At long (long, long) last: the APHA @ih_section's #GlobalHealth Jobs Analysis has been published!

Wednesday, February 28, 2018

Ah, sweet victory. The Global Health Jobs Analysis project that I spearheaded has finally been published in BMC Public Health. The project, which came to me as a completely insane idea at the end of the 2015 APHA Annual Meeting in Chicago, was done over the course of about eighteen months by a group of dedicated volunteers who collected, entered, and analyzed data completely outside of their day jobs. All publications, as well as a link to an up-to-date data repository, are listed on the project page linked above. Here is the abstract:
The number of university global health training programs has grown in recent years. However, there is little research on the needs of the global health profession. We therefore set out to characterize the global health employment market by analyzing global health job vacancies.

We collected data from advertised, paid positions posted to web-based job boards, email listservs, and global health organization websites from November 2015 to May 2016. Data on requirements for education, language proficiency, technical expertise, physical location, and experience level were analyzed for all vacancies. Descriptive statistics were calculated for the aforementioned job characteristics. Associations between technical specialty area and requirements for non-English language proficiency and overseas experience were calculated using Chi-square statistics. A qualitative thematic analysis was performed on a subset of vacancies.

We analyzed the data from 1007 global health job vacancies from 127 employers. Among private and non-profit sector vacancies, 40% (n = 354) were for technical or subject matter experts, 20% (n = 177) for program directors, and 16% (n = 139) for managers, compared to 9.8% (n = 87) for entry-level and 13.6% (n = 120) for mid-level positions. The most common technical focus area was program or project management, followed by HIV/AIDS and quantitative analysis. Thematic analysis demonstrated a common emphasis on program operations, relations, design and planning, communication, and management.

Our analysis shows a demand for candidates with several years of experience with global health programs, particularly program managers/directors and technical experts, with very few entry-level positions accessible to recent graduates of global health training programs. It is unlikely that global health training programs equip graduates to be competitive for the majority of positions that are currently available in this field.
BMC series journals are all open access, so the full paper is available on the web and as a PDF download.

This was quite the learning experience for me - almost a baptism by fire into the peer review process. I suppose it is a taste of what is to come when I begin my PhD in epidemiology at U Maryland's School of Public Health this fall(!). I also hear that it is considered bad juju in academia to go into the gory details of the peer review exchange (unless your reviewers are blatantly sexist), so I'll refrain for the moment.

More important than certain people's conclusions that descriptive analyses aren't worthy of publication is the fact that now there is an evidence base for what has long been anecdotally known by anyone who has ever tried to get a job in the global health field (or international development more broadly). The TL;DR version of the paper is there aren't enough jobs for MPH grads, and - based on the continued growth of global public health programs - nobody seems to be communicating that to prospective students who are looking down the barrel of a 50+K-student-loan-debt gun. Based on my reading of the literature, it looks like schools of public health have been leveraging the popularity of global health in the media to bring in more students:
Driven by global pandemics such as HIV, increased foreign aid budgets from the U.S. and other high-income nations, the emergence of new multilateral institutions and NGOs such as the Gates Foundation, and increasing prioritization of country ownership of health programs, both the politics and the funding structure of global health work have shifted. Global health has also experienced increased levels of attention and funding. Interest among students in high-income countries has increased as well, as evidenced by the impressive growth in the number of global health graduate programs.
This looks a whole lot like the law school crisis that hit headlines about five years ago:
Ninety-two percent of 2007 law school graduates found jobs after graduation, with 77 percent employed in a position requiring them to pass the bar. For the class of 2011 (the latest class for which there are data), the employment figure is 86 percent—with only 65 percent employed in a position that required bar passage. Preliminary employment figures for the class of 2012 are even worse. The median starting salary has declined from $72,000 in 2009 to $60,000 in 2012. A while back, the Bureau of Labor Statistics estimated that 218,800 new legal jobs would be created between 2010 and 2020. As law professor Paul Campos points out, because law schools graduate more than 40,000 students per year, those jobs should be snapped up by 2015—leaving only normal attrition and retirement spots left for the classes of 2016 to 2020. Meanwhile, tuition has increased dramatically over the last several decades.
For the record, we got lucky and managed to land a very thoughtful and thorough editor at BMC, who recommended that we share the results through CUGH and other avenues. I fully plan to do so to the extent I can (while still keeping my day job).

@NASTAD launches a website to help PLWHA find health insurance that covers #PrEP

The National Association for State and Territorial AIDS Directors (NASTAD) has a launched a website,, to help those interested in PrEP navigate the health insurance marketplace. It was featured in the New England AIDS Education and Training Center's "In Brief" newsletter last week:
Although most health insurance plans in the U.S. now cover PrEP, out-of-pocket costs can be a barrier to use for many persons. To address this concern, NASTAD recently developed – an online tool to help people find the most affordable health insurance plans available through the individual marketplace for PrEP coverage. According to NASTAD, the PrEPcost tool assesses how the PrEP medication is covered in different plans, and applies income-based savings to monthly premiums for each plan. “It then calculates out-of-pocket expenses for the clinical visits, labs, and the medication, and it applies the manufacturer’s co-pay card to that estimate.”
Here is the YouTube video explainer:

Legal #epidemiology of #HIV in sub-Saharan Africa: How different colonial legacies impact HIV rates in women

Tuesday, February 27, 2018

A recent paper set to be published in the American Economic Review presents an incredibly fascinating analysis on the differences in HIV rates among women in different countries in Africa (the only region in the world where more women than men are living with HIV). The paper finds a significant difference in female HIV rates between countries using a common law system (the legal tradition of the UK) and countries using a civil law system (the tradition of continental Europe), according to each country's colonial legacy (i.e., which European country originally colonized them). My former colleague Mark Leon Goldberg, who featured the paper on his website, UN Dispatch, explains:
The legal traditions mostly developed separately from each other for centuries. This includes how these different legal systems approached property rights for women in general and married women in particular.

In the common law tradition married women did not have any property rights independent from their husbands. That changed in the late 1800s, when the U.K adopted the “Married Women’s Property Act” which allowed married women to own their own separate property in some circumstances. But if the marriage ended by death or divorce, the woman did not have any right to any common property. The civil tradition, by contrast, presumed that married couples owned property jointly, and upon the dissolution of the marriage the woman would be entitled to an equal share.
The paper elaborates on the differences between male and female transmission routes in these countries and explains the epidemiological theory behind them:
The vast majority of HIV infection in Sub-Saharan Africa is through unprotected heterosexual contact (UNAIDS). Male HIV rates on the continent have been linked to high-risk cultural patterns; chief among them traditionally liberal attitudes towards the sexual activity of men. Multiple sexual partners, and both pre-marital and extra-marital sexual activity, is widely tolerated and in some cases even expected.

The high endemic areas are also characterised by disproportionately higher HIV rates for young women relative to their male counterparts. The WHO, the UN, and the World Bank have conjectured that gender inequality plays an important causal role in this ‘feminization’ of the disease. Accordingly, policy has shifted to altering power relations within households, since more than 80% of HIV positive women in Sub-Saharan Africa were infected through their spouse (UNAIDS).
The author then goes on to explain how the existence of women's legal property rights allow women to leverage them to negotiate safer sex practices with a potentially infected spouse:
Property regimes allowing women to leave marriage with a significant share of household assets...can increase female sexual autonomy, even if never exercised. Conversely, regimes limiting women’s control to assets brought to the marriage and to assets acquired personally, limit female power to negotiate sexual interaction with husbands, hence raising female vulnerability to infection. ...women in these countries are more likely to rely on contraception methods that do not require negotiations with their partners, but also do not reduce their risk of contracting HIV, such as injections, the pill, and IUDs. By contrast, women in civil law countries are more likely to use contraception techniques that reduce their chances of contracting HIV, but also require compliance from their partner, such as condoms, abstinence, and the withdrawal method.

#OpenData highlights: #Rohingya refugees, disaster recovery, and fire safety

Friday, February 23, 2018

I have just returned from a trip to Beijing to see my sister who lives there (and to meet my nephew, who was born there last July), so I have some catching up to do. The two most recent additions to the Data is Plural newsletter archive have featured health-related data sets. The Valentine's Day/Ash Wednesday edition included data sets on disaster recovery in Nepal after the 2015 earthquake, as well as data on fire safety in the UK:
Nepal, post-earthquake. In April 2015, the Ghorkha Earthquake killed more than 8,000 people in Nepal, and destroyed hundreds of thousands of homes. In early 2016, a team led by the not-for-profit Kathmandu Living Labs, in collaboration with Nepal’s government, undertook “ a massive household survey using mobile technology to assess building damage in the earthquake-affected districts.” The responses to that survey are now available at the 2015 Nepal Earthquake Open Data Portal; you can explore the data online or download it in bulk. In all, the datasets include details on millions of individuals, plus information about each surveyed household and building.

UK fire stats. The United Kingdom’s Home Office publishes dozens of fire-safety related datasets, including aggregate statistics on response times, smoke alarms, and fire department staffing; incident-level data on appliance fires, vehicle fires, and fatalities; and much more. Of the 100,000+ domestic appliance fires reported over a six-year span, 52% were believed to have been caused by a “cooker incl. oven,” 11% by a “grill/toaster,” 2% by dishwashers, and just over 1% by deep-fat fryers.
This week's edition included a data set on Rohingya refugee settlements in Bangladesh:
Rohingya refugees. The Humanitarian Data Exchange has collated dozens of datasets related to the Rohingya refugee crisis. Among them: the geographic boundaries of Rohingya refugee settlements in Bangladesh, the numbers of refugees living in those settlements, and the infrastructure available there.