Thank you, President Harris, and good morning, members of the Board of Trustees, faculty, staff, parents, family and friends and, most importantly, class of 2021. It is such an honor for me to be here with you today. When President Harris called me a few months ago, inviting me to speak, I was so grateful for the opportunity - not only to return to a place of enormous importance to me, but to return at this particular time…an unprecedented moment for public health and arguably the most disruptive moment for higher education in a century.
Now, in full disclosure, the thinking process I’ve gone through since that conversation has not been without struggle. First, I had to get over the initial shock that it has been more than 40 years since I arrived as a freshman on campus. I found myself checking and rechecking my math thinking that cannot be right. I oscillated between extremes - excitement and anticipation on the one hand, dread and regret on the other. And then came the stages…beginning with casual musings, progressing to deep introspection, interrupted by the sinking realization I have zero advice to give you, and then thinking I have so much advice, I could not possibly fit it all into 15 minutes. Well, where I settled was to go back to 1984 when I sat where you're sitting now, and I tried to think about what might be most useful to you at this particular moment, at this particular time.
Now, you may be surprised at what you remember from Union as the years pass. There were moments here that felt monumental to me during my college years that have since faded into the background. And there are others that seemed so trivial at the time, but that have somehow persisted, and came to mind as I prepared this talk. For example, I didn't give my Union interview a second thought over the four years I was here, but when I think back now, I remember it as if it was yesterday. I remember I had narrowed my career choices to be an artist, a teacher or a physician. I remember feeling that the person I was talking to seem genuinely interested in what I had to say. And then there was a conversation with my calculus professor, who was convinced that deep, deep, down, I did have the capability to learn math and even that I might come to love math--a prediction of which I was quite skeptical. More on that in a bit. I remember doing poorly on a chemistry exam, and going to see my Professor, who took the time to notice that there more was going on and he discreetly handed me a slip of paper as I left his office with the name of a school counselor. And there are other memories, for which only later did I truly appreciate their value, such as my term abroad, where I had the opportunity to live in another country, get immersed in another culture, to speak another language, and engage with different perspectives.
These are just a few remnants of a collection of experiences, many of the most important of which were outside the classroom. It is without question, I received a stellar education here. But far more important, Union provided me with a sense of community, a sense of belonging, and just enough scaffolding to allow me to stumble and recover. I left with the confidence that comes with being surrounded by people that believe in you, and my journey would not have been possible otherwise. To that end, I want to share a few reflections about that journey – loosely organized into three chapters - that might be helpful to you as you embark on yours.
Chapter 1. Medical School, Residency, First Job
From a personal standpoint, the single most important thing that happened to me began on a Wednesday afternoon in neuroanatomy, when I met a guy, who initially irritated me, incidentally, but who I subsequently married and, to this day, is my very best friend. Nothing would be possible without Aaron. So, Lesson 1, there will be nothing as important to your journey, and to your life, as the people that you love - cherish them, and prioritize them.
After residency I became the medical director of an inpatient unit and associate director of residency training at a Yale-affiliated hospital. I often think back to a conversation I had with someone I really looked up to when I made the decision to not pursue a specialty. He said, “I am surprised, you seem so ambitious and driven.” Do not let anyone ever equate your degree of ambition and passion with a specific destination that they have in mind.
For me, I was steadfast in my journey and those years allowed me room to grow, and to ask some important questions. For example, as I cared for my patients, many of whom had health problems born out of poverty and lack of access to care, I struggled with the fact I was a member of a system which failed to recognize health is a human right. And while I tried to address their “health conditions” in the best way I could, I could do little about the “conditions for health” – the social, economic, and political factors, which had a tremendous influence on their health, and their choices and opportunities more broadly. I didn't know it at the time, but that was the roots of my passion for public health.
So, Lesson 2, Don't be afraid to deviate from an expected pathway. Give yourself time to wrestle with the inconsistency between what we say we want as a society and what we actually do, and imagine how it could be different. Not only will you have the chance to grow, but you’ll leave space for unexpected opportunities.
Now my unexpected opportunity came with a month-long program at Stanford focused on improving teaching skills in physicians. There was no space in the section of my first choice, but they had an available slot in “medical decision making”, which was based on decision science. Now I don't know about you, but I had no idea what decision science was.
In case you have not either - it's a field that draws on behavioral science, economics engineering and psychology and wait for it – mathematics, that studies how we make decisions and how we can make better decisions in the presence of uncertainty, complexity and competing values.
So short story…..after four weeks, I was hooked. I knew on the plane home to New Haven that my career was going to pivot. I just had to solve the slight dilemma that the best place to train was in Boston.
Here is soundbite from my conversation with Aaron, two days after I got home.
“Aaron, I've decided to be decision scientist”. He responds, “What the hell is a decision scientist?” (and don't you already have two jobs, and may I remind you we have two toddlers…..) I quickly reassured him, “Don’t worry, I have it all figured out, I'm going to take the 2am train, get to Boston by 6, ride my bike to the school, take morning classes, catch the 1:30 train home, do my homework on the train, and be back in time to pick up the boys from daycare.” And as often Aaron has done over the years, he put his head in his hands.
So I went back to school, and for three long years, along with the mail and the Amtrak conductors, commuted to Boston to study populations and policy, only to turn back later in the day to New Haven to focus on individual patients. It was not easy, plenty of folks thought I was crazy, some thought I was impulsive and unfocused, but three years later I accepted a faculty position at Harvard.
So, Lesson 3. When you do find that destination, that YOU choose, pursue it without restraint, be bold, take risks and use every creative bone in your body to plow through the logistical constraints. You are BY FAR the most prepared graduating class in Union’s history to do just that.
Chapter 2. Research and Policy
So there I was, a faculty member in decision science at the school of public health doing research which predominately involved, yes, mathematical modeling of viruses. Who would've guessed? Seriously, I never imagined that more than half of my work would be working in other parts of the world, that I could be both an analyst and advocate, or that I would be able to integrate my intense interest in how we learn and teach into every aspect of my work. Aside from the obvious message to leave yourself open to possibilities that you cannot imagine right now, I want to underscore that the path has been anything but linear or straightforward. And so, for lesson four, I want to share with you just a few things that were helpful to me along the way.
First, find good mentors. Better yet build a mentorship team. Different people can help you for different reasons. A major area of my research was sparked in a meeting with one of my mentors when I proposed a not so great research idea, and he pulled out a stack of index cards, tossed them across the table, and said here are research questions I think are really important but have not had time to pursue….And yes, my work on HPV and cervical cancer in more than 70 countries across 20 years started with a random card I picked up from that table.
Second, work on problems that you think are most important and work in them in a way that aligns with your principles. Be careful about overly fixating on metrics that have been selected to reflect your progress. For example, as a tenure track faculty member there is a lot of emphasis on number of scientific papers. But much of the most important work I did-- building collaborative relationships, listening to people's stories to understand their needs, spending time to find compromise with stakeholders who disagreed with me, are not reflected in papers. Work to find a balance.
Third, compromise where you can, but some things are never worth compromising. Integrity, honesty, kindness and empathy.
Fourth, you will make mistakes, you will try things that fail, you will face setbacks due to factors out of your control. But what you do have control over is HOW you embark on your journey, how you get up after you fall, and what values guide each and every one of your interactions. Be intellectually curious. Be open to learning new things beyond your field.
Chapter 3. Service and Leadership
So this brings me to my third chapter, service and leadership. Sometimes opportunities arise out of transformative changes or events in society that you just cannot predict. In my case, this took the form of being asked to lead a cross-university institute that was charged with transforming the way we think about, and work together on global health. And by global health, I do not mean the health of poor countries, but the health of every person, everywhere, regardless of where they live.
This didn't come at a “convenient” time. I was knee deep in my research. But it was an opportunity to have a broader impact in ways that aligned with my deepest convictions. It was also time sensitive - there was growing consensus about the connection between health and development, human rights, and security. And it was an opportunity to motivate and innovate in the educational space - I believed then, and still do now, that if we were to equip future generations to serve as interdisciplinary change agents, then we need to think in new and innovative about the what we teach, the who we teach, and the how we teach. You have probably gained some insights over the last year about the value of innovating on the “how to teach”. Just imagine if you were born in a place where higher education was only available to you, in no other way, but digitally.
You, too, will be faced with opportunities that may mean putting a collective cause in front of your individual goals, at least temporarily. Embrace these opportunities. They may lead to the most important work you will ever do.
Now let me bring this back to the present.
From a global perspective, the toll of COVID-19 has been almost unimaginable, in so many ways and across all of society. Yet, it is but one of many 21st century global challenges. There are other emerging infectious diseases with pandemic potential we are facing - , environmental and climate change, migration crises and displaced populations. What is common to all of these, in addition to their impact on health, is their relevance to every sector of society and the reality that no one nation can address them alone. We must find new ways to work together as a global community.
The good news is that there is an equal set of opportunities: advances in knowledge, from biomedical science to materials science, and new technologies, some of which are game changers, like the cellphone or mRNA vaccines. Some of you may directly work on these global challenges, while some of you may contribute to new global opportunities. But the challenge for all of us, is how to level the playing field, because right now, the most vulnerable in society bear a disproportionate burden of the risks, and the best off disproportionately benefit from opportunities. In this regard, each and every one of you has a role to play regardless of your career path and profession.
Now from a local perspective, you already know too well, the far-reaching consequences of the pandemic in the U.S., and without doubt, it has exposed in the most glaring of ways, the inequities in society. But these are not new, they have roots in structural factors – including racism - that have been deeply embedded in our institutions and communities for decades. And we need to remember, we have other epidemics - opioid addiction, gun violence, misinformation – all made more complex by the unprecedented divisions within our country.
My message to you: Take on these challenges with courage and conviction. You will need to lean forward, seek the truth, speak up, and fight for what you believe in, but you will also need to find ways to listen – and even to empathize with - those who you really disagree with. We need to find ways to recognize our common humanity. Be a leader. Whether you accept a leadership role, volunteer for public service, or demonstrate leadership through your daily actions, you MUST step up.
Your journey begins at a moment of intense disruption and without a doubt, the challenges are sobering. But I believe with all my heart there are uniquely transformative possibilities from such intense disruption. My greatest source of optimism comes from the promise of your generation. And like me 37 years ago, you are leaving with the confidence that comes from being surrounded by people who believe in you. I know that you are prepared. Find the moral conviction to use the foundation established here to not only imagine the possibilities of tomorrow, but to make them a reality.
Good luck and congratulations class of 2021.