Mellissa Withers, PhD, MHS – Associate Professor, Keck School of Medicine, University of Southern California

Interview Questions

[OnlineEducation.com] Let’s start by talking about the focus of your work and where it fits into the broader sphere of public health. How would you characterize what you do?

I would say that my work is related to public health in several ways. In public health, we pay a lot of attention to the determinants of health in individuals and in populations. Not just biological factors but also the environmental and the social determinants of health, as well as the behavioral and lifestyle issues. Public health looks at health at a population level with the aim affecting change at that level as opposed to just at the individual level, not that an individual person’s health isn’t also important. My work definitely incorporates that in the sense that I am aiming to help facilitate changes at the population level specifically related to women’s health. So, we’re looking at policies and programs to promote and protect the health of women.

[OnlineEducation.com] So, your research is population based and it has a social/behavioral component related to women’s health issues, which would seem to fit at least one fairly common perception of public health, although I’m not sure how many people outside of the field spent much time thinking about public health prior to this past year.

Exactly. I would also say that public health is distinct in that we prioritize looking at vulnerable populations, including groups of people who are disadvantaged or marginalized in some way. We are interested in addressing barriers to care and identifying the social determinants of health in those communities.

[OnlineEducation.com] You are a professor of clinical preventive medicine, and your graduate training is in community health and global health. What were some of the formative experiences you had along the way – life experiences, academic experiences – that you feel put you on a pathway to a career in the public health sphere?

[Dr. Withers] Well, I never expected to go to graduate school, much less to get a PhD and to become a professor. But I always knew that I wanted to do something global and something to improve women’s lives. I think that stems from opportunities I had when I was growing up to travel abroad. My family did quite a lot of traveling. I would go to other countries and I would see women who were suffering, women who were in poverty, women who did not have enough to eat, women with children begging on the sidewalk. That left an impression on me.

I spent some time over the summers in high school in Guatemala. One summer I volunteered at an orphanage in Guatemala. My job was to play with the babies and to give them some human touch and connection. It seemed like every afternoon when I arrived, I would find out that one of the babies I had played with the day before had died.

It’s heart wrenching to see that and it leads you to ask yourself, why are these babies coming in malnourished, sick, and orphaned to begin with? A lot of it had to do with the conflict that was going on in the highlands of the country. And that definitely left an impression on me. It stuck with me and, when I got to college, I wanted to do something about it. I started working as an interpreter for an asylum project for Central American refugees. At the same time, I had chosen to major in Global Development at UC Berkeley. It was a very interdisciplinary major. You had a list of courses you could choose from, and that’s how I ended up in my first public health course.

To pick up on what you alluded to earlier, I certainly had no idea what public health was back then. But the class was International Nutrition, which tied into the interests I had developed as a volunteer in Guatemala. I had certainly become aware that the death of those children and the suffering of the women I had seen on the streets were issues of social justice. In that first class, I could see the connection between public health and social justice, and I had this feeling of, yes, this is exactly what I want to do.

After that, I took another class in public health and that’s what started me on the path. I graduated from UC Berkeley, I went and got my master’s in global health at Johns Hopkins and, when I finished that program I still wanted more. I didn’t want to just be part of someone else’s research project. I wanted to design my own research projects and come up with my own research questions.

[OnlineEducation.com] What was the time frame for when you were in Guatemala? This was prior to college?

[Dr. Withers] Yes. I would go there during the summers starting when I was in high school. It was the late 1980s and early 1990s.

[OnlineEducation.com] As you looked toward getting your PhD, what kind of research were you primarily interested in doing?

[Dr. Withers] At the master’s level, you are doing some form of research – data collection, data analysis, helping with writing. But you are part of a team and it is somebody else’s research project. I wanted to do my own research in the area of women’s health and in ways to empower women, whether that was poverty alleviation, economic development, education initiatives, or looking at unintended pregnancies and ways to give women more access to family planning.

[OnlineEducation.com] In addition to your interest in doing public health work on issues that affect women, were you aware of or did you become aware of any gender disparities in the field of public health itself? I ask because the studies I’ve seen indicate that women are quite well represented in public health professions, but that the ratio of women in leadership positions remains disproportionately low. Does that align your perceptions and/or experiences?

[Dr. Withers] Yes. Absolutely. A lot of the students in academic programs are women. For example, in my PhD cohort at UCLA there were ten of us and only one was male. But the focus of the program was community health sciences. You tend to see women over-represented in community-oriented public health programs, whereas in biostatistics, epidemiology, and environmental health it’s more evenly balanced in terms of men and women.

[OnlineEducation.com] Closer to 50/50?

[Dr. Withers] I don’t know if it’s 50/50 but it’s typically more balanced than in community health.

[OnlineEducation.com] And in leadership positions?

[Dr. Withers] Definitely a lot more male representation in leadership roles and administrative positions, both in this country and internationally. I’m in charge of organizing an annual international conference on global health. Each year I work with the conference’s host university, which rotates among the participating countries. When I get the list of proposed panelists and speakers it is always predominantly men. I try to aim for a more gender-balanced panel and to make sure we have adequate representation of women as speakers, but we’re not there yet.

[OnlineEducation.com] Do you have any thoughts of your own on what accounts for this in a field in which, by most accounts, there are a lot of women professionals? I mean, in academia you could argue that because seniority can be an important factor in who gets promoted, you’d expect to see more men in administrative and leadership positions today because thirty years ago the people entering a particular field were predominantly male. There may also be cultural biases that come into play in scientific fields, as well as structural impediments to women’s advancement.

[Dr. Withers] I think there is still gender discrimination that is structural in terms of policies or lack of policies that support women. For example, that’s often true when you have women who are coming back to work after maternity leave. In global health there’s definitely an expectation of travel and working outside of the normal nine-to-five work week, which probably discourages some women from entering the field. There is also a lack of female role models in leadership, which can cut down on your opportunities to be mentored by a woman in a leadership position. That can lead to imposter syndrome, where you just don’t feel that you’re good enough professionally as a woman. I remember reading an article several years ago about how if someone is looking at a job posting and there are 20 criteria that candidates are expected to meet, men will apply for the job even if they don’t meet a couple of the criteria, whereas women who lack just one qualification will not apply. I think that the lack of self-confidence that characterizes imposter syndrome is a real thing.

[OnlineEducation.com] Were there points along the way in your career when you remember becoming aware of or being made aware of the unique challenges or hurdles women in the field faced?

[Dr. Withers] I can’t pinpoint one exact point, but in my first full-time job I experienced sexual harassment. When I decided to report it, it turned out there were others in the same office who had experienced the same treatment by the same boss. When we did report it, we were fired. We ended up filing a class action lawsuit, which we eventually settled. But, during the year and half that the suit was going on, he got promoted. And he is still in one of the top leadership roles at his university. So that was a pretty good indication that gender inequalities certainly exist and that there were unique hurdles for women.

I have a different example of a different kind of issue from just last year. I teach a class that involves a number of instructors and universities. We have high-level guest speakers each week. The other co-organizer of this class is a man. I noticed that when the guest lecturer was, for example, a former director of the CDC and that person was a man, he would be introduced as doctor so-and-so. But when it was a woman, even if it was a person who had served as director of the American Health Association, she would be introduced referring to her first name.

[OnlineEducation.com] That is striking. And it can be difficult to tell in a situation like that if what you’re seeing has intent and is malicious in nature or if it’s just a thoughtless oversight.

[Dr. Withers] Yeah, I don’t think there was malice at all. I think there was a lack of sensitivity and awareness. The students noticed it. Some of the guest speakers noticed it. And I corrected him numerous times. But it just kept happening.

[OnlineEducation.com] Given that there are situations in which biases surface, what kind advice and/or guidance would you give to women who have begun to pursue academic studies and/or a career in public health?

There is actually an organization called Women in Global Health that represents a global movement. It works in most countries. And its mission is to increase women’s representation in leadership roles in global health. So, I would say that there is power in numbers. Getting involved in organizations that are taking concrete action to promote women in public health is a good place to start. And it doesn’t have to be specific to public health.

I am also involved in another group called Asia Pacific Women in Leadership (APWiL). It’s part of the Association of Pacific Rim Universities (APRU), which includes more than 50 universities in the Pacific Rim region. APWiL is a similar type of organization that focuses on creating gender equity in higher education.

In addition, I think we need to pay more attention to mentorship opportunities. We need to look for mentors and we need to provide mentorship to women as they are coming up in the field. And there are other things that you can do once you are in a leadership position. For example, if you are organizing a meeting or a panel or a conference, you can commit to having women more equitably represented.

[OnlineEducation.com] Tell me more about your involvement with APRU.

[Dr. Withers] I am the director of the APRU’s Global Health Program. APRU has a number of initiatives. the Global Health Program is one of them and so is APWiL. The APWiL program is aimed at increasing the number of women leadership roles in academia. The people that belong to that organization are senior leaders at their universities.

[OnlineEducation.com] What type of work are you involved in with the APRU in the area of public or global health?

[Dr. Withers] One thing that is really important is that we need to collect data to be able to provide evidence for gender disparities. Anecdotal evidence is great, but we need concrete data that we can present that can’t be disputed. APWiL generated a gender gap report for the universities in the region, looking at trends over time with the hope of establishing that things are improving but, so far, they are not. And they have mentoring programs for newer women faculty at the member schools.

That’s one organization I belong to. Another organization that I think has an interesting spin is Healthy Women, Healthy Economies, which is part of APEC, the Asia-Pacific Economic Cooperation. APEC is a high-level organization that looks at various ways to promote economic development. Healthy Women, Healthy Economies works to raise awareness about the importance of women in promoting the economic growth of its member nations.

[OnlineEducation.com] That seems like an obvious point but, going back the Asia Pacific Women in Leadership organization and the APRU’s Global Health Program, you could make an argument that having women to provide leadership in areas like public health and economic development is, in and of itself, a kind of public health intervention because there are specific health issues that may not otherwise get attention and resources. Does that make sense?

[Dr. Withers] Absolutely. I can give you an example of this. A few years ago I was asked to give a talk at the National Center for Maternal and Child Health in Mongolia. My talk was on culture and how much culture influences maternal healthcare behaviors, including whether or not women utilize the healthcare that is available. While I was there, I met with various people and I was in the office of the Assistant Director of the center talking about the challenges that Mongolia was facing in terms of maternal and child health and women’s health in general. I just happened to mention post-partum depression. I wanted to know how they were addressing that problem in Mongolia, and if they had programs or policies or any data on the prevalence post-partum depression.

I was told that post-partum depression was not really a problem in Mongolia. I thought to myself, that’s fantastic; maybe there’s something we can learn from this. But after I asked a few more questions, it became clear that they were not screening for post-partum depression and had collected no data on it. So, of course they didn’t think it was a problem because, how can you know that something is or isn’t a problem if you haven’t done any formal research on it? Much to their credit, they were very open to starting collaborative research on post-partum depression and they told me that if I were interested in getting something started there that they would love to have some support in doing a small study to look at the problem. I worked with them on that for about a year. We screened women post-partum and, as it turns out, they had about an 18% incidence of depression.

[OnlineEducation.com] How does that compare to what you find elsewhere in the world?

[Dr. Withers] It’s comparable. Between 10 and 20 percent is what you’d expect to find.

[OnlineEducation.com] When was this study?

[Dr. Withers] This was a few years ago. We did the screening and ran the statistical analysis to determine the prevalence of post-partum depression, and we also did interviews with women who had screened positive, as well as with healthcare providers to find out what their perceptions were regarding post-partum depression. It was fascinating and it made an impact on government and healthcare policy in Mongolia. It certainly made them realize that it was something that they should be looking at more closely, and that they should be training healthcare providers to at least bring up the issue during ante- and post-natal care.

[OnlineEducation.com] That’s amazing. Have you had a chance to follow-up on any progress that’s been made?

[Dr. Withers] I’m still in contact with them. We hope to get more funding at some point to be able to broaden their efforts. They’ve been able to do some training and implement some policies at the national level in the capital city. But they haven’t had the funding to do much in the more remote and rural parts of the country.

[OnlineEducation.com] That’s a hopeful development and a great story. Is there anything you’d like to add in terms of general advice or encouragement to women who are interested in public health research, policy, advocacy?

[Dr. Withers] I would just emphasize the importance of getting involved in collective action through organizations like Women in Global Health and APEC’s Healthy Women, Healthy Economies, and also the importance of collecting data on women’s health issues so that we know what problems need to be addressed, especially internationally. It’s crucial to get governments and the private sector to see that there are real incentives, including economic incentives, for supporting women’s health and promoting policies and practices that address women’s health issues, like gender-based violence and workplace gender discrimination.