Students and global health experts share their experiences working with communities.

Author: Global Health (Page 1 of 12)

SPH - Research, Innovation and Global Solutions Operations

Staying Connected

Melissa in a field of sunflowers at the NC Museum of Art.

Enjoying the colorful sunflowers, cosmos and zinnas at the NC Museum of Art.

As I was driving a familiar route on I-40, admiring the lit up American Tobacco Trail bridge against the various hues in a beautiful Carolina sunset.  I wondered, “What does a sunset over Lusaka, Zambia look like?” if I were there for my practicum.  I have only heard of my colleagues and friends’ experiences as they lived and traveled there.  I understood it to be a place that drew someone I admired and respected back so many times that when we ordered her retirement party cake, it had the colors of the Zambian flag on it.  I searched for images online, and as I scanned the landscapes, buildings, and people in photographs, in that moment, I wished that I could be there experiencing a universal, cyclic sunset that is familiar yet different everywhere you experience it. When I applied for this practicum, I knew that it would be understandably remote as we are still in a pandemic, but I still wished I could travel and meet with my colleagues in person.  The past year has been a roller coaster ride of emotions through the challenges and opportunities while being remote pursuing an MPH with a concentration in Nutrition at the UNC Gillings School of Global Public Health and working full-time as a project coordinator also at UNC.

Prior to becoming an MPH candidate and returning to work in global health, I earned my culinary arts degree in New York City and worked as a line cook and sales account manager. I also have bachelor’s degrees in Anthropology and East Asian Studies from the University of Virginia.  My partner and I moved to Chapel Hill, North Carolina so I could be an assistant cheesemaker and cheesemonger.  It has been a long journey leaning on my support system of family, friends and mentors to get where I am today able to pursue my passion and studies in global health nutrition.

For my UNC Gillings Zambia Hub practicum, I am part of a qualitative research study funded by the UNC Center for AIDS Research (CFAR).  The study examines the feasibility and acceptability of engaging male partners, grandmothers, and other family members to support HIV-positive mothers in Lusaka, Zambia, to practice recommended infant care and feeding practice and adhere to antiretroviral therapy. The data collectors are trained in Trials of Improved Practices (TIPs), which is a formative research technique, and they counsel women and their families.  Data are collected during a series of three interviews with HIV-positive women, and two interviews with the women’s male partners or family members. TIPs is a consultative methodology that focuses on understanding what is adaptable and feasible for HIV-positive mothers and their partners and families to improve infant feeding and care, bridge the gaps between knowledge, and put improved health for mothers and infants into practice.  I am particularly interested in learning from the Zambia-based team and my preceptor about conducting interviews and using TIPs as a research method and technique to give participants a voice in program planning.  It is vitally important to understand the context and practice cultural humility with stakeholders, which assists with sustainability.  I also like how the participants try out the agreed upon practice and I am eager to learn more about the support system of these women and its impact on their and their infants’ nutrition and prevention of mother-to-child transmission of HIV. During my practicum experience so far, I am learning how to use Ona, an online platform using Open Data Kit (ODK) to collect data and summarize participant characteristics and responses. I have also given feedback on the interview guides and written transcripts.  I look forward to working with the team to create a codebook and code transcripts in Atlas.ti. and synthesizing what we will learn. I also continue to learn from the team on how to conduct qualitative research effectively in interviews and be faithful in translations while maintaining the dignity and privacy of the participants.

My summer days have been flying by as I started a new job within UNC Carolina Population Center (CPC) at the end of May and continued to work full-time in addition to my practicum.  I meet virtually with my preceptor, Dr. Stephanie Martin, and a fellow student every week, and with the Zambia-based team frequently, which keeps me connected and moving forward. I am appreciative and grateful for the team that I work with for their flexibility and understanding. The silver lining that I have found in a remote practicum and hybrid work schedule is I am able to do both. Similarly, to what others have said in this blog space, I reflect upon my current situation daily and strive to change my mindset/perspective by practicing gratitude one day at a time.  I recently watched Chef’s Table: BBQ featuring the James Beard Award winner, Rodney Scott on Netflix.  He said, “Every day is a good day. It doesn’t always go as smooth as we want, but life is what you make it.” “My glass is going to be half full each time.” “What did I do yesterday that I can improve on today?” These words and his approach resonated with me to apply this to life and my practicum experience of doing qualitative research in a pandemic. All research activities in Zambia involving direct contact with participants were temporarily suspended for over a month due to the increase in COVID cases and only recently resumed on August 4.  We have what we planned in the theoretical sense, and then we had to face real-life implementation.  The safety and well-being of those in Zambia were most important. I learned more about communication and how to move forward even during these most challenging times.  Due to the delay in completing data collection and changing timelines in project implementation, my practicum was slightly extended, and I will continue to work with Dr. Martin and the team through an independent study this fall.

Beekeeping boxes.

Backyard beekeeping

Picture of a bunch of different vegetables picked from the garden.

Proud of the harvest from our garden.

In addition to a busy work and school schedule, I am finding respite by taking care of our four beehives and mini homestead garden with my partner, Michael.  I am also spending time with my co-worker and cat daughter, Honey. She reminds me to get up and move away from my computer to pay attention to her and what is going on outside.

Brown, tan, white and grey cat sitting on a chair.

Honey, our amazing and wonderful cat


Learning practical data analysis for strong sanitation programs in India

Picture of Katie in a kayak on a lake.

Enjoying my summer kayaking whenever I got the chance.

I worked with Gram Vikas (GV), an Indian NGO, based in Bhubaneswar, Odisha, India for my practicum this summer. GV has been working in the Odisha state for the past 50 years. GV partners with rural communities to enable them to lead a dignified life by building their capabilities, strengthening community institutions, and mobilizing resources. Gram Vikas has been working to understand and expand access to piped water supply and sanitation in the communities it reaches, as well as to understand and strengthen the institutional systems for community ownership and management of water, sanitation, and hygiene (WaSH) systems since 1993.

Gram Vikas recently completed a sustainability assessment survey capturing data on water and sanitation access, functionality, and management status for over 40,000 households in areas of India where Gram Vikas has worked between 1993 – 2020. Household survey data were collected between August 2018 to January 2020 covering a total of 10 districts across the Odisha state. The sample frame for the survey was a census of communities served in these districts (n = 41,586), meaning that GV attempted to collect data from each household in each community across these districts in which GV had worked.

Working with this dataset from GV has been an incredible learning experience. I have been able to learn Stata in a way that I could not have been able to otherwise. Using data collected by GV across a diverse geographic region, in combination with additional publicly available secondary data, we undertook additional analyses to support GV’s efforts to better understand what variables and factors influence service delivery, service quality, access and use, and sustainability, to strengthen service delivery, enhance equity, and expand access to sanitation across the Odisha state

Some of the challenges that came up from working with this data included my learning curve using Stata in an applied way for the first time and determining how to clean up the variables to get an accurate read. My previous class experience taught me the basics of how to use Stata, but this dataset allowed me to learn in an applied way. Using some of the resources from those classes, the expertise of Cathy Zimmer from the UNC Odem Institute, and assistance from my team I was able to get the support I needed to tackle this dataset. Some of the variables in the dataset needed to be edited to provide the best possible outcome. For example, each household answered a question what type of phone they had, but the outcome of no phone was not included in this variable. It was important that I combine them to have the full picture of what type of phone outcome each household had. I will be grouping this variable with other variables in order to create a wealth quintile in the coming months to see how wealth impacts households ability to have a toilets and bathing rooms in their home and other sanitary dependent variables.

Gorgeous sunset during my vacation to Hilton Head Island

Gorgeous sunset during my vacation to Hilton Head Island.

I have been given the opportunity to continue working on this data in the fall semester and look forward to learning more about what impacts sanitation and how GV’s interventions are helping to close these gaps.


“On my feet” Adaptation Skills

A Tableau map we constructed from geotagging ourselves once in each of the 35 surveyed villages.

A Tableau map we constructed from geotagging ourselves once in each of the 35 surveyed villages.

Hello again!

I hope everyone’s summer went well. Ours was … honestly… a bit chaotic, but it taught me a lot of patience and “on my feet” adaptation skills! While I was always safe and cautious, we did encounter some challenges with COVID-19 during our Sickle Cell Awareness Survey and Community Needs Assessment in Western Uganda. The national policies on travel were changed a few times, and usually with little notice – which made planning our daily work nothing short of challenging.

– However-

I’m really really proud of the work that we did and am very thankful for the help and support that I had along the way!

We [surprisingly] were able to interview ALL 35 villages in the sub-county. This ended up being a little over 200+ individual household interviews. It was not an easy feat but was extremely important, as we wanted to establish the baseline awareness of sickle cell in the area. So far, we are finding an unexpected spatial distribution of sickle cell awareness, which will be interesting to dig into later.

To estimate the current burden of disease, and service utilization in the nearby municipality we visited the records department of four different hospitals and mapped the five-year trend of in-patient, out-patient, and laboratory visits for sickle cell – a bit of grunt work, digging through a lot of loosely-organized dusty papers, and broken binders, but the recovered information is really going to give us some great insight into the current situation in the area.

Most importantly, we got a good look at the service availability and challenges for families with sickle cell from 19 family interviews, and visits with local and national stakeholders in sickle cell care. We looked more deeply into resource availability by surveying 23 area drug shops and traditional healers.  And identified some gaps in provider knowledge and awareness of sickle cell, areas for improvement, through 51 health provider surveys.

Overall, the last three months have been really busy – but really rewarding – because I know the efforts of that work won’t end here. We expect this Community Needs Assessment will lay the groundwork for a future monthly clinic day dedicated exclusively to sickle cell. A day where individuals in this sub-county can come to test for sickle cell and where those with Sickle Cell Disease or Sickle Cell Trait can receive regular health visits and support within their own community.


With goal-motivated fun, time flies

I have been privileged to work on a hugely satisfying and rewarding practicum with the Gillings Zambia Hub. It is qualitative research to assess the acceptability and feasibility of engaging male partners and other family members to support HIV-positive mothers to practice the recommended Infant feeding practices and Anti-Retroviral Therapy (ART) adherence.

My drive and interest in HIV research and the prevention of mother-to-child transmission stem from seeing the hardship faced by people living with HIV. Hence, I was glad for the opportunity to work on a subject matter I find interesting and relevant, so I have had no problem finding my footing or staying motivated, especially with the practicum being a virtual one.

For the project, we use the Trials of Improved Practices (TIPs), a formative participatory research technique developed by the Manoff group to pretest and improve the recommended practices on a small scale before introducing them broadly. Trained interviewers discuss current feeding practices and ART adherence with study participants in individual interviews. In addition, study participants are encouraged to identify home supporters. Subsequently, there is counseling on the recommended practices, and with the interviewer’s help, each study participant decides on specific practices to be adopted over a trial period. In follow-up meetings, the interviewer asks questions to assess the uptake of the recommended practices. By taking this approach, we draw from the experience of the study participants, who are members of our target population, to pilot test our recommendations. This approach enables us to recognize and determine the practicability or limitations of recommended infant feeding practices in the context of the local communities. Furthermore, using TIPs makes it possible to identify possible challenges that might impact the uptake of our proposed recommendations, provide solutions to these challenges, eliminate or modify practices that are not feasible.

As an intern, I support the team by reviewing the transcripts of the focused interviews and providing feedback. I also use Ona to assess and summarize the data and ATLAS.ti for qualitative data analysis. In addition, I am working on a secondary analysis of already coded data to determine the role of social support systems and couples’ joint decision-making in preventing mother-to-child transmission of HIV. Through my interactions with the research team, I am learning to be perceptive of cultural differences, be humble and respectful while giving feedback, and be open to responses that challenge my worldview and perspective. The opportunity to work on a diverse team has also afforded me a better appreciation of the interaction between individual social identities and power dynamics in a research ecosystem.

Sometimes, things do not go according to plan. A little over a month ago, the project had a slight hiccup when the Zambian government had to suspend all hospital-based research because of another wave of the COVID-19 pandemic. Data collection had to stop temporarily, affecting our deadlines for specific points in the study. Thankfully, the COVID-19 cases are dwindling, the suspension was lifted a week ago, and data collection has commenced again. Overall, I would say that this summer has been productive and a lot of fun. Through meeting other students,  I expanded my Gillings community. I also explored more of North Carolina. Most of all, I am thankful for a fantastic opportunity to learn and grow my skills through the Gillings Zambia Hub. Now, my only grudge is the swift passage of time because it feels like I started the practicum a day ago, yet it’s been three months and more. Indeed, time flies.

While spending a summer day at Ft. Macon State Park, I couldn’t resist taking a picture of these lovely seagulls.


Barreling Towards The End

My last practicum blog post, I expressed the slow-build experience making connections and forming relationships with the collaborators and community we were bringing together to support my practicum agency, Pitkin County Public Health, in executing deliverables for a grant addressing health inequities for the Latinx population of Roaring Fork Valley in Colorado exacerbated by COVID-19. Since that last post, I feel like the summer’s flown by, as our team of collaborators and stakeholders has barreled forwards towards the grant deadline next week. The experience has been both exhilarating and thought provoking, providing me many experiential lessons I will take forward into my second year of my MPH program and beyond.

First, I gained a greater appreciation for the challenge of balancing community-driven approaches that prioritize human relationships and creating shared spaces, with the logistical pressures and timelines of working within the institutional norms of grant-based financial infrastructure. For example, to support the Spanish Mental Health Media Campaign funded by the grant, we formed a Strategic Planning and Marketing Committee comprised of various community leaders interested and passionate to address the burden of mental wellbeing challenges in the area. While my preceptor and I prioritized ensuring that all members of the group were properly compensated for their time, as the grant deadline drew nearer, I felt the implicit pressure to increase the number of weekly meetings, and expectation for deliverables for the group to complete all campaign materials by the end of the grant period. I feel it can be so easy working within groups seeking to make a positive impact, and united by common values, to take advantage of these positive qualities. My practicum experience has left me reflecting on how easy it can be in the field of public health to succumb to prioritizing white supremacist norms, such as perfectionism, timeliness, and a sense of urgency, in the pursuit to fulfill the requirements of entrenched institutional standards.

However, my practicum experience also helped me gain a greater appreciation for how the field of public health can (and likely should) intersect with a broad range of other disciplines in its application. While I had the opportunity to participate in perhaps more traditional elements of public health work, such as delivering presentations to the state Board of Health, and developing monitoring and evaluation plans, I also was forced to step out of my comfort zone into other disciplines to properly support the efforts I was involved in. For example, I gained a crash course in budgeting and contract development for media campaigns, working with a county marketing specialist to solicit media purchase estimates from radio stations, public bus lines, and Internet spaces. Once our marketing committee had selected its primary forms of delivering the Mental Wellbeing Media Campaign, I coordinated directly with radio management and talent, and local social media influencers, to draft Scope of Work contracts; process media buys, and manage limited grant funds. There were several hiccups in this process, especially learning to navigate county rules around payment structures for contracted work, to be able to properly reimburse the media talent and campaign designers. I feel like I gained a lot of practical knowledge from these experiences, and I was reminded that in the gap between conceptual public health knowledge and the implementation of health promotion interventions and activities, there’s a variety of practical skills and leadership capacities that can be highly relevant. The varied experiences and skills I’ll take from my practicum have reinforced three lessons for me for my future public health practice: 1) to stay creative about the way public health can be combined with other disciplines 2) to continue developing varied skillsets not immediately incorporated in academic training 3) to seek out and value the knowledge and input of “expertise” from non-traditional sources and community leaders.

Also, I feel inspired to continue bringing my guiding value of creativity into my global health practice. I had the chance to bring my visual eye to my practicum in several respects, by creating logos and visuals for the campaign messaging that had been created by the Marketing Committee, and by building the formatting for resource guide for Immigrants and other Latinx families in the area.

It was a joy to help foster a creative space within the Marketing Committee meetings, cultivating an environment where everyone was sharing ideas and building messaging and campaign materials relevant to their own community. This Marketing Team developed a vision for a three-armed campaign, focusing on a local radio station, a local interview show, and social media pages on Facebook created during the pandemic, to direct limited campaign funding to the mediums with greatest reach and impact for the intended audience. I can confidently say these would not have been the mediums chosen by Pitkin County if left to their own devices, and are another example of the power of tapping into the expertise of community knowledge. I was very inspired to see the demographic-specific messaging the group devised for women, men, the older aged, and adolescents, as well as the compelling radio ads they drafted and moving video testimonials they produced. The unifying feature of the campaign the group devised utilized the imagery of a stoplight to encourage destigmatization, preventative action, and seeking help around mental wellness challenges. I honestly think this idea is super clever, and I can’t look at a stoplight now without being reminded to stop and check-in on my own mental wellbeing.

I also met with a myriad of community leaders, service providers, and other stakeholders, to conceptualize and produce a format for a community resource guide that would be inviting, useful, and accessible. Based on this input I devised a system using visual icons to aid in navigation of the guide and decrease the extent to which literacy is a barrier to access, also highlighting key potential barriers to accessing the services in the guide such as cost and documentation status.


Most of all though, the biggest thing I’ll be taking with me from my practicum experience are the positive memories, connections, and relationships I was able to form (albeit remotely) with so many wonderful individuals. I feel incredibly lucky to have had the opportunity to meet and become friends with the incredibly talented individuals in the Marketing Committee we formed, and I’m so excited to see all the positive work they produce in coming years.  It was difficult to say goodbye, it was a both a valuable reminder of the importance of the human element of public health work, and refreshing validation of my interest in pursuing a career in global health.


Three takeaways from my summer on TB

A map of North Carolina on a laptop in Jaclyn's backyard.I finished my practicum last week with the Tuberculosis (TB) Control Program at the North Carolina Department of Health and Human Services (NC DHHS) and wanted to share a few final reflections.

  1. Practica will inevitably change and evolve throughout the summer – but that’s not a bad thing! I originally thought I would be using surveillance data to estimate the prevalence of latent TB infections in the state. However, I was able to come up with a better strategy after consulting with the TB epidemiologist at DHHS. She illuminated some of the issues with the data reporting system we currently have and encouraged me to consult other estimates from the literature. This new direction allowed me to redirect my efforts to interpreting and assessing the quality of available estimates, which is ultimately an important skill for me as a budding “applied” epidemiologist.
  2. Practica can be a great opportunity to network and meet people outside of your normal circles. I got the chance to meet with some health departments from other states that had already done a similar educational outreach project around latent TB infections. It gave me the chance to see how other health departments structure their programs and often collaborate across states. I also got to peak into some of the case-level work that TB nurses do in North Carolina and how that feeds into the larger population-level work at the health department.
  3. Getting creative and taking initiative can help you get what you want out of your practicum. Part of my project involved compiling a list of doctors (called civil surgeons) that are active in providing medical exams for people seeking immigration status adjustment. I wanted to get some practice creating maps and my preceptor was on board, so I took some time to train on Tableau and then create a map of all active practices. This map was useful in presentations I gave to show where these doctors were concentrated, potentially helping to prioritize hotspots for the educational intervention. This map also illuminated that there were “deserts” in the state, where people might have trouble finding a nearby doctor and potentially get discouraged in the status adjustment process.

Overall, the practicum gave me an interesting look into the work that goes into planning an intervention at the state health department and learning how to use my knowledge and interests to potentially add value in unique ways. I am grateful for the opportunity to get some exposure to the government sector and practice some of the skills I’ve learned in the first year of the MPH.


Practicum Reflections in Preparation for the Start of Year 2

It seems crazy to think that we are all signed up for courses and getting ready for the second year to start. My practicum flew by and I am excited to have the opportunity to stay involved with the work as we start next semester. I am working with Kybele on a project called MEBCI 2.0 (Making Every Baby Count Initiative) which aims to improve quality of newborn care by using quality improvement, systems thinking/strengthening, and leadership trainings. Check out this paper to learn more about the first iteration of MEBCI! For my deliverables I am creating PowerPoint presentations and training manuals for (1) Models for Improvement and (2) PDSA (plan, do, study, act) for clinical providers in Ghana.

We were told from the start of practicum searching that there is no such thing as a “perfect practicum,” so I definitely feel like I lucked out. My work with Kybele, using quality improvement (QI) and systems thinking to improve neonatal and maternal outcomes, is exactly what I want to do in the future and gave me irreplaceable insights on the field. The best thing that came out of the practicum was being able to see the program design process from early on, from brainstorming competencies and training topics to drafting training materials. I’ll be working over the next few weeks to finalize these materials. Throughout, I have used materials from the Ghana Health Service and the National Healthcare Quality Strategy along with information from our project partners, mostly the American Academy of Pediatrics, in order to make sure that our trainings are the most relevant, usable, and built upon previous training experiences opposed to being redundant. I also spent a lot of time making sure that language was appropriate and consistent with materials that were already in circulation throughout the tertiary hospitals that Kybele is working within.

Although I was a little intimidated at the start of the practicum and felt like there was so much literature I needed to read in order to get myself speaking the same language as the team, I learn best by actively doing things and am grateful that the team allowed me to jump right into this project, consistently providing me with critical feedback along the way. It was also great to meet the team that I have been working with (in person!) before the practicum officially began and to have another Global Health student, Erin, working on the same MEBCI project. I’m excited to start next semester with this new perspective on program design and material development and look forward to continuing to work on similar projects in the Fall!

the best thing about practicums being remote? Getting to check off some major bucket list hikes/climbs, this is peak three of Olomana in Oahu!

The best thing about practicums being remote? Getting to check off some major bucket list hikes/climbs, this is peak three of Olomana in Oahu!

Hope everyone has a good rest of the summer!


Key Lessons

Like many others who have contributed to this blog, my practicum experience has been fundamentally altered by the pandemic. It’s been great to read about others’ experiences and know that the separation from the communities we’re working with has affected everyone. For me, that community is nearly 8,000 miles away – in Lusaka, Zambia.

A little bit of background on my practicum: Zambia has one comprehensive cancer center, the Cancer Diseases Hospital (CDH), which serves the country’s population of over 17 million people. Since 2006, when the CDH was established, they have treated over 20,000 new cancer cases. The most common cancers seen at the CDH are cervical, breast, and prostate cancers. In recent years, in an effort to better understand determinants and outcomes of these cancers, doctors and researchers at CDH have prioritized data collection and exploration. They’ve developed a retrospective-prospective database to capture data on the cases of breast and cervical cancer at CDH. As part of my practicum, I am helping one of the data teams with data cleaning and validation, and conducting some research using the information in the database.

The distance to Lusaka fortunately hasn’t prevented me from being able to develop and practice data management skills. In my practicum search, I knew I wanted to get experience working with data, and the work I’ve been able to do this summer has been incredible for giving me opportunities to expand on concepts and techniques we’ve learned across in our first two semesters of coursework.

But the distance has also created challenges – divorcing the content of my work from the community I am meant to be working in. Our instructors at Gillings this past year have repeatedly emphasized that humans aren’t data points. A person’s story cannot be fully understood when it is distilled into a series of responses across a set of variables. But the separation from Zambia has left me feeling the absence of community interaction and the context of the of the data I work with day-to-day. I’d love to have been able to be safely face-to-face with researchers, co-workers, and patients at the CDH.

Other posts on this blog have wisely extoled the power of gratitude and searching for silver linings during these unconventional times. And I have a lot to be thankful for! I’m glad I’ve gotten to spend (virtual) time with the CDH data team over Zoom, learning snippets here and there about them – their academic and career interests, their thoughts about certain health topics, what sports they follow. Being remote also means that I’ve been able to see my family and friends and get to know Chapel Hill/Carrboro better! And, finally, this experience has instilled in me a key lesson I intend to carry throughout my career: some public health work can be done extremely effectively remotely, but the quality and value of this work can always be made better through connection with the community.


A global practicum in times of COVID-19 doesn’t feel as new as expected

Hi! My name is Keely and I’m an MPH candidate at Gillings School of Global Public health with a concentration in nutrition. This summer, I’m working with the London-based Institute of Alcohol Studies (IAS) to develop reports which will be used to help guide future alcohol research and inform evidence-based alcohol policy in the UK.

Prior to my studies at Gillings, I received my bachelors in German studies and taught English with Fulbright Austria before working for a short time with a major health insurance company as a health advocate—I’ve jumped around a bit in fairly different areas, but the accumulation of all of these experiences is what led me to pursue public health nutrition. This past year has taken a slight turn, however, as my interest in nutrition education and community involvement has shifted to one of bringing change through policy advocacy. I’ve also grown more interested in alcohol consumption and misuse as a public health issue—two of my major projects last year focused on alcohol misuse. As a result, I’ve reflected a lot on alcohol’s role in my life and in my surrounding community, and on the social responsibility of the alcohol industry. When it came time to search for a practicum, I fortuitously stumbled upon my current position with the IAS and knew that it was the perfect fit for my developing interests.

Over the past three weeks, I worked on a briefing for alcohol use and harms among UK-based LGBTQ+ people, intended to identify gaps in knowledge (spoiler, there are a lot), and guide future research. Ultimately, this should help tailor health messaging and provide evidence behind advocacy for safer, more inclusive spaces for queer people within healthcare and alcohol treatment services. I had a slower start than I’d planned for—my job is fully remote, and I meet with my team for only one hour per week. Because of this, I found it really difficult to feel like a part of the organization and find the momentum to start during my first week (luckily that didn’t last long!). Aside from a slow start, my practicum hasn’t felt so out of the ordinary as I was expecting; I’m learning new things and my work is meant to contribute to more than a grade on my transcript, but I feel comfortable and confident working from my living room. Now that I’ve settled in and finished up my first product, my attention has turned to my second project, which will be a rapid review on the calorie labeling of alcoholic beverages.

Currently, the alcohol industry is not required to label beverages with nutritional information; UK government has announced a consultation to consider requirement of calorie labeling on alcoholic beverages as part of their new Obesity Strategy. The review that I’m putting together will be used to guide IAS’s work on the consultation. I thoroughly enjoyed my areas of research in alcohol use for last year’s academic, skill-building projects, but it is such a different (read: more enjoyable) feeling to begin work on something that will hopefully help create real societal impact. It’s somewhat intimidating, but in a good way that also makes me incredibly excited to begin a career in less than one short year.

For both projects, my days have consisted of and will continue to consist of literature reviews and writing. I’m excited to continue learning about this topic and the alcohol industry, and how the UK parliamentary system works. I’m considering pursuing a career in alcohol research/policy following graduation, so it’ll be interesting to build this base of knowledge and identify potential areas for alcohol research and policy advocacy within the US. I’m very grateful for the opportunity to improve upon my research and writing skills and work within a small, female-run research organization that has significant influence in the UK policy sector.

The rest of this summer will be quite busy, as I’m working a second job atop my practicum, but it’s already shaping up to be one of the best I’ve had— from the meaningful work and connections I’m building, to making the most of my free time and weekends. I’m looking forward to what’s to come!


Nutrition Lessons from Peru

Well, just like that, June is coming to an end and so is my internship. You’ll recall that I spent my spring and summer Working from Home with the World Bank. During my practicum I performed a literature review of several low- and middle-income country’s health care systems and how they are working towards universal health care for all and incorporating nutrition services within these models. There are a multitude of learnings and moments of insight I could expound on, but I’ll focus on Peru’s efforts to reduce stunting in youth under-five years of age.

Stunting is a form of malnutrition that results from chronic undernutrition. Broadly speaking, undernutrition can present in four forms: wasting, stunting, underweight and micronutrient deficiencies. Stunting is diagnosed when a child presents with low height-for-age two standard deviations below the WHO Growth Standard deviation median. Wasting is low-weight-for-age and a sign of acute undernutrition; by definition one is wasted if he or she is more than two standard deviations below the WHO Child Growth Standard deviations weight-for-age median. Globally, the prevalence of under-five stunting and wasting are on the decline, but an unacceptable number of youths still suffer from undernutrition. In 2020, 149.2 million of the world’s under-five youth were affected by stunting and 45.4 million were affected by wasting. Among the global health and nutrition community, Peru is best known for its achievements in reducing the prevalence of under-five stunting from 28% to 13% in just eight years (2008-2016).

Stunting affects physical and mental growth. Early deficiencies in cognitive development can be catastrophic for an individual’s lifetime quality of life, educational opportunities, and economic earning potential. This has implications for the prosperity and development of nations at the population level. The economic cost of undernutrition is projected to be 2-3% of gross domestic product (GDP) on average and as high as 11% of GDP in some African and Asian countries each year. Figure 1 shows the effects of stunting on white matter tracts in the brain of a stunted infant (left) versus brain development of a healthy child (right) at two to three months of age. The density and richness of neural networks differ in the images and by the time a stunted child gets past their first thousand days they have up to 40% less brain volume compared to non-stunted children.

Figure 1: Representation of Neural Networks in a Stunted and Non-Stunted Infants.

Figure 1: Representation of Neural Networks in a Stunted and Non-Stunted Infants.
Source: Nelson, C. 2016. Brain Imaging as a Measure of Future Cognitive Outcomes: A study of children in Bangladesh exposed to multiple levels of adversity, Presentation at the Grand Challenges meeting, London, October 2016 and 2017

There is no silver bullet that fully accounts for Peru’s success in reducing under-five stunting. It can be attributed to a combination of grassroots advocacy, political commitment, and systemic changes in how nutrition services are prioritized and delivered. The details of this effective combination are too nuanced to delve into during a blog post, but the short version is: Peru’s government and leaders recognized the need to reduce stunting, it allocated money and resources to this end, and it iterated on programs and policies to reach its goal. One of my biggest learnings from the Peru case study is that health care is about trade-offs! I’ve read that health care is a triangle of tradeoffs between health, wealth, and equity. I certainly believe that to be true and it should be front-of-mind as more countries explore the means to provide a basic level of healthcare to their citizens.

Signing off,


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