Probably the first time I was a boss was when I was associate dean of the graduate school at the University of Southern California. I was in my early 30s.

There's nothing worse than a leader who lacks ambition.

There are hundreds, even thousands of remarkable pilot or experimental projects in all fields - in agriculture, health, education. But where do these pilots take us? Do they lead to change on a broader scale? If not, how can we ensure that they have broader impact?

Nobody had counseled women to expect the changes in bleeding patterns which are typically associated with IUD use, and they received no support from the health clinics with their problems. Because in traditional Hindu culture menstruation is associated with a variety of social taboos, prolonged menstrual bleeding produced conflicts within families.

It is not enough to give money for demonstration projects. From the very beginning plans should be made for the scaling-up of successful innovations.

One of the things we have learned in the first year is that if you want to scale-up, the first thing you have to do is to expand your own team.

My colleagues from the Department of Health Behavior and Health Education are working on participatory public health initiatives in Michigan, and there is much that we can learn from each other. In fact it is essential that we strengthen efforts to learn from each other, and stop considering public health in the third world and in the U.S. as separate intellectual and practical endeavors.