Improving Global Health Across Disciplines with Keith Martin, MD

• Martin came to Canada as an immigrant from England when he was a child. As a young person he disturbed by injustices and violence and also really enjoyed biodiversity and solving environmental challenges. He believed by becoming a physician he could find a way to connect the well-being of people and the well-being of our planet. 
• As a physician, Martin worked in an emergency room and served First Nations communities in British Columbia, which had some of the worst health outcomes in Canada. He  traveled internationally, too,  to South Africa where he witnessed much trauma to people in need. 
• He decided to devote his time to  a career in politics, in order to address some of the injustices he saw at the policy level. He served six terms as a Member of Parliament in the Canadian House of Commons, from 1993 to 2011. 
• Today, as the founding executive director of CUGH, he leads 186 institutions around the world with a network of 34,000 individuals who work on global health issues worldwide. 
• CUGH also hosts an annual conference. This year the CUGH 2023 Annual Conference will focus on equity, climate change, and microbial threats.
• Broadly, CUGH is bringing together academia,  governments, the private sector, NGOs, INGOs and others, to try to convene, organize and mobilize for impact.
• In order to implement many of the scientific findings that could make an impact on global health, Martin says academia needs to reform the way it communicates to the public and politicians. “Politicians are not going to reach back to us. We have to reach out to them, understand their incentives, understand ... the  language they use and engage them effectively,” he says.

Additional Reading:

• Find out more about Martin and the mission of CUGH
• Register for the CUGH 2023 Annual Conference

Rob Murphy, MD [00:00:06] Welcome to the Explore Global Health podcast. I'm Dr. Rob Murphy, executive director of the Harvey Institute for Global Health here at Northwestern University, Feinberg School of Medicine. Today's guest, Dr. Keith Martin, has had many incredible career moves in medicine, politics and global health. He is now the founding executive director of the Consortium of Universities for Global Health Care, the world's largest consortium of academic organizations working across research, education, advocacy and service to address global challenges. Keith joins me today to talk about his career path and also how the world of global health has changed since the start of the SARS-CoV-2 pandemic. Keith, welcome. 

Keith Martin, MD [00:00:51] Thank you very much, Rob. It's a pleasure to be here on your podcast. 

Rob Murphy, MD [00:00:54] Yeah, this is our first podcast of this session and we're really, really very pleased that you're willing to join us today. If we could start, let's go back to your Canadian roots. You're Canadian, you studied at the University of Toronto. And then tell us, why did you pick medicine in the early 1980s? 

Keith Martin, MD [00:01:13] Well, thank you, Robyn. I'm actually an immigrant. I wasn't born in Canada. I'm Canadian by citizenship, very grateful. But I was born in England, so I'm an immigrant to Canada. And honestly, growing up in Toronto, two big things drove me, number one, people's well-being. And I was disturbed by things happening around the world, injustices, violence. And I also really enjoyed biodiversity and the environmental challenges before us and really wanted to find a way to deal with both of them. So what did I do? I said, Oh, I think I'll become a physician. And I believe that I could find a way to connect the to the well-being of people and the well-being of our planet. 

Rob Murphy, MD [00:01:49] That is really great. How old were you when you came to Canada? 

Keith Martin, MD [00:01:53] Eight when we traveled over a boat. So I remember seven days, five of possible motion sickness. I'm the eldest of five boys and four at the time. And so we go traveling across the North Atlantic, which is a pretty rocky place to go, and then five days of motion sickness at a seven and two that were okay. And then seeing the the captive island in Quebec City as we were hitting terra firma was a joy to see in the morning for an eight year old going, I'm getting to land. I'm not going to be sick anymore. 

Rob Murphy, MD [00:02:21] Oh, that's amazing. You ultimately, of course, you went to medical school and you became an emergency room physician. How did you pick emergency medicine at the beginning there? 

Keith Martin, MD [00:02:30] Well, I loved the variety of medicine, Rob. And in going through medical school, I thought, where can I make an impact on people's lives acutely? And so I decided to work in emergency medicine and also do family medicine with obstetrics. So I had an amazing career in British Columbia, Canada, which is where I spent most of my life. And I had an amazing hospital in a place that was in sort of in the middle part of the province where there was this extraordinary interface between people who were quite poor indigenous populations, some who had a lot of money, a place of high violence and a lot of industrial accidents. So there was a lot of trauma, a lot of challenges. And I got to have an incredible practice working in emergency. I used to also treat inmates in jail. I also helped to run a clinic in the morning for people who are homeless and drug addicted. So I got to see an incredible arc of the human condition in that space, which I'm incredibly grateful for. 

Rob Murphy, MD [00:03:23] Wow, that's quite a career that you've had. What incredible stories. So medicine, we understand now your original background and the things that you did. But in 1993, I understand you actually became a member of Parliament in the House of Commons in Canada, and you've said you view your time in politics as an extension of your work as a physician. Maybe you could explain that a little bit more because that is really fascinating. I've never met a member of Parliament before or a former member that doesn't mix much in the United States. We have very few physicians actually in power. There's the ones that are typically private practice physicians who have sort of a medicine business background like Bill Frist and others. We rarely get more people interested in global health, in government at all. So can you take us back to that period? 

Keith Martin, MD [00:04:17] I'll tell you what really disturbed me. So I also worked in a bush hospital in South Africa during apartheid, and I saw obviously quite extensive trauma that were being inflicted on people. And then when I worked in emergency and general practice, worked in jails, visited First Nations communities that were some of the poorest, most disaffected and ignored parts of my country. I remember sitting in emergency and childhood exams who'd been taken away from his parents and had really suffered a lot. And I looked at this kid, they said, You know, this kid is going to have all kinds of problems. But the reason why that child came to my emergency department was a result of a whole lot of things that I have no control over. And so I think one of the beauties of being in medicine that we have is that we really see the arc of the human condition and the reasons why people come to our attention as physicians. And I asked myself in my thirties, I said, Look, I've got some ideas and how to deal with some of the medical challenges we're seeing there, social causes. I see a lot of the environmental challenges we're faced with. How can I best? At least drive those ideas forward in a space that might make a difference and hopefully attract people who have a lot better ideas than me to actually implement things that will prevent those problems. And I decided to go in. And in Canada, it's not that much different, in fact, from the United States because there were only five physicians in parliament in Canada. So it's a pretty rare thing. But I was had a crisis of conscience. I said, look, if I don't do this now, what would I say to myself ten, 15, 20 years from now? And I said I had ideas how to prevent the problems they saw, but I chose not to do that. And I thought, you know, I'll just throw my hat into the ring and try. And so we were very lucky to be elected back in 1983. 

Rob Murphy, MD [00:06:03] Wow. How many terms did you have?  

Keith Martin, MD [00:06:05] I served six. So I served from 1993 to 2011. We actually no one gave us a chance to do it because we defeated a former premier of my province like a governor in the United States and the de facto leader of his party nationally. We defeated him, which nobody expected. It was a big change but had a remarkable team to be able to do that. And I was very privileged to the citizens in my community in Vancouver Island are remarkable and we certainly wouldn't have won without them, that's for sure. But we did things a bit differently because I think as physicians we know, right? We've seen we have a remarkable insight into the human condition that a lot of people are privileged to do. All the things we see in our offices in emergency, no one else has that opportunity for people to reveal their lives like they do to us as docs. So that knowledge gives us a lot of background. And I went into Parliament to try to apply that and I went with a very specific list of things to do. I said to myself, You know, I'm going for one term. If people don't elect me for this or no, that's fine. But I need for your own conscience to do this. 

Rob Murphy, MD [00:07:08] Well, I like the term the arc of humanity. I guess, to paraphrase you a little bit, it is something that physicians, you know, have the opportunity to see basically every walk of life, especially in the emergency room. I remember working in the emergency room and same sort of thing. I worked at the V.A., I worked at Cook County Hospital. I did some work in the jails, but it was more I was invited in as a consultant when there was a lot of HIV floating around in the jails, and there was very little preventive efforts going on. So it really is a very broad thing. And then, of course, working in Africa or middle income countries also brings a different focus to the situation. And maybe we could talk a little bit more about Africa. You mentioned you were there in the apartheid era in South Africa. Can you tell us a little bit more about the experience, the first experiences you had working in Africa or being in Africa? 

Keith Martin, MD [00:08:06] So working there during a state of emergency, Rob Where I was on the border with Mozambique, Mozambique was a failed state. We had 50,000 refugees pouring across the border, people fleeing for their lives. South Africa was the state of emergency because apartheid was collapsing at that time and the government of the time cracked down brutally. So you were at a very interesting interface between what was happening in South Africa on the border with a proxy war and seeing also big game politics played out because the Cold War was still, if you remember, well in play. So the Cold War was, in fact, playing out in our border with Russia and the West, fighting it out in that space. And the victims of it were just ordinary people like you and I. It hits me as such, so fundamentally awful that as I said, I had a crisis of conscience in my thirties. To say you have an obligation to try, because if you don't try to do something, at least try to do something, you'll never be able to do it as somebody out in the public as well as you could possibly do it within politics. So that's why I ran it. It drove me in combination with my experiences as a physician and seeing that the reasons why people were coming to our emergency department and in my office, which were incredibly gripping as well, I worked there a lot of First Nations communities and some of them have the worst health outcomes in Canada, equivalent to what you'd find in a low income country, by the way. And people don't know this and no one sees that. So I would fly in a small chopper through the incredible mountains of British Columbia, a small chopper for two people, land in a First Nations community and see people who were in extreme destitution and suffering from horrible medical conditions, as were their children. 

Rob Murphy, MD [00:09:50] Now it brings back my own experiences. When I started working in Nigeria, it was during the last dictator. Nigeria was very unstable. Every airport in the United States. I remember getting on an airplane in Bangor, Maine, and it said, Don't go to Murtala Mohammed Airport in Lagos, Nigeria. It is unsafe. I became obsessed with that message because it was in every airport in the United States. And so I went to Murtala Mohammed Airport. I was invited there. I was a little bit nervous and the person who invited me worked for the military. He said, Oh, don't worry, it's actually not as bad here as everyone is saying. And he had some soldiers meet me at the door of the airplane with rifles, whatever, and they escorted me through security. And it was I mean, the country was just in real chaos. But what I found in the whole chaos, I don't even know if they drove on the right or the left of the street. The Coast Guard. 

Keith Martin, MD [00:10:50] You remember that road between the airport and Lagos, just like crazy? It's called Murder Alley. 

Rob Murphy, MD [00:10:56] Yeah, right. But what I found really fascinating was I think you could relate to this. There's a group of people in there that function, no matter what is going on with politics, and they're smart and they want to do what's right for their country. And it was really an incredible pleasure to work in that country for many years and see the remarkable changes that took place when a solid democratic government got into place. And I think, you know, the same thing in South Africa. I mean, you know, they have problems. We all have problems. But the changes from back then till now are really so dramatic. 

Keith Martin, MD [00:11:32] But you see the impact of politics on people's wellbeing, which vastly overshadow things that many of us are concerned about. But the big political decisions can have a huge impact on people's lives. 

Rob Murphy, MD [00:11:42] Enormous. Let's go past your political career. Since September 2012, you have served as the founding executive director of the Consortium for Universities for Global Health. Can you explain some age for those listening who may not know, especially our students who may have not even heard of the organization? I think it's very important to get this really out there. 

Keith Martin, MD [00:12:07] The Consortium of Universities for Global Health, we started in 2008. We're based here in Washington, D.C. We work across, as you said, research, education, service and advocacy to improve the health of people and the planet. That's our mission. And we have 186 institutions around the world, including yours, which we're very grateful for a network of 34,000 individuals that work in global health worldwide. And we mobilize all of those assets and organizations across our annual conference, which is going to be next April here in Washington. And we have committees, we put out symposia, webinars, and I would encourage people to look at our website at college dot org, to see the vast wealth of material we have in education and research and advocacy for students. We have a specific student group called the Trainee Advisory Committee, and we also have campus representatives around the world, and there's more than 120 of those and anybody can join that. So we really encourage students around the world to join this because we're trying to build a network of students that can work together, share things, collaborate in a way that addresses the global health challenges before us and improves and addresses some of their interests in having a career in global health. 

Rob Murphy, MD [00:13:18] Maybe we could just dig in a little bit more about universities. What do you think they can do that other institutions and NGOs cannot do in transforming global health? 

Keith Martin, MD [00:13:30] That is the million dollar question, isn't it? And I think that academia needs to reform. One of the amazing privileges of this position, as I see across my desk, as you do in your role, Rob, a vast swath of incredible research that is produced that can really make a difference in people's lives, but they're siloed. They're not known by policymakers. They're not known by the public. So we need to reform, I believe, academia, to be able to breathe life and do justice to that incredible work by researchers and educators and academia so that it is connected to policies that are implemented and do have the impact and aspiration that scientists want. And I think that's huge. We're doing that and trying to do that not only in academia, but we're bringing in governments. We bring in different sectors, including the private sector, NGOs, NGOs and others, to try to convene, organize, mobilize for impact. One of the reasons I got into this job at least applied for it. Rob was in Parliament. I said people coming to my office as a member of Parliament and they'd bring together these bricks of scientific reports saying, Oh, we'd like the minister to read this. I said, The Minister will not read anything that is more than a page. So you've got to put it in the language, right? That people understand. That also appeals to their incentives. And we don't understand each other. We don't communicate with each other. We don't understand each other. And society, of course, has moved on to a space where knowledge has a different values to the public, where infotainment, entertainment and very short attention spans rule the day. So that's not going to change for us. We've got to change to that environment. 

Rob Murphy, MD [00:15:15] Now, that's a great point. And to hone in on this. Students. And so you gauge tell us a little bit more about the annual conference. I think it was 2019. It was in Chicago and I was one of the local co-hosts, and it was a great meeting. And then, of course, we had the pandemic and, you know, everything became virtual. But now we're back live. Right. So do you want to tell us a little bit more what we can expect. 

Keith Martin, MD [00:15:42] April 13th to the 16th here in Washington? Everybody's invited. Check out the site C 2023 dot org. The theme is equity, climate change and microbial threats. But we have seven subthemes and that includes all the things you could imagine both biomedical and non biomedical that go into human well-being and the well-being of our planet gets back to our mission. What's really exciting that's never happened before, Rob, for our conference next year is that the M8 alliance in Berlin, which is an umbrella organization of National Academies around the world. They're holding their annual International Regional Summit, also as part of H1 2013 and the Association of Academic Health Centers are holding a global innovation forum also at sea. So we've never had these groups come together. The other cherry on top of this is that we've invited representatives from the embassies here in Washington to attend, and we're getting numerous embassies saying we're going to attend. They're going to receive a registration. So we'll be bringing in the political, the international, our members, the academic health centers and the World Health Summit, folks all here together under one roof. For those who cannot attend. We have a virtual meetings from April 3rd to the seventh. Anybody can register for them. They're all free. But we'll have a whole range of virtual half day, two full day sessions at that time. Look at the website such as 2023 dot org and please register for the conference, come to Washington and attend the virtual sessions too. 

Rob Murphy, MD [00:17:19] Now it sounds like it's going to be a really great meeting. We are definitely going and we're playing a role in it as well. And it's nice that you have the live meeting again and Chicago was the last one. All right. One final thing that I think we have to address, and we've talked about it really just indirectly. So much has changed in many spheres, but especially global health since the start of the SARS-CoV-2 pandemic. In an article you published in Spring 2021 and Lancet Global Health, you wrote The SARS-CoV-2 Crisis is an Opportunity to Reform How We Practice Global Health. Tell me about that statement and how countries and institutions are rebounding and building better global health initiatives after the height of the pandemic. 

Keith Martin, MD [00:18:07] I think, Rob, that with every crisis, of course, there is an opportunity and it ought to be tried about it. But we also know that we haven't really made the reforms that we need to to be able to not only prevent, detect and respond to future pandemics, but nor are we dealing with the noncommunicable diseases situation. We're not dealing with climate change. We just went through the COP 27 meeting recently and there is no plan to actually effectively reduce carbon emissions. So we're not actually seriously bringing together the people and the finances to effectively address the challenges before us. Academia can play a vital role in that. I think we do the research. There's a capacity building component in that and there's an advocacy component and a service component in that. We need to be much more deliberate in terms of how we work with our partners effectively and equitably around the world to deal with those challenges. And that's an important thing. The other thing, what we learned, I think, Rob, first is the role of non biomedical sciences in our space. Global health, as you and I we know, was born with people like us in medicine. And I think of it as one of the things we've learned through the the the failure of not responding adequately to COVID 19 is that the non biomedical sciences are as important as the biomedical and being able to deal with these challenges, and we need to bring them in across disciplines. It's a challenge, but it's also an opportunity to do that. And the other thing is we can't be too precious about not engaging the politicians. That chasm remains. We talk about the historical silos, the ivory tower. Well, politicians are not going to reach back to us. We have to reach out to them, understand their incentives, understand how they the language they use and engage them effectively. And also the public the public moves the political. And if we're going to be able to have the impact that we desire, I think we have to rethink what we do, how we do it in a way that's effective. And the funders can do this because I don't think it's going to move on its own. Funders will lead action. And I think that. It needs to be strong financial incentives to be able to do that. That will be the most expeditious way to really being able to have the outcomes we want in our space, but also realizing the unrealized potential, if I can say, of academia. 

Rob Murphy, MD [00:20:33] Keith, what a fascinating interview. And you've had a fascinating life and you're you've got a long way to go. And I imagine there's going to be a lot of changes coming in the future, all going in a good direction. I can't thank you enough for joining us today. I can't thank you enough for all the work you've done with yoga, how you've grown that organization to the level where it's at today and it looks like the future is incredibly bright. And thanks again for joining us. 

Keith Martin, MD [00:21:03] Well, thank you for we have a great team and we're really grateful to you and your team for supporting us. It would not exist without members like you. And it's been just a real pleasure to be here and to work with you and continue to work with you in this common space. We're privileged and very lucky to have you as a member and working with us. So thank you, Rob, very much. 

Rob Murphy, MD [00:21:22] Well, it's a mutually beneficial relationship, I can tell you. Thanks again, Keith. 

Keith Martin, MD [00:21:26] Thank you, Rob. 

Rob Murphy, MD [00:21:32] Follow us on Apple Podcasts or wherever you listen to podcasts to hear the latest episodes and join our community that is dedicated to making a lasting, positive impact. 

Unidentified [00:21:42] On global health.