Elizabeth H. Bradley, MBA, PhD is faculty director for the Global Health Initiative and the Global Health Leadership Institute at Yale, professor of public health and director of Global Health Initiatives at the Yale University School of Public Health. As a recipient of the Bill & Melinda Gates Foundation Grant, Dr. Bradley is leading the development of an operational framework of diffusion, dissemination, and widespread take up of family health innovations.
She also works with the Centers for Disease Control and Prevention and the Clinton Health Access Initiative on the Ethiopian Hospital Management Initiative. Dr. Bradley has also been involved with several projects regarding health system strengthening in other international settings as well, including China, Liberia, South Africa, and the United Kingdom.
She is a member of the World Economic Forum, Network of Global Agenda Councils, and, in 2010, she was selected as facilitator for the strategic planning retreat for the Board of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Dr. Bradley has a BA from Harvard, an MBA from the University of Chicago, and a PhD from Yale University in health economics and health policy.
HCGHR: You have done research on a wide range of topics, from hospitals’ proficiency in treating cardiovascular disease, to how race affects black physicians. What criteria do you use to determine on which topics to conduct research?
Dr. Bradley: Would we have a large impact on the society or population? That’s the biggest thing. What kind of ultimate impact would we have by answering the question? Secondly, if we look deep into the literature, can we find the answer? If the answer’s there, then no, I wouldn’t touch that question. I would try to find something novel that we really needed to know about. The third criteria that I would use is whether this is truly feasible because there are an awful lot of good ideas out there, but a good idea without any implementation is nothing but a daydream. So, I try to take on projects that I think are feasible and could be marked improvement.
HCGHR: You have received the Teacher of the Year award by the Department of Epidemiology and Public Health at Yale three times. What do you find most rewarding about teaching?
Dr. Bradley: When you, as the teacher, have some wisdom about something, start to talk and lecture about it, and then suddenly see the light bulb go off in the heads of students, who don’t stop there, but then embellish and add something to the idea, you realize that you are forever changed because you’ve really learned something. You’ve learned as much as you’ve taught. I don’t get that high every class, but I will get it several times a semester, and it’s a really special realization that I’ve seen some part of the world that I’ve never seen before because we spent that couple of hours together. I also get a huge charge out of seeing what students I’ve taught and colleagues I’ve worked with, are doing now. Because I’ve been teaching since 1994, to see what some of the graduates do is pretty inspirational, especially if they keep in touch. You just feel a little bit more connected to the real world. You trained a number of the people who are now out making policy.
HCGHR: Have a lot of your students gone on to public health?
Dr. Bradley: Yes, I would say many have gone on to public health. If we think of public health broadly, which would include governmental agencies, and all kinds of private sector, delivery systems, and practices. If we add that all together, I would say most of my students, one way or another, have done something in public health.
HCGHR: What do you think an ideal health care system looks like?
Dr. Bradley: Well, you can never answer that quickly, but I would hope that the system promoted equity in health, and was integrated with social care and social services. So, we would look at the health of the population as determined not just by their medical care, but also by their social and behavioral [status], like what kind of occupation people have, how much money they have, what kind of education they are able to attain, and what kind of nutrition they have. So, an ideal health care system would recognize that there is a connection between the medical care system and the rest of our social contacts, and direct itself that way.
I think that means that the medical care system and health care spending would be of sizes relative to the extent of social services. We have a pretty large medial care system now. So, I guess recognizing that health is determined by multiple determinants, and promoting equity would be critical. The last principle I would look for in a system is that the system was responsive to community voices and community needs.
HCGHR: What role do you think the government should or should not play in ensuring that every individual has access to proper health care?
Dr. Bradley: I think that what role the government should play is debatable, but that they should play a role, no question in my mind. I just don’t think you can expect any private sector alone to insure people for whom it is not really in the interest of private investors to insure. I just don’t think you can do that through a private model alone. I do believe you can fund Medicaid and Medicare programs through delegated private insurance companies, but the financing and regulation should still have to come from a selective voice of the government.
HCGHR: You have helped to develop and implement strategies to improve health care in other parts of the world. How is dealing with issues of public health in the U.S. different than in other countries, like Ethiopia or the United Kingdom?
Dr. Bradley: Well, I think that in the United States, it is close to invisible sometimes, but less and less so because we now understand more about social marketing, obesity, smoking, and the environment (these things would fall into public health). The medical care system is so huge here. We have technology and sophisticated drugs. People can get into a hospital easily, and hospitals are highly invested in.
And of course, in Ethiopia, the balance between medicine and public health is quite different. There are only 120 hospitals for 80 million people in Ethiopia; there are 6000 for 300 million, here. There is such a tiny number of hospitals in Ethiopia, so the medical care system is very underdeveloped. The public health system–that’s kind of all they have in many ways, and it’s all government run. So, I would say the relative side of medicine and public health is very different in low income settings. In such settings, major issues are infectious diseases and malnutrition, maternal mortality, and very basic health needs. Whereas in Europe, of course there are infectious diseases, etc., but they have an awful lot more resources to treat cardiovascular and chronic diseases. Needless to say, nearly everything is government run, so that’s different from the United States as well.
HCGHR: You have an MBA from the University of Chicago, in addition to a BA from Harvard, and a PhD in health economics and health policy from Yale. How does a business mindset shape your perspective on health care policy?
Dr. Bradley: Well, I do have an MBA, although my focus was organizational behavior, not accounting. In organizational behavior, you’re really thinking about how organizations are able to organize to produce the most effective and equitable outcome. So, I was really influenced to understand implementation. I have a unique interest, not just in policy, where you decide how to pay and regulate. Primary for me is the actual implementation. How do we actually get hospitals to perform in a certain way? How do we get communities to perform in a certain way? How do we get nurses and physicians to work together? That implementation was of interest throughout my managerial training, which is kind of ironic because although I agree that most MBAs go into business, I got a health administration degree. I learned an awful lot about how hospitals work and how health care interacts. So, that’s really how it’s influenced me. I guess it’s a little unusual for most MBAs.
HCGHR: How has public view on health care changed during the time you have been working in the field?
Dr. Bradley: In the ‘80s, when I began, there was just a very hospital based system. I think we were still in expansionary mode, and still trying to enact our health care system.
Then, in my early career and certainly in the ‘90s, we were trying to contract the health care system. Then, questions about medical errors increased. When I began, there was no such thing as thinking about medical errors. It was before quality improvement in health care, before the medical error report. Mostly, people had a much stronger sense that physicians were doing everything right and the health care system worked really well, and we needed to expand it. Now, I think we’re in a different situation where the physicians are not viewed at the same level of legitimacy that they were in the ‘70s. There was a fall from power. People ended up questioning whether hospitals have done the right thing, and whether doctors have done the right thing. There are all types of medical errors people are now documenting. There’s much more qualm about the medical care system and I think there is also much more attention on how the environment and our health behaviors influence outcomes, which was almost non-existent when I began. People just did not think a whole lot about that. So, I think we’re becoming more enlightened, actually.
HCGHR: The Harvard College Global Health Review is geared towards young people aspiring to become involved in the field of global health. What do you think the next generation can do to improve health care policy?
Dr. Bradley: I think one thing the next generation can do is ensure that they travel the world, and that they engage, not just on the Internet, but with diverse communities, and really work at understanding and bridging what is sometimes an ‘us’/ ‘them’ view of health.
We’re in the same world and our outcomes are determined in part by outcomes in low income settings. So, I think you get that insight by spending time in other countries and cultures, and really engaging with an open heart and an open mind. I honestly think that’s the number one thing.
I also think that the next generation can promote health policy by elevating health to become part of national policy. In other words, getting good at the language of economics and law, the language of lobbying, and the language of politics. I think in the old days, people who wanted to be doctors or hospital administrators went into a technical field and had to learn accounting for Medicare cost reports, etc.
It adds to the technical knowledge of health, but I think the best thing the next generation can do for health policy is really get a good idea of how to use cost effectiveness analysis. They have to understand finance, politics, and lobbying, and use those tools in a sophisticated way to promote health and a peaceful society.