This episode features an interview with Dr. Shadi Saleh (01PhD in health management and policy), the founding director of the Global Health Institute at the American University of Beirut.

The views and opinions expressed in this podcast are solely those of the student hosts, guests, and contributors, and do not necessarily reflect the views or opinions of the University of Iowa or the College of Public Health.

Lauren Lavin:

Hello everybody and welcome back to Plugged in to Public Health. I’m Lauren Lavin, and if it’s your first time with us, welcome. We’re a student-run podcast from the University of Iowa College of Public Health, where we talk about major issues shaping the field and how they matter to all of us inside and outside public health. Today’s conversation is an important one. We’re joined by Dr. Shadi Saleh, founding director of Global Health Institute at the American University of Beirut, a visionary leader working to build context-driven equitable systems in fragile and conflict-affected regions. Dr. Saleh is also a professor of health systems and financing with prior roles as associate vice president for health affairs and department chair at AUB, as well as faculty at the State University of New York.

With over 150 publications to his name and ongoing collaborations with the WHO Epic Systems and countless civil society groups, Dr. Saleh brings deep insight into health systems, strengthening digital innovation, and the global health power dynamics that must be challenged. In this episode, you’ll hear about how global leadership can drive more sustainable health, what it means to shift from implementers to originators of global health solutions, and how technology including AI is being shaped by and for communities in crisis. He also shares what gives him hope for the next generation of public health leaders. So let’s get plugged into public health. Plugged In to Public Health is produced and edited by the students at the University of Iowa College of Public Health. The views and opinions expressed in this podcast are solely those of the student hosts, guests and contributors, and do not necessarily reflect those of the University of Iowa or the College of Public Health.

Thank you for being here. I’ll have you introduce yourself.

Shadi Saleh:

Sure. So my name is Shadi Saleh and my journey with public health started in my undergrad as an environmental health and then environmental health degree. Then a master’s in public health with a focus on health service administration. Then a PhD at the University of Iowa.

Lauren Lavin:

Did you do your master’s here as well?

Shadi Saleh:

No, I did my master’s at the American University of Beirut, where I’m currently at. And then I did my PhD here at the University of Iowa in Health Management and Policy. Then went to SUNY Albany, upstate New York, where I taught for a TS. Then moved back to AUB as the chair of the Department of Health Management and Policy. Then as the associate vice president for health affairs in an attempt to realize the health vision of the university, to sort of bring all of the health units to work together more closely. And then in 2017 I was asked to start a Global Health Institute, which I currently am the founding director of. So this is a quicker of [inaudible 00:02:53].

Lauren Lavin:

Yes. So were you born and raised in Lebanon then?

Shadi Saleh:

I was born and raised in Lebanon. And actually I was just saying this morning that when I came to Iowa in 1998, that was the second time I was in a plane.

Lauren Lavin:

Really?

Shadi Saleh:

In my life.

Lauren Lavin:

So how did you decide Iowa?

Shadi Saleh:

And the first time I flew actually was to go and get my student visa from Cyprus.

Lauren Lavin:

Oh my gosh.

Shadi Saleh:

So why I decided in Iowa, I got a scholarship to come to Iowa to do my PhD. And three or five days after I accepted the offer and the scholarship, I got accepted at the University of Minnesota with a scholarship. But then, me not knowing a lot about the geography of the US and the pre-Google era, I thought that Iowa would be warmer and I was quite mistaken. So that’s how I ended up in Iowa.

Lauren Lavin:

How long were you here?

Shadi Saleh:

Three years.

Lauren Lavin:

Three years, okay. You did it fast.

Shadi Saleh:

I wanted to get out as much as possible from the cold weather.

Lauren Lavin:

Is New York warmer?

Shadi Saleh:

So for some reason upstate New York is not necessarily warmer, but it just feels warmer. The winter over there for some reason seems to be more poetic.

Lauren Lavin:

It’s probably something about the coastline. You get some ocean air.

Shadi Saleh:

Exactly. And I’m a big fan of being next to big bodies of water.

Lauren Lavin:

So Iowa is not for you?

Shadi Saleh:

Not the rivers. Seas are the least that I can live next to.

Lauren Lavin:

Okay. So you talked about Global Health Institute. You were a founding member of it. What gap were you trying to fill in the Middle East and North Africa region with the founding of this institute?

Shadi Saleh:

So soon after I went back, it was obvious through one many interactions with especially universities, located what we call the technical term is the Global North. So the Global North, you’re talking about Europe, North America. So for most of the global health problems usually happen in the Global South. So you’re talking about Latin America, Africa, Middle East, Southeast Asia. And think of any global health problem, and that’s where it’s located. Think of almost every intervention and that intervention is being led by the Global North, right? Universes in the Global North, coming in with solutions, the one size fits all. And then, institutions in the Global South end up being implementers. So universities in the Global North come up with the idea and universities in the Global South or researchers just implemented, they’re like, they’re field workers. And we wanted, I was very, very adamant, having been in the Global North, lived there, I’ve lived here for 11 years, very adamant to change that dynamic, which is part of it is a power dynamic, I call, not I, but people call it the colonization of global health.

Lauren Lavin:

Oh, interesting. I haven’t heard that term before.

Shadi Saleh:

It’s the old colonization concept has filtrated many fields, including global health. So we wanted to change that dynamic on two aspects. One, stop being the implementers of global health ideas and rather be initiators of global health solutions. Secondly, stopping being listeners to a global health dialogue that we are not part of and have our voices heard. And that has changed in the past five to 10 years, I would say. Not as much as one would like, but definitely. Universes in the Global North are more sensitized now to this or they act as if they are. And the funders are very, or the donors or the partners, are also very aware of this dynamic and they try to address it as much as possible.

Lauren Lavin:

Who are the funders for the institute?

Shadi Saleh:

So the institute has a very diverse group of funders, and we have made sure that it does one, so that we’re not, I want to say in debt or in the favor of one specific funder, which give us our independence.

Lauren Lavin:

Yeah, diversification.

Shadi Saleh:

Right? And secondly also from a sustainability standpoint. So our funders are government-based funding agencies, so funding agencies that are governmental, whether in the EU, European Union, the UK, the US, Canada, private foundations as well, as well as contracts to do work on specific issues. For example, we do quite a bit of work with civil society organizations as well. We do work with UN agencies as well. We work with them, the World Health Organization, other UN agencies. Now we have a big project with the World Health Organization on sexual and reproductive health among refugee women. So this is just one example. So it’s quite diverse and it’s healthy, I think that way, because we have seen what happens when an institution of higher education has all of its eggs in one basket. And if funding stops, then obviously it’s a big problem for that institution. So we try as much as possible to diversify our portfolio.

Lauren Lavin:

Yeah. That makes a lot of sense. So you kind of talked about how you guys went from implementers to generators of ideas. Do you find that the ideas or the research that you’re doing as generators of it, are more suitable to address the problems in those areas, because you guys are now doing that type of work?

Shadi Saleh:

Yes. And implementing is easier, the uptake makes more sense and it’s sustainable. Versus a university in Europe or in North America getting funds, deciding that there’s the best way to solve a problem, asking us to be field workers for them. And then once that grant or project ends, everything is wrapped up and it’s back to points here with everything. And we had faced that early on. So early on, we started this in 2017. So early on, the first, I would say one or two projects, we were still perceived as field workers. So I had to really get into big fights with our North and in that instance, EU based institutions, to change the dynamic of the relationship. It wasn’t easy. It required a sort of shift in thinking, but it became easier later on, as this became part of the global health dialogue. So maybe we played a part in changing of the dialogue, but I think overall, the direction was going that way anyways.

Lauren Lavin:

Are there any particular projects that you feel have been stand out in their impact, that you’ve worked on with the Global Health Institute?

Shadi Saleh:

Yes, so many. But I’m just going to give you probably one or two examples. There was a project that is called [foreign language 00:11:02] in Arabic means my record. So we partnered with Epic. Have you heard of it?

Lauren Lavin:

Oh yeah. Everyone’s heard of Epic around here.

Shadi Saleh:

Yeah, a 100%. So we partnered with Epic, who is one of probably the top one or top two electronic health records companies in the world. Two, create a project that is a cloud-based electronic health records for refugees. Because refugees, from their point of origin, they have what is called a migration journey. So they keep moving until they settle. They move from one country to another country, and then that second country might be a transitional country till they settle most probably somewhere in the north. And the problem was that when they left their original country, in almost all of the cases, they are mistaking with them their health records. They take with them whatever money they have, gold, the keys to the house, but they’re-

Lauren Lavin:

They’re not taking medical papers.

Shadi Saleh:

They never think about taking their medical records. So what happens is as they move into the migration journey, they have to try to remember everything that was wrong with them. And with the tragedy of moving, sometimes they may forget as they’re moving from one place to another. So we partnered with Epic to create a cloud-based electronic health records, so that wherever they move in the world, they have access to their health records electronically, through sort of very, very secure platform, obviously, because they’re vulnerable population. And we did that for 10,000 people.

Lauren Lavin:

Oh, my goodness.

Shadi Saleh:

As a face. It was featured as a BBC on store, you can search for it. And now hopefully, so we did that for Syrian refugees in Lebanon.

Lauren Lavin:

How do you enroll them in that? Was it once they sought out healthcare or did you just automatically?

Shadi Saleh:

So we went into settlement camps and we did that. So we did it for Syrian refugees from Lebanon. And now we are in the process of, also in partnership with Epic, doing it for Gaza, because many of them are having to leave. They’re going to neighboring countries for health reasons. So we’re doing that for them as well. So this is probably a project that we are very, very proud of.

Lauren Lavin:

As you should be.

Shadi Saleh:

Yeah. Yeah. Very proud of. The second thing that is quite impactful, is related to medicine. So we have a program on conflict medicine within the institute, and through our interaction with clinicians, healthcare professionals, we found out that the way that medical students, nursing students, whatever, the [inaudible 00:14:30] students, the way that they’re trained, they are trained to practice clinical care in settings that are stable and safe and resources are available.

Lauren Lavin:

Right.

Shadi Saleh:

But put those people in a low resource setting or a conflict setting, and they’re lost, because their minds, their training hasn’t been in disrupted environments. And in the world, especially in the Middle East and North Africa, there’s quite a bit of conflict. So we have started a global movement, global movement on how to integrate conflict medicine and the training and education of healthcare professionals.

Lauren Lavin:

In the Global South and Global North?

Shadi Saleh:

In anywhere.

Lauren Lavin:

Okay.

Shadi Saleh:

Because you have quite a bit of, for example, if you think about the International Red Cross, the Doctors Without Borders. So in most of those cases you have physicians and healthcare professionals from the Global North who want to do good for humanity. So they end up volunteering in Africa and Latin America and the Middle East, but they have been trained in a hospital in Zurich, or in Heidelberg in Germany, or in Boston. And put them in a conflict zone or in a low resource setting, and their whole mindset is off, because they’re not used to doing whatever surgeries or whatever, in such an environment. So we have been global leaders in paving the way for people who are originally from conflict zones and folks in the Global North who are interested in their careers, to do work with any of these organizations, on how to be add to their training in practicing in conflict zones.

Lauren Lavin:

Yeah. So kind of touching on that conflict challenge, Lebanon and that broader region has faced some pretty serious conflicts in the past. And so, whether it’s a militarized conflict or economic collapses, how have these realities shaped the way that you think about public health broadly as well as the role of an institute like the Global Health Institute?

Shadi Saleh:

So first of all, it becomes very clear that you cannot isolate health, public health, global health from the context. So if I was, for example, in Germany and somebody is talking about public health or global health, I would advise that their priority be geriatric health, because the population pyramid in Germany needs is about that.

Lauren Lavin:

Right, the context.

Shadi Saleh:

Exactly. If it’s someone and maybe part of the US, I would say probably non-communicable diseases, anything related to epidemic opacity or even substance abuse, because it’s the context. In the Middle East and North Africa, conflict is refugees is a context, conflict is a context. So that’s why we have those at the core of our programs. Now, we try to spin off some of the stuff that are global health, generic such as digital health, such as epidemic, pandemic preparedness, climate change and health, which is our latest program, at the institute. But even with those, we try to contextualize the angle that we approach them.

Lauren Lavin:

And when we think about the context, obviously a lot of the work happens in fragile settings and with vulnerable populations. So what does effective healthcare support actually look like in those areas and for communities in crisis? And what do you think that we often get wrong, especially in the Global North?

Shadi Saleh:

So the first is understanding the problem, one. Second, coming with a one size fits all approach. And I do understand that, because being in a university in the Global North, do you really, as a researcher or a faculty member, do you really have the time to understand the context, which may take years, right? Because you’re not living it. Before you can go in and tailor make a solution, probably not, right? You’re thinking about if you’re pre-10 year, you’re thinking about 10 year, you think about how am I going to supplement my salary, which is required in many universities, how can I publish quite effectively and efficiently use my time to do that, versus doing things properly, which is investing years to understand the context. So I do understand where folks come from, from a practical standpoint, but they’re getting it many times wrong. And hence why something like the Global Health Institute and other Global South based institutions are important when working in these regions.

Lauren Lavin:

Right. They have the context.

Shadi Saleh:

A 100%.

Lauren Lavin:

Yeah.

Shadi Saleh:

And they’re not mere field workers for something that they know it’s not going to work.

Lauren Lavin:

No, they’re researchers too, right? Because what kind of people do you employ at the Global Health Institute?

Shadi Saleh:

Global health by its nature is quite diverse. So global health is medicine. Global health is public health. Global health is nursing, global health is nutrition. Global health is computer science now. So, global health is pharmacy. And all of those are reflected in the staff of the Global Health Institute. So we have pharmacists, we have public health, we have people who have a medicine background. We have computer scientists who are working with us. We have people who with a background in nutrition and biology. So it’s very diverse background, because global health is a diverse area, and that’s what makes it interesting.

Lauren Lavin:

And effective. You get all of these different perspectives that come in and offer expertise.

Shadi Saleh:

Sure, yeah.

Lauren Lavin:

And I kind of want to touch on the technology component. You mentioned computer science, but there’s a lot of talk about technology transforming healthcare. In your experience, what do you think is the real potential of technology, maybe especially in the Global South, and what do you think the limits are in these lower resource settings?

Shadi Saleh:

So let’s divide that into two parts, which may be of personal interest to you.

Lauren Lavin:

Yes.

Shadi Saleh:

On your path to your PhD dissertation. So, the first is the intersection between AI and health care delivery. So that’s one discussion. And then there’s a discussion of AI and global health. So for the first, the uptake is obviously exponential in the Global North. My assumption is that the Global South will lag by probably 10 to 15 years.

Lauren Lavin:

Wow.

Shadi Saleh:

Yeah. The uptake of it.

Lauren Lavin:

Just because they don’t have the infrastructure to uptake something like that?

Shadi Saleh:

Yes. They don’t have the luxury of the infrastructure. They don’t have the luxury of capacity for experimentation. So hence, they will be more of late adopters. And there’s quite a bit of also level of societal acceptance that has to be there, which again, all of these factors going to make the Global South lag in that for maybe 10 to, I’m say 10 to 15 years, I’m guessing. So that’s AI and healthcare delivery. Now, AI and global health may be a bit more feasible, because it doesn’t require an investment in infrastructure, meaning you don’t have to have the hospital data systems and EHRs, and decision DCS, decision support systems, DSS, all of those reconfigured for AI. And global health, sometimes it’s an intervention within a community with an AI component that is a chatbot or a messaging that is quite smart to transform what’s being sent, which doesn’t require infrastructural changes, and which the end user can see the value of.

Lauren Lavin:

Do you know if that kind of initiative is being instituted anywhere?

Shadi Saleh:

We are doing it.

Lauren Lavin:

Oh, you are?

Shadi Saleh:

Yeah. Yeah. We’re doing it.

Lauren Lavin:

And is it effective?

Shadi Saleh:

So we are, because you have limited me to saying that the initiatives that we are very proud of, and I go directly to something that is quite impactful at the bigger scale, but we at the Global Health Institute, at the American University of Beirut have been designated as the regional hub for AI and global health.

Lauren Lavin:

Wow.

Shadi Saleh:

By IDRC, which is the Canadian Institute for Development and Research. So we are the regional hub. We give out also grants as an institute through the support of IDRC, to researchers and innovators on AI in global health. We are in the process of completing an initiative adopting AI for community health work as well, also in primary healthcare, sexual reproductive health as well. So the answer is yes, and in the global south, there is quite a bit of movement on AI and global health. You would be surprised, again, because I think the infrastructural investment is not as much as that when you have to change your hospital system and health system. It’s a community health based.

Lauren Lavin:

I’m going to have to look into that more. That’s really interesting. Okay. So as we wrap this up, I kind of want to end on a positive note. You work a lot with students, researchers, young professionals. What gives you hope about these next generations of leaders, especially in the Global South?

Shadi Saleh:

That they have the same mindset that we have, we started off, which is they do not want to be field workers. They want to be equal partners and finding solutions for global health problems within their communities. And so, this is Global South. But I want to add and say, I do encourage, especially this new generation of global health folks, public health folks, students such as yourself, PhD students, who have an interest beyond the country, the nation, to engage in global health. It’s a harder path than the more comfortable finding a faculty position and doing that close to home, but it will be a much more interesting life to have. I’ve never met a person who works in global health from the Global North, who isn’t more fascinated and fascinating as a person than those who decided to not engage in global.

Lauren Lavin:

Yeah, that’s an interesting perspective. Yeah. Well, thank you so much for sharing on the podcast today. I appreciate you taking time out of your day to chat with me.

Shadi Saleh:

It was my pleasure.

Lauren Lavin:

Great. Thank you so much.

Shadi Saleh:

Thank you for the time.

Lauren Lavin:

That’s it for our episode this week. Big thank you to Dr. Saleh for joining us and sharing not only his global perspective, but also practical examples of how public health systems can become more equitable, resilient, and community-driven. From reimagining refugee healthcare records through cloud-based platforms, to spearheading a movement for conflict medicine, Dr. Saleh reminds us that effective solutions come from understanding context and that global health must be led by those living the realities of fragility, conflict, and displacement.

This episode was hosted and written by Lauren Lavin and edited and produced by Lauren Lavin. You can learn more about the University of Iowa College of Public Health on Facebook and find Plugged in to Public Health on Spotify, Apple Podcasts and SoundCloud. If you enjoyed this episode and want to support our work, please share it with your friends, colleagues, or anyone interested in the future of public health. Have a suggestion for our team? You can reach us at cph-gradambassador@uiowa.edu. This episode is brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and take care.