The power of humility and optimism in health equity advocacy

As vice chair of the Clinton Foundation and the Clinton Health Access Initiative, Chelsea Clinton, PhD, grapples with some of the world’s most disturbing problems, among them high maternal mortality rates, the anti-vaccine movement and the effects of climate change on children.

Yet she’s upbeat — in part because, for her, optimism is a moral choice, she told Lloyd Minor, MD, dean of the Stanford School of Medicine and vice president for medical affairs at Stanford University.

During a recent fireside chat at a Stanford Medicine leadership retreat, the two spoke about how Clinton’s Stanford University undergraduate experience sparked her advocacy for health equity and child development, the power of building relationships, and how humility and optimism keeps her focused in challenging times. 

Her interest in public health was first inspired by a junior-year reading: Infections and Inequalities, the autobiography of renowned physician and medical anthropologist Paul Farmer, MD, PhD, she said. The book tells how Farmer co-founded Partners in Health, a global nonprofit dedicated to bringing quality health care to impoverished people. 

Clinton went on to earn a master’s in public health and a doctorate in international relations. One of her priorities today is promoting early child development through the Clinton Foundation’s Too Small to Fail initiative, providing parents with early language learning resources so they can talk, read and sing with their children from birth to prepare them for educational success.   

This Q&A, based on the conversation between Clinton and Minor, has been condensed and edited for clarity. 

Minor: You’ve spoken and written about being at Stanford. What was it about the environment and your experiences here that helped guide your future education and leadership roles? 

Clinton: I was a little kid in the South and attended high school in Washington, D.C. I wanted to have a different experience … a different adventure in life. I certainly found that here and have extraordinarily rich memories of my time as a student and as a person here. 

I also made very strong friendships. I was a junior when I read Infections and Inequalities. I cold-emailed Paul Farmer three pages of thoughts, questions and critiques. He wrote me back and we started this pen pal relationship. 

I didn’t know at the time that my mother knew Paul because she recruited him and Partners in Health to provide medical and public health support to former Soviet Union countries. 

“It’s only better communication — at a policy level but also directly to communities, to families, even to kids — that will start to rebuild the trust that I think all of us recognize we desperately need in our country.” 

Chelsea Clinton, PhD

Fast-forward to my dad asking me and others what he should do in his post-presidential life. I said, “I think you did a lot of great things while you were president … but you haven’t done enough on AIDS. You need to do more, and you should start by talking to Paul Farmer.” 

Thus began a profoundly important relationship between my dad and Paul over the next 20-plus years working to understand the HIV/AIDS crisis, and catalyzing what would become the Clinton HIV-AIDS initiative, then, in 2002, the Clinton Health Access Initiative. 

Minor: What are top issues you feel the Clinton Health Initiative and those of us in the academic community can impact through our work? 

Clinton: At Too Small to Fail, we’re trying to better convey concerns about the impact of climate change on pregnant people, infants and toddlers. In our research, practice and advocacy, we focus on helping parents better understand why, for example, extreme heat is a danger for them, but also what they can do about it. 

Climate change often seems to be the pornography of despair. Everything feels so extreme and overwhelming, and I worry, consequently, of pushing people into cynicism. We’re trying to understand what helps parents and other caregivers best feel as if the science is informative and activating and not disempowering and disorienting. 

I also worry that, because of the intensity of the past few years for many of our physicians or nurses or physician scientists, there will be this receding from the public sphere. But we need people to be even more engaged. We are always learning more about how to best protect and promote health. It’s only better communication — at a policy level but also directly to communities, to families, even to kids — that will start to rebuild the trust that I think all of us recognize we desperately need in our country. 

Minor: You’ve written about global health systems and think a lot about how impact scales — how we take discoveries and advances and get them into parts of the world that traditionally haven’t benefited. What are the take-home messages from scaling? Are there principles we should keep in mind as we look at our work here?

Clinton: At the foundation, we try to always hold ourselves accountable. 

We try to meet parents and caregivers where they are with resources they need to be effective first teachers for their children on early language, math and numeracy, and on social-emotional development. 

We’ve built more than 600 libraries in laundromats, turning wash time into play time because low-income families spend two to four hours a week in laundromats. We also have more than 1,300 playgrounds across the country that are equipped with engaging educational signage to prompt parents and caregivers to turn play time into learning time and engage their children in language-rich conversations. And we’ve distributed more than a million books through partnerships with diaper banks. 

All of these have rigorous evaluations alongside them. It’s something we’re highly focused on. 

“Whenever I feel the edges of despair, I think, ‘Is this productive? Do I want to just be depressed?’ Or do I want to think, ‘What can I do with my experience, what I know, the people I know, the platforms that I am lucky and humbled to have, the sense that we can always be doing more?’” 

Clinton

We are also doing more in New York City, where much of the core foundation team works and where, candidly, we hadn’t tried to do anything. Now we’re a core partner for the New York City birth health equity initiative the mayor and local health commissioner started. 

While on a national average, a Black mother is three times as likely to die as a white mother giving birth, in New York City, it’s nine times. We like to think of ourselves as this bastion of liberal progressive policies. Yet, we have terrible — on an absolute and relative basis — maternal mortality rates.

We’ve partnered with the city to bring together this large set of different organizations who either could be or should be working on these challenges. 

I share that because we are trying to have the humility of learning what has worked around the world that can and should be urgently put into practice here at home … in our own ZIP codes. 

Minor: That’s such an important message … a focus on looking forward, on optimism, and on the key concepts of humility and empathy. How do you think about those attributes in a fairly polarized world today? 

Clinton: I’ve heard Jim Kim, one of Paul Farmer’s partners in starting Partners in Health, say that optimism is a moral choice. And I believe that deeply — that it is a more moral place to be, to think about how we can always be building a more equitable, more sustainable, more inclusive, more joyous world than just accepting the status quo. 

Whenever I feel the edges of despair, I think, “Is this productive? Do I want to just be depressed?” Or do I want to think, “What can I do with my experience, what I know, the people I know, the platforms that I am lucky and humbled to have, the sense that we can always be doing more?” 

Being a parent of three kids makes it easier for me to be optimistic. I want to be able to tell them what I did today that, hopefully, was generative and positive and productive.