Just before beginning his interview with the News-Letter, David Bishai was on the phone attempting to get in contact with a former student of his who happens to be the Minister of Defense in Uganda.
Such a statement seems almost exotic but after the explanation that Bishai, a professor at the Bloomberg School of Public Health, does a significant amount of his economic research in Uganda, it doesn't seem so strange.
Bishai is a professor of economic at the School of Public Health. As an economist, his research approaches public health problems as a social science. He specifically looks at population medicine in terms of cost and efficiency. In a discipline where an emphasis on the biological sciences dominates, speaking with Bishai sheds new light on the diversity that exists in the realm of public health.
Bishai's interest in Public Health began when he was a junior in college. "I was sitting in class and my professor showed me the population curve, and when you see that picture, immediately you realize something amazing has happened. Every generation has its crisis, and back in the 1980s, my generation, there was a population boom. Over-population back then was a big problem, comparable to the problems of terrorism and homeland security issues today," he said.
The issue of overpopulation was what drove Bishai into the field of public health. "We need better contraceptive technology and we need better economics in order to move those medicines out to the people. So both of those problems are what make public health; it is the application of health and science to the population. So I knew I wanted to become a doctor and economist."
Her two loves give Bishai a unique role at the School of Public Health, where he is one of the school's six economists.
"I use economics to solve public health problems. Our school has epidemiologists, statisticians, lab and bench scientists, and social scientists and I am one of the few in the social science field. The school has to tackle economics problems. Such problems are how to get medicines to the people," he said.
"For example, in public health, we want to know how to give away more treatment for heroin addiction. For the most part we aren't selling it in public health but people still don't accept free products. So my role as an economist is to address the question of 'why didn't this person take this item for free? What are their reasons behind it?'
"Not only are we focusing on how we get medicines out there for free, but we also look at what is the best price for the item in the market that will lower the barriers for someone to get the treatment one needs," Bishai said.
When explaining his views on the importance of economics within public health, Bishai said, "Let's let the market solve some problems. We also want to see if the public health advancement is cost effective or not. For instance there are some public health technologies that are too expensive and a big waste of money, but they do save some lives."
"From an economist perspective, it costs too much money to save lives that way and we should look for more cost effective alternatives," he said.
Bishai's strictly scientific approach as to whether or not certain public health ideas should be implemented creates many controversies.
He responded to those who do not agree with his statistical approach to solving public health issues by saying, "public health is science in a very politicized and value rich environment, but it needs to be a balance between values and science. It's not like physics - there's no politics in gravitational constant but public health is exactly that, very value laden. Everyone shares the same goal, they want to save populations, but in Washington, the goal is increasing the size of the economy or increasing faster travel times between two places.
"All sorts of things could be objectives but we all want to keep people healthier and take care of vulnerable groups," he stated. "So if we play by the rules of scientific inquiry, it disturbs me people aren't looking at scientific data - instead people are approaching issues with political engagement. I think we should just focus on what is the best way to solve the health problem."
"From an academic point of view, I was in Uganda studying traffic safety and I wanted to see how much it was costing them to put police on the streets. A month before we got there, they had launched for the first time an intensive initiative to increase traffic enforcement. They had four squad cars and radar detectors and they deployed a whole traffic safety unit. The chief of police brought out statistics for us and it showed the trends of fatality in Uganda.
"It showed that 100 lives were saved in the month that they increased traffic enforcement. Traffic enforcement is one of the most cost effective ways to save lives; it's up there with the polio vaccine. If you look at the statistics, it shows 27 dollars per life year saved ... They should get it but why aren't governments investing on traffic enforcement, if lives can be saved for just 27 dollars per life year?" Bishai asked.
"It is because in public health, if you can't take a picture of someone who is dying, no one cares. This person in the road crash doesn't have a face, so people can't get the photo-op and statistical lives don't count for the human heart."
He paused and took a brief moment to self-reflect. "But it is exciting to me! I'm excited by squiggles and statistical lives being saved," he exclaimed. "By God, 100 people are being saved - statistical lives of mothers, sons and people with aspirations are being saved with just this simple traffic enforcement intervention! I can't take a picture of that but I get excited to see these numbers, 100 lives that are being saved."
Bishai had words of encouragement for those interested in public health.
"You have this public health training as an undergraduate and you owe it to yourself to use this training to identify the big problems. There are too many pre-meds without the public health backgrounds that say they just want to take care of sick people, but public health majors, I can expect more from you," he said.
"You can see the big picture, like the top 10 causes of burden of disease in the planet, and say 'This how your work in medicine will address them.' You can have this vision of your role in the grand scheme of things, the big health problems; otherwise you are just a cog in the wheel of this little machine," he said.
