Kate Mandeville speaks in a personal capacity. It

Kate Mandeville speaks in a personal capacity.
It was the worst of times. I was halfway through my PhD, had just acquired a needy adopted cat and
my husband had a job tying him to London. Yet I had the opportunity to work for the World Bank for
two years as a public health specialist as part of their Young Professionals Programme. This is a
training programme for professionals from a diverse range of backgrounds including economics,
engineering and public health. As the name suggests, it’s restricted to those who are “young” though
– or at least young as flatteringly defined by the World Bank as under 32 years. I had always wanted
to move between research and policy and was undertaking a policy-focused PhD using an economic
approach favoured by the World Bank. Being able to see first-hand the needs of policymakers could
only enhance the relevance of my research and would give me valuable experience at an
international level – yet obviously wouldn’t help that much with finishing my doctorate on time. As
an international organisation had officially confirmed that my middle age was fast approaching,
however, I decided to take one last youthful risk. After discussion with the Wellcome Trust, David
Mabey and my supervisors, I put my PhD on hold and on a wet September day in 2012 left husband
and cat behind to move to the blue skies of Washington, D.C.
I thereby entered the steepest learning curve I’d encountered since starting as a junior doctor. The
World Bank is a development bank funded by member countries that gives grants or soft loans to
the world’s poorest countries for key development projects. Many of these projects are in health,
particularly strengthening fragile health systems such as those that contributed to the Ebola crisis in
West Africa. I was working as a public health specialist in the Europe and Central Asia health unit,
giving advice on projects mostly in the countries of the former Yugoslavia. Particular work that I was
involved in included the introduction of social health insurance in Kosovo, reforming pharmaceutical
procurement in Serbia, and forecasting the effects of the rapidly ageing population in the region. The
transition from working on local health issues in one borough of London to giving advice to Ministers
of Health on their national health policy was a little daunting, to say the least - but my UK specialist
training in public health stood me in good stead. Another change was my colleagues: whilst the
World Bank employs specialists in many different disciplines to work on these projects, it is primarily
an economist-dominated institution. My knowledge of economics wasn’t that shabby after spending
the last few years immersed in health economics tomes for my PhD, but I still had to become rapidly
fluent in economist-friendly phrases in order to get my points across in the most effective manner. A
final shift was moving from the introverted, informal academic culture in the UK to the slightly more
extroverted corporate culture in the U.S.A. By the end of the two years, I couldn’t quite talk myself
up with the same panache as my American colleagues, but I think I was getting a little better.
I’ve now returned to LSHTM and my PhD, with plans to finish early next year. Despite the disruption
to best-laid plans, I’m really pleased that I took up this opportunity. It’s opened my eyes to work in
an international organisation and how the global health architecture really fits together. I’ve learnt
about the political cycle and its impact on the needs of policymakers. Finally, I’ve learnt how to
frame evidence in more effective ways for policymakers – and confirmed my intuition that an
argument made for health in economics terms can be one of the most persuasive. I’m looking
forward to analysing and disseminating my results on cost-effective ways to retain health workers in
Malawi – and continuing to cross between policy and research.