Paula A. Johnson, Executive Director of the Connors Center for Women’s Health

MAURA FULTON: Good afternoon
and welcome to Decision Making, Voices from the Field
leadership seminar. My name is Maura Fulton. I’m a second year master student
in the Department of Health Policy and Management and
an executive member of the Women in Leadership student
group here at HSPH. It is my pleasure to introduce
Dr. Paula Johnson, who will be speaking to us about leadership
and action in women’s health. Dr. Johnson is an
internationally recognized women’s health specialist, and a
pioneer in the treatment and prevention of cardiovascular
disease. She is the executive director
of the Connors Center for Women’s Health and Gender
Biology, and chief of the Division of Women’s Health at
Brigham and Women’s Hospital, where she is responsible
for developing an interdisciplinary research,
education, and clinical program in women’s health. She is the founder of the Center
for Cardiovascular Disease in Women, where her
work has centered on developing new strategies for
the prevention of heart disease in women and to
spearhead research that advances understanding
of the impact of gender on heart disease. She is recognized as a national
expert in the area of quality of cardiology care
for women and minorities. Dr. Johnson serves as chair of
the board of the Boston Public Health Commission, and is
a member of the National Institutes of Health Advisory
Committee on Research on Women’s Health. She’s a graduate of Harvard
University and Radcliffe college and earned her medical
degree at Harvard Medical School as well as an
MPH here at HSPH. Dr. Johnson is the recipient of
several awards recognizing her contributions in women’s and
minority health, including the Abigail Adams award from
the Massachusetts Women’s Political Caucus, which
recognizes women leaders who have demonstrated, through their
work, an outstanding commitment to the realization of
equal political, economic, and social rights for women. Dr. Johnson serves as a role
model for men and women leaders alike, and it is an
honor to have her here with us this afternoon. I will now turn the seminar
over to our moderator for today, Dr. Jennifer Leaning. Thanks. JENNIFER LEANING: Thank you very
much for being here, and that introduction was
great, thank you. Paula, you and I go way back, as
we were talking about this. We met in the emergency
department at Brigham and Women’s Hospital. It was just starting to be an
emergency department, and you were just starting
your career. You were there a resident. It was during your residency,
wasn’t it? And we won’t say how many
years ago that was. PAULA JOHNSON: Some of these
guys might not have been born. JENNIFER LEANING: It was
fascinating to think about the paths that you’ve taken. And there are several
paths you’re going to talk about today. The paths you’ve taken and the
challenges you’ve faced, and over that pathway, how you’ve
develop your notions of leadership and women’s
leadership in particular. And I’m hoping that you will
begin by giving us an overview of that path and how things
develop for you in your mind and then in the community. You have helped shape both here
in the hospital community and public health community,
but really nationwide and internationally. PAULA JOHNSON: Well, Jennifer,
thank you. And Maura I want to say thank
you for that really wonderful and very generous
introduction. And Jennifer it’s, so special
to be here with you. We’ve come a long way
over those years. Both of us, I think, have
evolved in very different ways that we might not have
known at that time almost 30 years ago. JENNIFER LEANING: Well, you
weren’t supposed to say that. PAULA JOHNSON: But I think,
first of all, it’s wonderful to be here and to really think
about leadership and have an opportunity to reflect
on my own work. Because I think sometimes you
just do it and you don’t have an opportunity to
think about it. And I think doing this session
today has given me an opportunity to reflect a little
bit, which is always extremely helpful. And as I think about leadership
and my own leadership in women’s health,
and particularly at the Connors Center, we tend to think
about leadership in this very hierarchical way. You’re the head of something,
whether it be the hospital, the school, an organization,
a department. And it all flows from there. I think my leadership has really
worked in somewhat different ways, which is I’ve
really had to lead and to manage a matrixed
organization. And if you think about women’s
health and many of the problems you will be facing or
are facing that you’re going to address, figuring out how
various disciplines work together, how do you work across
disciplines, is going to be very important. And I think that’s been a
cornerstone of the work that I’ve had to do. Another important dimension has
really been influencing and really taking that deep
understanding, that deep base of knowledge that you develop
through your research, your clinical skills, and whatever
you do, but taking that and really using it for change. And probably the greatest
example in my own work and at the Connors Center is taking
that deep expertise in research and clinical care and
really bringing it to the policy world. How do we bring that knowledge
and help to frame issues through an informed women’s
health lens? And then the third is really
around collaboration and more collective leadership. You’re not always out in front
as a leader, but you are partnering. You’re really thinking about
what is it that you bring that changes the frame, brings a
unique perspective that’s important in advancing
the agenda. And I think there probably our
work in global health. And we can talk a little bit
about these areas later. But I think it’s really those
three areas of leadership that I think have really defined my
own leadership, particularly over the past 10 years. And I would venture to say, as
you go out in the world, these are dimensions that will be
very, very important to you. So I just want to get to the
Connors Center, because we’re going to talk a little bit
about my own journey. The Connors Center is an
interdisciplinary center. It’s hospital-wide, and we
really focus on building the scientific base. So, how do we better
understand? And really through discovery. Discover how men and women are
different in every aspect of health and disease. We do everything from more
basic science, to epidemiology, to clinical
epi, and then health services research. How do we take that science and
translate it into clinical care, to models of care that are
important for women, that are based in science
but also where we focus on the workforce? How do women in the workforce
need to work differently as they address particularly
women’s health? We are really focused on taking
that deep knowledge, as I just said, and translating
it, bringing it to policymakers. How do we train that next
generation of both scientists and clinicians to think much
more interdisciplinarily? And then how do we bring that
framework of women’s health, particularly as an academic
medical center, to the global health arena. So that’s really what the
Connors Center does. We also have a very strong
academic routing with the division where I can recruit
faculty and promote them. That’s the credibility. That’s the foundation of
academic medicine. So we have that as well. The center is 10 years old this
year, which is also an exciting time. It took me 20 years to get
there, though, you figure if we met 30 years ago. I know I keep saying that. JENNIFER LEANING: Always
fun to have friendships go for 30 years. That’s something for you
to look forward to. PAULA JOHNSON: But if you look
back 10 years, just turn the clock back, the Brigham decided
that it was going to really launch into women’s
health beyond its traditional strength in Obstetrics and
Gynecology, and at that time, primary care. They didn’t exactly know what
that meant, and there was one venture into it that kept
women’s health siloed, and that didn’t work. So they decided they were going
to take another leap, and they were going to really
focus on this hospital-wide initiative, not exactly
knowing what it was. But I just want you to think
about that time a little over 10 years ago. It was 10 years, so
that was in 2003. 10 years from the 1993 NIH
Revitalization Act. And that was the law that
actually mandated the inclusion of women and
minorities in NIH trials. Before that, women and
minorities were not included in trials in any
great numbers. So it had been 10 years since
that time, and it had been about a year since the Institute
of Medicine had published their study
that sex matters. Now, we might all know that. And they coined the term every
cell has a sex, which was really phenomenal. You know, every cell has a sex,
meaning that there are fundamental sex differences in
every aspect of health and disease, and we are
only at the very beginning of that discovery. So this was the opportunity. And at the same time, the whole
discipline of health disparities, understanding
health disparities where the Harvard School of Public Health
is really a leader, was also really getting
a major foothold. So, this was an exciting time to
think about women’s health, the opportunity in science, the
opportunity of translating that science, and also
incorporating this whole area of health disparities. And I thought, what could not be
a better opportunity for a person like myself who was
somewhat nontraditional– I’ll talk a little
bit about that. But where my passion for
women’s health had been longstanding, it was back in
college, and I won’t tell you when that was exactly, but back
in college when, during my freshman year, I took a
course with Ruth Hubbard. Does anyone know who Ruth
Hubbard is in this room? Nancy knows. Ruth Hubbard was the first
tenured biology professor at Harvard, and she taught a course
on gender and health. And it really focused on how
being female and sexism that was experienced in science
really influenced the way science was carried out
and also the way health care was delivered. And this was an eye
opener to me. And we looked at it both domestically, but also globally. I mean, can you imagine? This was late ’70s. So I think from then, this was
a path that I knew I’d follow at some point. And then about a year and a half
later, I went and worked for a small health policy
organization called HealthPAC. And it was in New York
and in Union Square. I can almost remember this
little office there. And we were looking at how do
you do research, looking at differences in health care
delivery based on race and socioeconomic status, and how
do you use that knowledge to impact policy. So it was exciting, but what was
really interesting and I think served as an important
model to me was the person I worked with. His name was Hal Strelnick, and
we’re friends to this day. He was not only working
at this health policy organization, but he was a
well-respected academic at Montefiore Hospital and was
head of the Preventive Medicine Training Program. And here was the first time that
I experienced somebody who had a foot in these
two worlds. He was bringing his credibility
as an academic to not only the study of
disparities, but how do you translate that information
actually into real policy. So I think those experiences
really informed my interest and path, and they were
really exciting. And when the opportunity to lead
the Connors Center came up, it was those interests
married with, I think, what were my skills that I developed
at that time that I think really made it
a perfect fit. And I’ll say just a couple of
words about the development of those leadership skills. Because as you guys sit in the
audience, you’re thinking about, OK, where am I today
and where will I be in 10 or 20 years. And some of it is planned,
and some of it is totally serendipitous. And for me, I’m going to share
two experiences, one of which was serendipitous,
and one which was really a strategic move. When I was about 29– so probably the same age as
some of you in the room– I was asked to join the board of
Planned Parenthood here in Massachusetts. And I was asked because people
knew that I had a deep interest in women’s health. They knew my research. I’m a clinical epidemiologist,
so I study patterns of care. They knew my research, and
they thought that I would bring something important
to their board. I joined the board, and lo and
behold, six years later, I became the chair. And so it was a phenomenal
journey being part of that organization. But as I launched into
becoming the chair, I immediately, through that
organization, had credibility in the advocacy world, which
would become very important later on. I also learned how to do certain
things, like lead a group of people who were far
more senior than myself. I learned how to raise money,
I learned how to make a case for raising money, and I learned
how to really work in very different types of teams. So that’s an experience outside
of the Academy that I never would have expected to
inform where I am today, but without a doubt gave me some of
the skills that, as I was looking at this job 10 years
ago, I absolutely needed. And then the second one was I’d become the head of quality. Quality was a new area. Quality of health in major
teaching hospitals. Now, you might wonder,
how do we go from women’s health to quality. And I still continued my
work in women’s health. I was leading cardiovascular
disease in women. But I knew for me to get to the
next step in an academic medical center in thinking about
these problems across institutions in a big way, I
really needed some experience managing a large organization,
managing a budget, and also working with leadership. And this was a matrixed
organization that served a very important role that allowed
me to bring in my interest in women’s health,
focus in women’s health and minority health, to become part
of the core strategies of looking at quality in
a major institution. And I learned how to work
with the leadership. I learned how to manage
a budget. So when it came time for the
Connors Center, as I look back, there were many
experiences over time in addition to the academic one
that really informed my ability to take that
on into shape something that needed shape. JENNIFER LEANING: Could you
a few examples of sort of leadership pivots or challenges,
either ones, that you’ve personally faced? Real examples. You can leave the names out. Or in terms of how you’ve been
mentoring and developing young leaders, leadership challenges
that they have faced? PAULA JOHNSON: OK, so
perfectly frank. When you’re leading a matrix
within a traditionally hierarchical organization– and that’s what I do– that presents any number
of challenges. Because just because I’m
passionate and I’ve been given a mandate doesn’t mean that
every last leader in the institution has the same
passion or commitment. That I do. JENNIFER LEANING: And recall,
we’re thinking about chairs of departments medicine. Chairs of neurosurgery, chairs
of vascular surgery. So we’re deep bastions of
established American medicine. PAULA JOHNSON: That’s good. Deep bastions. And also remember, here I am
really working very hard to be inclusive of the traditional
definition of women’s health, which is Obstetrics
and Gynecology. It’s all about reproductive
health. But I am now saying, we are
saying we are going to really expand the definition. That can be a little sensitive
to people who do much more traditional women’s health. So, one of things I learned
very early on was that you really had to meet leaders
where they were. You had to meet heads of
departments where they were to work with other department
chairs, to work with other leaders both internally
and externally. They didn’t necessarily have to
bring the same passion that you did, but you could meet
them for wherever the intersection could be. And it might be about
the business case. It might be that, gee, I really
think that focusing on women’s health is going to be
very important to my bottom line because it’s going to bring
in more women patients. It might not be where I start,
but it’s a start. It might be that there are
certain faculty who have particular interests and I want
those interests fostered. Can you work with
me to do that? A very important area, and
one that we’ve been very successful across the
institution in terms of building faculty. JENNIFER LEANING:
An interesting point here is that– So, here she’s talking about
leadership and trying to get buy-in, and one of the tactics
is to find common ground that might be slim. But another of the tactics
is to ask those other people for help. That’s often not what you
anticipate or would think would be a leadership strategy
for buy-in, but actually I think that’s worked with
you in several occasions just as you said. PAULA JOHNSON: Absolutely. So as I think about the
challenges, those have been places where I’ve learned a lot,
and then figuring out how to bring leaders along to a
point of much more advanced thinking around women’s
health. Another leadership challenge is,
I’ve talked a little bit about the policy agenda. That is not a traditional
agenda for an academic medical center. I think here at the School of
Public Health, you’re used to thinking about this. But taking your expertise, your
work, and really thinking very actively– it’s a pretty
activist role– about how that work may
influence the health of women locally as well as nationally
is not the usual business of an academic medical center. And I do think that
was a risk. It’s been a challenge. It’s still a journey, but one
that has, I think, been tremendously beneficial in terms
of the work we’ve been able to accomplish, but also
in helping faculty and coaching faculty to think about
the actual implications and translation of their work. JENNIFER LEANING: There are two
things I really hope you can touch on. One is you run, you design, set
up raise the money for– and for years now, it’s
been thriving– the Global Women’s Health
Fellowship at the Brigham. I know some of the people
who’ve gone through that program. If you could talk about some of
them and some of the things that excite you about how
they’ve grown in that fellowship. And then the other is the
leadership of the Boston Public Health Commission,
which is extraordinary. And that commission has made
some major changes in public health under your leadership. PAULA JOHNSON: So just to
thank you, Jennifer, for bringing those two up. The Global Women’s Health
Fellowship Program has been a very special part of the Connors
Center, and if you remember, I talked about those
three dimensions of leadership. I think this really sits
squarely in that collaboration area where we saw a very
significant need for really reframing some of the work
we were doing globally. When I say we, I’m saying
the royal we. The at the Brigham, at Harvard,
at the School of Public Health. How do we take that amazing work
but reframe some of the problems through a women’s
health lens? So yes, there’s the work that
is traditionally women’s health focused, like maternal
mortality and issues around sexual violence, but there’s
also cardiovascular disease, an emerging health problem that,
through a gendered lens, there’s the biology and the
social environmental issues. Pulmonary disease. Think about the social
environmental issues about cooking stoves. This is fundamentally a
women’s health issue. HIV, I think everyone’s
familiar, obviously, with the gendered aspects of HIV, but
some of the work in HIV and keeping the gendered lens
very clear and upfront. And how do you train young
investigators who have passions for these areas to do
the research through that gendered lens? And so we started the
fellowship now it’s six years ago. It is totally philanthropically
supported. We train about two fellows
each year. We’d hope to train more, because
there’s an absolute growing demand, to do research,
to be investigators looking at health issues
globally through that lens. So an example is cardiovascular
disease. One of our senior fellows this
year is finishing up and her area is cardiovascular disease
in women in India and really understanding what the risks
are, what the environmental factors around the advancement
and the increase risk of disease, and how we might
learn more in order to decrease risk. HIV in Botswana is where we
partner actually with the School of Public Health to
really look at some of the gendered issues around HIV
transmission and treatment, and also the role of women as
caregivers, which we tend to not include frequently in how we
view and think about health issues globally. So that caregiving role, which
is a gendered role. So those are just two
examples of fellows. But, it’s really an
exciting journey. JENNIFER LEANING: I was at one
of the research seminars that you helped convened with a
number of the fellows coming, and the extent to which they
had received training in public health, epidemiology, as
well as clinical medicine of whatever their field was, was
really quite remarkable. And I think it’s a cadre of
people that is going to make a very big difference
over the years as they’re moving forward. PAULA JOHNSON: The point being,
and I think that that’s exactly the point, which is
that the field of women’s health, the field is
a young field. So, unlike many fields that
have been around for eons, this is a relatively young field
and we are providing the building blocks of the faculty
and others who are now becoming junior faculty who
are now mentoring the next generation. So it’s important not only in
terms of the work that they’re doing, but it’s really building
that base for the building of the field. JENNIFER LEANING: So the Public
Health Commission, then we’re going to turn it
over for questions. OK. I mean you know the one thing I
know that you’ve done, which is about smoking, but would you
talk about that and say what kind of fight that was? It really puts us in a
leadership position around the nation, doesn’t it? PAULA JOHNSON: The role that
I’ve played first on the board and then as it’s chair, of
the Boston Public Health Commission is our public health
department in Boston. And I think it speaks to another
one of our tenants at the Connors Center and I think
why I was tapped to join that board, which is the very
important focus on bridging health care delivery
and public health. And for many of you sitting in
this room, that may be a no-brainer, but I will tell you
that I think as you move out into the world beyond this
phenomenal place, it’s not a no-brainer. You move back to either your
world in public health, or you move back to your world in
health care delivery, and usually there is very
little intersection. And really thinking about how
those world should intersect to advance health– obviously for me is the health
of women, but to advance health writ large– is one of the major challenges,
I think, in our country today. So, it was, to me, a tremendous
opportunity to join the board because it was
bringing a very strong voice that was rooted in health care
delivery but also had a foot in the public health world. And the work that we’ve been
able to do there under the leadership of Dr. Barbara
Ferrer, who’s a phenomenal leader, I think has been
extraordinary. The work in smoking and
thinking about our environmental advancements,
we’ve done a lot of regulations of banning smoking
that have absolutely affected rates of cardiovascular disease,
first in our city, and the state has
followed along. But we’ve also focused on issues
around public health and health care delivery. What should primary care look
like in the future? How do we root primary care
much more squarely in the public health world where
patients are not looked at as being owned by an institution
or a practice, but in fact a part of a community, and part
of a community that has both ills as well as resources? So really, helping to build
those bridges I think, has been a phenomenal experience,
and I think has really put our public health department in the
forefront in many areas. JENNIFER LEANING: Well,
that’s great, Paula. As we know, Boston is
a very diverse city. But there are many pockets and
barriers to having people come together around common issues. And the Public Health Commission
is one that has seen it as a whole. And recognizing the diversity
has moved in ways that will diminish the diversity around
goods delivered in health care, but paying attention
to the diversity that has strengths. It’s a nuanced way of handling
leadership for a very, very large and closely watched
community such as the city of Boston. So, I would very much like to
see if some of you could ask questions and we’ll
just go for as long as you have questions. I have a couple of follow up
things that I could ask Paula, but my hunch is that some of you
may have some things you’d like to ask her about. Yes, please, right in front. Here, you. AUDIENCE: Hi, I’m, Rachel
Liao, and I’m a doctoral student here in the biological
sciences and public health program at the school. Dr. Johnson, thank you so
much for being with us. And my question I think is one
that probably many of us in the room who are women can
relate to, particularly those in academic research and
in medicine, both of which you represent. And that’s the question that’s
discussed frequently about work life balance. And I was thinking as I was
sitting listening to you that you’re in a rather privileged
position to answer a question about work life balance, both
because you are a successful women in leadership, and in
medicine, and academic research, but also because
you study these sorts of gendered issues. And this seems like it’s quite
a gender issue to pursue a career in medicine or in
research, and to also make time for family or whatever
other outside of work pursuits that one might pursue. So I was wondering if you could
speak to that question from both those perspectives. PAULA JOHNSON: Thank you. I think it’s a great question. We didn’t talk about
my personal life. I am married to a physician
who’s a clinical rheumatologist, and I do have
two children ages 11– so a sixth grader– and a senior in high school. So I’m going to say that I
tend to call it work life integration, because I don’t
think there’s ever a balance, and it to me it’s about
integrating the two. And when I say life,
it’s not only– life for all of us in this room
is different, and it’s different at different
points in your life. So it might be children
at one point. But it might be elders, it might
be parents, or friends, or partners. There are very different
things– or desires– to advance ourselves in ways
that are not within your traditional realm of work. And how do you begin
to integrate those? Into the studying piece,
you’re right. We actually do use the Connors
Center as a laboratory, in a way, to study different ways
of configuring work so that women in particular might have
opportunities that they would not necessarily have had. So I’ll you a concrete
example. We started a 13 specialty, very different type of practice. It’s what we call a learning
laboratory, not because we’re experimenting on patients, but
because we’re experimenting with different models of work,
different models of care delivery , and really trying to
develop a sense that this is a real area of study and
focus that needs to inform how we move forward in
those areas. So we’ve experimented with
different models, what is the infrastructure needed, how do
we do team-based care, but team-based care that really
looks at flexible work schedules keeping, for example, patients at the center. We’ve published on this topic,
and it has been used as a model for others. So I think there is a real
ability to use our academic engines to actually study and
think about these topics. From a more personal
perspective, for me, it’s really been about figuring out
where my priorities are and figuring out how you integrate
those priorities into day to day life. And there is no right
answer for anybody. What I would say, though, is– and I do view myself as being
particularly aware of this– having leadership that values
that integration, that addresses it and makes it part
of the discussion, makes it part of the mentoring, makes
it part of what your advancement must include, to me,
is critically important. So that’s a very important role
that I play in my own leadership as heading a center
and a division, but it’s also one that I think I play with
other leaders in influencing other leaders around advancing
those areas. So I can’t give you a golden
nugget other than, you have to be true to what your interests
are but also understand the demands of your field. And what you do today may not
actually be the same as what you do tomorrow, and to be
open to that fluidity. JENNIFER LEANING: Great,
thank you. There were several
other hands? Yes please, in the back. AUDIENCE: Hello Dr. Johnson, and
thank you for joining us. My name is Denise Asafu-Adjei. I’m am an MPH student here in
health policy and management, and I’m also a medical student
at the University of Michigan here for the year. So my question was, and you
talked about strategy in terms of when you were 29 choosing to
join the Planned Parenthood board and some other decisions
you made that helped you to hone in on different leadership and management skills. I was just curious if you can
discuss some challenges you faced in being a clinician
moving from resident to other senior positions within medicine
and getting people interested about women’s health
and how you strategize when to push the envelope more
with research for women’s health, other community
leadership positions, and how you navigated those different
roles to get where you are today? PAULA JOHNSON: Really
good question. JENNIFER LEANING: If your
question, just to try to pinpoint it a bit, is it how
much attention over time do you give to being a really
fabulous clinician, like full time, and then when do you move
into these other realms, and then at a certain point,
what happens to your clinical practice? Is that part of what you’re
talking about? Because I would think as a
medical student, that’s front and center for you. AUDIENCE: Yes. Thank you. PAULA JOHNSON: OK. So it’s a great question. And I would say that, for me,
as I thought about my own career, there was one thing
that was very clear, even though I knew that my path would
probably be a little bit different, was that if I was
going to stay in the Academy, I really needed the credentials
that an academic setting requires. Which meant that I needed to
figure out which discipline of study was going to marry my
interests and passions with academic advancement. And so really, getting a degree
in public health– My first research mentor was
somebody named Lee Goldman. He’s now the dean at Columbia
medical school. Working with him around these
issues of health care delivery, understanding patterns
of delivery, but getting that deep rooting in the
Academy and in a research focus that could give me the
credentials to move forward, I think, was very important. And then really moving forward,
thinking about what credentials did I need
internally, and I talked a little bit about those. But then in the field of women’s
health, there’s also a need to have some external
focus as well. And so when I was asked to
join the board of Planned Parenthood, I’d been known in
that world, and it’s because I do believe that there is both
an internal aspect to the science and the work, but also
there’s external pressures. The field is inherently
political. I think to advance the field,
you have to have a foot in both worlds. And for me, it was also
important to keep it real. And to keep it real, you really
have to not only stay within your field, but also keep
getting some nurturing and information and partnership from those outside. So I can’t say that they were
any calculated decisions. Only a good sense of knowing
directionally where I was going, what I needed to build
in terms of my own body of knowledge, what were some of the
skills I really needed to know, and how I needed to work
both internally and externally to advance. JENNIFER LEANING: There’s
always an emphasis on credentials if you’re a woman
and you want to have a leadership role. That’s just a given. I mean, there are many new
pathways and new ways of earning a living and having
influence in this world now. Social media, web-based
things, new businesses, et cetera. So, what I just said probably
doesn’t apply to that. There are different kinds
of credentials you have to earn for that. But in medicine, in public
health, in major organizations, to be a leader,
there are these issues of where have you been, where have
you trained, what are your degrees, what’s your
experience, what’s your reputation, very
fundamentally. And I think Paula Johnson has,
both instinctively and then with some strategy, paid
attention to those issues. PAULA JOHNSON: And I’ll tell
you, Jennifer, there have been some tough times, and some,
once again, risks taken, which, when I was launching
into my career– so I was finishing my chief residency
and I was really launching into my training as a clinical
epidemiologist, and I was going to study the impact of sex
and race on the delivery of cardiology care. At that time, my very esteemed
chief of medicine thought that I was making a mistake,
and told me so. And he thought not that the
field wasn’t important, because it was an
emerging field. So it wasn’t the standard,
it was emerging. But he thought that for a woman,
and particularly a woman of color, going into this
field that it could be viewed as more self serving. Now, you can imagine me sitting
in his office and him sharing that with me. And I felt at that moment that I
could take one of two paths. I could take his advice, figure
out where I was going to turn next, or continue to
be true to what my passions were and get the greatest
academic grounding in that possible. I did the latter, and I think
what, to me, was really just a very poignant moment when
probably about five years ago, this very powerful man in
medicine, we were talking and he said, you know, I do remember
what I said to you all those years ago. And he said, and I was wrong. And I just think it was this
moment of just mutual admiration, because it was a
difficult moment, but what amazing insight for him to
come back, remember, acknowledge it, but also for me
to have gone on that path. So these are the things that
you will experience. JENNIFER LEANING: Another
question. Yes, please, and then we’ll
go back to you. In front, here. AUDIENCE: Hi there. PAULA JOHNSON: Hi. JENNIFER LEANING: It’s on. AUDIENCE: I’m Sarah Jenks, a
second year master student in global health and population,
and something that I’m sure a lot of us at Harvard have
grappled with is that with high achievement comes
high expectation. And I was wondering what you
deem to maybe personal failures in your past. How did you overcome them and
look forward towards making it up the ladder? Do you have any personal
suggestions? JENNIFER LEANING: Failure. Failure is very important. Failure is very important
in resilience. It really is. PAULA JOHNSON: Failure is very
important, and also dealing with life’s challenges is
also very important. Because if you haven’t
experienced them yet, they will come. I’m going to share with
you two quick stories. The first goes back to– now,
this might be a little early, but I’m going to share
it, because I think it’s important. I’m from Brooklyn, New York. Any Brooklyn folks? I’m from Brooklyn, and went to
public school in Brooklyn. And my dream, my vision of
myself, was to go to the premiere public high school,
special school in Brooklyn, which to me at that time was
Bronx High School of Science. And I lived to go to Bronx
High School of Science. It was an exam school. I studied for that exam, and
I actually made it in. And to me this was, at that
point in my life, at all of what age, 14, whatever I was,
a crowning achievement. I got there and realized after
a week, I could not do this. The travel was enormous. I felt like a fish
out of water. It was not the right
environment for me. And I came back home and
actually shared with my parents that I really needed
to come back to my local high school. That’s a story about a personal
view of failure, but staying true to what your
experience is and how it speaks to you and
moving forward. And I think that experience in
and of itself taught me that getting the information but
also following my gut was going to be a really important
way to move forward and continuing on the path. The second one is when the
Brigham first decided to undertake this women’s
health focus– remember I said the first
one was a failure– well, I applied for that first
job, which was actually years before the Connors
Center was born. And I didn’t get it. I presented what I thought
was an amazing vision. And actually, the vision isn’t
too far from what we enacted four years later. To me, it was a far-reaching
vision. It had many of the components
that we’ve talked about today. But, you know. The institution was not
ready for that, and I didn’t get the job. I didn’t hear about it. There was this huge gap in time
around who was going to get it and me not hearing
anything. And I learned not only about
what the gaps were, I also learnt how to communicate with
someone if you’re not going to give them a job, as a leader. So your own experiences of
failure help to inform your work as a leader and how
you lead as well. But I didn’t get the job. And I understood why. It was painful for me at the
time, I understood why. But that’s when I took that
information and I said, OK. I need to do certain
activities. I need to get that experience. That’s when I moved into the
leadership in quality. I needed to have a
leadership role. I needed to manage a budget. I needed to lead teams in
a very different way. I needed to discuss and show
how I could translate my research into actual practice. I needed to actually have
a demonstration ground. And I then strategically moved
to that area, always keeping a focus in women’s health and
building another area of women’s health. But that’s how I used those
experiences of failure. And I could come up with many
more, because there have been many more, but I think
those two in particular were important. JENNIFER LEANING: Thank you. Yes, and you? AUDIENCE: Hi, Dr. Johnson. Thank you so much for
sharing all your insight with us today. My name’s Neil Murthy. I’m a MPH student in the field
of global health, and I’m also a medical student in Texas
taking a year off and doing my MPH work now. I was just going to ask, in the
early part of your career as you were developing your
career, were there are any instances when you came in
contact with hierarchy who were completely dismissive of
the work that you were doing and you weren’t able to find
that common ground? And my follow up to that would
be, how did you deal with those experiences in order
to advance your advocacy and stuff? PAULA JOHNSON: I think, Neil,
that’s a great question. And the answer, I’m just going
to be brief, and I think we can have more conversation. But the answer to that is,
yes, there are people who actually don’t believe that
there are sex differences in health and disease. Who don’t believe that the
context of women’s lives both biologically and from a social
and environmental standpoint really require a special focus
and are actually where it’s a field of study, a discipline. So there are those people. But most importantly, they are
outnumbered by the people who actually think otherwise. So I think in this world,
as you move forward and especially in fields that
are relatively new, you find your allies. You work to potentially
influence those who are not interested, but you really have
to move the work forward and find the paths that are
going to give you, and your team, and the people that
you work with the greatest boost forward. And I think in particular, as I
said, in newer fields, this is critically important, because
as you look back 10 years or 20 years down the line
just like I was told, this might ruin your career,
it’s not the path. Moving forward, it might
look very differently. JENNIFER LEANING: There’s also
an aspect that is not immediately obvious in Paula’s
answer, which is that she immediately took the positive,
find the allies. But there is a question of,
when do you confront the people that really disagree with
you and you can’t find common ground on. And I have a hunch how you would
answer, but what do you say about confrontation? PAULA JOHNSON: Confrontation
occurs and is part of leadership. One must learn how to deal with
confrontation with people or organizations that are
confrontational, differences of opinion. And that is where, I think,
negotiation skills are critically important. Once again though, how do you
get the best data to make your case, have the best grounding in
routing in your particular area of expertise? And you may not come out
the other end agreeing. But what you will do is come
out being respected. And I think in many ways, that’s
sometimes the best way to end a confrontation. Because you’re not going to
come to yes, but there’s a respect at the end of the day. I think we could come up with
many examples around where there’s been tremendous
disagreement where you’ve worked to come to consensus. But sometimes consensus
is not possible, but that respect is important. JENNIFER LEANING: Because it
gets back to, you’re going to find these people again
in your lives. They keep coming back. And the respect is really
what matters. So we’re just after
an election. Health care reform
is important. As we’ve discussed, there were
a number of forces that brought President Obama
into the second term. And what do you think needs
to be done now in terms of women’s health, status of women
more generally, and if you want to go into health
care, that’s also obviously relevant? PAULA JOHNSON: Wow, Jennifer. JENNIFER LEANING: We have a few
more minutes, but only if our president were here. PAULA JOHNSON: It’s a great
question, and I think the past four years have been pretty
remarkable if you think about what has been achieved with
health care reform. And inherent in that are the
opportunities for women. I had the honor of being on
the Institute of Medicine committee that was really moved
forward by an act of Congress to come up with
the recommendations for preventative care in women. And I think it was a phenomenal
experience, but it was only an administration that
would have the vision that our current one does
that would accept those recommendations and make
them into the law. So I think we’ve come a long
way in four years, but this next four years is going
to be critical. Because part of our work
has been really taking Massachusetts health care
reform, looking at, studying the experience of women, and
taking that to exchanges as they get developed around our
country, which is making sure that as health care reform is
implemented that the health care needs of women, the health
of women, both from a health care delivery and public
health perspective, are absolutely addressed, but
addressed based on the data. So opportunity number one is,
let’s deliver on the promise of health care reform
for women. JENNIFER LEANING: I think
you’re talking about the health exchanges and what’s on
offer in any state, right? It has to have these
elements in it. PAULA JOHNSON: They will have
various elements, and how those exchanges– so these are where you build the
insurance, but also think about the translation of health
care and the connection to public health. What this looks like in
every single state. So this is happening
right now, and the opportunity is now. So that’s one major area. And the second, I think, if we
think about the advancement of women and the advancement
of women’s health both domestically and globally,
there’s a real opportunity in these next four years to connect
those two, to bring the right coalition of
leadership together to say that this agenda is critically
important both globally and domestically. It’s important because it’s
a major health issue that advances the health
of our world. It’s important because
it advances the economies of our world. And quite frankly, it’s
human rights issue. So this is, I think,
the opportunity– and I’m not going to pretend to
know all the answers, but we do know it is the moment. JENNIFER LEANING: And are you
planning to be at the table? PAULA JOHNSON: I sure hope so. JENNIFER LEANING: I think
we might have time for one more question. One more question. OK, so, great. All right. If you could make it brief, and
Dr. Johnson will make it brief, and then we’ll
come to a close. AUDIENCE: Thank you. My name is Charlotte Gamble, I’m
a PhD candidate can do it here and also a medical student
at the University of Michigan Medical School. Thank you so much for
joining us today. I had a question in terms of
coalition building and finding political will in terms
of women’s health. How have you done that in your
own career to bring groups of people to the same table to
advance one strategy that you see as important? PAULA JOHNSON: That’s
a great question. I’m going to give you
two quick examples. One is some very early work we
did around the affordability of healthy eating
in our state. It’s a major women’s health
issue because women are usually making the decisions,
and we did a study looking at affordability and looking
at some of the affordability standards. We quickly recognized that,
based on the data, there was real opportunity to move
this agenda forward. So it was both an agenda that
we needed to address in the health care delivery setting,
but it was a major public health agenda. And through the study, through
getting the data, we were actually able, in a very
collaborative way because we didn’t own any piece of this, we
were able to bring so many different partners to the table
that it ended up leading to some major work being done
in the city, and then in the state, and most recently with
the Food Policy Council being developed in our state. And I think it’s formed the
basis of a lot of other work that’s happened across
the country. I’m not going to take credit for
all of it, but I think it was really bringing the
science, bringing the knowledge, bringing the proof to
the table and then bringing other partners, and not
necessarily being the voice of the authority, but having
data that was able to bring people together. And then secondly, some of the
work we’re doing in health care reform has been very
important, and a real need to build coalitions. Once again, we’ve served as the
group that’s brought the data, brought the studies to the
table, looking at women’s health, analyzing experience,
coming up with a way of addressing women’s health that I
think is very valuable other organizations. So we’ve pulled together
organizations, a small coalition with the Kaiser Family
Foundation and with the Jacobs Institute of Women’s
Health and a number of other organizations to really think
about how we bring good information to the table that
helps inform policy. And that’s another way where,
once again, we’re not necessarily the leader, but
we’ve brought a very important piece of work to the table
that’s compelling and we’ve used that to build those
coalitions moving forward. So, great question. JENNIFER LEANING: So, this is an
argument for getting really well trained, and for learning
a lot, and always for various patterns and modes of gathering
the relevant information, or even the
information you don’t know if it’s going to be relevant. But go out and find it. This is part of the fabulous
quest of being in an academic setting, whether it’s at School
of Public Health or any one of various faculties at
Harvard and elsewhere. It’s a mission for educated
people, and you are a group of educated people. It’s a mission also if you’re
in anything relating to advancing the cause of
disadvantaged minorities, or marginalized populations, and
in some settings, women. That large population are
in those categories of discriminated against,
stigmatized, and marginalized, even if they may be
in equal number. And I think what’s really
quite visionary and extraordinary about Paula
Johnson is that she never gives up, she’s always
courteous, she is always, underneath, tough
on the issues. And usually, every setting I see
her in– this is true of friends who know her who’ve seen
her in other settings– she’s impeccable
about the data. So I’m delighted that you could
be here and that you and those watching had a
chance to meet her. So, thank you very much. PAULA JOHNSON: Thank you.

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