Bonus Episode: Building Stronger Health Systems in a Changing World with Joaquin Barnoya, MD, MPH

• Barnoya reflects on the future of global health, emphasizing optimism, innovation, and the growing importance of both social and commercial determinants of health.

• He shares how his career evolved from clinical medicine to research—and ultimately to serving as Guatemala’s Minister of Health.

• Barnoya discusses the challenges of translating academic research into real-world policy, highlighting the political realities and need for incremental progress.

• He explains the importance of strengthening primary healthcare systems, especially in communities, and reducing overreliance on hospital-based care.

• He encourages young professionals to stay curious, challenge established norms, and embrace global collaboration in an increasingly interconnected world.

[00:00:00] Dr. Rob Murphy: Welcome to the Explore Global Health Podcast. I'm Dr. Rob Murphy, Executive Director of the Havey Institute for Global Health here at Northwestern University Feinberg School of Medicine.

[00:00:20] Dr. Rob Murphy: We are continuing our recording of the podcast at the annual meeting for the Consortium of Universities for Global Health in Washington, D.C., where one big question is shaping conversations: What is the future of global health and what is it going to look like? Our guest today is Dr. Joaquin Barnoya, Guatemala's Minister of Public Health and Social Assistance. He's a physician and public health researcher by training, Dr. Barnoya is internationally respected for developing global strategies for effective tobacco control and mentoring graduate and postgraduate students in Guatemala and in the United States. Now, as Minister, he's leading efforts to modernize Guatemala's health system, expanding primary care, strengthening disease surveillance, and advancing digital health tools to reach communities more effectively. His work also includes navigating major international partnerships aimed at improving outbreak detection, response, and long-term assistance resilience. Dr. Barnoya, welcome to the show.

[00:01:15] Dr. Joaquin Barnoya: Thank you for the invitation. I'm honored to be here. I was part of the CUGH about 10 years ago. I didn't have any gray hair. Now I do. It’s been some time now.

[00:01:23] Dr. Rob Murphy: As I mentioned, the focus of this meeting is the future of global health. From your perspective as Minister on the front line, what does the future look like, especially for countries like Guatemala working to strengthen their health systems?

[00:01:35] Dr. Joaquin Barnoya: I think we need to be positive. I think if we want to look forward, I think we need to be positive. Because certainly things have happened in public health. We have moved forward in public health. Obviously, we have huge challenges ahead, but we have now new tools. We have now a different perspective and different approaches on how to face the upcoming challenges. It's inevitable that we are going to face challenges. This is how the world and history goes around. Obviously, there are worldwide struggles, wars, and ongoing economical struggles ahead. But I think this is why we need to work together. Not to be negative, but rather be positive and think about innovation, innovative ways to address these challenges. We are all on the same page about strengthening the primary healthcare approach to getting equitable and affordable healthcare to everyone. We are now talking about not only social determinants of health, but also commercial determinants of health. More and more, the discussion is going towards prevention but also access. Affordable and effective healthcare, and also making sure that the outcomes are adequately measured. More and more, we need to keep going on talking about evidence-based public health.

[00:02:44] Dr. Rob Murphy: I'm glad to hear that you're optimistic. Because I'm one of these eternal optimists. I think that we can make things better no matter what is going on, and we have to adapt and work with what we have. Tell me about becoming Guatemala's Minister of Health and Social Assistance. Was this a role you envisioned when you started on your journey in medical school and your early days as a physician and public health researcher? Is this something that just kind of organically grew or was it always your goal?

[00:03:11] Dr. Joaquin Barnoya: Nope. Nope. That's definitely an easy answer, and that's no. I was trained as a clinician, and then I went into public health training and then into research. But through my training, both at Harvard and UCSF, we always focus on doing research that somehow was policy-oriented: smoke-free environment, smoking cessation, or ultra-processed food advertising. So, then the offer from the President of Guatemala came saying, "Would you like to be Minister of Health?" And the first answer was no. Right? I was doing okay with my academic career, but in talking with my former mentors and colleagues, they said, "Well, this is the Kentucky Derby of Public Health, you better do this at least for a couple of days." It’s been now 16 months since I've been doing it. And the most important thing that drove the decision was building a team. If anybody's planning on getting into top politics or a Ministry of Health, nothing can be done alone. I guess that's in life in general. But in politics, you have to bring on board a very good team with the same plan, trustworthy, and honest.

[00:04:09] Dr. Rob Murphy: You know, I've interviewed in this podcast series over 40 healthcare leaders in the world, and I think that you've described what most of them have gone through. Nobody plans to be Minister of Health or president of this or whatever, but it just grows. And I, I think it's really great to hear that you took the opportunity and you're just doing such a great job. How does that academic lens shape the way you think about policy?

[00:04:33] Dr. Joaquin Barnoya: It's a huge learning experience, because from the academic's standpoint, things can stop in a publication and build our own curriculums. But how is that really impacting public health practice, clinical practice? I think that's yet to be seen, and we need to be more involved in that. Now, on the other side of the coin, I have to wear now my politician hat: how policies change and how much evidence can really be used to change policies. I think that's a moving target. Somewhere I read that changing policy is more a process rather than a product, and we need to keep that in mind. Otherwise, it becomes very frustrating. Obviously, we need to keep looking for the low-hanging fruit for the best buys, but sometimes those are not the most politically feasible. We need to be realistic and look for those that we can actually accomplish. Even if they're baby steps, we need to do it. We're from the chronic disease field, from the tobacco control field. I would love to raise taxes for tobacco products in Guatemala. Well, it is not feasible because that has to go through Congress. I'm a Minister of Health, not a congressman. So, you know, you need to realize and be very honest to yourself about what it is that you can accomplish, even if it's not on your original agenda. That goes back to the team you built. If you have a very strong team that will bring different parts to the puzzle, I think they will help you guide the administration towards a common goal.

[00:05:47] Dr. Rob Murphy: One of your recent initiatives is joining the Alliance for Primary Healthcare in the Americas to strengthen primary healthcare with a focus on digital transformation, integrated care networks, and expanding access in rural areas. Could you tell me about this effort and why strengthening primary healthcare is a strategic priority?

[00:06:05] Dr. Joaquin Barnoya: Well, first and foremost, we need to remember that most of the ailments, diseases that we have need to be approached and can be approached from the primary healthcare level. However, from a patient perspective, from a consumer perspective, unfortunately nowadays, patients are seen as consumers rather than patients. We all seek care at a hospital. We don't want to go to the next clinic that is next door to our house. We are going to go to the ER. We are going to have the CT scan. We are going to be seen by a cardiologist when you only have a headache. So, the more we strengthen that primary healthcare—not only at the different levels, but also make sure this is a network where referrals are happening, where diseases need to be treated at a different level, but also referrals and counter referrals. So, you might end up in the ER with a headache. Good. They solve your headache, but then you'll be referred down to the primary healthcare level. I think it's fundamental that we strengthen that level as well, because that's in the community and individuals do not get sick in clinics. Individuals get sick in communities, and that primary healthcare level is going to be in the community. And the physicians, nurses, social workers need to be from the community so they know where the patient—where the individual—is getting sick.

[00:07:11] Dr. Rob Murphy: Yeah, I couldn't agree more. We at Northwestern have a Center for Global Primary Care, one of the first such centers. We started looking into this whole thing, and the hospital has set up an Institute for Primary Care, which is very unusual for an academic U.S. institution to put so much emphasis on primary care, but it's a true Institute. It's incredibly important, and I agree with you completely. I've got one last question to ask you. I ask all the people that come on this podcast: What advice do you have for young people who are just now embarking or wanting to embark on a career in global health?

[00:07:43] Dr. Joaquin Barnoya: Be curious, not judgmental. That's a Ted Lasso quote, by the way. We need to think outside the box. We need more young people engaged in global health. Then, the definition of global has changed a lot in recent years. Frontiers are no longer existent. Economically, in healthcare, and disease-wise—those geographic barriers are gone. So, I think the more we get connected with each other, we can learn from experiences, but also from mistakes. The gold standard, I think, needs to be challenged as well. From a clinical standpoint, from a treatment standpoint, from a medication standpoint, the whole thing of the gold standard needs to be challenged. Sometimes they're very expensive. Sometimes they're not as effective as they used to be. But for students, yes, travel around, meet people, have an open mind. More and more, we live in a polarized world where we need different ideas in the same room discussing potential solutions for common problems.

[00:08:34] Dr. Rob Murphy: Dr. Barnoya, I appreciate you being on the podcast today and good luck with all your efforts in Guatemala.

[00:08:40] Dr. Joaquin Barnoya: Thank you.

[00:08:40] Dr. Rob Murphy: Follow us on Apple Podcasts or wherever you listen to podcasts, to hear the latest episodes and join our community that is dedicated to making a lasting positive impact on global health.