, patients, members of communities, a person we sat next to on the subway, or on a plane, or at a conference. While we have all been focused on creating positive change with populations we have connected with individuals, with small numbers.
So I invite you to join me here at A Private Life in Public Health. I will post essays I have written about my personal experiences learning about a public health issue: the travel to programs I have visited, some people I have met, the changes that I have experienced personally and professionally. I’ll add as many references as I can for those of you who would like to do more research on the topics. I’ll invite some dear friends and colleagues to share their experiences, their journeys. Please contribute your ideas and comments and your experiences as your private life in public health.
So please join me on this journey to health, friendship, and peace. As Joseph Campbell wrote:
“As you go the way of Life, you will see a great chasm.
It is not as far as you think.”
Karel Rose Amaranth, MPH, MA
Gawande, A. (2007). Better: A surgeon’s notes on performance. New York: Henry Holt and Company.
Issel, L. (2004). Health program planning and evaluation: a practical, systematic approach for community health. Sudbury: Jones and Bartlett.
Morrison, J., Tamang, S., Mesko, N., Osrin, D., Shrestha, B., Manandhar, M., Manandhar, D., et.al. Women’s health groups to improve perinatal care in rural Nepal. Retrieved April 10, 2010, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079874
From the online Merriman Dictionary
a. Secluded from the sight, presence, or intrusion of others: a private hideaway.
b. Designed or intended for one’s exclusive use: a private room.
a. Of or confined to the individual; personal: a private joke; private opinions.
b. Undertaken on an individual basis: private studies; private research.
c. Of, relating to, or receiving special hospital services and privileges: a private patient.
3. Not available for public use, control, or participation: a private club; a private party.
a. Belonging to a particular person or persons, as opposed to the public or the government: private property.
b. Of, relating to, or derived from nongovernment sources: private funding.
c. Conducted and supported primarily by individuals or groups not affiliated with governmental agencies or corporations: a private college; a private sanatorium.
d. Enrolled in or attending a private school: a private student.
5. Not holding an official or public position: a private citizen.
a. Not for public knowledge or disclosure; secret: private papers; a private communication.
b. Not appropriate for use or display in public; intimate: private behavior; a private tragedy.
c. Placing a high value on personal privacy: a private person.
The name “public” originates with the Latin “populus” or “poplicus“, and in general denotes some mass population (“the people”) in association with some matter of common interest. So in political science and history, a public is a population of individuals in association with civic affairs, or affairs of office or state. In social psychology, marketing, and public relations, a public has a more situational definition. John Dewey defined (Dewey 1927) a public as a group of people who, in facing a similar problem, recognize it and organize themselves to address it. Dewey’s definition of a public is thus situational: people organized about a situation. Built upon this situational definition of a public is the situational theory of publics by James E. Grunig (Grunig 1983), which talks of nonpublics (who have no problem), latent publics (who have a problem), aware publics (who recognize that they have a problem), and active publics (who do something about their problem).And so public health is organizing populations around the situations of health, usually health problems, illnesses, behaviors contributing to poor health outcomes morbidity, mortality