More “Cooperative” Than “Corporate”
“Nurture, non-selfishness, and the real importance of grassroots organizing”—that was how moderator Jacqueline Bhabha summed up a wide-ranging panel discussion Friday morning about the role of women as leaders in global health. The opening event of Radcliffe Day, it preceded a formal ceremony in which Partners In Health cofounder Ophelia Dahl was presented with this year’s Radcliffe Medal, and panelists’ discussion often mirrored many aspects of Dahl’s own work as a leader and physician and lifelong activist for justice and equality in global health.
Bhabha, a human rights attorney and expert, led the conversation. In addition to being professor of the practice of health and human rights at the Harvard T.H. Chan School of Public Health, she is Smith Lecturer at Harvard Law School, an adjunct lecturer at the Harvard Kennedy School, and director of research at the Harvard FXB Center for Health and Human Rights. “I think it’s not an exaggeration to say that global health and its leadership is one of the key social and human rights issues of our time,” she said, introducing the morning’s event. The term “global,” she added, “encompasses the U.S. just as much as it encompasses what we often think of as the Global South.” And women, she said, “are central to this discussion.”
The panelists were:
- Agnes Binagwaho, a Rwandan pediatrician and Harvard Medical School senior lecturer on global health and social medicine who cofounded the University of Global Health Equity, a Partners In Health initiative that trains global health professionals;
- Abby Maxman, president and CEO of Oxfam America, who, since joining the organization in 2017, has focused particular attention on gender, climate justice, and inequality;
- Natalia Kanem ’76, executive director of the United Nations Population Fund (UNFPA), an agency focused on sexual, reproductive, and maternal health;
- Reema Nanavaty, a development worker and director of the Self-Employed Women’s Association, the largest union of informal-sector workers in India, representing 2.5 million women.
Covering health issues such as AIDS, Ebola, and the COVID-19 pandemic, the panelists returned again and again to themes of inequality and injustice—both economic and healthcare-related, and at individual, national, and global scales. Bhabha noted that for every 100,000 live births in the United States in 2021, maternal deaths affected 23.5 white women and 55.3 black women—slightly more than double. “And this is within a general picture where the U.S. does extremely badly,” she added: in the Netherlands, the comparable figure is 1.2 maternal deaths per 100,000 live births. Maxman pointed out that in 2021, low-income countries spent 27.5 percent of their budgets on debt repayment—“which outstripped the amount of resources they could spend on health care, health systems, education, and social services.” These structural issues, she said “keep people trapped and unable to deal with the big issues of our time.”
Women in general, and poor women in particular, usually suffer most. “There was a mantra during the pandemic, that no one is safe until everyone is safe,” Maxman said. “And I think that was an aspiration,” but three years later, it remains unachieved. She pointed out that today 75 percent of people in the Global North have access to COVID vaccines, but only 25 percent in the Global South. “And we also see a disproportionate impact [in] who was getting sick,” she added, “because the people at the front lines were often women,” who outnumber men in healthcare jobs as a whole.
Kanem put a number to that argument: more than 70 percent of the world’s healthcare workforce is female, she said, but only 25 percent of senior roles are held by women. “In other words,” she said, “we’re busy delivering global health, and men are busy leading it. It’s this type of power imbalance that can turn a deaf ear to the plight” of poor women seeking care, especially for reproductive health. “You have biases and discrimination that come out of this….When women occupy leadership position in the health workforce, the system actually changes and respect is accorded to issues that are important to women.” In 2014, for instance, health organizations around the world began observing Menstruation Day annually on May 28, “precisely to shatter the taboos,” she said, that often keep women and girls from having access to menstrual hygiene materials. “A quarter of their school life can be abruptly changed if they don’t have a menstrual pad.”
Kanem offered another startling statistic: half of the 120 million that occur every year are unintended, and 500,000 of those unintended pregnancies belong to children 10 to 14 years old. Even that knowledge is very new, he said, reinforcing her point about deaf ears. Until very recently, the UNFPA “didn’t even measure pregnancies and outcomes in girls that young,” she explained. “So, to see the prevalence, it really hits home.”
Nanavaty stressed the importance of grassroots leadership and empowering women in villages and rural communities to take control of their own healthcare. “When we act as leaders in the community—and I’m talking about women workers—I think that what we experience is that we do not have to wait,” she said. “There is a thing that ‘the poor can always wait.’” They should not have to, she said. She described how the 2020 COVID lockdown in India raised a sudden need for regular water supplies “in every slum.” Meanwhile, “in the villages, we were all told to keep washing hands, but where is the water to wash those hands?” Women in her organization went from village to village, she said, often in spite of resistance (sometimes from their own families) to ensure that handpumps, which many rural people in India use to harvest water from underground, were working and usable. They repaired more than 50,000 pumps, Nanavaty said. They also began delivering rationed food and medicines. “These women leaders understood and acted [on] the needs of their fellow women in the communities,” she said. “They took on the risk, but also the responsibilities, and they were accountable to their members.” Without enough women—and especially poor women—among healthcare’s leaders, “we have needlessly made health more corporate rather than cooperative,” Nanavaty said, “more cost-driven” than driven by the needs of communities.
Binagwaho struck a similar tone about the importance of accountability among leaders in healthcare, and the dangers of not having it. Calling humans “an amnesiac species” who repeatedly fail to learn from experiences like the COVID pandemic, she said, “We forget what to do in a time period of crisis. We have everything in our hands to protect the vulnerable; and we know that if we answer a threat by focusing on protecting the vulnerable, everybody will be served. But we don’t do it.” Also, she added, “The more countries cultivate individualism, the worse it is for the most vulnerable.” COVID, she said, offered another lesson about the importance of good leadership in countries both rich and poor: “I’m so shocked that there were more than one million deaths in the rich countries,” she said. The United States is the country with the highest number of recorded COVID deaths to date, with 1.16 million. “Where are the [people] responsible for that?” Binagwaho said. “They go free? It’s a scandal.”
Panelists contrasted failures like these with Dahl’s decades of work and leadership at Partners In Health, which she co-founded in 1987 with the late Paul Farmer (whom the panelists also mentioned and mourned multiple times). “I’m so pleased to have traveled—and it was not easy, because I come from all over the world—to honor Ophelia,” Binagwaho said. In introductory remarks about Dahl and her work, Chelsea Clinton, who sits on the board of Partners In Health, praised her “true spirit of leadership” and sense of partnership. “Ophelia has the unique combination of confidence and humility that I think is quite rare,” she added, “But that I do think we see more often in very exceptional women leaders than, candidly, we see in men. The confidence to know that her calling and her purpose is exactly what she was set on this earth to do, and yet the humility to know that she’s only able best to manifest that when she finds the people she needs to be in partnership with along the way.”