Read the Conversation

EF: What motivated you to return to Germany and take up the position of leading the Center for Global Health Charité? 

BK: With over three decades of experience in English-speaking countries, primarily the UK, with significant time in the US and West Africa, particularly in the context of global health, I'm witnessing a rising momentum towards greater global health investment and focus on Germany. 

This shift is exemplified by Angela Merkel's leadership, notably in the antimicrobial resistance movement, a priority underscored by the pandemic. I was drawn to my current role at the Center for Global Health within the charitable sector due to my extensive background in diverse settings, from high-income institutions to low-income countries. 

Though the challenge is substantial, particularly in a German landscape characterized by siloed efforts, I firmly believe in the strength of collective action. Global health calls for inclusive and equitable partnerships that transcend borders. The Center for Global Health Charité aims to foster unity and collaboration, bridging initiatives under one roof. 

The pandemic's profound impact has underscored the critical importance of global health, spanning from vaccines to antimicrobial resistance. The pandemic has proven that collaborative efforts yield significant outcomes, even though national priorities can sometimes counteract these endeavors. Infectious diseases respect no boundaries, making global health a linchpin for both public well-being and economic stability. A holistic perspective is essential, aligning individual health with broader socioeconomic dynamics. 

EF: Could you please explain the impact and significance of having a full Center for Global Health and how Charite's role is positioned on a global scale concerning this? 

BK: The importance of global health cannot be emphasized enough, and Charité has a significant role to play. The organization has resources from patient care and innovation, essential in addressing global health issues. However, it is important to note that no single institution should be the sole advocate for global health, as we need to work together to make an impact. In my current role, I have come to understand the various stakeholders in Berlin are well-placed to interact with organizations such as the WHO Global Hub and political agencies in the area. I aim to establish the Center for Global Health Charité as a center of excellence for research, contributing evidence-based science to the global health dialogue and policy-making process. We must engage in a worldwide conversation with various stakeholders, including industry players, to develop effective global health strategies that benefit everyone. Major academic institutions such as the Center for Global Health Charité have a significant role to play in this endeavor. 

Universities worldwide, including Germany, must foster educational and career opportunities for future global health leaders. Creating an interdisciplinary environment for experiential learning through our programs or partnerships is essential. Existing initiatives, like clinical partnerships funded by government and foundations, exemplify this approach. While our researchers and physicians can contribute to international patient care, we should also appreciate the insights our foreign partners offer. It's a reciprocal exchange of information, acknowledging that methods effective in Germany may not be universally applicable. 

EF: How can we effectively raise awareness and engagement regarding the crucial role of global health? 

BK: Dedicated funding for global health research would encourage fruitful collaboration among researchers. Despite the pandemic's impact on domestic concerns, younger generations recognize global health challenges, drawn by their interconnected nature. While advocating for global health may prove challenging for established professionals, personal experiences can sway stakeholders. International exposure aids in grasping the significance of thinking globally to act locally, contrasting with a siloed perspective. 

EF: How does the Center for Global Health Charité contribute to shifting the paradigm towards a more comprehensive and inclusive approach to healthcare? 

BK: There is a need for transitioning towards better regulatory and political frameworks to achieve global health goals. Coalition for health systems approaches are also important, and there needs to be a stronger commitment to system strengthening. The EU has a strategy for global health, but it needs to be more connected globally and not only to northern partners. Finding an aligned language across regions is important, and the WHO has a significant role to play. However, investment is also necessary for the implementation of initiatives, such as the vaccine manufacturing initiatives in Africa. This should be an area of interest for the German industry as well. 

EF: From your experience across different markets and countries, how can we effectively apply this knowledge to penetrate new markets without compromising the local health systems? 

BK: A shift in our language is needed, moving away from an "us versus them" mentality. Global health isn't something done for people but rather improved alongside them. The inclusion of those residing in areas requiring system strengthening is paramount; their needs should guide the conversation. This is a two-way dialogue, requiring their input in investment decisions. Additionally, we must explore the economic advantages of broad health benefits, considering climate change, migration, and pandemic readiness. While not an economist, it's crucial to delve into these potential gains. 

EF: Could you please share your perspective on the role of healthcare in fostering growth? 

BK: Health is a cornerstone of functioning societies. It ranks alongside clean water and financial stability in importance. A lack of health support disrupts everything when illness strikes. In countries like the US, the absence of health insurance can lead to catastrophic consequences. A robust healthcare system is vital. In South America, communal support is common, yet it's precarious. Equipping people with diagnostics empowers them to manage their health. Healthcare professionals require effective tools and patient engagement is crucial. Technology and information facilitate active participation, adding market value while enhancing care. 

Improving health literacy is crucial, and it is something that can be improved in all societies. Even those who are more affluent may not be very health literate, as we can see with vaccine hesitancy. Some people may believe they are health literate, but their actions suggest otherwise. The pandemic has brought attention to epidemiology and health literacy, but there is still work to be done to ensure that people have accurate information and can make informed decisions about their health. 

EF: What strategies can be put into play to address gender disparity in healthcare management positions in Germany, given that while approximately 70% of healthcare professionals are women, leadership positions are predominantly held by men? 

BK: Since my return, I've observed a gender disparity in senior positions, particularly in Germany compared to my experiences in the UK and the US. The prevailing hierarchical and patriarchal structure often confines women in the middle tiers. Achieving a balance between assertiveness and likability can be challenging for women, impacting their progress. Addressing family and maternity leave regulations is essential for more equitable sharing of responsibilities. 

To drive change, inclusive discussions involving both genders are pivotal for unified solutions. The system must accommodate diverse career paths, eliminate age-based grant restrictions, and encourage shared childcare responsibilities. Engaging men in work-family conversations enhances equity and decision-making. Achieving balance at work demands women adopt assertive approaches to reach equal achievements. 

While I have reservations about Affirmative Action, it's essential to rectify the underrepresentation of women in healthcare leadership. Parity goals in departments, meetings, and conferences can foster equal representation, akin to the 50-50-50 approach in the HIV field. Qualified women abound; it's the male-dominated networking influencing appointments that need transformation. Broadening inclusivity can create momentum towards equal representation, even acknowledging initial challenges. 

EF: What are your key recommendations for policymakers and government officials who are responsible for leading global health initiatives and developing health policies? 

BK: Cultivate connections with diverse individuals, particularly beyond the hierarchy's apex. Broadening your network beyond familiar circles is crucial. Embrace chances to empower the younger generation and those forging their path. Extend your support beyond the self-driven and foster growth opportunities. Proactively initiate change rather than deferring it until later stages of life. 

August 2023