Q&A with Dr. Essue

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Dr. Beverley Essue is a Global Health Systems Leader and Health Economist. She is an Associate Professor of Global Health at the University of Toronto focused on strengthening health systems, supporting effective and equitable priority setting and advancing equity and gender equality. She is also a Leader in key global health initiatives including the Disease Control Priorities initiative, the Lancet taskforce on noncommunicable diseases and the Lancet Commission on Gender Based Violence and Maltreatment of Young People.

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What did you want to do when you were younger (just starting your educational career) and how did you go from that to who you are today?

 

My earliest memory of what I wanted to be was a doctor. Going through high school, I was good at science, and math … and from a career counseling perspective, many people were sort of steered according to these arbitrary boxes: you're good at sciences means you pursue the doctor/nurse/dentist path. I was definitely only exposed to more traditional professions and being a doctor seemed attractive at the time.

 

I  started my undergraduate degree and became a little bit more exposed to a world beyond being a doctor. I think that exposure helped to change what expectations I had for my career. I certainly didn't set out to become a health economist or a health systems researcher - I only came to have a better understanding of what those professions entailed through my master's degree. I then went on to do a PhD so I suppose I became a ‘doctor’ in the end. 

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Throughout your journey, did you ever encounter any barriers to success or growth as a black female leader? 

 

I have a very clear memory from grade school. I was a fairly rambunctious and opinionated child and I had a teacher berate me in front of the class and yell: “Are you out of your cotton-picking mind?” After mentioning this to my mom, she immediately demanded a meeting with the teacher and principal and insisted on an apology and a commitment that this language would not be tolerated in the classroom and the school. At the time, as a 12 year old, I didn’t fully grasp the meaning of this term. But the experience taught me at an early age that there was zero tolerance of racism in our family and that it was important that we feel empowered to advocate for ourselves on this issue. 

 

I went on to study in Australia. Australia has a history of having a contentious relationship with race. It goes without saying that there are issues with systemic and structural racism there, as is the case in most other countries. Despite this, I feel fortunate that I can not identify and pinpoint explicit and blatant examples of barriers during that stage of my career. But I think this is a key point: so much of this goes unseen and is not  easy to pinpoint. 

 

I have certainly experienced impacts in my personal life, that’s for sure. But professionally I would say that it hasn't been a feature that I could say has fundamentally altered the course of my career, to my knowledge. I recognize that I’m fortunate to have that as my experience, because it's not the common experience for everybody, that’s for sure. 

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In terms of your personal achievements - I'm just curious as to what you consider to be your biggest professional achievement to date?

 

It's an interesting question that I've been reflecting on recently. It was part of my training early on to celebrate all wins and to ride all your lows. I can’t pinpoint one defining moment. My career is better characterized as having a series of smaller, isolated events, that have collectively really contributed to where I am today. For example, I was successful in getting an overseas doctoral research award, to fund my PhD in Australia and through that opportunity, opened numerous doors. While there, I had opportunities to be involved in really important global health work with incredible mentors - which has shaped my work as a global health systems researcher  - opening other doors to collaborations and opportunities from there. I really value all of the smaller wins I’ve experienced that as collective have shaped and influenced the success that I've achieved. 

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The work you are doing for the Lancet Commission on Gender-Based Violence (GBV) and Maltreatment of Young People is exciting and will be an important step to help many women that suffer from GBV across Canada - made even more relevant now that GBV has augmented due to the pandemic. In our previous GBV series, we highlighted how GBV is a public health crisis. In what ways do you think your work will impact the health and conditions of Canadian women? 

 

It's an important point. Early on in the pandemic, GBV was being described as a “shadow pandemic” - but it's not a “shadow” pandemic at all. Actually, it is a pandemic that has existed and has largely been ignored. As we look at the many silver linings of Covid19 (I try to look at things with a positive attitude), there's a lot of light that has been shone on GBV as a result of the impact of Covid and Covid response. 

 

The Lancet Commission on GBV and Maltreatment of Young People is being co-chaired by Felicia Knaul and Flavia Bustreo, who have done important work in this space and are important Global Health leaders. My involvement is in the economics stream of this Commissions work: I am anchoring the economics work that will generate comprehensive estimates of the cost of inaction, exploring the impacts of violence across the lifecourse as well as intergenerational impacts of GBV. This work will be focused across all world regions and within populations. 

 

GBV is a key priority here in Canada with a lot of attention and momentum developed through the office of the Minister of Women (The Honourable Maryam Monsef). Canada may be developed as an anchor country in this work which will provide really exciting opportunities to leverage the excellent data sources that are available and to explore how these estimates can be used to catalyze more action on GBV by governments, the private sector and civil society. We want to understand these lessons for Canada as well as what they mean for other parts of the world. We’ll explore this in a number of case study countries and I believe Canada will be an important country to include. 

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The representation of women in health leadership is low and even when they are represented it's mostly white women -  Indigenous women and black women are usually underrepresented. How do you think this affects the way in which black women - and women in general - are represented and taken care of by the health system? 

 

I think it's multi-layered. Your ability to see representation as a younger person when you go to the doctor, when you go into the hospital or when you're interacting with the health system shapes your idea about what future you might have. Those are early ideas about role models and what one perceives to be possible. So the representation is important to model what the realm of possibility might be for younger people. 

 

I think it also shapes your experience going through your education. Through high school, there is a lot of career exposure that one can get, and the ability to see someone that looks like them - to see other black leaders - also then offers the opportunity to think: “Actually, this is something that I could achieve within my career”. So it’s about having the representation and also ensuring that representation is actually exposed to the next generation. 

 

I attended a really interesting session on unconscious bias training that was offered through IHPME (Institute of Health Policy Management and Evaluation) earlier this week and they showed this shocking pyramid of the proportion of women in Canadian universities in 2018/2019: It starts out with a fairly even ratio of  men to women at entry level into University studies (Bachelor degree). But as you move up the pyramid, at the top, I think it was 21% of Tier 1 CRCs are held by women and 4% of CERCs. I find this appalling. If you add an intersectional lens and consider race, there are even fewer black women. So there's the representation piece here is missing. But I think there's also the value that we get from having different perspectives sitting around the table. Diversity and diverse perspectives bring different life experiences and different takes on how one addresses an issue. Businesses are realizing that you stand to grow by having that diversity - there is actually a profit associated with it. 

 

I think within Public Health, we need to constantly be thinking about new ways and better ways to solve some of the persistent and pervasive health issues, particularly inequities in health outcomes that we're seeing within populations. And that needs all hands-on deck and an ability to have a place at the table for people who have important experiences. My research helps to support decision making and priority setting for health systems. So while I'm not providing direct care, I think the ability to understand how we shape the questions that are relevant is important. How do we ensure that there is disaggregated data to even be able to show that there is a problem - that we know exists through our own lived experience? How do we ensure and push the boundary so that those data are available and then can factor in to support decision making,  which hopefully will then flow back and improve patient encounters. I think representation in leadership is critically important to be able to start to create this meaningful change. 


 

When starting this project, we realized that people were not aware about there being a gender disparity in health, which is thought to be a female dominated field - so it’s true that even in regards to this, people need to be aware of the problem sooner.

 

While it is true that women provide the majority of healthcare, when you actually start to look at the distribution between who are the actual providers - proportion of doctors - even to the proportion of nurses, midwives, community health workers... the bulk of women are often still in lower paid professions or being paid less for similar jobs. The gender wage gap in the health and medical field is a topic of my current research. What we see is that equal numbers or even more women enter into medicine. But several studies show that the actual opportunities for progression differ, there are differences in the number of female to male full-time equivalents in medicine and this is especially true for leadership roles which are still dominated by men. Women in Global Health have tagged the line: “Led my men, delivered by women” to acknowledge this disparity and persistent gender inequality. There has been progress, but not nearly enough or fast enough.

 

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Say you’re someone that's just starting your career, how do you move forward when someone tells you that your ideas or personal goals are impossible?

 

My advice would be that no idea is a bad idea. This links back to the importance of mentorship and mentorship opportunities. The role that I take on quite seriously is: how do I support the person I'm working with to nurture those ideas, to grow those ideas, to understand how those ideas exist within the context of other potential options, and help that person to come to a decision about how they pursue it. Everyone has to be interested in their own area of research. I think that the amazing opportunity we have in Academia is that we're not all researching the same thing. My advice would be that I wouldn't take it as the final word. I think we have the ability to write freely and so if we have ideas about the way we want things to be done, or ideas about what we want to achieve, find other people to speak to and float those ideas off of. Find like-minded and supportive people who are going to amplify you and your capacity. We need to foster imagination and innovation in this pipeline of people coming up into public health - that happens through nurturing and mentorship, not through dismissing ideas.

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You mentioned that you've been mentored in the past. In terms of fellow black female leaders that you worked with, what kinds of traits have come up that you admire and that you've seen make successful leaders?

 

One that stands out for me in particular is this idea that we can all rise up together. We (in a collective sense) don't have to hold each other down in order to achieve success. There's room for success for everybody - in fact, we should celebrate each other's successes. We should be there for each other when things don't go as well. And that has translated into some really meaningful things: being part of a research group where you're very comfortable standing up and presenting preliminary work to people who might not have been involved ... you do this because they genuinely have an interest in seeing you succeed. They are constructively critical in the work, and that's not seen as they want you to fail. It's this constructive criticism that will help you to present your work in a better way - that applies to grants as well. Having internal opportunities for internal grant reviews where it isn't about being worried that “you're gonna steal my idea”. It’s more about, ‘how can I assist to help you present yourself in the strongest way and you will do the same for me. And when you get it and I don't get it, there's no ill feelings because through your success, we all succeed. So it's not a trait as much... I think it's an approach to working. It's a mindset that has left an imprint on me and impacts the way I collaborate and it impacts the way that I do my own work as well. 

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What are some words of advice for those that want to pursue a similar career path as you: go into Global Health and reach a leadership position within Global Health?

 

We hear a lot about imposter syndrome: this feeling of  “do we deserve to be in the place that we are”. It’s something that I certainly struggle with from time to time and I think a lot of us do. I think we have to recognize that there are objective things that we can look at - like what we have achieved - to show that we do deserve to be there, and we do have the qualifications that are required. So my advice would be to try not to listen to that voice that might say: “oh, I won't apply for this thing because I'm not ready”. I think: believe that you're ready and do it. You learn from every single rejection of a paper, you learn from every single rejection of a grant... every job that you don't get gives the experience.  I think all of those experiences culminate to help to push us forward. So trust yourself is the other piece I'd add as well. 

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If you could say there's one takeaway from today for our members that they should carry on going forwards. What would it be?

 

To persevere. We are in a moment in time right now where attention to equity, diversity, inclusion has never - at least in my experience - been where it is, which comes with a lot of opportunity. It's forcing all of us to recognize the important value and appreciate that we have a right to be at this table, we have the experience and we are good enough to do it. So persevere and trust yourself and don't be afraid to fail. You take the chance, you take the risk and you learn from it.  If it doesn't work out, you pivot and you move on. There's strength in being able to move in that way. 

 

I hope that younger black women who are thinking about a career in Global Health will listen to this and see that it's possible and that it's needed now more than ever. The problems facing health more generally, but also the development of global health systems, need fresh perspectives. Those don't necessarily come from Canada, either. I think we're lucky in Canada to have a diversity within our population - that is a real strength. The solutions that are required to address the global health problems need different faces around the table to really help us get there. So it's an exciting time. 

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