Please tell us a bit about yourself.
I am a professor at the Barcelona Institute for Global Health (ISGlobal), in Spain, a senior scholar at the City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), in the United States, and give talks all over the world. Luckily, I enjoy travelling! I consider myself to be a researcher advocate. On the one hand, I have co-authored over 300 scientific papers, on the other, I spend a lot of my time working on health policy issues, at all levels.
How does your work relate to SDG3?
SDG3 is to “ensure healthy lives and promote well-being for all at all ages.” I knew I wanted to work on global policy, hence I have a graduate degree in political science from Georgetown University and a BA in Romance languages from New York University. In grad school, though, I had no idea my focus would become health policy.
A chance encounter with the World Health Organization (WHO) Regional Office for Europe, when I was living in Copenhagen in 1998, led me to apply for and start my first role in public health: editing WHO’s journal on sexual and reproductive health, Entre Nous.
Since then, my career has remained aligned with SDG3 - even before the SDGs were developed!
This includes 11 years at WHO in different roles (including two years with the emergencies unit, three years with the European Observatory on Health Systems and Policies, and four years with the HIV/viral hepatitis programme). It also includes serving at the Global Fund to Fight AIDS, Tuberculosis and Malaria, fulfilling a dream to work on the strengthening of health systems in low-income countries. After I left the Fund, I helped start the WHO Collaborating Centre on HIV and Viral Hepatitis, in Copenhagen, and at the same time co-founded Health Systems Global, serving as its director for three years.
What's the most pressing issue you're facing now, and what are your hopes for progress in the future?
Over the past century, in most countries, the march toward longer - healthier - lives seemed inevitable. In the last three years, though, humanity has experienced what for generations seemed unthinkable: increases in mortality and exacerbated morbidity risks across a number of fronts. It is easy to lay all the blame at the feet of SARS-CoV-2. But this would be a half-truth.
What is consistent across all of these diseases is that, so often, we know what to do to improve health outcomes, yet, so rarely do we do it.
Many of us in public health, myself included, were naive in the earliest days of the pandemic to assume that this time it would be different.
Nature, as a function of biology, will always present pressing health issues to us. The most pressing issue is the intersection of our human nature in response to those health issues.
With COVID-19, though, we’ve seen this occur at a scale we haven’t had to grapple with for many generations.
I am a firm believer in achieving the Sustainable Development Goals by 2030. Public health researchers may differ on the relative import of their specific disease area compared to other diseases, in relation to SDG3.
All of my peers in public health are also keen students of human behaviour. I believe that I can speak for the public health community when I say that we all recognise that helping decision makers to keep a sharp focus on SDG3 is crucial. Otherwise, we will not win-back those hard won, too easily lost, gains in longevity and quality of life. While a focus on SDG3 is needed, the COVID-19 pandemic has taught us that addressing health requires addressing all of the SDGs. This means taking a whole-of-society approach. Reaching agreements on ending the pandemic as a public health threat has been the most pressing issue I have faced during the past year.
Please describe hurdles you’ve come across during your career.
I’ll approach answering your question both at the personal level and at the systems level.
Personally? I am a native English-speaker, primarily working in a European context. Fortunately, my degree in languages - and love of cultures - means that I can communicate and engage effectively in many countries. Still, working cross-culturally is challenging.
I earned my PhD in public health a bit later in life than most. In some respects, I started out ‘behind’ compared to the amount of publications, conference presentations, etc., that many of my peers had achieved at the age I started my PhD. Thankfully, though, I have had many mentors and collaborators throughout my career who have helped me to rapidly advance.
My family and friends are spread throughout the world. On the one hand, we meet-up in remarkable places. On the other hand, multinational work is not often easy for family and friends.
In terms of hurdles at the systems level that I address in my career? I believe that we can eliminate hepatitis C globally by 2030, and in many countries already within the next few years. Following the first WHO strategy on eliminating viral hepatitis as a public health threat, published in 2016, our micro-elimination approach has been pivotal in this effort and, with the European Association for the Study of the Liver (EASL) International Liver Foundation, we worked in countries around the world to facilitate it, with my research group implementing it with others in Spain.
With COVID-19 continuing to present a pressing public health threat globally, we are planning several national consensus statements to provide specific, contextualised recommendations now that our global consensus statement is out in Nature. Together with a new global effort, “Healthy Livers, Healthy Lives”, I will work on behalf of EASL with the leading international liver organisations to develop a global research and action agenda on fatty liver disease (a condition that is about to have a new nomenclature) – also being agreed on through a global process, with the methodology being led by Professor Diana Romero of CUNY SPH and myself.
The foundation of global public health is equity, which is achieved through solidarity and requires collaboration. The pandemic has set back society as we know it. Moving ahead, my efforts will continue to reside on convening large groups of experts, both scientists and people from the community, to collaboratively address a range of public health issues that I have been focused on for years.
Please tell us about a resource or person that has particularly inspired you?
My mentors include Andrew Gray, of the International Working Group on Indigenous Affairs (IWGIA) and Oxford University, Jerker Liljestrand, my PhD supervisor and now good friend, and Srdan Matic, my boss at WHO Europe’s HIV programme and likewise a good friend. I learned so much from each. First and foremost, they were brilliant and humble. They were also likeable and empowering. They were incredibly versatile, able to synthesise information on so many issues and transform it into action. If not for a plane crash in 1999, I might have joined Andrew at Oxford to study anthropology. I had already visited him there with that intention. Instead, I went to Sweden (well I commuted from Copenhagen) to start a PhD with Jerker on sexual and reproductive health. Partway through, now working for Srdan at WHO, I changed my focus to HIV and still work as a researcher-advocate in the field.
Together with Nikos Dedes, who never ceases to inspire, and others, I co-founded in 2007 what is now EuroTEST and then we started HIV Outcomes Beyond Viral Suppression, inspired by our work on health-related quality of life for all people living with HIV. Nikos and I recently joined the Global NASH Council, and much of my work focuses on fatty liver disease, also known as steatotic fatty liver disease.
Finally, I learn every day from colleagues around the world and especially my colleagues at ISGlobal and CUNY SPH.