Bringing fairness to health care access

Thalia Porteny
Thalia Porteny, SM '14

May 27, 2014 — Outside the gates of her Mexico City high school, Thalia Porteny would always see kids begging for food. “It made me feel uneasy and frustrated,” said Porteny. “I knew I’d had amazing opportunities given to me, and I felt responsible. I wanted to do something about it, but at the time I didn’t know how.”

Porteny’s discomfort with the disparities she first witnessed as a teenager ultimately led her to Harvard School of Public Health (HSPH), where she’s set to graduate this May with a master of science in global health and population. And her future plans will keep her around campus: In the fall, she will enter a PhD program in health policy, focused on ethics. Her ultimate goal: to change health policy at the highest levels, so that health resources are more fairly distributed across Mexico and around the world. “I hope my ethics work will inform my health policy work,” she said.

The importance of prevention

During college, Porteny considered becoming a doctor. After a summer internship with Doctors Without Borders in a clinic in Ghana, she realized that, “by focusing on the individual, I was tending to someone who was already sick. I wanted to do something with higher impact—to help prevent the sickness in the first place.”

Returning to Mexico, she spent four years working on prevention programs at the Ministry of Health. For one project, she collaborated with officials from the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA)—which works to improve health care access for the uninsured, isolated, or medically vulnerable—to help boost the health of Mexican migrants in the U.S. “These people have very limited access to health care,” Porteny said. “Roughly 13 million Mexicans live in the U.S.—a number equivalent toat least 10% of the Mexican population—and they’re often afraid to go to doctors because they think they’ll be deported. So it’s important to make an effort to give them better access to health care.”

‘People are doers’

Porteny said she came to HSPH to take her skills to “the next level”—and that HSPH impressed her “as a place where people are doers. The question is never ‘Will I be able to do this?’ It’s ‘How are we going to make sure we do this well?’ ”

Porteny fit right into the “doer” category at HSPH. One example: she and several classmates proposed and participated in an independent study—involving HSPH Dean [[Julio Frenk]]—on Mexican health reform, which the Dean had spearheaded when he was Minister of Health in Mexico from 2000–2006. “It was amazing to have a chance to learn from a leader who actually changed policy for millions of people,” said Porteny. The students went on to write a case study on the politics of implementing health reform in Mexico that is now being used in several HSPH classes.

Porteny also helped design and generate student interest in a winter session program in Mexico examining the challenges of implementing health reform. The course was led by [[Michael Reich]], Taro Takemi Professor of International Health Policy, who hatched the idea for the course with [[Martin Lajous Loaeza]], a research fellow in the Department of Epidemiology. Thirteen HSPH masters students and four students from Mexican universities spent January 2013 hearing from expert speakers, visiting both urban and rural communities, and participating in hands-on public health projects. Porteny said that the program motivated some of the Mexican students to think about public health careers. “That’s really important, because in Mexico there aren’t that many people going into public health—and we need more,” she said.

Porteny also connected with Mexican students across Harvard, and across the U.S., as a vice president of the Harvard University Mexican Association of Students. She coordinated a multi-university team that brought 80 students from 30 universities around the U.S. to a mid-April Cambridge conference, “Lab de Ideas,” aimed at inspiring and motivating the students to help transform their home country. “There are about 14,000 of us in the U.S.,” Porteny said. “If we connect, we can generate better ideas for ourselves and for Mexico.”

Ethical thinking

A class on ethics with [[Norman Daniels]], Mary B. Saltonstall Professor of Population Ethics and professor of ethics and population health at HSPH, inspired Porteny to intern at the World Health Organization in Geneva last summer, where she helped with a project to set ethical guidelines for countries trying to determine the fairest benefits packages under universal health care. “It’s important to build a standard to support countries trying to set priorities,” she said. “There is no process right now for making these decisions—but there should be.”

Eventually, Porteny hopes to use her health policy and ethics training to work as both an academic and policymaker back home in Mexico—with the aim of making that country’s health system as fair as possible. “I would like to be able to use evidence to have a positive impact in Mexico—and in the world,” she said.

Karen Feldscher

photo: Emily Cuccarese