An Anthropologist's Career in Global Health with Sera Young, PhD

•  Young started her international education as a senior in high school when she received a brochure in the mail inviting her to apply to the United World Colleges (UWC), where an International Baccalaureate program was first developed. She spent her senior year of high school and freshman year of college at a UWC in Wales and gained a global perspective and an interest in anthropology.
•  The first impactful experience that led her to global health happened during her junior year of college, when she was a junior at the University of Michigan, helping out with anthropological field research in rural Mali in West Africa. She thought her research that summer would lead to a career in the anthropology of religion. But the summer she spent making anthropometric measurements on young children and their mothers, many of whom were either sick or not growing as they should, she was compelled to change her focus to health-related research.
• Young speaks many languages including French, Dutch and Swahili. She picked up these languages by immersing herself into the cultures where they are spoken. This has helped her greatly in her global health career.
• After finishing her post-docs, Young received a K01 award from National Institutes of Health that funded her for five years to study the impacts of food insecurity in the first thousand days among women of mixed HIV status in Kenya. She says the award was not only beneficial for the financial stability but also because it gave her protected time for research.
• It was while listening to Kenyan women as part of her K01, that Young became aware of how fundamental access to water is to health, and how problematic it can be. She wanted to add a measure of water security in her study, but found such a measurement did not exist.
• This realization led her to the major focus of her research today, water insecurity. She has led the development of several tools to “bring the human voice to the water sector” known as the Water Insecurity Experiences (WISE) Scales. The scales have been established as reliable, equivalent, and valid, and only take 3 minutes to implement. Her goal is to have experiential measures of water become a standard global indicator used by scientists, policymakers and development organizations around the world.
• In another water-related project, Young partnered with her husband, Julius Lucks, PhD, a Northwestern University Professor of Chemical and Biological Engineering. He has developed tests using naturally occurring biosensors that can identify key water contaminants, including fluoride and lead. The tests are similar to a rapid at-home COVID test. They are about to launch a pilot project in Chicagoland to test water for lead using the biosensors and tests.
• In the way of advice to listeners who are just starting out in global health and wondering how to balance career and a family life, Young, who parents two young daughters with Lucks, talks about the importance of having a supportive partner. She also encourages researchers to bring their children with them into the field when they can.
• She says early career researchers should consider applying for a K01 award. Her award led to many opportunities such as a well-received book and high-impact publications.
• If a grant application you submit is rejected, she says persistence is key. Rejection is part of the process. Lastly, she encourages young researchers to have fun while pursuing their research, “If you are answering questions that you care about and find to be important, this gig is pretty fun.”

Rob Murphy, MD [00:00:06] Welcome to the Explore Global Health podcast. I'm Dr. Rob Murphy, executive director of the Heavy Institute for Global Health here at Northwestern University Feinberg School of Medicine. Water insecurity is a growing global health issue that impacts nutrition, health and well-being. Today's guest, Dr. Sera Young, is leading research projects focused on thinking about water in new ways. Most recently, she has led efforts to develop the Household Water Insecurity Experiences Scale, a cross culturally valid tools to measure household water insecurity. Dr. Young is an associate professor of anthropology and global health at Northwestern University, and she joins me today to talk about her career journey in the field of nutritional anthropology, and her work leading international research projects that impact global health. Welcome, Sera, to our show today. 

Sera Young, PhD [00:00:59] Thanks for having me, Rob. 

Rob Murphy, MD [00:01:00] You're based here at Northwestern in Evanston, the main campus of Northwestern University. But a question I like to ask our guest on the show is where do you call home? Is there a place in the world and you've traveled quite a bit where you feel the most at home? 

Sera Young, PhD [00:01:13] That's a great question. I would say Evanston is where I've lived for the longest period of time and my nomadic life. I feel quite at home here, but I feel most at home when I'm with people who care about global health. I know that that sounds like you told me to say that, maybe, but I really do. I am at home with people who care about other people. 

Rob Murphy, MD [00:01:31] I understand your feeling. So you're a nutritional anthropologist. Can you explain this field to me and why you decided to pursue this subdiscipline of anthropology? A little bit about your background from your CV. You got a B.A. in Anthropology from the University of Michigan. You got a M.A. in medical anthropology from the University of Amsterdam, and you got a Ph.D. in nutritional anthropology from Cornell University. Tell us, how did this happen? 

Sera Young, PhD [00:01:59] I'm either a sheep in wolf's clothes or a wolf in sheep's clothes, depending on the company I with. Technically, my Ph.D. is in straight up nutrition. I went from a highly social science oriented to taking classes that I never thought I would be taking for my Ph.D. I mean, to get into the program, I had to take general chemistry and organic chemistry concurrently. And so then with that out of the way, I could take biochemistry and eventually nutritional biochemistry while being a grad student. And I would say it was hard to make the transition from qualitative to quantitative stuff, but it made me such a better scientist to be able to like engage not just with the biochemistry but with the epidemiology and the biostatistics that inform my work to this day. So, I can run with nutritionists, I can run with anthropologists, and I'd like to think of myself as bridging the two ways of knowing about the world. 

Rob Murphy, MD [00:02:51] Part of your graduate career is in medical anthropology at the University of Amsterdam. Can you elaborate a little bit more on that? I would say for Americans, most of them have not included training in other countries. Can you tell us a little bit more about that? 

Sera Young, PhD [00:03:05] To answer that question, I'm going to have to take you back to when I was 16 years old. I got a brochure in the mail. Would you like to go to the United World Colleges? And that's a system of schools dedicated to international understanding and community service. And it's where the International Baccalaureate program began. So some of you will be familiar with that certificate. And I said, "Let's try it!" I put my application in and this was in the good old days when we still communicated by postage mail and the letter of acceptance saying, "Yes, you'll be going to school in Wales in September" got lost. And so a month before it was time to go, I learned that I would be spending my senior year of high school and my freshman year of college at this castle in the south of Wales where I was exposed to the world. I am from the Midwest. I was a mildly smart and mildly accomplished Midwesterner who knew very little about the world. But I was suddenly transplanted to Wales, where in the dormitory there was an Israeli and Palestinian girls who were roommates, and I didn't understand the gravity of that. There were soldiers from Georgia, there was chess champions from Hungary. You know, the Dutch king went there. And my eyes were opened so enormously to the world. And I started asking, How are we all the same? How are we different? Why are we different? And that naturally turns for me to anthropology. 

Rob Murphy, MD [00:04:32] So you got set up during this IB type program and you ended up in the Netherlands. What was it like going to school there? 

Sera Young, PhD [00:04:40] It was really a cool experience because I didn't live right in Amsterdam. I lived just outside and it was really like living with real Dutch people and it really got to like develop my Dutch language skills and really live Dutch culture. 

Rob Murphy, MD [00:04:54] Everyone that we interview on this podcast, everybody identifies the trip wire that got them going towards global health. You know, there's like one certain experience that just made you realize you wanted to devote time working on a global scale or in a low resource country. What was that moment for you? 

Sera Young, PhD [00:05:12] So my first one of those trip wires was when I was a junior at the University of Michigan. I was so fortunate to be an undergraduate researcher for a professor named Beverly Strassmann, who was working in rural Mali in West Africa. Thanks to my time at Atlantic College, my French was greatly improved and that was an important skill to have for research in a francophone country. And I went there thinking my major was anthropology of religion, and I went there thinking, I want to understand more about Dogon cosmology. But my job there was to conduct anthropology on, I think, 1100 children under five in their mothers. And that was a lot of measurement, of a lot of diaperless babies who were not growing as they should. And some children were extremely sick. I'll never forget there was a three-year-old child and a one-year-old child of the same mom and they were the same size, which is not how it should be. And to me I thought, wow, it's interesting to understand architecture, but there are some real problems here that need solved. That started me more and more . 

Rob Murphy, MD [00:06:27] So you've already mentioned that you speak a little Dutch and that you speak French, and I also understand that you speak Swahili. So when did you pick up Swahili and why did you feel it was important to learn Swahili? 

Sera Young, PhD [00:06:39] Well, for that, I have to thank Rotary. When I graduated from the University of Michigan, I knew I cared about global health things, and I knew also that it was good to not only be in school. So I took the opportunity to apply for a Cultural Ambassador scholarship, which sounds very fancy, but what it meant was that I think they gave me $4,000 to go live with a Swahili family. So I lived on the island of Zanzibar, which is just off the coast of Dar es Salaam, part of Tanzania. And there's no better way of learning a language than living with a family who speaks that language and who mostly only speak that language. And so I did that. And then that served me well for my Ph.D., which was on Pemba, a smaller island in the Zanzibar archipelago, where I could really use those language skills to do more global health. 

Rob Murphy, MD [00:07:25] Much of your work is on impacts about food and water insecurity. One of your first big studies on this was in Kenya and was focused on the reduction of maternal and child undernutrition in the first thousand days of a child's life. Can you describe that work for me? 

Sera Young, PhD [00:07:41] I was so fortunate as to land a K Award when I was a research scientist at the time at Cornell that funded me for five years to study the impacts of food insecurity in the first thousand days among women of mixed HIV status. So what we wanted to do was quantify what food insecurity did, not just for nutrition, but for mental health, for economic well-being, so on and so forth, and understand it within the context of the dyad and with my nutrition head on. We know how to measure the key exposure, which is food insecurity. With my anthropology hat on, I wanted to make certain we were talking to the moms about stuff that they cared about too. So we did something called photo elicitation interviews, which is where you give a woman a camera and say, "Take pictures of X, Y, or Z" and then you come back and you interview them with the photos that they've taken. We asked them to take pictures of that which influenced how they fed their babies. And we got pictures of things I expected back, sick chickens and failed crops and the dads drinking up the food money, using it for alcohol. But then there are all these other pictures of dirty water that women had to choose between buying food or buying clean water and using that water. Of water sources that were very precariously located so that they had to leave their infants behind to go fetch the water and so on and so forth. So with these photo elicitation interviews, we were receiving all of these pictures of water, which I did not see coming because I was focused on food. But through these conversations, through listening to the mamas, I soon realized that water was fundamental to all aspects of life in a way that I am still slapping myself on the forehead. How was I not seeing this before? Women were not able to prepare the food that they wanted. They were dehydrated for breastfeeding. They were being beaten up when there wasn't water in their household. They were going into debt in order to get water for their family. I mean, it touches all aspects of life. So with my food insecurity, like lens on thinking, okay, we measure food stuff by measuring how people access and use it. We measure their experiences with it. We're not just counting the number of calories that are available to them. I wondered if we could do that with water too. So that was a new, fresh K01 baby assistant professor wanting to like, think, "Surely someone has figured out how to measure water access and use in a reliable and valid way, so I can pop that measurement in the study design." But lo and behold, such a measure had not been developed. And so we got an R21 to develop a scale that was appropriate for measuring water access and use in Kenya. And anthropologists love comparative work. And I started to see that water problems were a global phenomenon that right here in our backyard, even in Chicago. We wanted to develop a scale that was globally valid, equivalent, reliable. And that's the work that I've been spending the last decade on. 

Rob Murphy, MD [00:10:29] You brought up a very interesting point. I was unaware of that you were a K01 one awardee. It's a really wonderful career development award, K01. And I'll tell you that the NIH is trying to recruit Americans like Sera to apply for them because they think it's not applied for enough. It's really a wonderful award. It's just incredibly supportive, heavily mentored, and everyone ends up doing a great job after they finish one of those awards like you did. 

Sera Young, PhD [00:10:57] Well, I agree with you. I can't recommend a K01 enough. And it was because of that opportunity to really dig in deep to what was happening in terms of food insecurity for these moms that I stumbled onto what I think is my best idea so far, which is all this stuff we're doing with water security. 

Rob Murphy, MD [00:11:14] Because of your group's work, we now have a pretty good snapshot of what water insecurity looks like in a variety of different places where you worked in China, India, Brazil and much of Africa. How do you want to see this data utilized? 

Sera Young, PhD [00:11:28] So the U.N. always has these high level panels on X, Y and Z. And so it won't surprise you that they have a high level panel on water. And in that report, the high level panel said we can't manage what we can't measure. And that is true for water. And I agree with those high level panel of experts. Right now, the common indicators of water have been how much water is out there. So cubic meters per capita. And when you take Lake Victoria and divide it across Kenya and Tanzania, people are water secure. There is enough water physically available, if that water was equally distributed. But of course it's not. So we have good data on physical availability, but that doesn't tell us about what water is in people's lives. We also have another indicator of what water is like in people's lives by measuring people's water infrastructure. So right now, Sustainable Development Goal 6 has as an indicator, tracks the type of water infrastructure that people have. And I would say physical availability and infrastructure are both necessary, but not sufficient for having enough water in your life for basic household domestic needs. And so we aren't measuring well enough that which is so precious to us. And there's kind of a playbook for improved measurements of resources. And we have that from the food and nutrition world. So Sustainable Development Goal 2 is oriented to food and nutrition. And one of the indicators there is experiential measures. So the food insecurity measure that I was using as part of that, that K01, it's one of the ways we track progress towards food and nutrition for all. My strong argument is that we need to have an experiential measure of water to really know if people are water secure. We need to know if people are worried about water. We need to know if they have enough water for both consumption and for hygiene behaviors. And right now, that is not the global indicator and we're going to change that. 

Rob Murphy, MD [00:13:19] That's quite a goal. I understand that you and your group actually developed a measurement tool called the Household Water Insecurity Experiences Scale. Can you elaborate a little bit more how your team did this and the impact that's had. 

Sera Young, PhD [00:13:34] We were in Kenya and we had developed an experiential measure of water access and use there, but anthropologists, they love a good cross-cultural comparison. And so we wrote a proposal that was funded by an amazing organization. The funding mechanism is called Innovative Measures and Agriculture and Nutrition, IMMANA. And that's an amazing organization funded by Gates and FCDO, the artist formerly known as UK Aid, and they have been enormously supportive of this work. So I applied for a grant from them, was denied it the first time. Second time's a charm, it seems. Sometimes it takes third or fourth. We were funded to develop a global scale and we were funded for four sites. But as I kind of reached out to my networks and said, "Hey, we're doing this, we're doing this." People loved the idea. And for much of this work, I keep looking over my shoulder to think, "Surely someone has developed an experiential measure like this is so obvious coming from nutrition. This is how we measure food security." So there's a good one for Bolivia and a good one for Ethiopia, etc. There's nothing that globally relevant. So mentioning this to my professional network, by the end of the data collection for developing the household version of the scale, I think we had 30 collaborators when we collected data in 28 sites in 25 countries. There were geographers, there were epidemiologists, there were nutritionists, anthropologists across time zones, career levels. And and from there we formed a consortium with UNESCO and Gallup to put these items into the Gallup World poll, and that is an individually oriented survey. So we switched the questions from "How often have you and your household been angry about your water situation." To "How often have you just you yourself been angry about your water situation?" And we extended the recall period so that the data were comparable. And from that came the IWIES is the individual water insecurity experiences scale. Both of those take 3 minutes to administer. They're easy to analyze and they've held up well in all the places that they've been administered, which is now in more than 60, 70 countries, 100 or so organizations. 

Rob Murphy, MD [00:15:39] That's amazing. What a great achievement. I'd like to switch gears and get a little personal here, if you don't mind. I understand that you're working pretty closely with your husband, Julius Lucks, who's professor of chemical and biological engineering and co-director of the Synthetic Biology Center at Northwestern, And he's focused on using RNA based technology to develop a simple, inexpensive test that could determine water quality. Can you tell me about that project and what it's like working with your husband? 

Sera Young, PhD [00:16:09] I've been really lucky in who I have partnered with, and when our daughters aren't interrupting us a dinner, we'd like to talk about our research. And so in our stolen moments of talking about science, I was explaining just what people are up against with water contamination globally. And as it happened, the universe was conspiring to like, bring us together intellectually in that he was working on biosensors. So you know this better than me. All cells need to detect that which is in their environment so that they can move towards it or pump it out or do what they need to do. And he and his group have identified biosensors of key water contaminants, including fluoride. So a little bit of fluoride is good. A lot bit of fluoride is not good. And there are many areas, including along the Rift Valley, where eugenic fluoride is really problematic. He also had identified a biosensor for lead. And so what he's done is made what you can think of as like pregnancy tests or at-home COVID tests to detect water contamination. And this is a big deal for a number of reasons. We can detect lead or fluoride in water with fancy machines in laboratories at great cost. What we can't do is do so privately and rapidly in the privacy of your own home. So he's good at developing biosensors. I'm good at talking to people. Engineers speak differently than anthropologists and have different types of questions, but what we did was we identified questions that were relevant for both of us. Do the tests work and are they sensitive and specific to detecting contaminants and can people use them? We have a paper now out and NPJ Water that shows that in fact these geogenic fluoride tests work well and that has inspired us to do the same for lead here in Chicagoland. So we have lead tests that are good to go and we're about to launch a pilot study seeing if they work as well as we think they do. 

Rob Murphy, MD [00:18:03] You alluded to this already, but I understand you do have two children and you've got a incredible career and a busy international travel schedule. How do you make that work? There's a very important question for young families going into global health, and everyone has approached it slightly differently. 

Sera Young, PhD [00:18:21] There are a few ways that we've made that work, and I think an important one is bringing your kids to the field. Both my girls have been to different field sites, different projects. Another is choosing your partner well. Julius has a lot of wonderful qualities, but one of them is he's very supportive of my career, so a very supportive partner and also a supportive family. I mean, my mom has been willing to stay with the girls and make things happen that would not have been able to happen otherwise, so I'm very appreciative of her as well. 

Rob Murphy, MD [00:18:49] One last comment and question. I asked this of everybody who comes on the podcast. What advice can you give our listeners, especially the students, people early in their career who want to get into the global health space? 

Sera Young, PhD [00:19:04] Creativity is underappreciated. I think that we all think we should know things and do things in certain ways, and I would encourage people to be comfortable to ask the questions and do the science the way that they are best suited to do that science. You know, you go in and you have questions that you think you need to have answered, and those are the ones and that's what you have the grant for. But if you can take a minute to not abandon your own, you know, line of reasoning, but to listen to what people are telling you, it's transformative. I mean, the same thing happened with my in my master's degree. I was studying anemia during pregnancy and I was studying how people understood it and how they treated it. But then people were telling me something about eating dirt and anemia, and I was like, "Huh, this is interesting." So I spent the summer asking, "Why are women craving uncooked rice? Why are they craving this earth?" And and they finally said, "You know, you tell us. We want to know too. Like look, look at you with your clipboard and your cassette tape recorder. You tell us." And so you know that listening to them, they they got me on a trajectory that led to a a well-received book and lots of publications. And again, listening to the women gave me the idea to to dig into water. But being willing to say like, "Hey, this is an important question and it needs answered and I'm just going to draw on the techniques from this field or that field or that field to do so." So being yourself and being creative. Those are nebulous, but key. Another is apply for a K award. Money is not only power, it's time. And the ability to really dig into both food insecurity, which then led me to water insecurity, without having to do a bunch of teaching, was priceless. So I would encourage grant applications and piece of advice someone gave my husband early in his career. He was complaining that he didn't get a grant, and this person said, "If you're feeling bad about not getting a grant, you're not applying for enough grants." You'll need to just take rejection as part of the process. It happens to everyone. My third one, if I may, is have fun. Life is too short for always doing the slog. And if you are doing you, if you're answering questions that you care about and find to be important, this gig is pretty fun. 

Rob Murphy, MD [00:21:23] Dr. Young, thank you very much for joining us today. It's been really great opportunity for us to hear about all the important things that you've done in this field and your career development and how you got there. I think it's incredibly valuable resource for us to have. And just thank you so much for joining us. 

Sera Young, PhD [00:21:42] It's been a pleasure and an honor to be on this. Thanks for having me, Rob. 

Rob Murphy, MD [00:21:52] 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 on global health.