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International Health

Interview with Professor David Peters

Professor David Peters spoke with the Department’s Communications and Marketing Manager, Brandon Howard, to answer a few professional and personal questions so IH alumni, faculty, staff and students could get to know the Department’s new Chair a little better.

Question: For those reading this who may not know or haven’t heard you say the word “about,” you’re Canadian. Where in Canada are you from?
Peters: I'm from Winnipeg, Manitoba, which is usually found in the fold of the map in the middle of North America. But I also lived a year in Montreal doing an internship at McGill. For another year, I was a general practitioner working on Indian Reserves in northern Manitoba.


Sher Shah, David Peters, Peter Hansen, Afzal, and Israel in Faizabad, Afghanistan
Photo credit: Professor Gilbert Burnham

Q: I learned recently you played the part of a famous Canadian in a PBS documentary about Johns Hopkins Hospital.
Peters: I was the voice of William Osler, one of the founding four professors of Hopkins Hospital. The documentary was about William Stewart Halsted. Halsted, Osler, William Welch, and Howard Kelly were the first four doctors at the hospital. There’s a famous painting of the four men by Johns Singer Sargent hanging in the Welch Library. The producers wanted me to do voiceovers of excerpts from Osler’s diary entries because I’m also Canadian. Whether my accent is close to a Canadian’s born in the 19th century is debatable. [Click here for more about the documentary—BH]

Q: You received your medical degree from the University of Manitoba. And you first came to Hopkins for an MPH and to do a medical residency. What drew you to the States and to Hopkins?
Peters: First, there were no schools of public health in Canada. And because I had been, and wanted to continue, working in international health, I was looking at either the London School of Hygiene or Hopkins. I missed my interview for London because my flight to Nepal was cancelled, and the next plane didn’t have a layover in London. So, then there was Hopkins. But, seriously, the program and opportunities at Hopkins were in line with my interests. Also, my wife was offered a residency here, so coming here allowed us to stay together.


David Peters conducting a health systems assessment in Ethiopia.
Photo credit: Assistant Scientist Agbessi Amouzou

Q: What were you doing in Nepal before you came here?
Peters: I was doing a medical rotation there with United Mission to Nepal. I did my rotation in the middle hills of Nepal (Okaldunga). Then I walked to the Mt. Everest base camp. I actually began my walk from the Terai, and overall took several days to get there. Except for a day lost to a really severe stomach illness, it was a great way to experience the country and the people.

Q: You eventually received your DrPH from International Health. What was your dissertation work on?
Peters: An assessment of how Sri Lanka could have such a low infant mortality rate with such very high levels of malnutrition.

Q: Were you able to determine why?
Peters: The first task was to show that it was true, which we did. We then found that institutional delivery was very high—over 90%. Another very important factor was that Sri Lanka had an army of community health care workers who were able to make post-delivery follow-up visits. Many newborns received 3 visits during the first week. Despite the relative poverty of the country (and a civil war), its infant mortality rate at the time was lower than those in some American cities. There was still a connection between low-birth weight and mortality, but these follow-up visits by trained health workers proved to be highly effective.

Q: Did you start your DrPH intending to work in health systems?
Peters: No, I was originally planning to be an infectious disease epidemiologist. I was working with Bob Black, Ron Gray, Stan Becker and others in the Philippines on algorithms for case management for childhood illnesses. We were also looking at the validity of verbal autopsies for measles, diarrhea and pneumonia. Originally, I was going to do my dissertation on research related to this project. But, the blood slides I had collected to test for measles were ruined in transit, so I wasn’t able to pursue that.

Q: Wasn’t that a big loss and a big change?
Peters: Yes, and no. Part of the Philippines project included studies on quality of care issues and I was always interested generally in health systems.

Q: Where did you work after graduation?
Peters: The World Bank on health programs in West Africa. I dealt with health sector projects, then started developing sector-wide approaches when I found that nearly everyone in government and in development partners weren't happy with the status quo. Later I moved to India and led the largest country health study the Bank had done. It investigated how to create better health systems for India’s poor.

Q: What did you find?
Peters: The data showed a large mismatch between the rhetoric to reach the poor and what was actually happening in the health system. It also highlighted the neglect of what was going on in the private sector, and the need to anticipate the growing burden of non-communicable diseases. Our findings allowed us to make four overall recommendations, which are still part of the policy agenda: (1) Improve oversight to make the health system more pro-poor and client-friendly; (2) Remove blind spots to harness the capacity of the private sector and to correct its shortfalls; (3) Develop a financing system and make plans for the health transition; and (4) Focus on improving quality, efficiency and accountability.


Peters working on the Safe Deliveries Project under Future Health Systems in Uganda.
Photo credit: Dr. John Bua

Q: Then you came back to Hopkins as faculty, right?
Peters: I did, but a few years later I split my time between Hopkins and the World Bank in its central health, nutrition, and population unit. I worked at the Bank on a global project on how to improve health service delivery.

Q: Your major Afghanistan project is coming to an end. Do you think the country will be able to hold onto the gains it has made in primary health care?
Peters: 2014 is going to be a year of great uncertainty and insecurity, with national elections and the pull-out of International Security Assistance Force (ISAF) forces. I am optimistic, but realize that it is very vulnerable. We are currently analyzing this year's balanced scorecard for basic health services, and it looks like performance in primary health care is starting to improve again, after an interruption in 2010-11.

Q: What are some of the accomplishments you’re most proud of from your time as Director of the Health Systems Program?
Peters: I’m really proud of the many successes of our students. Just to name a few who have gone on to do some great things: Krishna Rao is now the Head of Health Economics and Financing at the Public Health Foundation India; Peter Hansen is the Director of Monitoring & Evaluation at GAVI; Laura Steinhardt is an Epidemiologist at the CDC; and Aneesa Arur, a Public Health Specialist, and Junko Onishi, an M&E Specialist, are both at the World Bank.

The faculty have also been flourishing with several promotions and some great new projects. They have helped us make some great collaborations with organizations based around the world, including the Indian Institute of Health Management Research, ICDDRB, Makerere University, the China National Health Development Research Center, and the University of Ibadan, to highlight just a few.

Q: Are you worried that conducting your own research will be hard as you take on all the duties of the Chair? Are there any new projects you’re starting?
Peters: I will need to continue to do my own research, which I’ve always done collaboratively. I have been putting in a number of grant applications in health systems, but would like to develop a larger research program on innovations in health market systems, and particularly in better ways to regulate health systems to serve the interests of the poor.

I’m really looking forward to working with the faculty, students, and staff of this great department. It’s a very exciting time in global health and to be at Hopkins.