Spotlight Interview with Dr. Lawrence Were

“Anything and everything costs something” -Dr. Were

Location: Boston, MA, USA

Bio: Dr. Lawrence Were is faculty in the Department of Health Sciences at Boston University’s College of Health and Rehabilitation Sciences: Sargent College and Assistant Professor of Global Health at BU’s School of Public Health. His research focuses on the application of health economics in estimating the impact of reforms within healthcare systems and health insurance programs on the outcomes of marginalized and high-risk populations, such as informal traders, HIV+ individuals including pregnant women and their children, people with mental health challenges. He is also interested in global health, HIV/AIDS financing mechanisms, and geo-spatial aspects of public health. He has research projects in Kenya, Ghana, and Nepal. Dr. Were teaches courses in comparative healthcare systems, global health, social determinants of health, and research methods. He received his PhD in the Health Services Research– Health Economics track from the Department of Health Services Policy & Practice at Brown University’s School of Public Health.

When did you first get interested in global health? 

I first started getting interested in global health around 15 years ago. My first engagement out of college was working on healthcare financing mechanism known as micro health insurance. If you look at marginalized populations in the global south, especially in limited resource settings, , there is an enduring need adequate savings coupled with a robust health insurance systems that can enable the marginalized to access quality healthcare when they need it. So, when I was getting started, there was a global focus on microfinance, which is the idea that could we incentivize low-income households to save in groups, and then leverage their savings to enable them access credit. However, it quickly became apparent that one of the key threats to microfinance was health issues – whenever the microfinance members fell ill, they ran the risk of defaulting on their credit. We therefore had to innovate and find ways to enable these groups access to affordable healthcare when they needed it. So, I began working on micro health insurance in Kenya, and it really opened my eyes to global health.

Why is global health from an economic perspective important for others to consider?

Anything and everything costs something. There is a cost to everything. Right now, you and I having this conversation is an opportunity cost. We calculated and determined that we were willing to incur this cost, which in this case is time. To illustrate, some folks may believe if they sign up for Medicaid, which is insurance for low-income individuals and families in the U.S., they’ll access care for free. However, there is more to it. Medicaid is funded by tax dollars. When you go to the grocery store and you buy goods and services and pay tax, you are actually paying/contributing into a government fund, a portion of which will end up in a healthcare budget that pays for Medicaid. If you travel to a LMIC, you usually find people selling goods on the street as a means to make a living. If they fall sick, they need access to care. Accessing the healthcare that they need is going to cost them time and resources. Again, there is a cost to everything. For us to really meet the health care needs of different populations, we really have to quantify what that need is and what the associated costs are.

Why should we care about global health in general?

Local is global. The COVID-19 pandemic has taught us that. A local event in Wuhan, China has become a global event that has changed our lives forever. The same thing is true of mental health. Mental health in one corner of the world will affect mental health across the world. The pandemic has shown that mental health is a space that has been grossly neglected and needs to be addressed. Thinking about things from a global perspective allows us to be much more responsive and deliberate.

We are excited to have you join our team as the Director of Research for the GLCMHD! Can you share with us your vision for the Center’s direction in research?

It’s a wonderful privilege and an honor to be a part of the GLCMHD. There are not many centers out there that embrace both the global and local perspectives to something as critical as mental health. As far as my thoughts on the next steps - first we need to do a self-assessment. This would entail looking at the current research initiatives to take stock of their nature and structure. Then, we will need to deliberately pick the things we want to focus on both in the short and long-term and develop a strategy around these. The key is whatever we choose to do, we need to do it well by building on our strengths. It’s going to need to be a team effort with involvement from our local and international partners. That’s also going to require working with the clinical and educational aspects of the Center and the Department of Psychiatry. I am very excited.

What is your most memorable project you’ve worked on?

I am going to share two projects that stand out to me.

The first project is back when I got my feet wet. When I started working in microfinance, I traveled across Kenya and met people in urban & rural areas, in markets, and in churches trying to understand their needs and helping sign-up for micro health insurance. It was such a critical foundation for me. A year into the project, we had to sensitize people of the value of renewing their health insurance. It quickly became apparent that community we worked with had gaps in their understanding of how insurance worked. Some were reluctant to renew and asked for refunds. This was an aha moment because there are no refunds in insurance. I learnt the importance of never assume anything, always asking, double checking, and making sure people understand. And more importantly, acknowledge and appreciate the fact that before you showed up, people had a way to address and deal with the challenges they face. That was one memorable and seminal project that has influenced a lot of what I do today.

The other project is one that I am currently working on. Having grown up in Kenya, one enduring healthcare challenges revolves around HIV. HIV has changed communities and livelihoods in so many ways. In certain communities HIV is linked with a phenomenon known as “fish for sex,”.  It is a form of transactional sex where for fishers and fishmongers to exchange fish, money alone is not a good incentive given that the demand for fish outstrips the supply. There is thus the tendency to ask and exchange sexual favors in addition to money leading to a fertile environment for HIV to thrive. However, more recently climate change and its effects has changed the ecosystem in fishing communities with frequent cycles of droughts and flooding. This has changed the dynamics in these communities but the effect of these changes on transactional sex is not clear. I am currently working on a project that is examining the relationship between climate change and “fish for sex” in HIV-affected communities. I am excited and looking forward to seeing the results.

What is one life lesson you’ve learned?

Every setting or community, no matter how big or small, has institutional history. Nothing happens in a vacuum. Therefore, I always try as much as possible to understand and appreciate the institutional history because it will have a bearing on what you do.

Advice to youth?

Do not be afraid to go down the road less traveled. Be deliberate, and thoughtful as you navigate life.

Closing Thoughts

Local is global - it’s the world we live in. Everything that happens around us to a great degree is a manifestation of local and global dynamics and forces.  

By Joanne Won, October 2022