Adrienne Germain, President Emerita of the International Women’s Health Coalition

RACHEL YAU: Good afternoon. My name is Rachel Yau. And I’m a doctoral student in
the Biological Sciences and Public Health Program
here at the Harvard School of Public Health. Our guest today is Ms. Adrienne
Germain, President Emerita of the International
Women’s Health Coalition and an advocate of women’s
health around the globe for over 40 years. After receiving degrees from
Wellesley College here in Massachusetts and the University
of California at Berkeley, she spent 14 years
at the Ford Foundation advocating for women’s rights,
including four years as the foundation’s representative
to Bangladesh. She was that country’s first
female representative from any donor agency and worked to
improve women’s health and educational opportunities
while there. Ms. Germain left Bangladesh to
co-found what became the International Women’s Health
Coalition, with the hope to invest in local women-led
organizations that provide services in countries rife with
gender inequality, as well as advocating for Global
Policy changes and funding for women’s issues. Since its inception, the
organization has invested in countries in Africa, Asia,
and Latin America. Ms. Germain became president
of the IWHC in 1998. And in that role she continued
the group’s advocacy against gender inequality, for an end to
violence against women, and for access to needed
health care. She served in that
role until 2011. Currently, Ms. Germain is the
Menschel Senior Leadership Fellow here at HSPH and serves
as a member of the Council on Foreign Relations, the UNDP’s
expert group on gender and age responses, and two Human
Rights Watch advisory committees, among others. She also speaks and publishes
extensively and this year received the United Nations
population award for her lifetime work. And we’re excited to have
her here with us today. Now, as I turn the session over
to Professor Dyan Wirth, please join me in welcoming
Ms. Adrienne Germain. DYAN WIRTH: Thank you, Rachel. Thank you for that wonderful
introduction. And Adrienne, welcome
to this event. I was delighted to hear that
you won the United Nations award for population. But you told me that
you were surprised to receive the award. And having looked at your CV and
all of your work, you’re totally deserving
of the award. But tell me why you
were surprised. ADRIENNE GERMAIN: Well
basically, I’ve spent all of my work life challenging the
population field to better meet women’s health and
human rights needs. So I really, you could say, have
been a thorn in the side, basically since the
field started. It began really in earnest
in its contemporary period in the late ’60s. And I felt a great sense
of interest, of course. But what was really driving me
was that, in 1968, as a junior in college, I had spent
six months in Peru on a household survey. And I didn’t speak Spanish
very well, which seemed a handicap at the time. However, what it meant was
that I absorbed, quite viscerally, what women’s lives
were like in the Amazon and the high Andes Mountains, down
on the plains on farms and villages, and in urban slums. And that experience
never left me. And I saw a sort of roundness of
needs that women face, all of us, any one of us here in the
world– that we don’t just have the capacity to conceive
and bear children. We have many other capacities. And we should be invested in and
supported in those ways. Well, after Wellesley,
I went to Berkeley. And that was the time of Paul
Ehrlich’s Population Bomb. Paul was at Stanford and the
Demography department part of sociology was active. And so I was reminded of those
women in Peru and inspired by one set of professors– Kingsley Davis and Judith Blake,
famous demographers– who basically understood, as no
other professors did, what I had viscerally experienced
with women, which was they had very good reasons to have
lots of children. And until and unless their lives
were changed, they would probably go on having
children. So that led me then to the
Population Council for my first job, where I immediately
got into a bit of a tussle with staff and the presidency. Because all I ever heard about
there was users of contraception or postpartum
cases. And that didn’t match up at all
well with the women I had come to know in Peru. So there was also a deep
injustice at that time. Contraceptives were much
less perfect then than they are even now. The population council was a
very important leader in developing those contraceptives
and also helping to deliver them
to poor women in low income countries. But they weren’t willing to
provide backup of safe abortion for contraceptive
failure. And to me, that was
profoundly unjust. So I was fairly vocal about that
and was about to decide to leave the council because
I didn’t really feel I was getting anywhere, even though
we had some data at that time, not many. And the Ford Foundation called
me on the recommendation of my professors at Berkeley. And basically, I left and went
to Ford for 14 years. DYAN WIRTH: That’s great. Well, thank you for that. Now, tell me. As you’ve sort of looked through
time, there have been different challenges to
women’s sexual and reproductive health,
in each period. And I wonder if you might
reflect, for the students in the audience, the big challenges
that you see now and sort of contrast those to
the challenges you saw in the earlier days of the field. You’ve just talked a little bit
about your early days, but maybe give us some sense of
where you see the field having gone– from where you
started to now. And what are the kinds of
challenges that the students entering the field now or the
professionals entering the field now are going to face and
what kinds of things they need to know to be able to
address those challenges? ADRIENNE GERMAIN: The biggest
challenge now, frankly, is implementation. We’ve gone through a whole set
of steps in these last years that have led to a better
database, more understanding among professional communities
about women’s health and the intricate interrelationship
between women’s health and their human rights
or violations of their human rights. We have a lot of rhetoric. And thanks to efforts that I
might talk about a little bit later, if you want to go in that
direction, we have global policy change that we women from
around the world created. So we have a lot of advantages
now that we didn’t have then. But the agenda that we put in
place in the early 1990s, at the global level, with the
world’s governments– we being women. and the world’s government,
mostly their representatives being men, nonetheless agreed
in 1994 at the World Population Conference that
population policy should change, that it should not be
simply vertical delivery of what are called in the UN Family
Planning Services. It’s separate, as much
as possible, from the health system. But rather, it should be a
policy which starts front and center with the health and
human rights of women and which provides at least a
minimum core package of service which includes
contraception but also the skilled technical support that
women need to go through childbirth safely, which until
that time had been invested in almost nowhere in low
income countries. It involved sexually transmitted
infections, including HIV, which was just
beginning to come to the global consciousness
at that time– 1994. And then the fourth element was
access to safe abortion. Now, it was astonishing that
we could get that shift. One reason that we could get the
shift in population policy was that we also brought into
that dialogue and negotiating arena the fact about demographic
momentum, which is to say that most of the
countries in Asia, Africa, and Latin America that we were
focused on have very large populations of young people
under the age of 19. And what we got through for the
first time in Cairo, in addition to the reproductive
health package of services that I named, was a recognition
that adolescents have a right to information,
education, and that package of services. This was an incredible
breakthrough. And that makes it basically– this new population
policy approach– a win-win situation. For women, it is what women
need and have a right to. For the demographers and the
population-oriented people, those who work on environment
and climate change and so on, this approach was far more
suited to all of these adolescents under the age of 19
who keep coming through the system than the earlier approach
of simply delivering a narrow set of contraceptive
services, most of which are not appropriate for
adolescents. So since that time, however, the
big challenge is to get it implemented. Because just as you have
departments in universities that need to try to get together
and collaborate and exchange and so on, these
fields were siloed. DYAN WIRTH: It’s a really
important point. So how do you to get this across
to policymakers, to people who aren’t experts in
the field but need to be convinced in order
to implement? What challenges do
you see there? How have you done this? What role has your leadership
played in that? ADRIENNE GERMAIN: Well, first of
all, despite our discussion here and whatever you might know
about what I’ve done with my life, I’m not a
revolutionary. I’m an evolutionary. And so I started. My core premise in the
population council, in the Ford Foundation, and then when
I later on became an overt spokesperson myself, is that
we have to have data. We must have evidence
to make our case. Because resources are always
scarce and people who hold power are going to make
decisions that distinguish among different groups of people
or different health problems, in regard to who gets
funding, who gets the human resources and so on. So data were terribly
important. And the first 10 years of my
work at the Ford Foundation was fundamentally supporting
research, just because we had not nearly enough information. And what I came to understand,
however, was that when I arrived at Ford, very early
actually, I was asked to do budget memo. And that led me to look at what
the Ford Foundation was doing in the world. And I came to discover that
there was one other woman in the Ford Foundation
International Division. There had never been any women
in the country office staff and certainly no representatives who were women. They had no programs in support
of women, except family planning. The Ford Foundation was a leader
in helping to create the population field
as I described it. So I said in this budget memo
to the vice president what I had learned at Berkeley from
Kingsley Davis and Judith Blake that made sense to me in
terms of the women’s lives in Peru that I had seen, which is
that women have good reasons to have large families. And if you want and expect women
to have fewer children and also to use imperfect
contraception, you have to give them options– education, employment,
and so on. But you also have to approach
their health as a package. And even if women have a lower
desired family size and start using contraception, they
do want some children. And when they have the wanted
pregnancy, then they need to be supported with
delivery care. So this was not popular. But Dave Bell, who later spent
years at Harvard– so some of you might
know him– was an extraordinarily
open-minded person. He liked not simply the evidence
that I could give him at that moment, which was very
early– this was 1972– but the logic of what
I was saying to him. So he said, OK fine. You don’t have to do the job
you were hired to do. Look at the Ford Foundation and
tell us what we should do. So later on when we have your
questions and answers, we could have some examples. But let me tell you that it was
a WASP, male establishment par excellence in those days. And nobody wanted to
do this, nobody. So I learned at that
moment that, OK, evidence is not enough. Logical use of evidence
is not enough. I’m going to take a lot of my
time and go out and be with these country offices of
the Ford Foundation. The first one was Bangladesh. So I’ve worked there
since 1975. And I’m going to hear
from women. I’m going to find them in all
their different communities at whatever level they may be in
the university, all the way down to the most impoverished,
landless women. So at the same time that I was
funding mostly research from New York, I was learning
enormously from the realities of women’s lives and writing
reports and holding meetings and so on to help my colleagues
understand what are the realities than women live. This isn’t just about a number
of children or how many women die in childbirth. This is about violence. It’s about sexually-transmitted
diseases and what that means not only to
their health but to their social standing. And so this combination of, on
the one hand, scientifically based evidence, logical
argument, but bringing in the qualitative work of what
are women’s lives like. What are the factors that
constrain them from reaching their full potential? It was just vital. Now, we don’t need
that so much. There’s been years and years
of this kind of investment. The difficulty we really
face is this siloing– whether it’s in your own
training, discipline by discipline, department by
department, or whether it’s in the separation, very often,
of the researcher from the policymaker. So the policymaker doesn’t get
what he– usually he– needs. And so it’s that iteration
that a new generation now needs to come up with. DYAN WIRTH: Now, Julio
actually likes to talk about this. He likes to talk about the
T-shaped individual, a person that has a real in-depth
training in a certain area but then has enough knowledge, sort
of deep knowledge, of the other areas to address
big problems. And I think that’s what
you’re saying. So not only do you need
discipline depth, because you have to be an expert. You have to generate evidence
or help create policy. But then, you need to understand
the other fields. And it’s very interesting to
hear that from someone whose life was in the practice area. Because that’s one of the big
discussions we’re having now at the school. Now, maybe switching topics just
a little bit– can you give us a sense about the
social and cultural and religious taboos– obviously, this is an
area which touches many aspects of life– and where you think that plays
a role and how one needs to address that going forward? ADRIENNE GERMAIN: Well, that’s
also a very important question for me, because it’s very
common question. And it’s a challenge to all of
us, actually, who’ve been working to promote sexual and
reproductive health and rights in other people’s countries. And from the beginning, I’ve
always been very aware of being an outsider. But the fact is that, from
the earliest time– my experience in Peru, which
I’ve mentioned– I’ve learned what I
know about women. And also I have learned my
feminism from women in these other countries. And from the point of view of
all the women that I found during those years with the
Ford Foundation, when I mentioned that I reached out
to try to find women, they just deepened my own knowledge,
my skills, my understanding of what it is that
women need to mobilize and to two act vis-a-vis their
own governments or their own communities. In fact, I used to get in
trouble with American feminists, because I’ve not read
any of the literature. I don’t know it. A lot of my life work has been
built on making certain kinds of compromises, which is
something that I really wanted to mention here today. And that is that, as long as
you have a commitment and a knowledge of what it is
that you want to do– and in my case it was to reduce
an area of extreme and very widespread injustice. And you keep your eye
on that ball. When you work in the policy
arena, and even to a great extent if you’re doing research
in other people’s countries or you’re teaching
people from other countries. You can move and tack,
as in sailing. You know, you can move off your
course a bit and then come back onto it and
then move again. But if you don’t have that very
clear conviction out in front of you, several
things happen. One is– and that’s what’s
happened after the population policy changed. And we have reproductive
health and rights. Many people in the population
and family planning field adopted that language, either
with no understanding of what it really meant for
their own work. Or– I’m sorry to be cynical– they adopted it because it
was politically correct. But they went on doing
the same work. And there’s a lot of pressure
to do that. From day one in the Ford
Foundation, very early, I had a colleague say to
me, Adrienne, why are you doing this. You’re going to ruin
your career. Here you are this young,
bright thing. And why are you focusing
on women? It’s happened to me
over and over. And whether it’s about
focusing on women specifically, or whether it’s
taking up a sexual and reproductive– sexual and– and rights perspective, to
bring those two things together has been entirely
innovative. Many of the funders and
national governments– that includes finance
ministries, who are really strapped for resources. And I know all about that,
having worked in Bangladesh in the worst of the worst years
after the Civil War and the famine of 1974. But there it there is out there
a whole world of people and institutions that do not
recognize entitlements. They do not recognize
human rights. They rather want to know, well,
what is simply and only the scientific evidence. And I can tell you from my life
experience that, if you go only with your scientific
evidence– and I mean they’re mostly
quantitative. And you don’t get down and
really understand what, in my case, women and adolescents
lives are like. You can go way off course. So it’s a constant learning. And the researchers, I
think, are important. DYAN WIRTH: Good. So why don’t we let the students
ask some questions? I think there are a number
of people with questions in the audience. So do I have a volunteer? MARTIN REEDY: Thank you. Good afternoon. My name is Martin Reedy. I’m a second year masters
student in the Department of Society, Human Development
and Health. And I was just wondering. You mentioned having drafted
a budget memo while you were at Ford. And you also spoke to
the need to have the data, to have data. And I’m just wondering, there
are a lot of us here very mindful that we have
to have research. And we have to be
very good at it. And you mentioned the T, being
a T. But what are those other skill sets that aren’t in the
research lane that would be beneficial for us to focus on,
especially if we’re looking to not only work domestically, but internationally, that you think– I understand you love
being a researcher. And that’s great. You enjoy that very
specific area. But make sure you get some
of these skill sets before you move out. ADRIENNE GERMAIN: Well,
I would say, there are several really. And they’re probably evident
from what I described to you about my own development. And that is, the sooner you can
go to whatever place it is that people live whom you
care about, the better. Understanding the reality
of those people’s lives. Whether it’s people who are at
high risk of malaria, or as in my case women, especially
those who are most disadvantaged. So the first thing is, get out
of this building, however you can possibly do it. And even if you leave this
building and are going on, say for example, as I did in
college, a household survey or an in-depth research project
or even an operational research project to see how well
a certain intervention is working, make sure you put into
your schedule, your time, the possibility to reach out
to local people who may be able to connect you more with
the wider community of the people you’re concerned about,
not just the respondents in your research. The second thing then– and you’re not taught these
things anywhere that I know about, in a formal sense. But it’s the development
of advocacy skills. And I found when I was hiring
for the coalition, that actually, people with MPH
degrees were often very strong candidates for our jobs. Because they had the core
abilities to look at research, to understand the data, to
question the conclusions, but then also to bring a wide base
of data and research findings together and say, what does this
mean in terms of, in our case, women’s lives or
adolescents lives. And who do we want to influence
that might respond to such information? So actually be the MPH degree is
a very important one, I’ve found, in my own work of making
this bridge between the scientific evidence and
the policymakers. DYAN WIRTH: OK. We have some additional
questions over here. REBECCA ROSS: Hi, I’m
Rebecca Ross. I’m a two-year masters student
in Health Policy and Management. And I was wondering what do you
envision for the future in women’s health and
human rights? And what obstacles do
you think we’ll face in 10 or 20 years? ADRIENNE GERMAIN:
10 or 20 years– Well, for all of us who’ve done
this work, we had to have a 20-year vision. But we never thought of it that
way because, frankly, that seemed too long to
let women go on dying unnecessarily or suffer from
violence and so on. But I think the challenges that
you’ll face right in the foreseeable future– that may be three years
or five years– is the overall economic
situation for the countries that at least I know about, and
I’m concerned with, and for the external donors, the
government donors like the US government or the Europeans,
but also the multilateral system, the United
Nations system. What happens when resources
become so scarce is terrible struggles. And the disadvantaged people,
whether they’re disadvantaged by their sex or by their race
or by their income, have the least opportunity and power
to affect those changes. And right now, we’re
in a period where– let me take HIV and AIDS,
because I, from the beginning, understood that to be part of
sexual and reproductive health and rights for women. But from an epidemiological
point of view, women are vulnerable. They’re not at high risk. And the donors in the UN system
who advise national governments are driven by
the core understanding epidemiological principles and
models, which I respect. Which is to say, that you want
to try to reach those who are at the greatest risk of being
infected and transmitting. Now, in most of the highly
effective countries of Africa and South Asia, if you only look
at those people who are very hard to access and reach
with services and so on, what’s going to happen and
what has happened is that girls and women who are
vulnerable are more than half of those people living with
HIV and AIDS now– and in particular among the
adolescent group. Adolescent girls have far higher
rates of infection in several African countries than
their age mates who are boys. And why is that? Well, that’s where you have to
look at the social conditions. Now, UNAIDS, which I’ve spent a
great deal of time with, has some emerging rhetoric about
this, has failed utterly to put money into it, to assign
skilled staff. They think that if you’re going
to deal with women, you can just have anybody. It doesn’t matter. And this is a typical
kind of response. I’ve seen it over
and over again. And it’s not to criticize or
jeopardize any one in United Nations’ agency. We just are in a situation not
much different from where I was on population policy, where
people at the core of the HIV-AIDS power structure
have come into that from a very different life experience,
which has been not the world of women, the women
and the adolescent girls who are so vulnerable, but rather
other populations who are very, very important. We want the women to be added. We want adolescents. We want AIDS money to support
comprehensive sexuality education for adolescents, not
disease education, of which there’s quite a bit, but
comprehensive sexuality education that really prepares
young people for a different kind of life than their
parents or older cohorts have had. But there’s just no fundamental
understanding of that among those who are making
the funding decisions. I deal a lot with PEPFAR, the US
foreign assistance program for HIV and AIDS. And it’s the same picture. So what I’m saying is, there’s
a lot of work to do, a lot of educating to do. And in these years, several
things are going to be most important that had been
important all throughout– marshaling the evidence; getting
it to the people who make a difference, in terms
they can understand; make arguments that are based
on their own vested interest, not just ours. But it took a long time for
the AIDS community to recognize how vulnerable
women in Africa are. And yet, the main response has
been there only on vertical transmission, including
by the US government. And that is not going to really
get us out of the situation where– while we try to reach the men
who are having sex with many, many partners or we try to reach
the sex workers, the high risk groups, more and more
women and younger and younger women are
being infected. So it’s a combination of that
passion, that women’s reality. Another thing I think I haven’t mentioned is gaining access. In my life I’ve had the good
fortune to have access to someone like David Bell, and
later on, Franklin Thomas, who was the foundation president
who sent me to Bangladesh. But if your career, if your
interest is to see things change directly and not only
produce the data and information for the change
you want to see. Then, advice that was given to
me by the head of the National Planning Commission in
India in 1976 is what you have to know. And it’s the same thing that
Sujatha Rao said in one of the forms here. Data are not enough. And what Raj Krishna
said to me was– and at that time I was actually
working on rural wage rates and the desperately bad
discrimination against women in agricultural labor. And he said to me, look Adrian,
you can generate whatever data you want from
all these economists that we’ve gotten together. But the fact is, rural wage
rates in India are not going to change until women
take to the streets. And that has come up to me
over and over again. So it’s the combination of the
advocates in the movement with the researchers and the evidence
generators that is, I think, so vital to
these issues. DYAN WIRTH: Great, thank you. There’s at least another
student question. But let me just intervene here,
just for a quick answer. And then, we may come back
to it at the end. One of the things that has
really changed in the world, if you think about the late to
2000s and the early 2010 year, is the sort of advent of social
media, of really access to information through what we
would call non-traditional channels, and also with that,
the spread of mobile technology, particularly
cell phones. And I just want you to reflect
a little bit on what impact that might have. Is that a game changer
for women’s health? Or is it just a fancy new
technology which everyone is talking about? So you can think about that. Well, you could answer
it a little bit now. But I don’t want to take the
whole rest of the time. ADRIENNE GERMAIN: Well, I think
it’s a game changer. I was in Bangladesh last year
with a large NGO called BRAC, which I’ve known since
it started in 1972. And it’s only now, however
many years later, in the last– I think it’s about
three years– that they started to include in
their health program basic prenatal care and support for
normal childbirth and then effective referral for
complications of childbirth to district or higher-level
hospital. And one of the main impediments
in Bangladesh actually had been getting women
to come for such care in the first place. It has one of the highest rates
in the world of women giving birth at home. And it’s a problem that I’ve
worked on for a long time. The cell phone, in this
context, was amazing. The women in these
communities– this was a flood-prone area. They’re living in bamboo-sided
shelters on pylons or whatever you call it, in the most
crowded and difficult conditions you could think of,
including malaria and dengue fever and whatever, because
of the water. But anyway, in this very, very
most basic room near the community, they had placed
mid-level health care providers with cell phones. And then, in certain parts of
the community where the women are living, they gave cell
phones and informed the community that, if any pregnant
woman got into difficulty, they could
call the birthing center and et cetera. So that was unimaginable
a very short time ago. Similarly, if you’re going to
give women a full package of health care, we have to move
toward health systems which can provide a record that’s
centered on the woman. And that’s feasible to manage
in the health system. So all of this effort now to
have health workers in the field input data for each client
or each patient, there and then, at the time, and
immediate transmission back to the center wherever that is and
into the computer rather than having to go through
the hand-entry process and all is amazing. Because if you’re really going
to follow the woman, which is the key view that we have,
you have to have the clinical data on her. And this is transforming the
possibility of actually creating a patient record
that is in the system. It’s not a piece of cardboard
paper that the woman has to keep track of herself, which
is how we used to do it. It’s rather this amazing
electronic process. And so I think there’s
a lot of potential. DYAN WIRTH: All right. We have another student
question yet. SUSAN FIELDS: Thank you so much
for taking the time to be here with us today. It’s really a pleasure. My name is Susan Fields-Meade. I’m a student in the QM
department of the Master’s in Public Health program. And my background is in both
biology medicine and anthropology. And I can’t help but wonder,
through this whole conversation and through my
work, about the structural and systems-based inequalities that
continue to limit women’s access to power and economic
opportunity. And I see this playing out in
a conflict that we have between our biological bodies
and our biosocial bodies. Meaning that our biological
bodies dictate that to have babies early and often is
preferable from health standpoint. But our biosocial bodies prefer
later or never, to have children, in terms of access
to opportunity. So I was wondering if you had
any comments regarding that, specifically regarding
contraception as sort of a temporary fix to allow women
greater access to the system that doesn’t account for their
biological needs as reproductive beings. ADRIENNE GERMAIN: It’s a
challenging question, perhaps because as much progress as has
been made for some women in some parts of the world
that I know about. For example, in the
higher-income or the middle-income countries now,
like Brazil and Mexico or supposedly India, women are
facing, I think, the challenge that I understood you to put
out, which is to delay childbearing so that they can
complete higher education and have professional opportunity
and so on and so forth. But so much of my work,
actually, is today still with hundreds and hundreds of
millions of women where that’s not the question. It rather is that the social
conditions are forcing them into very early marriage, proof
of fertility by having a pregnancy immediately– preferably in too many
places, a son– where they don’t have even the
social possibility, because of a violent husband or a
disagreeing mother-in-law, to decide when they want to
have a baby or not. It’s such a fundamentally
different situation. We’re seeing some small
increases in some countries in the average and median age of
marriage, for example, which is bringing many more women into
a safe time period, like having babies from say 16 or
17 onward not at 12 and 14. But basically, that’s what
this struggle is about. And it’s about really the self
determination of women, that women make their
own decisions. I don’t know what to do after
all these years to redesign and encourage societies to
adjust so that, truly, women and men can have equal
opportunity and the equal ability to decide. Because most societies have not
yet raised their sons to understand and to accept a
joint, fully-equal role in the household in childbearing. And as long as that’s the
case, whether in the corporations or in the couple
itself, women are going to have to be super women
and do it all. And so it’s tough. But I think it’s one of the
reasons that, when I was first drawn into this work by women in
other countries, that human rights and gender equality were
so central to all of it. It wasn’t a fertility
issue by itself. It wasn’t a health
issue alone. But we have to bring about
changes so that women do have fully protected human
rights and equality. Now, I think partly that means
raising sons differently. And that’s why our own work
shifted more and more to younger ages. Not neglecting the women, we
still are out there for all the women, but realizing we
have to incorporate the adolescents. And now, we’re realizing– whoops. We have to go to children as
young as seven or eight. So that’s politically very
challenging to do. But I wouldn’t do it, and I
wouldn’t be here if I didn’t have the full hope and
expectation that that is the right thing to do and that we
have the people and the energy, particularly in the
countries, to do it. DYAN WIRTH: Yes, that might be
the challenge of the 10, 20 year time frame. ADRIENNE GERMAIN: Yes. DYAN WIRTH: Great. So I think we, unfortunately,
don’t have time for more questions. But thank you very much. If you’d like to say a few
concluding remarks, we just have a couple of minutes left. It’s a pleasure to
have you here. ADRIENNE GERMAIN: Well, I’m
delighted to be here because the only way these changes are
going to happen is through new generations like you. And the only thing I’d like to
say, I think, is really that you follow your passion, decide
on something you really love to do and want to do, and
always keep that conviction in front of you– no matter what the
opposition is. And there will be more
or less opposition. It’s not easy. But finding allies, whether
they’re organized allies or just informal colleagues– and of course, through the
internet, you all have much more capacity now. It’s crucially important because
health policy making is fundamentally political. We cannot get away from that. And in order to sustain your
conviction through that kind of political process,
you need allies. You can’t do it by yourself. DYAN WIRTH: Great. Adrienne, thank you very much
for a very inspiring session. ADRIENNE GERMAIN: Thank you.

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