Thanks so much for writing this – I really appreciated seeing a post about the positive mental health impacts of EA. As someone who's worked in mental health advocacy and now researches mental health (especially in occupational settings), it really resonated with me to see this side of the story being shared. I’ve been EA-adjacent for a long time but only recently got more involved, and I’ve found that having clearer guidance about how to do good with my career and donations – alongside a community of others who care deeply about doing good – has been a huge source of meaning and motivation.

Thanks for this insightful read. Cluster headaches were definitely under-emphasised in my medical training given the severity you describe, so it's great to hear there's some movement towards greater recognition in GBD and hopefully within EA too. Let me know if I can help in any way!

As an epidemiologist, the projected mortality from USAID cuts is deeply concerning to me but not surprising given how essential these programs are for disease control and health system stability. Beyond immediate deaths, we should consider how these disruptions could fuel longer-term consequences like increased antimicrobial resistance and loss of community trust in healthcare, which often go overlooked in mortality forecasts. This highlights the urgent need for not only restoring funding but also strengthening local health resilience to withstand such shocks in the future.

Spot on with highlighting labour shortages – this could really have a ripple effect across essential sectors. A key factor that’s often overlooked is how mental health can amplify absenteeism and reduce productivity during extreme pandemics. For instance, ongoing stress, anxiety, and burnout can take a toll on workers' ability to show up, even if they aren't physically ill. This could further exacerbate labour gaps, especially in high-stress environments like healthcare or energy sectors, where specialised workers are already in short supply. It’s crucial that response plans address not only physical health but also mental health support to reduce absenteeism and help workers cope with these extreme scenarios.

Thanks for this – it’s a thoughtful reminder that "work" and "meaning" don’t have to be mutually exclusive. As an occupational health epidemiologist, I often think about how much of our lives are spent at work, and how both the content of that work and the conditions we work under shape well-being, identity, and long-term health. I agree that time with loved ones matters enormously – but I also think there's something life-affirming about doing work that contributes to systemic change, whether that’s protecting people’s health today or reducing the risk of catastrophic harms to humanity in the future.

Hi Nick, I really appreciate the thoughtful and detailed reply. You're absolutely right that "resilience" is a broad and slippery concept, and I agree that attributing outcomes to specific components like CHWs is tricky, especially in crises with many moving parts.

By resilience, I meant something like maintained or recoverable delivery of essential services under stress – not necessarily stopping viral spread, but preserving routine care, adapting quickly (e.g., home-based care), and using real-time data for coordination. I take your point about the COVID epi curves – and agree that the mortality patterns owe much to demographic structure – but I’d argue that Rwanda’s capacity to maintain service delivery (e.g., immunisations, maternal health) and implement decentralised home-based care was in part enabled by their CHW and data infrastructure. That doesn’t negate the limitations of their COVID containment, but points to other dimensions of system functioning.

And yes, you're absolutely right that Rwanda saw early gains from its CHW programs in areas like malaria and maternal health – I didn’t mean to suggest otherwise, only that some system-wide or crisis-response benefits can be delayed or harder to isolate. I’ll have a read of your Uganda piece – thanks for sharing!

I appreciate the call for more scrutiny of cost-effectiveness in HSS. Given the EA community’s focus on measurable impact, do you think there's room to shift some methodological attention toward capturing system-level resilience, which is harder to quantify but critical for long-term outcomes (especially during shocks like pandemics or conflicts)? For example, Rwanda’s long-term investment in community health workers and data systems didn’t show immediate returns, but it was credited with enabling a rapid and coordinated pandemic response – suggesting that some HSS benefits may only become visible during moments of acute stress.

Yeah, I’ve had mixed results too. I find tools like Connected Papers or ResearchRabbit most useful when I’m exploring a loosely defined area – like when I was looking at how “burnout” and “compassion fatigue” are used across occupational health and mental health literature. I usually start with a solid anchor paper and follow citation paths out from there to spot newer or adjacent work I might miss with keyword searches alone.

Re: reference managers – I use Zotero, mainly because it makes tagging easy. I’ll tag papers with terms like “job strain” or “occupational stress” and leave quick notes on definitions or measurement tools. It helps when trying to map how constructs shift or get re-labelled over time.

Thanks for this – your point about choosing “Goldilocks” search terms really stood out. One challenge I’ve encountered is how quickly terminology shifts over time, which can cause even well-chosen terms to underperform in the long run. There’s some recent work suggesting that incorporating citation network analysis (e.g., using tools like Connected Papers or Litmaps) can help identify emerging clusters of related research that keyword-based searches might miss.

In my own reviews, I’ve found two strategies helpful: (1) combining PubMed’s My NCBI alerts with citation alerts for key papers to catch both direct hits and lateral developments, and (2) using a reference manager that supports tagging and notes to track how concepts evolve over time.

Would be keen to hear if others have different strategies for spotting shifting language in a field!

Very much agree about public health as low-hanging fruit when it comes to impact- hence my career pivot! We often use the term “wicked problems” to describe the public health challenges that are complex, interconnected, and basically refuse to be “solved”. In my view, some of the “wickedest” problems in epidemiology include climate change and health, non-communicable diseases (NCDs), antimicrobial resistance, mental health, pandemic preparedness, and global health equity (among others). 

My own research mostly focuses on NCDs (particularly diabetes) and occupational health epidemiology, while I teach subjects like climate change and public health, as well as health communication (which I also see as particularly important given the rise of health misinformation). I’ve also served on various mental health and global health boards and committees, so I guess you could say I’m trying to contribute to solving as many of these big public health problems as I can!