Dr. Maria Neira, Department Director at the World Health Organization (WHO)

Three pieces of advice:

1.     Be a lifelong learner

2.     Ask yourself every morning: “Where can I have the highest possible impact with minimal resources?”

3.     As a woman, be happy and conscious of the fantastic pieces that you have inside of you & unlearn the habit of feeling guilty over every small thing.

CV IN BRIEF

EDUCATION Medical Surgery at University of Oviedo, Spain. Endocrinology and Metabolic Diseases at Université René Déscartes, France. Public Health and Human Nutrition at Université Pierre et Marie Curie, France. Emergency Preparedness and Crisis Management at the University of Geneva, Switzerland.

CAREER SO FAR Medical coordinator with Médecins Sans Frontières (Doctors without Borders). Vice Minister of Health and Consumer Affairs in Spain. President of the Spanish Food Safety and Nutrition Agency. Public Health Adviser in the Ministry of Health in Maputo and Mozambique. UN Public Health Advisor/Physician for the United Nations Development Programme (UNDP).

WHO CAREER Coordinator of the Global Task Force on Cholera Control. Director of the Department of Control, Prevention and Eradication. Director of the Department of Public Health and Environment. She is part of the High Level Advisory Board of the Lancet Countdown: Tracking Progress on Health and Climate Change.

LANGUAGES SPOKEN Spanish English Portuguese French Italian

DATE OF INTERVIEW 16.12.2019

AUTHOR Martha Bowler

As the director of Public Health, Environmental and Social Determinants of Health at the World Health Organization, what made you choose to specialise in Global Health instead of a typical medical career?

My life-changing point was when I started working with Doctors without Borders (Medecins sans Frontieres) in a refugee camp during armed conflict in Salvador, Honduras, after I specialised in endocrinology at the Université René Déscartes. In particular, I was treating an asthma case every week and hence realised that there was a need to understand why children were developing asthma. We traced one of the contributing causes to be the conditions in which they were living, for example, the use of charcoal or kerosene and the lack of ventilation in the house. I realised that you need to understand the causes of diseases if you want to have an impact on people's health. My experience at the refugee camp shaped how I viewed Public Health at its core, leading to my decision to pursue further specialisation in Global Health. 

Can you share more about your experience working at the refugee camp? 

My experience was incredibly rewarding because I was very young and full of energy. I was terrified of the responsibility, so I was always consulting my books and asking other colleagues. I was also in a permanent state of worry as many people depended on me since I was the only doctor there, yet given my specialisation I felt that I did not have the appropriate training at times. It was humbling as well because I realised that I had to do almost everything, including tasks that I was not trained for as a foreign junior doctor. 

However, people made any difficulties worthwhile. They were affectionate as I was having a great impact on their lives by providing appropriate treatment or facilities which they lacked. Little by little, I extended my work beyond the refugee camp to the whole population by initiating nutritional programmes and organising vaccinations. I started to understand the whole purpose of humanitarian assistance and worked with the government to shift the way they would do certain things.

What did you do after your experience with Doctor without Borders?

I then moved to Africa for five years and worked with the Ministry for Health in Mozambique. It was at the time of the HIV/ AIDS epidemic, so we had to organise programmes to raise awareness of treatment and prevention. I was acting as the director for the hospital as the two local doctors were on holiday, so I had to do a little bit of everything. Since it was during a period of conflict, I also learned a lot, even things that I never wished to learn like cruelty and lack of humanity. Fortunately, after a year a peace agreement was signed and things changed in a very rewarding way, and I began to regain faith and trust in humanity.

Can you share more on your experience in Rwanda, especially how it shaped your perspective of public health?

Public health is something that you learn in the field, meaning operating with limited resources and striving to gain maximum results. For example, instead of treating a child’s condition every three days, you should instead invest in access to safe water and waste management and convince people to wash their hands. In Rwanda, I started to do things that you never think you would do, like waste management. Previously, people were throwing everything away so it would accumulate, or they would incinerate the waste. I was able to discuss with the mayor of Kigali at that time to put in place a system to change people’s behaviours.  

I was also discussing with officials in charge of urban planning to implement road safety policies to reduce traffic accidents. Additionally, I contributed to implementing food safety protocols: from improving butcher practices to creating hand washing facilities in the market. In this field, it is crucial to get out of the clinic and be conscious of daily practices: we cannot just keep dealing with diseases, we also need to deal with health. Health is generated almost everywhere in the little thing that we do every day, so it is crucial to change small habits for the better. 

Do you feel like you had the influence to shape policy in Rwanda and Mozambique when you were working there?

 I was working in very hard situations and I wanted to avoid complying with policies just because of my status as a foreigner. I could not accept certain policies, even though they were sometimes based on the traditional status quo. I felt that I had to fight sometimes, while still respecting and understanding different cultures, and not coming across as arrogant. We are so lucky to live in other parts of the world where our facilities and learning are better, so we should cooperate to make changes for the better for other countries as well. For instance, corruption was always something for me that has always been unacceptable, so I found myself in situations where I had to contest, in a calculated and persuasive way, to get my points across in order to protect health.

Has being from Spain sometimes been a barrier in your career, in terms of languages, for example?

I love to communicate with people, so I learned very quickly that I had to speak different languages. I learned Italian and Portuguese in Mozambique, French during my studies, and English because I understood that it was a crucial language for communication in Global Health. Languages have never been a barrier- when I couldn't communicate verbally, I would use my hands. There are incredible ways of communicating with people even when you don't talk the same language. 

Fast forward to your current role as Director of PHE at WHO where you work on raising awareness of the health challenges posed by climate change and air pollution. Why was this particular focus chosen? 

The actual enemy that we are focusing on is the burning of fossil times. This is a big cause of air pollution and a huge exacerbation factor of climate change. In order to stop the combustion of fossil fuels, you need to invest in renewable energy, have better public transport systems and urban planning. Little by little, all these things come together, with sustainable food production and consumption as well and it all becomes basic public health. 

In essence, public health is looking at where you can have an impact and what issues are topical. When I reached the environmental health department, I realised that everything was connected. If you don't have access to safe water, infectious diseases will be a problem, and you will not have sustainable food production. If you cannot walk in your city, you will be obese. In my opinion, it is not a big change, just a way of reaching out more and having a holistic approach to health. Fundamentally, it is the same battle, we need better nutrition, we need better cities, we need cleaner air and water. Everything is connected.

With you having such an important role especially working on international issues like climate change, how do you manage to have time for a personal life?

All the women I work with always ask me if it is possible to be good mums alongside having a fun, interesting, and rewarding career. My answer is always: 'of course'. You can dress fashionably and be nice to yourself and take care of yourself. We have time and we can definitely be all of that. If you're a woman, even better, because we can do more. We need to shift the belief that we have to fail in our private lives if we are good professionals. In fact, the opposite is true, the better your private life, the better you can deliver in your professional life.

In 2015, the Lancet Commission on Women and Health estimated that nearly half of the women's contribution to Global Health is unpaid. How did you manage to achieve the position you hold today? What barriers did you face and how can we address this imbalance?

I'm very lucky to be born in Europe, where things are relatively easier for women. However, I never wanted to see or accept the barriers though I have had moments where I felt that I lost credibility. When entering a meeting room, people probably think my male colleague must be the director, not me. Every day, we need to make sure that we do not promote those barriers- sometimes we ourselves are responsible and we tend to believe that people have more credibility if they are male. Young men at 30 years old will say 'I definitely want to be a director of a department at the WHO', while some women will say 'I'm not prepared yet'. Somehow it is good because we don't have this arrogance but consequently, we are genetically manipulated to be less confident in high-level positions. I don't think we deserve more than men; we deserve the same. As women, we should not demand more privilege because of our gender, but look to promote those who are competent and who are right for the job. 

Women are increasingly more vulnerable to climate change and the adverse effects caused by social determinants. Does your work take into consideration these discrepancies?

That's interesting, they signed something like that at the Madrid COP25. One of the reasons for our increased vulnerability is because we are more generous. If there is a danger, the woman will remain behind to protect her children and family. Firstly, the role of caregivers is putting us in more difficulty. Secondly, the lack of education doesn't allow women to have the capacity to make decisions and migrate to another area. In my personal experience, I saw the gender-specific vulnerabilities in the Rwandan genocide. When refugees were coming back from the massive repatriation, we acted as medical assistants and conducted epidemiology in-the-dark. We recorded minimal pathologies and we realised that most of the medical issues were in men and children. This wasn't because women were not affected, but because they were prioritising their children and husbands to go to the clinics, making themselves more vulnerable.

How do you think we can change this socially ingrained norm?

We need to be strong in our fight against discrimination. We need to focus on things that will have a huge impact; sometimes we write very intellectually interesting papers, but these are addressed to high-level women. Education is a strong way to empower women because it equips them to better understand the predicament that they are in. The focus on education is crucial, and particularly, making sure that those women are convinced that they deserve it.

I am also particularly passionate about advocacy for basic human rights for women. I wish to see girls going to school instead of collecting wood and water for three hours a day. I wish that they do not have to enter a forced marriage, nor be dependent on their husband to open a bank account. 

What would be the best way to address these issues? 

By enforcing legislation. If you are in Sierra Leone and the law says that adulthood is reached at age 18, the law cannot accept the marriage of a 13-year-old girl to a 55 years old man, for example. It should be illegal. So, enforcing legislation where there is legislation and implementing legislation where there is a gap. Additionally, the focus should be where an impact can be made on millions. For example, by providing access to safe water sanitation and energy, more women can go to school and receive an education.

What are the biggest challenges you face when you suggest new policies?

Public health is a non-controversial issue, everybody will agree that we need to improve peoples' health and reduce mortality. However, barriers start to emerge when you get deeper into the issue. For example, if you say, to reduce mesothelioma, we need to stop using asbestos; and to reduce the obesity epidemic, we need to tax sugar and sodas. When you do this, you generate enemies- powerful enemies that own multimillion-dollar companies. The art of public health is identifying where you can have an impact and going for it no matter what while keeping secondary effects in mind. In a way, it is just like treating a patient, you need to remember that a drug to control hypertension may create side effects on their stomach. The key is a well-thought and courageous holistic approach which is not naive.