Faces and Numbers
By David Addiss, MD, MPH
In global health, the tools through which compassion is expressed and suffering relieved can seem impersonal and indirect. In the clinical setting, a touch on the shoulder, a word of encouragement, or a gaze into the eyes are possible. Global health, however, seeks to relieve and prevent the suffering of entire populations – billions of people. Of necessity it utilizes the tools of organizations – program planning, budgets, grants, protocols, training, evaluation, and logistics – and it measures impact through a rigorous insistence on numbers, on “objective” measurable indicators.
Yet in a speech at the US Centers for Disease Control (CDC) in 1984, Bill Foege, former Director of that institution, challenged CDC to look beyond the numbers. He said, “If we are to maintain the reputation this institution now enjoys, it will be because in everything we do, behind everything we say, as the basis for every program decision we make – we will be willing to see faces” (Foege, 1984). This was an extraordinary message for a public health agency, responsible for the health of populations, not individuals. CDC’s reputation would depend not on programmatic effectiveness, measurable outcomes, or epidemiologic prowess, but on compassion – the willingness of its employees, collectively, to see the faces of suffering.
In 1999, Foege extended this view. With Mark Rosenberg, he wrote, “Successful public health leadership in the next millennium will require….the ability to see the whole and its parts simultaneously