The Challenges and Opportunities in the Field of Global Health and Development

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Podcast

In this episode, Crown Family School Associate Professor Alida Bouris is joined by Ertharin Cousin for a conversation about the challenges and opportunities in the field of global health and development. Bouris's research is broadly focused on the relationship between social context and health, with a particular emphasis on understanding how social inequality, social networks, and social support shape the health and well-being of historically excluded and marginalized youth and adult populations. Cousin is the CEO and Managing Director of Food Systems for the Future. She led the United Nations World Food Program from 2012 until 2017.

This conversation was held during the recent launch of the Susan and Richard Kiphart Center for Global Health and Social Development. Housed in the Crown Family School, the Kiphart Center will build on the University of Chicago's global health efforts. The Center aims to further integrate multidisciplinary expertise and expand collaborations to promote community health and well-being in communities around the world.

Iframe Video

 

We'd like to thank Augusta Read Thomas, University Professor of Composition in the Department of Music and the College, who composed the music.

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Transcript

Announcer: Welcome to the UChicago Crown Family School Podcast, presented by the University of Chicago Crown Family School of Social Work, Policy, and Practice. In this episode, Alida Bouris is joined by Ertharin Cousin for a conversation about the challenges and opportunities in the field of global health and development. Bouris is an Associate Professor at the Crown Family School. Her research is broadly focused on the relationship between social context and health, with a particular emphasis on understanding how social inequality, social networks, and social support shape the health and well-being of historically excluded and marginalized youth and adult populations. Cousin is the CEO and Managing Director of Food Systems for the Future.

This conversation was held during the recent launch of the Susan and Richard Kiphart Center for Global Health and Social Development. Housed in the Crown Family School, the Kiphart Center will build on the University of Chicago's global health efforts. The Center aims to further integrate multidisciplinary expertise and expand collaborations to promote community health and well-being in communities around the world.

 

Alida Bouris will begin with an introduction of Ertharin Cousin.

 

[Music and applause.]

Alida: I have the distinct pleasure of introducing Ertharin Cousin and leading a discussion over the next hour. So Ertharin Cousin currently serves as the CEO and Managing Director of Food Systems for the Future, a nutrition impact investment fund. She also is a Distinguished Fellow at the Chicago Council on Global Affairs, a Bosch Academy, Robert Weizsacker Fellow, and as a visiting scholar at the Stanford University Center on Food Security and Environment.

From 2012 until 2017 Cousin led the United Nations World Food Program. As Executive Director Cousin guided the 14,000 member WFP team to feeding more than 80 million people each year, while also identifying and championing longer-term, more sustainable solutions for global food insecurity and hunger. And there’s more.

 So in 2009, Ertharin was nominated and confirmed as the U.S. ambassador to the UN Agencies for Food and Agriculture in Rome. Prior to her global hunger work she helped lead the U.S. domestic fight to end hunger, including service as the Executive Vice President and Chief Operating Officer of America’s Second Harvest, now Feeding America.

She is currently a member of the Bayer AG supervisory board, the Mondelez International board of directors, the Royal DSM sustainability board, and a trustee of the African agriculture think tank Academia 2063. She also is a graduate of the University of Illinois at Chicago, the University of Georgia Law School, and an alumnus of the University of Chicago executive management program, finance for non-financial executives.

She has been listed numerous times on the Forbes 100 Most Powerful Women list, as the Fortune Most Powerful Woman in Food and Drink, on Time’s 100 Most Influential People list, and as one of the 500 most powerful people on the planet by Foreign Policy magazine. Please join me in welcoming Ertharin Cousin. [Applause.]

Alida: I know it’s not always easy to hear yourself be introduced, so thank you.

Ertharin: I smile. I say where’s my mother? [Laughter.] Because you always want your mother to hear that. But what it tells me is I really need to rewrite that bio, cut that thing in half. Anyway.

Alida: Okay. So thank you for taking time to talk with us all today. Your commitment to ending food insecurity and hunger embodies the goals of the Kiphart Center and the Kiphart family’s commitment to partnering with communities, researchers, and policymakers to address global health inequities.

So we have a diverse audience here today, including, I see, many of my own students and I imagine students and practitioners who are starting their careers in social work, public policy, and global health. So to start, I’m hoping you can share with us how you came to this work and what continues to drive your work to secure health for vulnerable communities around the world.

Ertharin: Well, first of all let me thank the Susan and Richard Kiphart Center for Global Health for including me in this announcement, this launch of what I am hoping will become a force to be reckoned with in the space in helping us develop the answers to some of the world’s complex problems. I appreciate this opportunity to be here with you this afternoon.

So what got me started in this work? I am plagued by the fact that I have not yet written a book. And I say plagued by it because I feel like it’s like the sword hanging over my head that I haven’t. But I have the title for the book, and the title is Born This Way, because I was born into a family where service was part of the values that we were given by my parents. I grew up in a household where my grandfather was farm laborer, okay? That’s the language we use.

But at the same time he was so committed to having my mom, who was obviously a quite bright young woman, educated. And so she was the first person in her family to go to college. And he worked picking cotton and worked in the plants in Washington, Georgia, but my mom went on to Paine Women’s College. And when she married my dad and moved to the South Side of the city of Chicago, it was, for them it was all about how do you make your community better.

And so we were the household that my dad belonged to every community organization. I often say he made community organizing—he was a community organizer before Barack Obama made it popular. He was on every community organization in the 1960s when we were progressives in the city of Chicago, you had the Progressive People’s Action League.

And he worked for every progressive candidate on the West Side of the city of Chicago after we moved there, sat on the board of every organization. And as a result his children were responsible for passing out the literature, preparing all the chairs, making sure everybody had water in every meeting, and so we grew up hearing politicians at our table talk about what was necessary to change community policy, what was required for people to get involved to drive and increase the number of people who were voting at the polls, and working every single election passing out literature. And I smile because I said and then my—I’m the oldest of four girls. My sisters all grew up and got jobs. I made a living out of this, because I realized that this was…making a difference in the world was what I wanted to do.

I’ll tell you one last story, and that is during the riots in the 1960s, and many of you are too young to remember the riots on the West Side when we burned, when the entire city was on fire, what I was doing, I was ten years old at that time, I wrote a petition, a hand petition, I handwrote a petition, and I was knocking on my neighbors’ doors, while the city’s burning down, telling them we needed to save the baby seals … and getting all of my neighbors to sign a petition that my parents helped me send to the White House to save the baby seals.

And the President actually wrote me back. I’m sure it was somebody down in an office somewhere who wrote back and thanked me for my commitment, and they still have that letter. But it was a fam—that was just an example of my family’s commitment to supporting this child, who was so out of step with what was actually happening in the world, but committed in her own way to making a difference and to telling me that it was okay for me to do it my way, just keep doing it.

And so when you have that as the basis of how you are brought up, like any value, it stays with you. And so that was what started me down this path. And we can talk about the long, winding path. But what keeps me going in that work is that I’ve seen success. I’ve seen babies who do not starve. I’ve seen fat, healthy babies in some of the worst places around the world when we get it right. And that’s what keeps me going every day, when things are really hard and really tough.

Alida: So I want to shift a little bit to talk about your leadership in the United Nations World Food Program. So as I mentioned in your introduction and we saw in the video, you led the World Food Program from 2012 to 2017. And the World Food Program has been called the largest and most effective humanitarian organization in the world.

So we find ourselves at a particularly fraught moment with food insecurity, in particular, with global food systems that are strained by ongoing social, health, economic, and politician crises, including the war in Ukraine and the ongoing climate crisis. So I’d like to ask you, drawing on your own UN expertise and ongoing leadership to address food insecurity, how can an organization like the Kiphart Center support the long-term goal of ensuring the presence of a robust food and social safety net for vulnerable populations around the world?

Ertharin: This is exactly the type of center that the world needs right now. And I’m not saying that because you invited me to speak here today, because Susan Kiphart’s sitting here. But more important I’m saying that because we need to ensure that we are developing policies and programs that are based upon data, science, and research, and the challenge that we have is historically academic leadership, academic success was about research and publishing, publish or perish.

That’s how you got tenure, that’s how you receive stature. But there’s a recognition that we need academics outside the ivory tower. We need the work that, and the outcomes of that work, that you perform in order to support the development of policies that are based upon science, that are based upon data, that are based upon facts and not just a whim of an elected official or what we too often see, donor directed ideas about what will work.

And even worse, the policy, the programs that we see implemented or the policies that we see developed that are based upon political and too often, when we’re talking at the international level, geopolitical issues as opposed to the outcomes that will ensure that we can create opportunities for prosperity for the entire global community, opportunities to support the creating, for me, where I spend my time, an equitable, sustainable, and just food system. That will not come without the type of work that will hopefully derive from the efforts and the scholarship of those from this center.

We need systemic change in the relationship between academia, public policymakers, multilateral institutions, and even the private sector. And unless there is a concerted effort to change those relationship dynamics, to change the desire for and the commitment to partnerships in different ways it will not happen. Because it’s not easy. Those of you who have attempted to take your research and turn it into policies or programs have the experience, you have the lived experience of the challenges, of bureaucrats who too often change, have too much on their plate, and are not often, too often are not receptive to even academic support.

There is a movement afoot to change that paradigm. But what we need is to ensure that we have the academic interest in changing that paradigm because if we are out there demanding that we have more partnerships between multilateral agencies and the academic community, multilateral agencies and the political community, as well as the NGO community where programs are often designed after being funded by governments and implemented on the ground, and academia doesn’t respond, you don’t have the tools, the wherewithal, the financial support to assist in developing those partnerships, we will fail.

So I’m excited that you’re developing a center with that level of partnership, collaboration, and drive towards outcomes that will affect people’s lives as the basis for the work that you are going to perform.

Alida: So I have a follow-up question. So as you’re talking about the need for academics to get out of the ivory tower, to move beyond the publish or perish model, and the importance of collaboration, I think a huge part of that is the importance of local community and ensuring local community has a seat at the table. So I’m curious to know if you can talk about what your experiences in leadership have taught you about the importance of harnessing local knowledge to effect change and really assuring that local community has a meaningful seat at the table and not a tokenized one.

Ertharin: First of all, it’s hard. It’s really hard. There is a growing movement toward localization of program design, program implementation, to support the resilience and sustainability of programs and the implementation of policies that are community led and community supported. The reality is I can say those words, but making it happen, there’s so many reasons why we’re stumbling. First of all—and it’s how donors spend their money. Donors tell you they want localization of programs, i.e., a seat at the table for local leaders.

Yet they still fund the same organizations. They don’t fund the local organizations. They don’t provide the capacity-building that is necessary for the local organizations to take a seat at the table and have the ability to contribute at the level that will ensure that their voices are heard. And so it requires moving the policies that will support increased funding for local actors. And you will hear all of the well, there’s a level of control, accountability for taxpayer dollars that are necessary to ensure, and to ensure that we must go through the organizations and have the systems in place to support it. You can’t have it both ways. And so that conversation is ongoing. So that’s one piece of it.

I think the other hurdle to ensuring that seats at the table include local leaders, local actors, those with lived experiences who are often responsible for maintaining and operating programs long after the international professionals have left the community, the hurdle is our lack of respect for those who don’t have a degree from the University of Chicago or Harvard University, and the mother who comes from the field into the community center to sit at the table, and to the voice that she brings from her lived experience as a factor for consideration in program design or policy development.

And that’s a historical challenge that we must all overcome if we are going to make localization, local participation, a reality. I’ll give you one last example. As we were preparing for the UN Food System Summit last year one of the indigenous community leaders from Latin America was was talking about the importance of indigenous knowledge in agricultural production and ensuring that along with academic knowledge, along with the institutional knowledge that was developed by the World Bank and other facilities that indigenous knowledge should rise to that same level of credibility in the conversation.

And everybody nodded. And everybody nodded. But it didn’t happen. And so we had about 200 NGOs walk away from the UN Food System Summit before the final document was released because they felt as though the summit was a…the outcome was based on the recommendations of those from the private sector, government and multinational civil society organizations, but not indigenous and local organizations. And if we truly want to create durable action on the ground, we need to move from lip service to truly implementing the commitments that we make.

Alida: I have a follow-up question which I’m curious to know, is what was the response to the NGOs walking away?

Ertharin: Frustration on the parts of many. I say frustration on the parts of many. When you’re working with the UN and governments, our international organizations were not created to listen to the voice of people. We created institutions that the member states of those institutions, those who lead it, those who fund it, are governments.

And more…and over time we’re seeing more space for private sector and other philanthropic organizations, and even multilaterals. But most governments don’t want to hear from their people in their national documents, in international outcomes. And we are witnessing, again, as we…you mentioned this looming high food price hunger crisis that we all can see on the horizon and are watching every day one more pillar fall to an acute hunger crisis that we’re doing little different to forestall. You can see that our institutions are not fit for purpose.

And I am not here to denigrate the multilateral system or governments. We get a lot right. But we also have many, many blind spots, and one of them is how we provide voice, space, and opportunity to be heard for those who are not members of the institutions or organizations or governments that our multilateral system was created to hear and to include. And so there’s a lot of work.

Again, that’s why I’m excited about the Kiphart Center because I am hopeful that the type of research that you will do, the students that you will educate, the leaders that will walk through these halls begin to recognize that there is value in the research that includes those indigenous voices, those local voices, and through their research, through their youth and enthusiasm and lack of jaded—[laughs]—attitudes are willing to take on these hard challenges of changing how our systems work.

Alida: I couldn’t agree more. I’m thinking I teach an implementation science class here, and we’ve been having a conversation around the concept of reverse innovation which emerges in different health literatures, which is the idea that good ideas can come from low and middle income countries. And just I think implicit in a concept like that, right, that you even call it reverse innovation, like this idea that innovation only comes from centers of power. And so I think academics and researchers have such an important part to shift, a role to play in shifting that paradigm and in really elevating local voices, and for us to learn to listen more and talk less as well.

I’m going to shift to a related question. And you’ve answered some of this, but I think it’s worth asking you explicitly. So, you know, when I look at your work across the course of your life, the goal of the Kiphart Center, I see a really strong emphasis on the importance of being proactive, of building and encouraging and sustaining leaders and systems—and I’m going to quote you—“to rise to a challenge before it becomes an emergency.” So I’m wondering if you have lessons to share with us about what you’ve learned from your own leadership in that area.

Ertharin: I often talk about preemptive humanitarian action. And this is not a new concept. See, when the weather man comes on and forecasts a storm that will—and the rivers will rise about its banks, the government invests in sandbags, the community comes together, and we stack the sandbags. In humanitarian response we wait until the water’s in the house and then we say it’s an acute emergency, there’s a CNN moment, and we provide the assistance to help people bail the water out of their houses. When, if we stack the sandbags, we could have saved the house. We could have saved the money for rebuilding the house and eliminating the mold from the house, and all the… We know that preemptive action is seven times less expensive than acute humanitarian response.

Yet again, the systems are not in place to support preemptive action. We have systems that support development work which are very long processes of concept notes, and program design, and timeline development, and platform creation, all the things that we do to support the design and implementation of a development system. And we have emergency, acute emergency response. We provide food to people when they’re hungry. We’ve modernized our systems. When there’s food in the market we provide cash to those who’ve been affected so that they can buy food.

But we don’t, as part of the emergency response, when we can see it coming, but we know the challenges—farmers don’t have access to the fertilizer that they need, they don’t have access to the seeds that they need, or the capacities that they require in order to change their agricultural production to more precision agriculture to increase the quality and quantity of their yields in times when the rains aren’t coming as … an emergency response … in anticipation of what will happen. I had the administrator say to me just yesterday, Ertharin, I wish I had more money. And she said but could the agencies actually do that? Said the agencies do what you pay them to do. You pay them to distribute food, so that’s what they do.

When I was at WFP, and during the Ebola crisis, I called the president of the World Bank, Jim Kim at the time, and I said give me $50 million and I will create a logistics network to support all three of the African countries that are affected by the Ebola crisis. We will create a deep field set of warehouses, transportation system, and distribution system. And he said, really? I said we are the logisticians of the entire humanitarian system, but you guys just think that we bring food. You don’t really think about how it gets there and the skill set that’s inside the organization.

So let’s take that skill set and use it to create an effective health response. And we did it. And to the point where the U.S. military was in Liberia and when they were asked what is your scale down plan, because the military will tell you when they come in on a humanitarian response they say we’re big, we’re noisy, we’re expensive, and everybody wants to know how quickly we’re going to get out. He said our exit strategy is WFP. As they increase their presence, we can reduce ours. The capacity is there, but we need leaders who have the ability to see beyond what we’ve always done, to design programs and interventions based, again, upon data, and science, and what is possible to help us do it differently.

Alida: How can an organization like the Kiphart Center—we have an amazing amount of resources, an amazing amount of leaders, and thinkers, and practitioners—help leaders to be…to think outside the box, to innovate, to step away from what they’ve always done in the past?

Ertharin: I think about what the Crown Family School is known for. It is known for the work that you do that has application outside of the academic setting. And you pride yourself on the applied research that you perform here, the cross collaboration with other institutions.

And now you have the money and the support to, and the mission, as I’ve read it, to think outside that box. And to use those resources to build the relationships that will support the implementation of the research that you develop, the students that you train, getting them into those places where they can make a difference. The comments about the luxury of having University of Chicago students. I taught—I’m still affiliated with Stanford and I taught at Stanford. I actually taught at the Institute of Politics here in the fall of this year.

And I know what good students University of Chicago attracts, the students Stanford attracts, and those students are coming into these institutions today with the idea that they want to change the world. Now if you’re at Stanford they want to build something that’s going to make them a billion dollars, and everybody’s sitting up at night trying to figure out which, you know, what app are they going to create.

But when I was here at the University of Chicago I had a number of students in my seminar who were sitting there every day saying how can I make a difference. And shame on the leadership of this institution and of the new Kiphart Center if you don’t shape those students by giving them the experiences, the academic support that is necessary to turn that desire to do something different into helping their ability to actually change the world.

Alida: We are running out of time to do so.

Ertharin: [Laughs.]

Alida: So in our prior conversation, when we talked about preparing for today, you and I talked at length about the importance of media literacy and the need for academics to better communicate their research to the public. What are your recommendations for helping academics working within the Kiphart Center in the area of global health, and as we saw today really addressing some of the most complex health challenges to better communicate their research with the public and with policymakers?

Ertharin: We talked about the quality of the students here at the university. Let’s talk about the quality of the faculty here at the university.

As my grandson, who’s over at the Lab School, will say, I’m scared of you all. You know, just it’s amazing the level of intellect, the number of Nobel prizes that come out of this university. And there’s not a faculty member here, regardless of whether or not they have tenure, who doesn’t feel like they should be here, who doesn’t believe that their research is quality and of the highest quality, and exceeds that of their peers. They may not say it, but most of them believe it and some of them will even say it.

But that level of confidence in your capacity as an academic is the same level of confidence we need in translating the work that you perform here into the action that is necessary to support the outcomes that we’ve talked about here today that we must deliver in order to solve the many complex problems that require us to address them in order to create a more sustainable world, in order to achieve the Paris Accord, in order to achieve the sustainable development goals, in order to create peace and prosperity.

And as I said before, it is hard. But you know your work better than that policymaker, better than that program operator, better than that media person who’s interviewing you. I often have to tell myself that before I go into a room where there are people I think…I said oh my god, I can’t believe I’m speaking in this place, that I know more about what I do than anybody in this room.

And so when you can, … I attended Madeleine Albright’s funeral a couple weeks ago, and someone recalled when she, on the floor of the Security Council, said 'get some cojones and do what is necessary,' and everyone said we can’t believe she used such language. But we all remembered it. And it’s important, though, that we do recognize that nobody’s going to… While we talk about the need for partnerships with academics, while we talk about the need for collaboration and using academics to ensure that we’re developing better programs and better policy, there are very few people who sit in the chairs today who are waiting for you.

It doesn’t mean you shouldn’t go see them, it doesn’t mean that you shouldn’t knock on the door, it doesn’t mean that your research, your work is not necessary, is not appreciated. And it may not be appreciated by that legislator or by that media person, but by the person on the ground who receives better service because the program was better, the policy was better, because of your intervention, that person will appreciate your work. And that’s who you must always remember that the effort that you put forward to drive the changes in our policymaking and our programming, that’s your audience. You may never see that person, but that’s your audience.

Alida: I think that speaks to what you said at the beginning about being driven by values and commitments beyond yourself to do this work. I have a final question for you, So, you’ve described yourself as a pragmatic optimist, and certainly in talking about a lot of the complex challenges that we’re faced in the world today it can feel quite overwhelming to confront the multiple forces that produce and reinforce health inequities. How do you maintain your optimism?

Ertharin: Well, I’ll go back to where I started. When I was Executive Director of the World Food Program I would not take pictures with a starving baby, a baby with flies on their eyes. The world’s seen too many of those children, to the point where we don’t believe we can change. Those fat, healthy babies that I talked about in the refugee camp or in a situation of abject poverty, or after an acute crisis where we’re supporting a vulnerable community, those were the babies I took pictures with. Because that’s the goal, is that all babies have that opportunity to live through those first thousand days fat and healthy.

I was in Haiti, and I was sitting…we were out visiting one of the projects, and there was a woman sitting on the porch of a house with literally nothing. You went inside this house, there was a bed, there were a couple pots where…some firewood where she cooked. And the entire ground around her house there was no vegetation, it was all dirt. And it was black dirt. She had this baby who was probably, it was less than 18 months old. She had the baby in her arms and the baby was wearing a white shirt and white pants, and there was not a speck of dirt on that baby.

I took a picture with that baby because I wanted mothers and fathers around the world to see that in the worst of conditions there was the same level of commitment to the children by their parents as any mother anywhere in the city of Chicago, city of New York, and that with support we could help that mother make a difference in that child’s life.

And so that’s what keeps me hopeful, is that I get to see those babies. And I still do. I still go to the field and spend time with those moms and those babies because that’s why you perform this work. That’s what keeps me optimistic. And that’s why I am rooting for the success of the Kiphart Center.

Alida: Wonderful! Thank you so much. [Applause.]

Announcer: The Crown Family School thanks Alida Bouris and Ertharin Cousin for this conversation and Augusta Read Thomas, UChicago University Professor in the Department of Music, who composed the music. If you would like to learn more about the Crown Family School of Social Work, Policy, and Practice, please visit us at crownschool dot uchicago dot e-d-u.