Jeanette Vega: putting equity and resilience into global health
(The Lancet) - With its centenary next year, the Rockefeller Foundation's mission remains unchanged: promoting the wellbeing of humanity worldwide. But the landscape a century on is very different, according to Jeanette Vega, who became the Foundation's Managing Director earlier this year and leads the agency's global health programmes. “There are so many complexities in our world today. Social inequities are widening. I see the priority of my role to ensure that we fund projects that expand opportunities for more equitable growth, and that increase resilience to populations under prejudice and stress”, she told The Lancet.
Advance Health is one of four interlinked areas that the Foundation operates in (the others being Transform Cities, Secure Livelihoods, and Revalue Ecosystems). One of Vega's key objectives is to implement the Transforming Health Systems (THS) initiative, to which she brings her wealth of experience in public health. This 5-year project focuses on four target countries—Ghana, Rwanda, Vietnam, and Bangladesh—to show how a nation's health can be advanced through strengthened health systems and the ultimate goal of universal health coverage. Getting THS embedded into a UN resolution after 2015, in the post-Millennium Development Goal era, is a priority for the Foundation.
Vega emphasises the importance of resilience in development programmes. What does she mean by this? “Here's an example”, she explains. “During the next three decades, 60% of the world's population increase will occur in Asia's cities. And eight of the ten countries most vulnerable to climate change's effects are located on that continent. So development efforts in these places must include primary and persistent emphasis on building greater resilience: integrated urban planning, land-use regulation, water management, infrastructure investment, and emergency preparedness. Resilience is crucial in all aspects of human development, and not just health development.”
Born in Santiago, Chile, at a time of great advances in social policy under the socialist government of Salvador Allende, Vega grew up with the country's free education and national health service. But the turbulent political change that resulted from Augusto Pinochet's coup in 1973 had a profound influence on her direction. “It was the extraordinary shift from a progressive social democracy under Allende to the Pinochet dictatorship that was the turning point in my life. I wanted to have social influence and thought that medicine was the vehicle for doing this.”
It was, however, public health, not clinical medicine that inspired Vega, as she obtained postgraduate qualifications from the Universities of Chile and later Illinois in the USA: “I fell in love with public health, being able to care about the needs of the individual at a population level.” Her thesis on the effects of preterm birth in Chile highlighted the importance of equity as a key driver of health outcomes. “The results were always the same—the most disadvantaged people had the highest prevalence of disease and mortality”, she says. “I knew then that my over-riding goal was to pursue equity in health.”
Ricardo Lagos, the first socialist President of Chile after Pinochet, invited Vega to join a national assembly on the reshaping of Chile's health system. But just 2 years later she left her homeland for an office in Geneva, at WHO, to establish a new department on equity, poverty, and the social determinants of health (SDH). The outcome was the landmark WHO Commission on SDH. “I have great memories of my time at WHO, it was inspiring to work with incredible individuals like J W Lee, Tim Evans, and Michael Marmot, and to implement something I felt very important to global health”, she says. During her time at WHO, Vega also raised awareness of the need for health systems strengthening.
But Chile called again, when the country's first female President, Michelle Bachelet, invited Vega to be Deputy Health Minister in 2006. Bachelet, who left office in 2010 and is now Executive Director of UN Women, comments on Vega's contribution: “As Undersecretary of Health, Jeanette was a dedicated member of my cabinet. Her overall vision of public health as a key contributor to everyone reaching their full potential for health, independent of their social and economic position, was fully aligned and concordant with the social and people-centred focus of my government.” Vega's passion for health equity was put to work in the ongoing reform of Chile's health system, with the formation of a pioneering 13-step health equity plan. “This was a different kind of thinking”, Vega explains. “Rather than relying on the population to come and access government health services, health was just one social programme that families could access through an integrated social services package.” This radical integrative approach has had a lasting legacy by becoming enshrined in Chile's legal system.
Vega then moved into academia as Director of the Centre of Public Health Policy at Chile's Universidad del Desarrollo, teaching public health and doing translational research, before joining the Rockefeller Foundation. Just 3 months in post, how does she see the Foundation's future priorities in global health? She barely pauses for breath. “We must ensure that universal health coverage is sustainable and embedded in the global health agenda; we must create a clear roadmap with overarching goals post MDGs; and we must ensure that universal health coverage includes the child health perspective, otherwise it will never happen.”