Heidi Morefield, Ph.D., postdoctoral fellow at the Center for Health and Wellbeing (CHW), has a unique perspective on public health. After growing up in Canada with the security of universal health care, Heidi experienced a far more fragmented health insurance system in the United States, where coverage has not kept pace with escalating capabilities and costs. During later travels in Africa, she also witnessed the consequences faced by developing countries with little or no access to safe, effective medical care. These alarming disparities enlightened her point of view while affecting the trajectory of her education, career and studies.

In this Spotlight, Heidi shares her pathway to Princeton along with her research probing the intersecting histories of medicine, technology, capitalism, the environment, and international development.

Q. What inspired your interest in history and global health? Any early influences that shaped your academic and professional concentration?

A.  Back in high school, I had some great Social Studies teachers! While I’ve always been fascinated by international politics and history, they definitely influenced my decision to major in International Development Studies at McGill [University]. I thought about becoming a diplomat until I took a Sociology of Health class in undergrad, which opened my eyes to the unequal distribution of disease and disease burdens – and their huge impact on society.

I grew up in a place that valued social spending, where I never had to worry about [health] insurance or the economic burden of an unhealthy population. It’s hard for people from Canada and other developed countries that have universal coverage to conceptualize what it’s like to stress over medical bills or access to affordable health care. It just wasn’t part of my reality. I decided to obtain a Master’s degree in Global Health and Public Policy and wound up at the University of Edinburgh in Scotland.

Q.  Tell us about your post-graduate pursuits, particularly your work in Africa. Can you share a bit about your projects in Congo and Ghana – what kind of issues you tackled and how your contributions impacted global communities?

A.  I wanted to be part of the international development sphere, and Washington, D.C. was a great place to do that. I got a job with Management Systems International, a global development company focused on improving health, reducing poverty and strengthening communities. Since I speak fluent French, they immediately put me on a USAID funded project in the Democratic Republic of the Congo, where I worked with the people of North and South Kivu to assess and address their needs. With an emphasis on infrastructure, we built maternity hospitals and schools, rehabilitated roads, and rebuilt bridges to promote stabilization.

In Western Ghana, I managed a democracy and governance project. Interestingly, the region had just been declared a “middle income community” after discovering off-shore oil. The project facilitated responsible management of those new funds, encouraging the government and local chiefs to invest in infrastructure and give back to the community.

Q.  What was the most compelling lesson from these experiences?

A.  I realized the importance of community engagement and infrastructure, which are often overlooked in global health. You have to talk to people and learn from them. Also, our society tends to focus on technological solutions without considering the wider context. For example, while touring health clinics in South Kivu I saw a lot of new refrigerators, all donated but none functional or filled with medicines or vaccines. The funding organization had recognized the importance of the cold chain, but failed to see how the refrigerators would be useless in an area with no power grid and widespread gasoline shortages. We must ask ourselves if we’re spending money on things that have an impact, or making assumptions about what people need without learning their reality.

Q.  After your work in Africa, you earned a Ph.D. in the History of Medicine at Johns Hopkins University. Why did you return to academia?

A.  My experiences in Africa prompted critical reflection regarding quantitative public health in the absence of local needs assessment and community engagement. Researchers can design a study to say virtually anything by choosing the variables and sample population, and looking at the issue from a singular point of view. What we call the “projectification” of public health incorporates little memory of what went wrong and what went right, so we repeat the same mistakes every five to 10 years. Studying the history of medicine, as a discipline, allows us to dive deep and connect the dots… to look across longer time spans and really learn from the past.

Q.  Broadly, what was the topic of your dissertation? What aspect of your research surprised or fascinated you most?

A.  My dissertation interrogates why global health has become so focused on the development and distribution of new technologies, which can be anything from vaccines to rapid test kits for hepatitis B. The concept of distributing these individual, small-scale, point-of-use devices en masse, which dates back to the 1970s, is often funded at the expense of permanent infrastructure, maintenance and the environment. I argue that while some novel technological solutions have merit, they have rarely panned out. We can’t get sidelined by recurrent dreams of technological salvation while losing sight of mundane solutions that work, like pipes for clean water and roads for transporting people to hospitals.

I was surprised by the widespread realization and acceptance – in the 1970s – that health and the environment go hand in hand. We’re having the exact same realization today with discussions of “planetary health.” It’s fascinating how we’ve come full circle.

Q. What attracted you to Princeton’s Global Health Program? How do you contribute as a historian?

A.  I was looking to work in an interdisciplinary space, and Princeton has incredible resources, from the History of Science program, to the Department of Anthropology, to the Environmental Institute. The Global Health Program allows me to engage with these different fields and gain new perspectives as I further my research and teach, equipping students with the information and skills they need to ensure their work has impact.

History is underrated in the field of global health. All too often, society is preoccupied with the current health emergency or preparing for future outbreaks. We don’t spend enough time looking backwards. Almost inevitably, the newest approach or solution has been tried before; it’s important to evaluate how that went so we can do better next time.

Q.  What are you working on now?    

A.   I’m preparing my dissertation for publication as a book, so I can share those findings with a broader audience. Academics, and historians in particular, have a duty to write for the public, especially in this moment when the public is hungry for facts and truth.

My postdoc research, over the next two years, will be in support of two new projects. The first is a history of humanitarian surgery. A recent study published by the Lancet Global Commission on Surgery noted that approximately two-thirds of the global population does not have access to safe and timely surgical care. I’ll trace the historical roots of this gap, particularly as it relates to sub-Saharan Africa, including the intentionally limited investment in surgical infrastructure in favor of cost-effective interventions for primary care. My second project will look at road infrastructures in Africa, which as a continent has the highest burden of road traffic fatalities despite having the lowest number of vehicles per capita. At the same time, the limited number of paved roads means that many people do not have timely access to medical care. I’m looking at the social, environmental and political history of roads on the continent, which continue to be a source of vast inequity.

Q.  Have you given thought to the next chapter in your research and career? Any other global health issues you wish to conquer?

A.  We cannot escape the issue of climate change. We must figure out a model of global health that integrates environmental health to ensure the survival of our planet.  I’m keeping a watchful eye on how that discourse is playing out in global health and am excited to contribute some historical understanding to the current policy discussions.

Q.  Any advice for undergraduates interested in pursuing a career in global health?

A.  Read as much as you can… especially history! Explore what has been done already to create long-range perspective and knowledge. That’s how we break the projectification of public health and move forward in a real sense.