Is there a global health bubble? (Or: should you get an MPH?)

There’s a LinkedIn group for Global Public Health that occasionally has good discussion. One example, albeit a sobering one, is the current discussion of employment opportunities after MPH. I’ve been meaning to write about jobs for a while because now that I’m on the other side of the picture — an employed professional with a job at a reputable organization, rather than a grad student — I find myself doing an increasing number of informational interviews, and saying much the same thing each time.

[First, some caveats on the generalizability of the advice below: first, folks with an MPH from another country often have less debt burden than Americans, so may find it easier to do long unpaid or underpaid internships. Second, folks from low- to middle-income countries are and should be more employable, especially in their own countries. Why? Because they have incredibly valuable linguistic and cultural talents (see Alanna Shaikh’s recent post on this), so much so that an organization choosing between an outsider and a local with the same technical skills, communication skills, etc, should almost always choose the local. If they don’t, that’s generally a sign of a dysfunctional or discriminatory organizations.]

The problem is that there is something of an MPH bubble, especially in global health. The size of MPH classes has increased and – more importantly – the number of schools granting degrees has risen rapidly. Degrees focusing on global health also seem to be growing faster than the rest of the field.  (I’d welcome data on class size and jobs in the industry if anyone knows where to find it.) This is happening in part because public health attracts a lot of idealists who are interested in the field because they want to make a difference, rather than rationally choosing between the best paying jobs, and global health has gotten a lot of good press over the last decade. Call this the Mountains Beyond Mountains Effect if you like.

If you know this, and still go into the field, and don’t have an MD or PhD that qualifies you for a different sort of job altogether, then you need to distinguish yourself from the crowd to be employable. I’m assuming your goal is to get a good job in global health, where “good job” is defined as a full-time professional position with a good (not necessarily big-name) organization, working on fulfilling projects and being paid well enough to live comfortably while paying off the loans that most American MPH grads will have. For some, though not all, a good job might also mean one that’s either based abroad or involves frequent international travel. If that’s the goal, then there are several ways to distinguish yourself:

  1. get some sort of hard, transferable skills. This can be research or M&E skills, especially quantitative data crunching ability, or it can be management/coordination experience with serious responsibility. Or other things. The key point is that your skillset should match jobs that are out there, and be something that not everyone has. A lot of MPH programs feature concentrations — or the lack thereof — that are more appealing to students than they are to employers. A biostatistics concentration will likely serve you better than a global health concentration, for instance, and with some exceptions.
  2. get solid international experience, preferably a year or more. Professional experience in public health — even with a lesser-known organization — is much more valuable than experience teaching, or studying abroad. Travel doesn’t count much, and it’s better to have experience in the region you’re interested in working in. There’s a huge catch-22 here, as you need international experience to get it, so that many global health folks start off doing work they’re critical of later in their careers.
  3. relatedly, speak an in-demand language, though this will only help you to work in the region where it’s spoken.
  4. have professional work experience. Even if it’s not in global health, having worked an office job for a year or two makes you more desirable to employers. No one wants to be your first employer, so folks who go straight to an MPH may find themselves less employable than peers who worked for a bit first.
  5. go to a top school, which signals that you’re smarter or better qualified than others (this often isn’t true, the key part is the signalling, and the networks you acquire). Also, graduates of top schools often get good jobs in part because those schools select people with good work experience, skills, and connections to begin with, so that a superior candidate at a school that’s perceived to be a second or third-tier school can do just fine.
  6. avoid debt (which often conflicts with ‘go to a top school’) to give yourself the flexibility to work for less or for nothing at first, until you can do the above.

Any one or two items from this list probably won’t cut it: you need to acquire several.  For example, I’ve known peers with a solid technical degree from a top school and some international experience who still struggled to get jobs at first because they had never had a regular office job before grad school. Also, the relative importance of each will vary according to the subfield of global health you’re interested in. For instance, learning languages might be more important for an implementation person (program coordinator or manager) or a qualitative researcher than it is for a data cruncher.

I used to be pre-med, until I realized I was more interested in policy and did not want to be a clinician, and the path to doing so in the US is long and expensive. Like many former pre-med students who decided not to go to medical school, it took me a while to figure out what I wanted to do, and how to do that without an MD. A couple years post-undergrad I found myself working a job that was interesting enough but not what I ultimately wanted to do, and unable to get a first job in global health without the requisite skills or longer international experience, and I didn’t have the resources to just up and move abroad on my own. So, I went to go to grad school with a technical focus (epidemiology) at a top school, and then used the practicum requirement to build more international experience (Ethiopia). The combination of school and work experience gave me solid quantitative skills because I chose to focus on that each step of the way. But, it also meant taking on quite a bit of debt, and the international practicum would have required even more had I not had generous funding from the econ/policy degree I did. This has worked out well for me, though that same path won’t necessarily work for everyone — especially if you have different interests from mine! — and I think it’s instructive enough to share.

The upside of this bubble is that organizations often hire well-educated, experienced people for even entry level position. The downside is that people from less privileged educational or financial backgrounds often get blocked out of the sector, given that you might have to volunteer for an extended period of time to get the requisite experience, or take on a lot of debt to get a good graduate degree.

In conclusion, getting an MPH — and trying to break into global health — is a personal decision that might work out differently depending on your personal goals, the lifestyle you’re looking for, and your financial background. But if you do get one, be aware that the job market is not the easiest to navigate, and many MPH grads end up unemployed or underemployed for a stretch. Focus on acquiring the skills and experience that will make organizations want to hire you.


02 2014

8 Comments Add Yours ↓

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  1. 1

    Apparently I have lots of feelings about this.

    I’m still paying off my student loans. My goal is to get them cleared before my kids start college. And if I could go it again, I do a biostats or epi concentration rather than the international health focus I chose. I didn’t graduate with a lot of hard skills and I have had to learn them on the job.

    I think there really is an MPH bubble – so many new programs and so many graduates. I worry a lot about what’s going to happen to all these well-meaning people.

    Finally, I agree with all six of your points. For me, when I have hired in the past, my priorities were office experience and international experience. And writing skills, as evidenced by cover letter, writing sample, and resume.

  2. Ren #

    After I got my MPH in Epi from a good, reputable school, I landed a job at a state health department. I’d say that about 45% of what I learned in the MPH program prepared me for the job. The rest was just filler. The rest was about occupational health, environmental health, and the dreaded biostats. I didn’t need the filler for my job in infectious disease surveillance and outbreak investigation. Sure, it helped to have the filler, but I would probably not be able to tell you much about it if you asked me now.

    Thing is, I went on to start a DrPH, and I nearly drowned in biostats. The filler became required knowledge for the doctorate, but the 7 years between the MPH and now took the filler away. But that’s a whole other story…

    During my time at the state health department, tons of young men and women with MPH degrees applied to be epidemiologists there. The problem was that their “filler” overwhelmed their basic epidemiology studies. More than half of them had no clue how to investigate an outbreak. Many of them had no real-life experience between their bachelors and their masters. This was their first time even applying for a job, something the MPH didn’t prepare them for either.

    I got my MPH job because I was a lab tech at a hospital for about 6 years, and I was very interested in infectious diseases. I got a lot of exposure to the work that physicians and “mid levels” do. My capstone project for the MPH was all about influenza surveillance (which came in handy as the health dept. was looking for a flu surveillance person). But I was one applicant after another come in with capstone projects which didn’t fit with working at a health department.

    And then there are all the MPH students who hope to go into medical school but — statistically speaking — probably won’t. They’ll find themselves with a degree that doesn’t fit their needs or their interests… And you know what happens with those? Nothing. You just have the debt.

    In short, you really, really, really have to want to do epidemiology at the ground level (none of the “executive” stuff), with tight schedules, with overwhelming limitations and demanding bosses… Very few MPHs get the job of a lifetime right afterward.

    Some of us leave that job of a lifetime to go do crazy things like become full-time students at high-pressure settings like that school whose name rhymes with Bob Hoskins.

  3. KL #

    I think this is really good advice and I will share with friends who are considering an MPH. I have an MPH and I probably only fit 3 of your points at the time I got my degree. I over came it by being flexible and putting in the grunt work after I graduated – and being realistic (and extremely lucky!!). I got a job right after graduation and now, two years later, I have what you would consider a “good” global health job. Hard work pays off. If you are passionate about public health and willing to put in the work to gain technical skills ( and getting points 1-6 you mentioned), an MPH can be a great investment. One point I would add is networking while in school with profs and fellow students. It’s a small global health world afterall.

  4. Suzanne #

    Great post, Brett! As someone ten years post-MPH, I have to strongly endorse points 1, 3, and 6. While the majority of my experience is in domestic public health, I think some of it is still relevant; the domestic PH career field is tough too and a lot of people switch back and forth over the course of their careers. I can say in retrospect my mistake in grad school was focusing on interesting content and less on hard skills, as others have said. The content area can always be picked up later (I now work in a completely different area than I went to grad school in) but skills, like quant data analysis, are much harder and more expensive to learn outside of school than content.
    To point 3, as someone who has done some hiring and supervising for entry level staff, I’d much rather hire a BA or BS with a year or two of work experience than an MPH with no work experience for entry-level public health work. I’d go so far as to say MPH programs should only accept people with two years of work experience beforehand (as mine did). If you’ve never had a real job, but come out with a master’s, not only will it be harder to find a job than it is for your peers with the work experience, but I’ve found people are frustrated with the entry level work they need to do to learn how to work a full-time job. There’s a lot of “What? You want me to just take notes and set up conference calls and do admin work?” when in reality all that grad school hasn’t taught people basic office skills and etiquette or attention to detail. It’s actually pretty frustrating to work with, as a supervisor. The job market is really tough right now, and there’s nothing like actual experience. Hiring managers can be really picky, and so they will be.
    Finally, I’d add that people should think really hard about what they want their day-to-day lives to be like ten or fifteen years down the line before taking on the debt of an MPH. I like to say I bought a grad degree and six years of living in NYC and working in public health, instead of a house or a car or any travel in my 20s that wasn’t visiting my family and therefore free. I was 32 before I could afford to live without roommates. I think I’d make the same choices given the opportunity to do it over again, but I wish I had more carefully considered the implications on my day-to-day life and my long-term financial goals of that level of debt and the low salaries when I was 23.
    In conclusion: is there a bubble? Yes, definitely. Should you get an MPH? Maybe. But don’t be starry-eyed about it; treat it like an engineering or nursing degree and focus on the hard skills, and know that even the best programs aren’t going to prepare you like actual work experience will.

  5. Erin Hohlfelder #

    Great post! As a global health policy director for an advocacy (not implementing) organization, and as someone who’s done a fair amount of hiring, I’d emphasize that it’s important that would-be students try to identify what it is about global health that compels them, and the type of skills/jobs they’d like to acquire, rather than focusing on the issues/topics that interest them. Lots of people think they have to get an MPH because they want a good job in global health, when in reality the type of skills/jobs they’re interested in pursuing are much better served by an MPP, MPA, or no grad school at all (especially given point #6). In many cases–particularly for those interested in the policy and advocacy space–I’d argue that point #4 is really important, and emphasize that in many cases job experience far outweighs an MPH.

  6. April Harding #

    I’d like to elaborate and underscore your first point.
    If you want to work on health in developing countries, frankly, public health (or global health, whatever that is..) expertise is rarely the most urgently needed.
    There are heaps of public/global health experts produced every year, many are working in developing countries, as will the folks graduating this year, and the next….

    In terms of implementing health programs and providing assistance in the health sector more broadly, the following technical expertise is often urgently needed and in short supply:
    – Logistics & system design and analysis
    – Market analysis
    – Comparative health systems analysis
    – Healthcare organization and hospital management
    – Institutional and organizational analysis
    – Business administration
    – Health policy & public policy
    – Public administration and financial management

    I expect bringing this expertise to such work would both improve your employment opportunities and increase the value of your contribution.

  7. J.B. #

    Sound advice! I too am very interested in earning an MPH and have flirted with concentrating on Epi and Health Communication. Point one is one of the reasons why I have been soo indecisive about MPH grad programs in general due to the large amount of students I see graduating with little hope for employment because the lack a strong skill set.

    Would you say that Health Communication ( a career focused on delivering health messages to audiences effectively) would fit in the same boat as a general MPH track ? I feel that communicating itself is an art that not everyone can master and one has the potential to have a lucrative career.

    Just curious about your opinion and would love to hear a response. Thanks


  8. Cynthia #

    I agreed wholeheartedly with this blog post! With a BA in Economics from a liberal arts school, I am no stranger to the need to have tangible skills. I took three years off before entering grad school, a year to teach overseas, a year to sit behind a desk doing economics consulting that dabbled in public health work and was accompanied by two part time internships, one at Harvard SPH and another at the International Rescue Committee. The third year I spent pursuing public health opportunities in East Africa. I volunteered for groups and used connections from my aunt and a colleague and worked for free for two months. Then, I earned a stipend and a place to live after I had proven myself. While overseas I applied to grad school and while I was offered a full time position with the international health group I worked with, decided the MPH would be valuable. My specialization was Epidemiology, which was a great decision and included minimal fluff. While I had moments of regret leaving my job for school, I absolutely made the right decision. Upon graduation, I took a job NOT in international health, but in health outcomes that has turned into an amazing opportunity, that I lined up before graduation. While I took a hit on that specialization, I have learned so much in my position, become the first author on papers, conduct research studied and have been promoted to the Principal Research Coordinator position at my research group and am coming up on three years here. I am well on my way to having my loans paid off (3 more years) and because I had tried out public health in a few different ways before the degree, know that I got more out of my degree than the few that entered right from undergrad. I also know that my job is MUCH more focused in public health and my career has advanced at a higher rate because of that work experience.

    I work on hiring at my group from time to time and know that we look at work experience in public health as something that sets candidates apart and will pass on those that have come straight from undergrad through their master’s.


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