Contain This: The Latest in Global Health Security

Celebrating women in public health: A special discussion with Beverly Kirk, the Executive Director of JOURNEY, at the Australian Embassy in Washington, D.C. for International Women’s Day 2022

March 11, 2022 Indo-Pacific Centre for Health Security: Department of Foreign Affairs and Trade Season 2 Episode 17
Contain This: The Latest in Global Health Security
Celebrating women in public health: A special discussion with Beverly Kirk, the Executive Director of JOURNEY, at the Australian Embassy in Washington, D.C. for International Women’s Day 2022
Show Notes Transcript

The theme for International Women's Day 2022 is "Gender equality today for a sustainable world tomorrow." Women and girls in the Indo-Pacific region are at the forefront of dealing with the effects of climate affected disasters – from natural disasters to pandemics. They are also leading the charge on disaster risk reduction, climate change adaptation, mitigation, and response, and building a more sustainable future for all.

To celebrate International Women’s Day this week, we are presenting two episodes of Contain This. The second is a recording of a special event hosted by the Embassy of Australia in Washington, D.C., in which Australian Ambassador for Regional Health Security Williams was interviewed by Beverly Kirk, the Executive Director of JOURNEY, a new not-for-profit venture that's focused on the goal of seeing more women in senior leadership roles. 

Beverly and Stephanie discuss how we can support the leadership pipeline for women in public health, and how the pandemic has affected women and girls in the Indo-Pacific. They also discuss how podcasts like Contain This can help give women a voice and lift their stories to wider audiences.

We hope you join the conversation @AusAmbRHS Twitter and @AusintheUS Twitter and Facebook.

Ambassador Stephanie Williams 0:01

Today we present the second of two episodes of contain this to celebrate International Women's Day in 2022. Last week I was honoured to speak with Beverly Cook, the Executive Director of JOURNE in a special event for the Embassy of Australia in Washington, D.C. We are very grateful to Beverly and the Embassy for letting us air this discussion on Contain This. I hope you enjoy the episode.

Ambassador Paul Myler  0:28

The Embassy of Australia in Washington is delighted to host this discussion in honour of International Women's Day 2022. Our guests are both distinguished in their fields, with a broad range of high level experience between them, both examining some of the world's most pressing problems. 

Dr Stephanie Williams, is Australia's Ambassador for Regional Health Security, and brings to the role a wealth of experience as an epidemiologist, a clinical practitioner, and as a special policy specialist in the area of public health. 

Beverly Kirk is the Executive Director of JOURNEY, a new not for profit venture that's focused on the goal of seeing more women in senior leadership roles. Beverly describes herself as a recovering journalist and has an extensive experience across international security and diplomacy. Both of our guests can hold their own in front of a microphone as podcast hosts in their own right and I'll let them tell you more about that. 

The UN's theme for International Women's Day 2022 is "Gender equality today for a sustainable world tomorrow." And this theme recognises the contribution of women and girls around the world who are leading the charge on disaster risk reduction, climate change adaptation mitigation response, to build a more sustainable future for all. 

Today's discussion will take a look at some of the challenges faced by women in their pathways to leadership roles. And it will also examine how the pandemic has affected women and girls in the Indo-Pacific. We'll also look to some of the women across the region who are actively working to promote the safety, security prosperity of women against the backdrop of a global health emergency. Like I said, we're really excited to be part of this and I thank you both for joining us. Happy International Women's Day to both of you and everybody who's out there. And I'll hand you over to Beverly Kirk to get the discussion underway.

Beverly Kirk  2:38

Thank you so much Ambassador Myler. I really appreciate being here and I am honoured to talk to you Ambassador Williams, about your work, your leadership in the health security area, the COVID 19 pandemic and its impact on women and girls in the Indo-Pacific region. Women in Leadership is something that I am very passionate about, and the new nonprofit that I lead, which is called JOURNEY, it's focus is on accelerating the trajectory of women into the very top echelons of leadership, like the position that you have Ambassador Williams. So first, I want to ask you about you and your path. Tell me how you went from being a clinician seeing patients every day to someone working in the policy world.

Ambassador Stephanie Williams  3:28 

Beverly, it's so nice to talk with you today and please call me Steph. And I'm really looking forward to this conversation. 

I think that that path, that transition from direct clinical care to public health and population health policy really took hold in me when I was working in Uganda in primary health care delivery in the setting of internally displaced people and populations. And in delivering that service with Ugandan clinical officers and Ugandan clinical teams across an area in northern Uganda, we were collecting information about what was going on what services we were providing, what were the common presenting complaints, and it was really my first experience of seeing the importance and the power of understanding what is going on between you and the patient for that patient, but also understanding what's going on between you and the community. That what public health seeks to do is understand who's getting sick, or who is well, why and how we can make it better for everyone at the same time. 

That really spurred in me an interest in making sure in work I was always seeing the bigger picture, which led me to public health. And at its core, public health is about equity and inequity, because what makes us healthy is our access to power, money and resources, as well as it is our access to seeing a decent doctor or clinician down the road. And those driving things, those driving forces, in what public health tries to address to make the world fairer was really what pulled me into policy field.

Beverly Kirk  5:10 

And before I move on to ask you about your leadership style, since you mentioned about public health, being about equity, and that's so important for women and girls, and we know that the theme, as Ambassador Myler mentioned, for International Women's Day, is "Gender equality today for a sustainable future tomorrow," and it's really important to keep this focus on women and girls every year, could you talk a little bit more about some of the best ways to keep that focus on equality for women and girls.

Ambassador Stephanie Williams  5:49  

So I think, part of it being an everyday thing that you don't have to remember to take a perspective from multiple points of view or multiple groups. In our work in Foreign Affairs and Trade and through health within the aid programme, we have had gender as a pillar of our development programme for many, many years, to the point that it's just part and parcel of what we do. Doesn't mean it's necessarily easy, or just because you think of it every day, what you do is being effective. But it actually does move us forward in how we think about the design and implementation of programmes. 

So I'll give a really specific example - we fund the workforce capacity building and field epidemiology in the Pacific through, in Solomon Islands, in Papua New Guinea. We fund institutions and local partners to deliver that programme. As part of that we have made it explicit that we consider gender equity in applications and opportunity. And in the delivery of those courses that accommodation and support is provided for women who need to bring dependents or need to be able to have the caring responsibilities, and can't discharge them for the course. So that's a micro example of the ways in which having a gender lens makes you programmatically shift some of that design and implementation of work.

Beverly Kirk  7:22  

Let me now talk about your leadership style. How do you how do you lead? I mean, you have a huge position as Ambassador for Regional Health Security in Australia. Talk about your leadership style, and how you're working to bring other women in the field along into these top echelons of of leadership. I mentioned that as I as I said in the open, women in leadership is a passion for me and JOURNEY's focus is making sure that more women are at the top of the pyramid. If you think of women in leadership as a pyramid, and you've got women, you know, at the ground level in the middle, but as you go up the pyramid, there are fewer women. Our goal with JOURNEY is to open that aperture and bring more women to the top. How were you working to do that in the in the global public health field?

Ambassador Stephanie Williams  8:15  

Goodness, I'm not the best judge of one's own leadership style. So you'd have to ask others for the truth. I think I try and operate with two principles really. One that to be kind and inclusive at every moment. That almost nothing requires anything other than kind and inclusive responses with the humans that you work with. And the second principle is that the best work comes from the ideas of many. It's what has always drawn me to public service and public health is a sense of our collective efforts. And in doing and having that as a principle means that you are dependent on and rely on the good contributions and ideas of so many people. That's what I try and do. 

In terms of bringing people with me, this a really interesting question. I'm surrounded by women in the workplace. I think health attracts women by and large. Globally, that's a bit of a different story at some of the senior leadership in health organisations and in the supporting and enabling them, I just try and do what I've benefited from from smart women leaders in my path, which are people who gave me the opportunity to give it a go, gave feedback when it was good and not so good. And just really tried to understand what I was trying to achieve. I try and do that to the women around me. 

And then slightly less and less directly through a Centre for Health Security podcast called Contain This, we started Pacific Health Indo-Pacific Health Leaders series, where I have preferenced / prioritised wherever possible interviewing women health leaders from Indonesia, from Fiji from Kirabat to give a platform to voices that a sometimes less heard but are just so important to hear from in health in our region.

Beverly Kirk  10:20

You mentioned that the health care field attracts women but at the top leadership level, sometimes there are more more men than women. What do you see as as challenges to women in global health leadership? And how do you get around them? And also, more importantly, how do we get more women who are already in the field and leading such as yourself and the women that you mentioned? How do we get more of you and them into those high leadership positions?

Ambassador Stephanie Williams  10:52

There's a great organisation called Women in Global Health and it's run by a woman called Dr Rhoopa Dhatt. And it is an advocacy body really leading in this articulation of what are the opportunities and inequities for women in the global health workforce. And it delivered a great report a year or so ago that said exactly this, women are 75% of the caring workforce of the healthcare workforce, but globally represent 20 to 25% of the leadership. And the the approach that that organisation takes is advocacy, data collection, evidence, opportunity, mentorship, you know, there's principles of measuring, creating momentum for change, and then not polishing the problem, but seeking structural opportunities to change the system. Now, that's pretty hard globally. And I think the example I gave before about how we do that in our work through health in Australia in the in the aid programme, is a mainstream policy approach. Deliberate programming decisions, and and every time we do that, it's not just about making sure health services are delivered to women, it's about putting women in positions where they can be leaders in their own systems. And we have these asking the right questions as we design interventions to make sure that we are not perpetually neglecting the need to create structural change and opportunity. And so right from advocacy to programme detail along that spectrum, got to keep their fingers in the pie almost every day, every moment.

Beverly Kirk  12:37  

COVID-19 and certainly presented a lot of challenges for everyone working in health care. And since a lot of women work in health care, those are challenges that have fallen on the as a burden for women. Can you talk about the impact of COVID-19 on women and girls in the Indo-Pacific region?

Ambassador Stephanie Williams  12:58  

So I mean, health is local, so and it's so when I give some now global and regional examples, I just want to be cautious to not presume the individual experience of any any woman or girl in the Indo-Pacific but just to comment on some very broad trends. So globally, there's a great organisation running the sex and sex disaggregated tracker for COVID-19 which looks at what's the experience between women and men in countries reporting disaggregated data for testing treatment, hospitalisation, etc. It's really interesting picture. For every 10 females tested for COVID, eight males are tested. For every 10 females hospitalised for COVID, 12 males are hospitalised. For 10 Female deaths, there have been 13 male deaths. And for 10 female vaccinations and for COVID. they've been 10 male ones. It tells us it's a picture, which looks like it's a bit worse for men globally. Now that's a generalisation. The picture will be different. Certainly not every country has seen men disproportionately affected. Many did in 2020 but there are some outliers. India for example, women were more likely to die than men in the early part of their Delta wave. So that's one part.

Then you're going to think go beyond that. Why do men get hospitalised more? Is it because women never got to hospital, they didn't have time to get there is it because when they're sick in low resource settings, that it men are prioritised for access to intensive care versus women. So we have to ask about the social systems and structures that might be underpinning those numbers.

Where the impact I think has for most heavily on women and girls is one, as the frontline health care workforce. So they not only faced unsafe workplaces in almost in so many settings early on, and continue to face unsafe workplaces if they're not in full position of safe and effective PPE. But they've also been there every day from the beginning, providing health care. So they've shouldered the responsibility of delivering country and global responses to COVID. 

The other major impact has been on what has happened to women and girls with too big interruptions to education, and to where countries have implemented harsh lockdowns, a huge increase in risk of their exposure to gender based violence, sexual violence. The impacts of far and wide and there's a lot of good analysis about that. But our challenge is how we get ahead of that for the next time. And make those underlying systems better for women every day, so that we can withstand impacts for another big event.

Beverly Kirk  16:07 

You know, I read a stat, according to the UN, globally 31 million more cases of gender based violence will occur as a result of pandemic triggers. And another impact specifically on women and girls is the lack of access to sexual and reproductive health services because of lockdowns and other pandemic related issues.

Ambassador Stephanie Williams  16:30  

So in Fiji, during the lockdown, the calls to the gender based violence helpline went up 600%. In PNG, the calls for help tripled. I think we have to remember what those responses meant for that those individual women, on the one hand, a government and health agencies saying we're protecting you from this risk, and this risk is COVID and to do that, we all need to do the following things, but in protecting you from this risk, I'm increasing your risk of death in your home tenfold. Now that is not for every woman. But for the women were that was the risk trade off, we cannot forget the impact of that and nor can we not respond. So part of our responses were making sure that those services the gender based violence and prevention services that we were already supporting through the aid programme we're able to turn up and meet the immediate demand. 

And the other point to your point about the interruption of health services for women and girls, the we funded Australia funded a programme called see surge, surge in the provision of sexual reproductive health services and information to try and avert the impact of the gap in women being able to access family planning advice, safe maternal care and, and good information about their sexual reproductive health for teenage girls. Information about menstruation as an example or contraception. So they were things we already did, but during the last year and a half have turned up the level of support to those services to try and address the big interruptions that we've seen over the last two years now.

Beverly Kirk  18:26  

You mentioned interruptions, were there other types of interruptions in the public health service in Australia and in the Indo-Pacific region, kind of writ large, because everyone was so focused and rightly so on the pandemic on COVID-19. And was there an impact on on other health related issues?

Ambassador Stephanie Williams  18:48 

Yes, and the story is varied. It's not a universal story in terms of everything stopped. So UNICEF gave an interesting presentation to us last year or the year before about the change in coverage of antenatal care over about 30 countries, which is a women's still attending for their screening and preventive health visits during pregnancy. In some countries, they went down in other countries they sustained, in some countries, they went up. 

In our region, childhood immunisation coverage in some places in Indonesia, for example, dropped 20% for two or three quarters of 2020, but is starting to move back up again in 2021. In globally, the tuberculosis case finding a notification dropped in 2020 and 2021, meaning that public health function of detection and surveillance of TB cases for treatment was interrupted. And access to HIV prevention services, including those for women and girls dropped off about 20%. So there is a mixed picture. But it's all but it's a mixed picture but it demands our attention in thinking about what are the priorities in restoring government's capacity to make decisions about COVID that frees them up to restore some of the fundamental pillars of essential health services and public health programmes.

Beverly Kirk  20:19  

The other thing you mentioned while you were speaking about the other issues was immunizations and seeing the numbers tick back up after after going down. I want to ask you about COVID vaccination coverage in the Indo-Pacific region. How's it been? I know, as a as a, as an American, the issue of COVID vaccinations became and still is very politicised. Was it the same in in that region? Or did you see higher vaccine rates than perhaps what was seen in the US?

Ambassador Stephanie Williams  20:56  

So yes, there has been in and when I say that our region I'm talking about Southeast Asian countries in the Pacific countries, and specifically Australia's COVID vaccine Partnership Initiative is with 18 countries in Southeast Asia in the Pacific, where we are supporting access to and delivery of vaccines. 

When you look at those countries globally, there are there's good vaccination coverage for two doses, or primary series in the majority of countries in Southeast Asia, with some exceptions, and in the Pacific, namely Papua New Guinea, Solomon Islands, are two outliers of where coverage has really struggled. Now, there's a whole lot of reasons for that. And part of what we are learning and continue to learn and adjust in the COVID vaccine campaign is making sure we test our assumptions about vaccine demand, vaccine supply and delivery systems, so that we are maximising the chances of a successful campaign in those places. There are high levels of hesitancy in some of the in Papua New Guinea and Solomon Islands for different reasons. 

We have funded some research and some a lot of work on trying to improve the communication and understand the reasons why people are less willing or inclined to take a vaccine. What that tells us is that there is no simple answer, in that in in some of the approaches that we've taken in Australia, and Victoria, Australia has a remarkably high double vaccination coverage currently, in excess of about 94%, was great work done in a through the Children's Hospital in Melbourne. Which their way to address hesitancy was multiple community engagement sessions. Didn't matter how long it took, that people are given time in a safe space to ask the questions they need to ask and be respected in the answers that are given to them. And building a community of people able to engage on questions for vaccine hesitant people, has led to a slower but an increase in demand over time, especially from women who are hesitant to begin with.

Beverly Kirk  23:28  

If I could drill down on the question specifically about women and how were you able to and not by you personally but you in the in the health industry? How has hesitancy been dealt with, especially among women health care workers?

Ambassador Stephanie Williams  23:47  

It's a really interesting challenge. So one of I think, an example of where we made an assumption about people's attitudes to vaccination that needed to be tested was on assuming that health care workers who provide healthcare and are trained and educated and deliver services would be early adopters, first adopters, high demand for a vaccine. When we looked at the indications of willingness to take a vaccine in the Pacific and good research funded and done by the University of Sydney with WHO and local health health ministries we found really interesting. So when we surveyed health care providers, they said 75% of them said we’re willing to administer a vaccine, COVID vaccine. 60% said they were willing to take a vaccine. These are the same people. And I think understanding that people first and foremost are women in their community who care for their family and their community members. Rather than women who are workforce who would just be, we just assume they'd be, you know, early adopters, s science based, was a really interesting finding. 

How we have dealt with that, or how we have how ministries and partners have tried to engage with that really does come back to understanding and measuring, not assuming people's attitudes and beliefs based on where they work or who they are. And then addressing the concerns in a way that gives time. What we have seen is that women's acceptance of COVID vaccines has increased over time. So WHO has also surveyed regularly 18 countries in our region, which showed and they've done it three times, they've funded an agency to do it three times to take the pulse of hesitancy or confidence during this campaign. And men started up here as willing to take a vaccine or women were here. And there we were up here. So and those sent a regular checking in and measuring and looking for the differences between women and men has been really important in this campaign.

Beverly Kirk  26:14  

A couple of follow ups on on that on that point. In any of the research that was done, was there were there reasons why? I'm thinking of the of the drop in the number between those health care workers, particularly women who were willing to give the shot versus taking the shot. Were there were were those reasons why there might have been fewer willing to take the shot, were those reasons addressed? And are there lessons that you gleaned from from that, that you're you'll be able to apply going forward? Since it doesn't seem as if COVID is going to completely disappear anytime soon.

Ambassador Stephanie Williams  26:57  

Some of the explanations for the less willingness to take a vaccine was concern about side effects and safety, which is interesting, because you think that would play into that that same providers willingness to be given a vaccine. Other factors explaining that were they had desire to know what was in the vaccine, so be ingredients. So a little bit more information about what was it. And when they looked at what motivated people what what motivates people to take a vaccine, tapping into willingness and want to protect others around you was a higher motivator for women than men. So the kind of self protection was important, but the community protection was as important in trying to to encourage people to be vaccinated. There're some examples of how understanding reasons why lead to different approaches to encourage and explain.

Beverly Kirk  28:05  

And are there other lessons learned just looking back at the last couple of years that you've been able to glean from the approach to the pandemic, the working and in in terms of policies toward dealing with the pandemic that you could share with the audience?

Ambassador Stephanie Williams  28:26

I would like to say that we have had a gender mainstreamed response to the pandemic from day one. If I'm being honest, I think globally and we across institutions, responders partners, were thinking first and foremost as a health emergency and and the initial speed of response required. And that we it took us a bit longer to remember and thus implement in responses, that successful responses to COVID needed to take the same principles that successful responses to all diseases have needed since the beginning, which is people at the centre, community at the centre of decisions that affect them and their capacity to impact and influence the health care and the information, the prevention measures that say access. I think we learned that and now, and the response has improved on that on that basis. 

Beverly Kirk  30:32

That is a perfect way to wrap up our conversation. Ambassador Stephanie Williams thank you so much for your work and everything that you’re doing throughout the Indo-Pacific region and globally, quite frankly, in the space of global health care, specifically for women. It’s definitely appreciated and needed.

Ambassador Stephanie Williams  30:52

It’s been so nice to talk with you Beverly. Thank you so much. 

Thank you for listening to this special recording of a discussion hosted by the Embassy of Australia in Washington D.C. I'm Stephanie Williams, Australia's Ambassador for Regional Health Security, and I joined Beverly Kirk to record this episode virtually last week. 

You can also catch up on the first episode in this special series for International Women's Day where I talk to Australian academic in Washington, Dr. Alexandra Phelan, who is an Assistant Professor in the Center for Global Health Science and Security, and an Adjunct Professor of Law at the Georgetown Law Centre. I hope you tune in.