Ahead of World Water Day later this month, we talked to one of the Society's waterborne disease experts, Stephen Luby, MD. Before moving to Stanford in 2012, Stephen directed the Centre for Communicable Diseases at icddr,b and served as the Bangladesh Country Director for the U.S. Centers for Disease Control and Prevention from 2004 – 2012. He also taught at the Aga Khan University, Karachi, Pakistan, and worked as an epidemiologist in both the Malaria and Foodborne and Diarrheal Diseases Branch of the CDC. He attended the University of Texas Southwestern Medical School and is the author of more than 200 scientific articles -- most on the topics of communicable disease epidemiology and prevention in low-income countries.
1. World Water Day – coming up on March 22 – is an opportunity to bring awareness to the important cause of clean water. What will you be thinking about this World Water Day?
Among health professionals the contribution of water to community health is generally thought of as providing sufficient quantity and quality of water to meet basic household consumption and hygiene needs. However, this overly narrow conceptualization restricts the productive contribution of health professionals to discussions within this critical area. 70% of all water use by people is committed to agriculture. Human population continues to grow, but this growing population is being fed on crops that are watered from nonsustainable abstraction of groundwater. The falling groundwater levels threaten humanity's ability to feed itself and this risk is even greater than the risk of insufficient household water for domestic use. On this world water day, I hope that members of ASTMH, can reflect more broadly on the hydrological imbalance of current practices and become active participants in multi-sector discussion on ensuring water security in high need areas for the coming decades.
2. Before accepting a prestigious position at Stanford University last year, you were CDC’s Bangladesh Country Director for eight years. Given your position with the CDC, what is your reaction to the ongoing budget challenges in Washington for the agency?
The U.S. Congress and the president face difficult choices in striving to align government spending with available resources. With the aging population, the growing cost of Medicare, and the size of the national debt, the long term fiscal health of the country will depend on limiting federal outlays to be more in line with resources.
Nevertheless, CDC provides an incredibly cost-effective service to the U.S. taxpayers. It provides evidence-based guidance on health issues ranging from individual decision-making for U.S. citizens to policy decisions for local institutions, municipal, states national and even international bodies. Internationally, CDC contributes importantly to health diplomacy. By providing technical support to foreign countries and improving health in the local populations, the U.S. government improves its relationship with other nations.
The growing interconnectedness of populations also means that CDC's work on surveillance and response not only improves the lives and health of people living in foreign countries where CDC is working, but these efforts protect Americans and people living throughout the world. If CDC and ASTMH are to remain influential in global public health, the long-term fiscal situation in the U.S. requires that we redouble our efforts to develop cost-effective interventions.
3. You also spent five years in Pakistan leading the Epidemiology Unit of the Community Health Sciences Department at the Aga Khan University working on water and sanitation in addition to other issues. What are some of the WASH-related accomplishments you’re most proud of from your time abroad?
I am most proud of developing constructive collaborative relationships with colleagues in Bangladesh, Pakistan, and Guatemala and working to improve our joint capacity to conduct research to improve public health. Through these collaborations we have been able to generate evidence addressing questions that remain relevant to low income communities including the benefits to both health and child development of handwashing with soap even in settings of widespread poverty and fecal contamination. Working together, we have made progress towards developing strategies that encourage the adoption of handwashing habits that are practical, scalable and effective.
4. ASTMH is widely regarded as a premier scientific society around the world. With all the time you’ve spent abroad, how can the Society better meet the needs and concerns of members who hail from countries outside the United States?
Talented young people in low-income countries who are interested in scientific research face shortages of opportunity and mentoring. ASTMH can be an even better platform to provide encouragement and support to early career scientists. ASTMH can encourage scientists based in high-income countries to engage early career students/professionals on their projects and provide them support to lead on some elements of analysis and scientific writing. In mature collaborations, it is often easiest for scientists in high-income countries to rely on their own graduate students and more senior investigators in low income countries. I would like to see ASTMH be more active in encouraging high-income country scientists to engage substantively in the development of early career low income country scientists, to accept skill building as part of the responsibility of engagement. The Society should continue to encourage the presentation of scientific work by early career low-income country scientists and providing them constructive feedback on their work at the Annual Meetings and through the Journal.
5. You’ve been an ASTMH member for more than 10 years (thank you). Why have you maintained your membership over the years?
Kent Campbell provided support so that I could attend my first ASTMH meeting in 1992. I have been regularly participating in the Society ever since. Through its Annual Meeting, Journal and other activities, the Society convenes a group of professionals who are interested in improving public health in low income country setting and are committed to rigorous scientific approaches. This convening improves and encourages our collective thinking.
In Bangladesh my research team targeted the ASTMH conference as the primary international scientific conference to attend. It consistently provided a thoughtful audience for our work, provided opportunities to be exposed to a wide diversity of scientific activities and supported conversations and collaborations with colleagues throughout the world. It is always a busy, but remarkably efficient meeting.
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