Joshua Greenberg

UMMS Class of 2021

Why UMMS and the MD/PhD program?  Finding the appropriate environment for interdisciplinary work is challenging, but Michigan offers exactly what I would want for combining an MD with a PhD in economics.  It is a university with low walls.  My interactions with faculty, staff, and fellow students -- stretching all the way back to interview day -- have repeatedly shown me the friendly, collaborative atmosphere that pervades the campus.  Importantly, Michigan is a place where real things happen.  It is a place where theory is translated into action, which is precisely what I'm interested in.  The university has a very distinct ethos—of collaboration, of furthering the public good, of serving humanity.  Everyone here is incredibly practical—something you simply don't find in academia all that often.  Michigan is truly my type of place.

Josh Greenberg (right) wiith Ugandan colleague, Jordan-Bateisibwa

How do you see yourself blending medicine and economics?
Medicine and economics exhibit several complementarities between each other, which make them an ideal combination in the pursuit of my driving interest – global health equity.  The first is what I would call “timescale.”  That is, medicine often operates in the short-term; it tends to be surface-level, but it is driven by a moral obligation to act immediately.  Economics, on the other hand, often operates in the long-term and offers the promise of achieving more fundamental change to sustain improvements in the livelihoods of the global poor.  A second area of complementarity arises from the dual perspectives I will gain.  As a physician, I will be able to view healthcare systems from within.  The observations I make will inform my work as an economist, as I analyze healthcare systems from a broader perspective.

In addition, there are numerous areas where research between the two fields may overlap.  Four areas of research are of particular interest to me: (1) social and economic determinants of health; (2) political economy and health; (3) healthcare systems in poor countries; and (4) impact evaluation of health interventions.  

There has been a substantial amount of work in the social and economic determinants of health that is correlational in nature.  I'm particularly interested in attempting to parse out relationships between different variables (such as education, socioeconomic status, race, etc.) and health outcomes to see if we can identify more causal factors involved in producing ill health.

I’m also very interested in political economy—the intersection between political science and economics.  For instance, by providing citizens the means to hold their governments more accountable for public healthcare delivery, can we use democratic decision-making processes and rights-based approaches to improve health outcomes?

Josh meeting with primary school teachers who participate in the Progressive Health Partnership (PHP)

As I gain an understanding of the social, economic, and political determinants of health, I believe I will develop a broad foundation on which to conduct further research related to specific solutions to health problems.  Along these lines, I am drawn to the design of healthcare systems in developing countries, especially with regard to the role of NGOs in these healthcare systems.  In my work with Progressive Health Partnership (PHP) in Uganda, I have seen that NGOs can be a force for both good and bad.  I would like to more closely analyze how we can optimize the role NGOs play, particularly in relation to the government.

Lastly, I am attracted to the design and evaluation of health interventions.  I’m interested in using conventional methods such as randomized controlled trials (RCTs) for the evaluation of health programs as well as more unconventional methods in settings where RCTs may not be practical.

 When did you first develop an interest in global health?
It was an evolving process. I’ve had a longstanding curiosity about biomedical research, arising from my childhood experience of losing my brother and sister to Canavan Disease and my family's efforts in spearheading research on the disease.  In sixth grade, I read a book on the etiology of HIV/AIDS and decided that I would become an HIV/AIDS researcher when I grew up.  I couldn't believe how many people across the world were affected by HIV/AIDS, and I thought the greatest thing I could do would be to discover a cure for the most challenging health problem of our time.

Throughout high school, I was very active on the debate team, and the research we had to do for debate ended up exposing me to a wide range of topics related to global development, human rights, and other related issues.  I also come from an area of the Chicago suburbs with very unique demographics, where you don't have to go too far to end up in some of the poorest parts of the country.  I grew up knowing that inequality existed in our world, and the debate experiences helped pique my interest. But I knew I had much to learn about social and economic inequalities.  

My real interest in global health began the summer after I graduated from high school.  After I finished high school, I decided to pick up a couple books on global development.  I was struck by what I was reading. As I realized more and more how my achievement in life was largely determined by where I had been born, my view of the world started to change.  I began to feel guilty about the type of life I was living, wondering why I deserved to have so many opportunities at my fingertips. As I learned more about social justice (and injustice), I began to realize that the incidence of HIV/AIDS (and many other diseases) was far from randomly distributed and was determined by much more than mere biology.  I realized that I could in effect "treat" HIV/AIDS and other diseases using social and economic policy -- often with a greater impact than biomedical interventions alone.

As I explored what I personally could do about the inequity of our world, I made it a top priority to get involved in service and other activities related to global health and development when I arrived on the Duke campus for my undergraduate work.

What are you looking forward to most as you begin your time at Michigan?
I am most looking forward to gaining in-depth expertise in my fields of interest and to meeting and collaborating with other like-minded people.  I would like to use the knowledge I gain to make PHP a more effective organization so that we can continually refine our approach and develop tangible solutions to problems in our world.  I'm really excited because my education at Michigan will give me the tools to do that, through the expertise I gain in medicine and economics, along with all of the faculty, staff, and students with whom I'll have the opportunity to work.  Given my strong interest in the intersection between service and research and in translating lessons from the classroom into reality, I am really looking forward to the possibilities of building a long-term, mutually beneficial partnership between the university and PHP.  I feel that my education at Michigan could be a good opportunity to get this started, which I hope would capitalize on the complementarities between Michigan and PHP.

Have you given thought about a medical specialty area?
I'm leaning toward emergency medicine.   When I served as a patient advocate in an emergency department (ED), I became captivated by the philosophy of equal treatment that is a defining feature of emergency medicine. With people from all walks of life entering the ED and an obligation to treat everyone, emergency medicine provides a moral framework for serving the poor. In addition, the non-discriminatory approach, which is part and parcel of the practice of emergency medicine, breaks down many of our instinctive prejudices. Despite its distressing nature, I believe the ED – the face of social justice in healthcare – offers a model of equity toward which the rest of our society can aspire.

PHP's Omukazi Namagara Program works to to reduce maternal mortality and morbidity

What is your involvement in Progressive Health Partnership (PHP)?
PHP was initially conceived in 2007 by Eddie Zhang and myself, when we were freshmen at Duke University.  I currently serve as the Chief Executive Officer of the organization.  Founded on the principles of social justice and solidarity, PHP is committed to eliminating the burden of disease on the global poor and to eradicating the inequalities that divide our world.  Our organization promotes a community-based model of healthcare delivery, through which we work with the poor as partners and equals.  In 2009, PHP began to deliver health services to the poor in Kashongi and Kitura, Uganda.  The next year, we transitioned PHP into a non-profit organization in the U.S., and in 2012, we registered PHP as an NGO in Uganda.  Along the way, our programs in Kashongi and Kitura have steadily grown, blossoming from a small antenatal care program that only lasted for a couple months into an ongoing maternal and neonatal health initiative called the Omukazi Namagara Program.

PHP has three pillars – service, research, and advocacy – which comprise the multifaceted approach we bring to all of our initiatives.  The Omukazi Namagara Program (“omukazi namagara” literally means “the woman is life” in Runyankore, the language spoken in southwestern Uganda where we work) is currently our major program.  The ONP encompasses service provision strengthening at the two local health centers in Kashongi and Kitura, an education campaign on maternal and neonatal health, and home visits to women during and after pregnancy by our team of community health workers.  Previously, we also carried out a rainwater harvesting program, through which we constructed seventy-six 20,000-liter rainwater harvesting tanks on public buildings throughout our partner community and carried out a water, sanitation, and hygiene education campaign.  Local community members play integral roles in conceptualizing and implementing all of our programs.  Looking forward, we have large ambitions, as we aim to deepen the services offered through the ONP and establish a comprehensive healthcare system in our partner community.