Week 0 Facilitator Notes

Week 0 Facilitator Notes — Setting the Stage

Session priorities

In rough order. If time runs short, protect the top of the list.

1. Get fellows to articulate motivation honestly, in their own words, before readings reshape it. Pre-session reflection prompts capture this on paper. The session’s job is to make the articulation public enough that fellows commit to it, but private enough that they’re not performing.
2. Calibrate the room. Fellows arrive from very different priors, some will have a clinical background, while some will have a background in global development, or humanities. You need a rough map of where each fellow stands so you can pitch Weeks 1–6 right. They need a rough map of their peers so disagreement feels expected rather than rude.
3. Set the discussion norm. Half-formed thoughts welcome, “I don’t know” welcome, disagreement welcome. The tensions in later weeks only land if fellows are willing to argue.
4. Plant the visibility-vs-impact gap. This is the one substantive idea worth surfacing in W0 because it’s the throughline of the whole program. Plant it. Do not resolve it.

Learning objectives

By the end of W0, fellows should be able to:

• State, in 1–2 sentences, what drew them to global health and what they want from the fellowship — and have heard their peers do the same.
• Recognize that “doing good in global health” and “what produces the largest health gains” often point to different activities, and sit with that tension.
• Distinguish global / international / public health well enough to follow W1 — not as definitions to memorize, but as different scopes with different governance assumptions.
• Identify at least one prior they hold about global health that they’re not sure is true (the worksheet’s “suspect is true but not sure” prompt — keep this answer; it returns in W6).

What this session is not

Not a preview of W1–6 content. Not a lecture on DALYs, governance, or the post-USAID landscape — those are coming. Not the place to push impact-bias hard; that’s a W2 and W5 move. If fellows want to debate cost-effectiveness vs systems change in W0, redirect: “good — hold that, we’ll spend a whole session on it.”

How the readings sit in this session

Fellows pick 2–3 of the required readings — you do not know which. Treat the readings as a menu, not a syllabus. Don’t ask “what did you all think of X.” Ask which they picked first and follow.

Three things to know about the reading set:

• OWID Global Health overview is the panoramic anchor. Most fellows will have read at least this. The interesting datum is which sub-topic a fellow gravitated to — child mortality vs mental health vs air pollution vs NCDs is a meaningful tell about priors. Note this.
• “A Million Lives at Risk?” (CGD) is the post-USAID stakes piece. Fellows who pick this are usually already thinking in policy / political-economy terms — they’ll be ready for W3. Don’t over-invest in their framing here; just register it.
• “The Epidemic We Already Know How to Stop” (PATH) is the NCD counterweight to the infectious-disease default most newcomers carry. Worth surfacing for ~3 minutes if anyone picked it; it complicates W1’s disease-burden discussion productively.

If only one fellow picked a given reading, give them ~2 minutes to summarize the core argument for the room. Don’t let this turn into five mini-presentations — one or two summaries is the cap.

The optional readings (End of Lead, Why we didn’t get a malaria vaccine sooner, Saloni Dattani’s EAG talk) are for fellows who want them. Don’t assume anyone read them. If someone references one, use it.

Session arc (90 min)

1. Welcome and frame — 5 min. Keep it brief. The fellowship is a starting point, not a destination. Sessions are discussions, not lectures. Disagreement is welcome and expected.

2. Round 1 — what drew you here — 20 min. Each fellow takes ~2 min on their pre-session reflection: what drew them to global health, what they want from the fellowship. Don’t let anyone skip. If a fellow gives a generic answer (“I want to make an impact”), one follow-up: when did you first think this, or what’s a specific problem you keep coming back to. The follow-up is what gets the honest version.

3. Round 2 — sources and gaps — 15 min. Worksheet prompt: where did most of your global health knowledge come from before this fellowship — news, courses, a specific book or person, direct experience? Fellows answer briefly. Then the harder one: what do you suspect is missing from that picture? Most fellows will name something. Let it sit. Don’t try to fill the gap — the point is acknowledging it exists. Note these privately; they return in W6.

4. Round 3 — the visibility gap — 20 min. The substantive block. Pose the worksheet prompt: when you imagine “doing good in global health,” what does the image look like — visible (you, doing a thing, with someone you helped) or invisible (a regulation passed, a supply chain fixed, a statistic that didn’t happen)?

Most fellows will name something visible — a clinic, a campaign, fieldwork. Let three or four answer before pushing. Then surface the counter-evidence: salt iodization, lead removal, water chlorination, vaccination, food fortification. The largest health gains in the past century. None of them have a face. The people who pushed for them aren’t remembered. The beneficiaries don’t know they were saved.

The question is not should you change your image. It’s: what does it tell us if the largest gains and our intuitive picture of impact don’t match?

If a fellow pushes back — “visibility has its own value, presence matters, communities matter” — take it seriously, don’t flatten it. The objection is real. The point is the gap exists and is worth noticing, not that invisible work is always better. Plant. Do not resolve.

This block seeds W2 (cost-effectiveness, hidden interventions), W5 (Shiffman on why some issues get attention while others don’t), and W6 (what fellows would actually find satisfying to do).

5. Round 4 — what’s “global” about global health — 15 min. Lighter. Worksheet prompt: what makes a health issue “global” rather than international or local? Where does the distinction break down? Fellows will offer answers ranging from “cross-border pathogens” to “shared determinants of health” to “it’s just a rebrand of international health with better optics.” All defensible. Don’t land on one. Walking into W1 knowing the term is contested is better than thinking there’s a definition to memorize.

6. Close — 15 min. Walk through structure: weekly worksheets, ~1.5–2 hours of prep, sessions are discussions and prep is non-negotiable. Set expectations on attendance. Take logistics questions. End with one line about W1: next week is foundations — how the field measures health, how it’s governed, where progress has actually come from.

If round 3 is going well, compress the close to 10 min and give it the extra five.

Recovery moves

• Room is too quiet or too polite. Most common W0 failure. Share one honest thing about your own path that includes uncertainty or a wrong turn. Modeling beats prompting. Or replace “what do you think about X” with “what’s something you’ve changed your mind about in the last year” — lower-stakes, more concrete, harder to perform.
• One fellow dominating. “Let me hear from someone who hasn’t gone yet” works in W0 because the round structure makes turn-taking the default. Don’t apologize for it.
• A fellow is visibly checked out or hesitant. Don’t call them out. Note privately. Make sure they get a deliberate, low-stakes opening in W1 before patterns harden.
• Round 3 turns into “actually visibility is fine.” Don’t argue. Just hold the gap. “Maybe — and here’s the thing to notice about the gap regardless.” The point is planting, not winning.
• Discussion runs long on round 1 or 2. Cut round 4 first; it’s the most compressible. Don’t cut round 3.

What to track for later weeks

After the session, write a short private note:

• Each fellow’s stated motivation (one line each).
• Each fellow’s “what I suspect is missing” answer — useful in W6 when fellows revisit assumptions.
• Anyone who pushed back hard on the visibility-gap framing — likely the productive dissenter for W2 and W5; lean into them when those tensions arrive.
• Anyone who was very quiet — needs deliberate space in W1.
• The reading menu: which 2–3 fellows actually engaged with. Tells you what to assume in W1.

What success looks like

Fellows leave with each other’s names and a rough sense of what each person cares about. At least two fellows have said something they would not say in a job interview. Nobody has been lectured at. The visibility-vs-impact question is sitting unresolved in everyone’s head. You have a private map of the room you can use for the next six weeks.