Ana Langer: global leader in women's health

Abstract

Ana Langer, leader of the Women and Health Initiative (W&HI) at the Harvard T H Chan School of Public Health, is the first to admit that there have been major advances in women's health in the past decade, notably in maternal and reproductive health. But she is also clear about what she calls “the unfinished agenda of women's health”. That agenda is powerfully articulated in the Lancet Commission on Women and Health, of which Langer is the lead author. “A key question the Commission seeks to address is why health systems are repeatedly failing women when women are the main users of, and providers of, health care”, she says. At the W&HI in Boston, MA, USA, Langer leads academic programmes in women's health and women's contributions to health systems, notably the flagship Maternal Health Task Force funded by the Bill & Melinda Gates Foundation. With its robust knowledge management system, educational activities, research, and promotion of scientific dialogue and consensus building, W&HI provides leadership and essential support to the global maternal health community, with a special focus on Ethiopia, India, and Tanzania. Langer's own background informs this work. Her parents settled in Latin America after fleeing Austria before the outbreak of World War 2. “My parents were liberal, progressive physicians, with strong principles about helping the most poor and vulnerable in society”, she says. “I never doubted that I would follow them into medicine, enabling me to work in an environment related to our family values.” Born in Argentina, Langer recalls a happy childhood in “vibrant, beautiful, safe Buenos Aries”, in sharp contrast to the time of her medical studies in the mid-1970s during the so-called dirty war when an oppressive right-wing regime ruled the country. She recalls working with her student peers to provide health services in the slum areas of the city. “We were perceived by the regime to be a threat, and many of my fellow students were killed, kidnapped, or just disappeared.” Having just qualified from medical school and started a paediatrics residency, Langer left Argentina for a new life in Mexico. She continued in paediatrics, followed by neonatology training at Mexico's National Institute of Perinatology. “It was during my time in neonatology where I first became deeply aware of how newborn health was inextricably linked with maternal health. My interest in motherhood broadened to women's reproductive health”, she says. “I also realised that I was not suited to clinical neonatology and the pressure to often make quick decisions with huge implications for babies, mothers, and families, which often caused me great anxiety and sleepless nights”, she adds. With serendipitous timing, she was invited to join a group of advisers to the then Minister of Health in Mexico, the moment when she knew that her future lay in public health. Julio Frenk, later Mexico's Minister of Health, invited Langer to be Chair of the Department of Research in Women and Children's Health at the country's National Institute of Public Health, a position she held from 1988–94. During “one of the most exciting times in my career”, she “collaborated with outstanding researchers on a variety of programmes, primarily in reproductive health”. It was here that she established the first masters programme in reproductive health in Latin America, in collaboration with WHO. Later, Langer continued directing research programmes as Regional Director for Latin America and the Caribbean at the Population Council. “One of the most challenging but rewarding areas of my work was engaging research efforts into the introduction of emergency contraception into the public health system in Mexico, which often met with strong opposition from the Catholic Church and conservative groups”, she says. Before moving to Harvard in 2010, Langer headed up the New York based NGO EngenderHealth, with its focus on family planning, reproductive health, gender, and maternal health programmes in low-income and middle-income settings. “I loved my work at EngenderHealth, but as a CEO there I sometimes felt too remote, too far away from the core activities and outreach of the organisation, as most of my time was spent dealing with management”, she says. Frenk, who will become President of the University of Miami later this year, has witnessed Langer's many contributions. “Ana's career has always anticipated the evolution of her field of interest. She became a prominent figure in the emergent field of reproductive health even before the 1994 Cairo International Conference on Population and Development. Always staying a step ahead, Ana has subsequently been a pioneer in articulating the integrative concept of ‘Women and Health’, whereby women are seen not only as the bearers of problems but also as the agents empowered to address them. As a leading global figure in women's health, Ana is herself the personification of this broader aspiration,” Frenk says. Langer is only too aware of the challenges ahead to keep women's health on the development agenda: “We will share Sustainable Development Goals (SDGs) with other human development goals, so we will have to work hard to ensure that the focus on the health of women and girls does not get lost. All of us working in this incredible field have a duty to ensure that the actions from the Lancet Women and Health Commission translate broad policy commitments from the SDGs into tangible actions that will improve the health of women, their status in the health system and society, and, consequently, the wellbeing of families, communities, and nations for generations to come.” Women and Health: the key for sustainable developmentGirls' and women's health is in transition and, although some aspects of it have improved substantially in the past few decades, there are still important unmet needs. Population ageing and transformations in the social determinants of health have increased the coexistence of disease burdens related to reproductive health, nutrition, and infections, and the emerging epidemic of chronic and non-communicable diseases (NCDs). Simultaneously, worldwide priorities in women's health have themselves been changing from a narrow focus on maternal and child health to the broader framework of sexual and reproductive health and to the encompassing concept of women's health, which is founded on a life-course approach. Full-Text PDF