Looking back at his long career in global health and academic medicine, Haile Debas said he has learned the value of persistence: “Don’t be discouraged even if things look impossible.” He has faced many obstacles—from practicing surgery in remote and underserved areas, to battling bureaucracy and dictatorships, to launching new initiatives like the UC Global Health Institute, which he said looked impossible at the beginning.
Debas did not anticipate being a leader of the global health movement. A native of Eritrea, he completed medical school and surgical training in Canada, after which he was promised a position as assistant professor of surgery at a prominent university in Ethiopia. After receiving a telegram (in 1969) informing him that the Ethiopian Ministry of Education had financial problems and the position was no longer available, he said, “I saw my future plans evaporate in front of my eyes with nothing to replace them.” Aided by fortuitous connections, Debas was able to change course and embark on a productive career in Canada and the US.
Years later, when Debas was stepping down as dean of the UCSF School of Medicine, he wanted to return to Eritrea to help establish its first medical school. “I’ve always been interested in capacity building… by that I mean training doctors, nurses, technicians, managers, and attending to the infrastructure—such as good sterilization, adequately equipped operating rooms, and providing access for women in rural districts to good care during childbirth.” Eritrea’s president cancelled the general election in 2001, however, and that effectively put an end to democracy there and thwarted Debas’s plans.
“It then occurred to me that I could perhaps make some [other] contribution in East Africa,” Debas recalled. He chose to stay at UCSF and develop Global Health Sciences (GHS), an organization that could help accomplish his goals of serving in developing countries through education and research partnerships, and create new global health opportunities for UCSF learners and faculty.
When GHS began in 2003, global health was still a new field, often confused with public health. While public health addresses the health of populations and medicine addresses the health of individuals, global health does both: it combines preventative, population-based health with curative, individual-based health. Debas explained: “Global health problems are so big that single disciplines can’t tackle them. They require a multidisciplinary approach that involves medicine, nursing, dentistry, pharmacy, agriculture, and policy-makers.”
Debas’s plan for GHS had begun with a vision for a School of Global Health at UCSF, and in 2005 Chancellor Michael Bishop encouraged him to bring that idea to the UC Office of the President (UCOP), which he did. “The UC provost [Wyatt Hume] sat up and said, ‘Wow, why not create a school for the whole university?’” remembered Debas. The idea of this system-wide interdisciplinary program also energized UC President Robert Dynes.
Creating a school that spanned the entire University of California was unprecedented and a major challenge, although at first the effort seemed promising. An initial steering committee recommended moving forward with the idea and every chancellor appointed a member to a planning committee to put it in motion, with generous funding from the UCOP. Debas, with the support of Provost Hume, also secured a three-year planning grant of $4 million from the Bill and Melinda Gates Foundation, which was enthusiastic about the proposal since one of its priorities at the time was supporting American universities to engage in global health.
Planning for a UC School of Global Health was making headway with the Academic Senate when, in 2008, the US economy crashed. The State of California cut UC funding; the Gates Foundation lost billions and restricted its funding priorities. The concept of the UC-wide school also had met with opposition from the Schools of Public Health at UC Berkeley and UCLA who “felt we were stepping on their turf and competing for state resources,” noted Debas. When UC President Dynes resigned, support from the top left with him.
The External Scientific Advisory Committee chaired by Harvey Fineberg, who was then president of the Institute of Medicine (now the National Academy of Medicine), “decided not to abandon the idea of a UC-wide global health initiative. But since we didn’t have the resources to start a school, we decided to scale down and establish a global health institute,” said Debas. This new institute, with Debas as the founding director, would build on the roots of UCSF Global Health Sciences, which had successful collaborations across schools on campus and with international partners.
What began as a vision for a School of Global Health at UCSF and progressed as a plan for a UC-wide school, was then re-formulated as the UC Global Health Institute (UCGHI). Launched in 2009, the UCGHI declared its primary goal: to leverage the knowledge and expertise of the 10 UC campuses by developing multidisciplinary, multi-campus Centers of Expertise (COEs). Debas said that involving all the campuses in this effort “was a no-brainer because no other institution had the resources that the entire UC brought.”
The UCGHI chose to establish three Centers addressing top global health priorities: Migration and Health, Women’s Health and Empowerment, and One Health: Water, Animals, Food and Society. It was important to the planning committee that each UC campus could participate and contribute to at least one COE with the potential to have a real impact in global health research, education and policy. The three COEs achieved this impact with UCGHI support from 2010 to 2015, when leadership called for new set of COE proposals as a way to provide opportunities for new global health researchers and approaches across the campuses. The two current COEs are Planetary Health and Women's Health, Gender and Empowerment.
Debas remains animated by the women’s empowerment mission, noting that, “In global health, women’s empowerment is the critical element—nothing will be accomplished to a successful end without women’s support.” He was especially impressed with how the initial Women’s Health and Empowerment COE, through a collaboration between UCLA Law and Sonke Gender Justice, advocated for implementation of the Sexual Offences Act in South Africa. Establishing that type of legal status was unique in African countries, and is difficult to accomplish even in the US, which Debas said inspired the UC faculty, staff and students involved in the effort.
The UCGHI accomplishment Debas is most proud of is bringing all the UC campuses together and seeing how an academic institution can make a huge contribution to global health. “I learned how people who are committed and optimistic can accomplish so much.” UCGHI’s contributions to research and education include establishing signature programs such as UC Global Health Day—an annual conference showcasing global health work across the UC—and the GloCal Health Fellowship, a mentored career development fellowship for US and foreign investigators studying diseases and conditions in developing countries.
Debas credits UCGHI’s successes to the early planning team, the people on every campus who have worked with the Institute over the years, and the “fantastic and dedicated” leadership—Thomas Coates, who became director after Debas retired in 2016, and Patricia Conrad and Craig Cohen, who are co-directors: “They all believed in UCGHI, and that’s what made it happen.”
Conrad, who has been part of this visionary UC Global Health effort since the first gathering of faculty leaders in 2008, said: “Who would imagine that all 10 campuses could unite to make the University of California a leader in global health, improving the health of communities in California and worldwide? Haile inspired that vision and from the start knew that this would require a truly transdisciplinary effort that reached beyond the traditional human health sciences to include faculty, students and staff with interests and expertise in veterinary science, agriculture, law, engineering, social sciences, humanities and fields that working together can improve the health of people, animals and the environment.”
UCGHI has come a long way since Debas launched it in 2009, and he sees more work to do in the future. He would like the Institute to continue to make women’s empowerment a priority and to play an important role in addressing planetary health. He always has had tremendous hope in young people and sees an opportunity to involve more youth in the Institute’s programs. Fundamentally, Debas says, “I hope UCGHI has a sound financial basis to continue its programs and grow. It’s great for UC to have a strong program in global health—it’s great for the country and the world.”