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 [emphasis added]. Public health leaders…need to scan and to focus and to see relationships. And they need to do these all at the same time” (Foege & Rosenberg, 1999).
The challenge – the paradox – of seeing the faces and the numbers at the same time, of bringing them together through the intention and integrity of our work as global health practitioners, is a modern manifestation of the ancient problem, addressed by Greek philosophers, of “the one and the many” (Johnston, 2004). In practice, how is this possible? How can we as global health practitioners be fully aware of the faces and the numbers, reconcile the local and the global, and be motivated by a profound sense of humanity’s vast interconnectedness and be fully attentive to seemingly endless, minute technical details – at the same time? How can we sustain our compassionate impulse when our work is situated in bureaucratic, efficiency-driven institutions, isolated from the very people we seek to serve, and focused almost entirely on the numbers?
These skills are not taught in schools of public health, medicine, or nursing, nor is this challenge discussed within most global health institutions. But intuitively, global health practitioners recognize the need to “see the faces.” We return from travel to the “field” energized and reinvigorated. We keep photographs from these trips on our office walls. I suspect there are many other ways that we, individually, seek to do this.
One of the goals of the Center for Compassion and Global Health is to provide a forum for conversations that enrich our capacity, individually and collectively, to keep “the faces” at the very center of our global health work, day after day. To begin our conversation on “faces and numbers” we were pleased to reprint an essay in May by Katherine Williams, which originally appeared as a blog on the Global Health Corps website.
We also invite and encourage you to share your experiences and reflections. How do you maintain awareness of both faces and numbers in your global health work? What challenges do you face in this regard? Please contact us with your thoughts!
Foege, W.H. (1984, October 26). Smallpox, Gandhi and CDC. Fifth Annual Joseph Mountin Lecture. Atlanta, GA: Centers for Disease Control.
Foege, B., & Rosenberg, M. (1999). Public and community health. In: R. W. Gilkey, (Ed.), The 21st Century Health Care Leader (pp. 85-90). San Francisco, CA: Josey-Bass.
Johnston, W. (2004). Mystical theology: The science of love. Maryknoll, NY: Orbis.