Health policy, global impact, and community roots
In this episode of Imagine A World, a podcast by Knight-Hennessy Scholars, Max Du (2024 cohort) and Anson Zhou (2024 cohort) speak with Eliza Ennis (2022 cohort) as she shares her journey from a tight-knit small town in New Mexico to working on global and U.S.-based health policy issues. Eliza discusses her research on reproductive health in Colombia, substance use policy in San Francisco, and how integrated, community-driven solutions can create sustainable healthcare systems. From backcountry skiing to leading global health initiatives, Eliza reflects on the importance of connection, advocacy, and action in shaping a better world.
Guest
Eliza Ennis (2022 cohort), from Cedar Crest, New Mexico, is pursuing a PhD in health policy at Stanford School of Medicine. She graduated from Harvard University with a bachelor’s degree in social studies with a focus on international relations and the Modern Middle East and a secondary in Global health and health policy. Eliza aspires to drive equitable health access and outcomes by improving health system design and building sustainable policy.
As a senior consultant at Dalberg Global Development Advisors, she provided policy recommendations on safe K-12 school reopening during the Covid-19 pandemic, designed global solutions to improve financing and procurement for contraceptives, supported ministries of health with health financing reform, and developed a quantitative model to reduce iron deficiency in sub-Saharan Africa and South Asia. She was awarded the Stanley H. Hoffman Undergraduate Research Fellowship and previously led the research team for the Women’s Media Center in Washington, D.C.
Imagine A World team
Imagine A World's theme music was composed and recorded by Taylor Goss (2021 cohort). The podcast was originally conceived and led by Briana Mullen (2020 cohort), Taylor Goss, and Willie Thompson (2022 cohort), along with Daniel Gajardo (2020 cohort) and Jordan Conger (2020 cohort).
Knight-Hennessy scholars represent a vast array of cultures, perspectives, and experiences. While we as an organization are committed to elevating their voices, the views expressed are those of the scholars, and not necessarily those of KHS.
Full transcript
Note: Transcripts are generated by machine and lightly edited by humans. They may contain errors.
Eliza Ennis:
My name is Eliza Ennis and I'm a member of the 2022 cohort in the Knight-Hennessy Scholars Program, and I'm also a third year PhD student in health policy in decision sciences. I imagine a world where everyone has access to the resources they need to live a healthy and fulfilling life, starting with healthcare, but also including education and social service programs.
Sydney Hunt:
Welcome to the Imaginal World podcast from Knight-Hennessy Scholars. We are here to give you a glimpse into the Knight-Hennessy Scholar community of graduate students spanning all seven Stanford schools, including business, education, engineering, humanities, law, medicine, and sustainability. In each episode, we talk with scholars about the world they imagine and what they are doing to bring it to life.
Willie Thompson:
Today we've got Eliza Ennis, a third-year PhD student in health policy and decision sciences. During our conversation, you'll hear her new Mexican pride, her deep passion for community-driven healthcare solutions, her love for the indoors, from rafting the Grand Canyon to back country skiing, and so much more.
Anson Zhou:
Hi everyone, welcome to today's episode of the Imagine a World Podcast. We have an awesome guest with us today, Eliza, but before we jump into that, I just want to give a quick intro of ourselves, the co-host for this episode. My name is Anson. I'm part of the 2024 cohort and currently a first year med student at the School of Medicine. And I'm here with...
Max Du:
Hi guys. My name is Max. I am in the 2024 cohort as well, and I am a PhD student in computer science studying robotics and artificial intelligence.
Anson Zhou:
Awesome. Eliza, welcome. Do you want to say a couple quick words just to introduce yourself?
Eliza Ennis:
Yeah, thank you guys so much for having me. I'm really excited to be here. And my name's Eliza Ennis. I'm a third-year PhD student in health policy at the School of Medicine. I'm in the decision sciences track, and I'm a 2022 cohort Knight-Hennessy Scholar.
Max Du:
Before we talk about the world you imagine, let's talk about the world you were born into. Where are you from and what was your journey like here?
Eliza Ennis:
Well, maybe I'll go back a little bit further and talk about where I grew up. I'm originally from New Mexico. I'm a very proud new Mexican. I think many people will tell you if they're from New Mexico, they'll always talk about New Mexico, but I grew up in a really small town called Cedar Crest. The population's around five or 6,000 people and we had a very tight-knit neighborhood community.
And then from there, I left and went to Harvard for undergrad and started studying social studies and thinking about international relations as well as healthcare. And then that brought me to a job at Dalberg, where I worked in global health and thinking about ways in which we can approach development from a community centered lens and social impact. And that then led me to Stanford where I wanted to go much deeper into healthcare and particularly thinking about ways in which we can build sustainable health policies and think about researching what is happening in the world and ways that we can identify solutions that can work across multiple communities.
Max Du:
I think the thing that I really want to lead into is you were born in this small town, 5,000 people in New Mexico. The first thing that you said that struck me is like people who are from New Mexico are proud of that. And I'm very curious why.
Eliza Ennis:
Yeah, I mean I think that it probably starts maybe when you first leave the state and people think that maybe you're not from the United States. I got that a lot when I was a kid visiting Chicago. People would say, "Oh, did you have to have a passport to get here?" And so I think there's a little bit of New Mexican pride in we are part of the United States, but also we are a little bit different from other places in the US.
Many people have been there for lots of generations, and so there's a huge connection with the place, and many people who haven't been there for lots of generations, like my family, moved there partially because of the outdoors and the outdoor community and the connection to nature. So, the small town I'm from, Cedar Crest, is located on the backside of the Sandia Mountains from Albuquerque.
They're called the Sandias, because they look like watermelons in the sunset. They're reddish when the sun is hitting them, and then they have green trees across the top like the rind of the watermelon. And so we live on the backside of those mountains, and the mountains are part of everyday life. People who live in Albuquerque always look east and see the mountains. There's west is the river, the Rio Grande, and so the place feels really, really important.
Then beyond the outdoors and the beauty of the nature and the magnificent sky that stretches on forever, there's also the food and the cultural aspects. So around Christmastime, there are luminarias, which are these amazing, like essentially paper bags, but filled with lights that go all around the streets and on rooftops, and they light up the city, but in a very different way than maybe traditional Christmas lights in the rest of the United States do. And our chilies are some of the most fantastic in the world.
Actually, now Hatch Green Chili is found in Trader Joe's and Whole Foods and grocery stores around the world, and so the red and green chili is pretty core to the smells of the autumn. And so New Mexico, I think, just runs through my veins and runs through the veins of most people who are from there.
Max Du:
And so the chilies, they were also growing in your small town?
Eliza Ennis:
So we didn't have chilies growing in our small town. But what's wonderful is that in the fall, all of the grocery stores roast chilies right outside the front of the grocery store.
Max Du:
Wow.
Eliza Ennis:
When you drive down the street or walk down the street, you just smell the chilies roasting and everyone will go into the store and get a bag of chilies, and then you can freeze them and eat them all around the rest of the year. And actually the state question is red or green and your state question, you can say you prefer red chili or you can say you prefer green chili, but the real answer you're supposed to give is Christmas that you like both together.
Anson Zhou:
I love that. What's your favorite recipe to use the chilies for?
Eliza Ennis:
I'm a big enchiladas fan. I think my mom's variation on enchiladas. My mom is such an amazing cook. The sort of variation that she makes is rather than rolling the enchiladas, layering them almost like a lasagna. And to me that just means you can eat more of them, which is a pretty good outcome.
Max Du:
Very good outcome. But So tell me about what it's like to grow up in such a small community. Do people know each other? What's that like?
Eliza Ennis:
Yeah, so what's interesting is because Cedar Crest is quite close to Albuquerque, many people work in Albuquerque, but the community itself ends up being pretty cut off from Albuquerque and the outside world at various times. Many people don't expect but it does snow in New Mexico. I'm from a place that's actually called Lost Valley Loop, and sometimes it does feel actually lost because there's a really big steep hill. And so if there's a snowstorm, the hill is full of snow and people can't drive out.
So, my high school actually had snow days that were only for our area. Everyone else still had to go to school, but we didn't have to. The community gets a little bit cut off, but it also means that the neighbors were incredibly close. We had a really wonderful network of neighbors from all over and doing all sorts of things, but we would have potlucks at one another's houses all the time.
I probably have a key to most people's houses and can walk in and grab some sugar off their shelf if I send them a quick text and then return some the next day. And we've all been caring for each other for a really long time, and I think that's been super important. But I also recognize that there was a lot of effort that went into that.
My parents worked really hard to connect with the neighbors early on, and particularly one of our neighbors, my dad and him built a lot of trails in the neighborhood and share some of the work equipment and things like that to clear snow and move logs and rocks and things. And that community has been built over time through a lot of effort of everyone in the area.
Max Du:
It's such a tight-knit community.
Eliza Ennis:
Yeah, yeah, very tight-knit. And I think that's interesting to me, because a lot of times people drive into their house and don't talk to their neighbors or don't know their names. And actually when I first moved to Stanford, I was really worried that that might happen here.
I try to make sure that I'm talking to people in the hallway when I lived on campus. And then now that I live off campus, I've tried to ask favors of my neighbors and I feel that that actually ingratiates you faster. And then they might ask you for a favor later on so you can build some community. So now I have an amazing neighbor down the road who has a lemon tree and lets us get lemons from her tree every once in a while, which is really nice.
Max Du:
But I think when I think about small town, I also think that it's isolated in some ways. Did you ever feel that way growing up?
Eliza Ennis:
Yeah, it was interesting. So I went to middle school and high school in Albuquerque, which was about a 45-minute drive away. So we had a great carpool. There was a bunch of people from our area and we'd all switch around. So that was community in itself.
But when I made friends who were based in Albuquerque, they didn't always want to trek all the way to the mountains to come and hang out. And particularly in high school when I started doing some swing dancing and other things in the evenings in town, it became a little bit harder to do the commute in the evening.
But I think really it felt like entirely benefits to me. And maybe the part of that is because we were close to Albuquerque, and so I did still get some of the benefits of being near a bigger city. But honestly, my favorite thing to do would just be to garden in the backyard or go on a walk. We had a rope swing that hung from a tree that our neighbors put up, and we could go on a run or a walk to the rope swing down in the valley and swing and hang out with friends. So I think it felt close-knit and not isolated, but I think there were definitely a few challenges in high school.
Max Du:
It sounds like you're very close to nature though.
Eliza Ennis:
Yes, yes. I love the outdoors.
Max Du:
What did you like to do there?
Eliza Ennis:
Oh, man. I mean I think that pretty much any activity that you suggest to me that is outside, I will agree to. Even just driving home in the evening, I get home and I stand outside for a few minutes and look at the stars, but right now I'm really into back country skiing because it's winter season. And then in the spring and summer, I do a lot of rafting and kayaking and hiking and camping. I really love all of those things. And my parents instilled from a young age that the outdoors is a great place to recreate, but also a great place to be with friends.
Max Du:
And your parents were also outdoorsy people, your dad made trails, right?
Eliza Ennis:
Yeah, we actually, I mean we've built trails together as a family too. During COVID, we all got out our Mcleods, which is a super fun tool that you can use.
Max Du:
Can you explain that?
Eliza Ennis:
Yeah. It's like a rake, but it's flat on the bottom and the rake is coming out the side and then you can use it to both pound down the trail to flatten it, but you can also use it to rake things and push things out of the way. And then one of the edges is sharp, so you can use that to lever up different rocks and things. So we had all sorts of different trail building.
My dad is originally from the Midwest and he then went to Maine for college and I think got totally enamored with the outdoors there and became a really big kayaker in particular. And he was also a big mountain bike rider and road rider. And then when he met my mom, they started doing a lot of things outdoors together.
My mom was a really big runner, and so when they moved to New Mexico, they actually moved because my mom got a professor job in Albuquerque, and they had been to New Mexico one time on a ski vacation. And so they said, "I guess that's where we're moving now." But because they loved the outdoors, and so we've been doing lots of outdoors things since we were kids.
Max Du:
And your mom is a professor?
Eliza Ennis:
Yeah. My mom is an amazing professor of French and comparative literature. I wish that I had her vocabulary and her grammatical abilities. She's really, really eloquent, but also has worked on feminism and women's writing and thinking about the ways that communication between women in France and England before that was really popular for women to be writers, the way that they could move their messages forward and be part of social movements. And now she's actually in the provost's office, and so she works there thinking about student success and really how to support the student population at the University of New Mexico.
Anson Zhou:
That's really awesome, and your mom sounds like a very inspiring person. And I know some of your work now bridges health policy obviously through your graduate program, but also with feminism and reproductive rights. I'm really curious how your mom and your community broadly inspired you to pursue that path.
Eliza Ennis:
That's a good question. And I think that also captures a little bit of my inability to choose one specific discipline within my PhD and wanting to work on a bunch of different projects. And I think part of that is because my mom and my dad as well have really pushed me to think about different fields. The feminism piece I think originally probably comes from my grandmother or maybe even my great-grandmother.
There's a long line of teachers on my mom's side and the sort of power of being able to educate and talk to people about what's important in the world and access to education and other things. But the feminism piece I think comes from really thinking about the way that women can carve their way in the world and be a really important part of the workforce, an important part of family life, an important part of communities, and that everyone is equal.
I think a lot of times people think of feminism as being about women, but it's really about all people being equal around the world. And so actually when there was a women's march in 2016, my grandmother and my mother and I all attended in Washington, DC, together. And that was sort of the last big trip that my grandmother went on, and I think it was a big effort for her, but it was really wonderful to have sort of three generations of feminists there together.
And I've taken that into my work now by doing some reproductive health work. I'm working on a project in Colombia where I'm thinking about how contraceptive access impacts health outcomes. So there was a price change in 2019 where the Colombian government dropped the price of a lot of contraceptives, and so we're looking at what is the impact of that on health outcomes for women and for children. So I'm doing an economic study there, but I'm also planning to do interviews with gynecologists and also speak with providers in pharmacies about what the access change there has looked like.
Anson Zhou:
It sounds super interesting. Are you planning to go down to Colombia?
Eliza Ennis:
Yeah, yeah. I'm planning to go this summer-
Anson Zhou:
Wow.
Eliza Ennis:
Currently applying for different funding to try to make that happen, but I should be able to go this summer, which would be great. And I think it's also a really exciting opportunity for me, because health policy is a very quantitative field. People don't necessarily expect that, but we do a lot of simulation modeling on the computer and thinking about ways in which we can take the world and turn it into quantitative questions to evaluate.
And I think that with going to Colombia, it will be a way to add some qualitative aspects to my work and think, particularly around as I build a model or as I think about some of the economic shifts, what are real people's decisions looking like on the ground? How are women going to the pharmacy and getting their contraceptive and how did that change before and after the price change in Colombia?
So, I think that will be really wonderful. And I took a Spanish class this past fall to brush up on my Spanish from high school and from undergrad, which I hadn't been using for a long time. And so hopefully, it's good enough to communicate with everyone.
Anson Zhou:
That's awesome. And you mentioned that when you're growing up in New Mexico, there was a pretty large Hispanic population as well. Is that part of where you were developing your Spanish skills as well when you were younger? And it seems like it's going to come back into play when you're doing your research.
Eliza Ennis:
Yeah, I mean, it's interesting, because it really depends on where you are in New Mexico, but there is a huge Hispanic undercurrent and I think like many people who are long-lived New Mexicans think about it as part of their culture even if they're not Hispanic. So thinking about like when we were singing little kids songs, we sang little kids songs in Spanish and in English. I had no idea what the Spanish ones meant at the time, but we still learned a lot of them. We said the Pledge of Allegiance in elementary school in both English and Spanish every day. And then my middle school had everyone start by taking Spanish and then if you later on wanted to switch to another language you could.
But for middle school, we all took Spanish together and then I continued throughout high school. So it was mostly through the educational system. Honestly, for me, my neighborhood is not a particularly Hispanic area in New Mexico, but also lots of street names and signs and announcements are all bilingual. So, that's been a really, really nice way to think understand more about New Mexico too, is to continue working on my Spanish.
Max Du:
I want to roll back the clock just a little bit, and I'm very curious about how you got into health policy as your main field of study.
Eliza Ennis:
Health policy, I think, for me sounds actually like the perfect mixture of what I would have expected I was doing after undergrad. In undergrad I studied social studies with a focus on international development and the modern Middle East, what that actually means is social studies is the interdisciplinary social sciences concentration at Harvard. So I took classes in sociology, history, philosophy, government, and all of those had to do with either international institutions or the Middle East and sort of the politics of the evolving Middle East. So, those were my classes.
But then I was also really interested in biology and anatomy and was thinking about the sciences. With that, I did a secondary in global health and health policy, and so coming out of undergrad I had this policy side, which was maybe more of the social sciences. I did a lot of classes in government and wrote my undergraduate thesis on the politicization of aid for refugees coming from Syria to Europe. And then on the other side doing the health and health policy work.
Health policy in some ways meshes those two. But in reality it's also really different because I had not done a lot of quantitative modeling before. I didn't do any coding in undergrad, and I spend most of my time coding now. And so thinking about the evolution there is really the intermediate time. So after undergraduate, I started working at a company called Dalberg, which does social impact work around the world and works for governments and foundations and nonprofits, and I mostly worked on the global health side of things.
Within that work, I had an amazing privilege to work on awesome projects. We did things around COVID response and reopening of schools in the United States. We did some work on health financing in East Africa. We did work on trauma-informed care for young kids. And all of these projects got me really excited, but then after a month or two or three, they were done. Because that's the model with consulting as you sort of go and learn as much as you possibly can and then give a suggestion and then and move on, and so I wanted to go a lot deeper.
And for me, the PhD program enabled me to ask the questions that I wanted to and keep studying the same thing for 2, 3, 4, 5 years and be able to go deeper in the areas that I had experienced while working at Dalberg, and also that I had been interested in undergrad. And so the health policy PhD pushed those areas and also pushed me to be more quantitative in my skillset.
Max Du:
I mean, that's something I'm so curious about is like you, as you said, you come from a less technical background, but you almost had to flip and you had to learn a lot of the technical stuff. You said you're coding every day. I want to hear about what that was like when you first made that transition.
Eliza Ennis:
Full fire hose, that would definitely be, I think, how many of us described the first year in the health policy program, but a fire hose of information that was so amazing. I think the late night problem sets were maybe not the most enjoyable, but having the most incredible economics professors and thinking about econometrics and thinking about ways in which current US policy is different from other places in the world and what the comparative study of that looks like. I learned cost-effectiveness analysis, which is so useful for thinking about in places where there's resource constraints, how do we identify where we can put our budget and what I guess monetary purchases within healthcare are going to make the biggest impact for the most number of people, and so learned so, so much.
It was pretty crazy I think, at first, but have really appreciated I think all the support from the other students in the program and the professors. And I've now hit third year, which is a little bit of a mellowing out where it's no longer people throwing lots of information at me, and it's now me trying to sort through and figure out what I want to do with my dissertation.
Max Du:
It's good that you hit that mellowed out point.
Eliza Ennis:
Yes.
Max Du:
But it does sound like the technical stuff helped you think more deeply in different ways about your other things in health policy, right?
Eliza Ennis:
Yeah, yeah. I think that for me, the technical angle is really helpful. I don't think long-term I want to be a coder, but the technical angle is really important for understanding what is good research and how can we then look around the world and evaluate what good research and what good programs have existed and be able to make better decisions looking forward. I think one of the tragic parts with how Global health has played out historically is that there's a lot of donor funding, but also governmental funding that has been set for a particular program.
A lot of these are vertical programs, so, "We're just going to pay attention to HIV and ignore the things around the edges," and that does make a huge impact. But integrated health care is really a way to make sure that people are supported. I'm sure you've run into this as well with your schoolwork, Anson, but thinking about within health policy, are there ways in which we can look through the pilot programs that have happened and look through the RCTs that have happened and say, "This was really effective. Why did we not keep funding it?"
What often happens is we publish a paper and then that's the end of the project, but the project, one, should become sustainable in the community that it's worked for, but also we should think about translation and how do we implement it in other areas and work with communities to have community leadership to tailor it to that area, but also learn from other areas. We actually wrote a piece when I was at Dalberg about how does the US learn from global health.
Sometimes we think about global health learning from the United States, but we know a lot of healthcare in the United States has a huge number of problems. And so we were thinking particularly around reproductive health. how can we learn from movements around the world?
Anson Zhou:
I love hearing you say that because an area I'm very passionate about is translation from I guess the science and medicine perspective into business and entrepreneurship, but obviously from policy research into actual policy and deployment of that is a huge issue as well. And I think part of it you mentioned is just looking at the numbers is not enough and you have to go talk to the people to actually get a sense of what's going to work and what's not.
To jump back a little bit to your upcoming trip this summer, what kind of things are you trying to learn from talking to all these different stakeholders that you think the numbers themselves aren't going to tell you?
Eliza Ennis:
Yeah, that's a really good question. I think that I've worked previously more with some of the international actors, the nonprofits and the governments, and I think that that's really important. So I want to make sure I'm talking to those people about why did they make this policy decision? Why was there a shift in the price of contraceptive drugs?
There was also a price for other medications at the time, but what was the decision making there? Because some people argue that if you drop the price, you're going to reduce innovation, but also if you reduce the price, you're probably going to increase access for people. So how did the government come to that decision?
And then in speaking to people on the ground, thinking about how does that change their individual calculus? Is it something around they're going to keep using the same medication that they were using previously, but now they have a little bit of extra spending money and are they able to use that on other provisions for their family or education or other healthcare? Or is it that they now can switch to medication that they preferred to use or that has fewer side effects, but they didn't have the opportunity to do that before?
And with the numbers, we can really just see what are the total number of people that switched to a different medication? What are the total number of people that started using contraceptive that had expressed interest but hadn't been able to purchase it before? But we can't understand the reasoning why. And particularly, I think for people who are new users who have never used a contraceptive before but have said that they have unfulfilled need, what were the reasons for that unfulfilled need?
And was it around price or maybe it was around geographic access and the price change actually didn't affect their lives at all. And so do we need to think about policies that are about improving access to rural areas rather than just thinking from a price angle? So, I think just getting a sense of some of the mechanisms beyond just causally what is the link.
Anson Zhou:
It sounds like you're going to touch on a lot of the edges that you were talking about as well as these just vertical policies that target a single issue.
Eliza Ennis:
I'm a huge proponent of thinking horizontally, and particularly with reproductive health, it's really important to think about integration of other services. So how do you think about for people who are choosing to get pregnant at a given time, what's the maternal health landscape look like? People might be more or less inclined to use a contraceptive if they have good healthcare for if they do get pregnant. And so thinking about what does that landscape look like, what is integration with HIV testing and all of those as well.
Max Du:
So the word of the day is the horizontal integration.
Eliza Ennis:
Yes.
Max Du:
When I think about horizontal integration, I think about getting to know stories of communities, getting to know people around it. I'm very curious, have you done field work before?
Eliza Ennis:
I have done some field work, but I had the unfortunate clash that my field work was when COVID happened. So I did field work on the phone, so not really field work, but many, many, many interviews at 6:00 AM with a bunch of people around the world. So I worked on a project, it was also on reproductive health, thinking about contraceptive access in Nigeria and Tanzania. And we looked at a few other countries as well, but those were my two focus countries.
And within that work, I interviewed many providers and talked to them about what some of their questions were on how we implemented this, on varying funding between different regions and mostly on last mile access. One of the big issues with that project was that the contraceptives were often paid for either by the government or by international donors upfront, and then were delivered to a warehouse in a community, but then they never could get to the pharmacies or to people's homes.
So they were actually WhatsApp groups where people would WhatsApp and say, "We need 50 boxes of this thing." And then they'd find someone who had a motorcycle and that person with the motorcycle would go to the warehouse and deliver it, but there wasn't funding for that last chunk. And so it often rely on community partners to be able to support that.
And so my field work was mostly phone work, but it did, I think, make me hugely aware of some of the inequities that exist in the last mile of delivery of care. And also when we're thinking about from a data perspective and when we're thinking from a community-based perspective, how do we bridge those two gaps to make sure that communities are able to voice what they're talking about and say, "The last mile is what matters here, not the funding for the initial contraceptive," or something like that.
Max Du:
And it sounds like that's something you found out only because you did these phone interviews, these phone field work?
Eliza Ennis:
Yeah. Yeah, I think that was a big piece of it, and I think that the other part was also just understanding the varying access in different regions of a country. Like for my Columbia work, there's probably a big difference between what's happening in Bogota and what's happening in Cali. And so thinking about the different areas and what it looks like to live in different areas, both from an economic perspective and an access perspective, but also from sort of a decision point perspective, especially around contraceptives.
People tend to use the contraceptive that other people around them are using because it feels safer or more comfortable, or they know more about it, thinking about those differences across the country. And you might need to provide more of one product to one area and more of a different product to another, because that's what people's preferences are.
Max Du:
When I think about that and hear about that, it sounds like it's so community-driven, just whatever the community needs. And when I think about interviews, I think about very personal stories at times. Were there stories that you got from these interviews that really stuck around with you?
Eliza Ennis:
I think there was a woman doctor who I spoke to in Nigeria, and she was in one of the states in Nigeria that had more support on what was going on. They had a lot of state-level support. They were starting to get funding. They had some national funding and some global donors, but they also had this local funding.
And she was seeing all of her colleagues around her in other states not have that local support and continually run into barriers where they weren't able to deliver the things that their community needed, because they didn't have the local support, even if they had some of this international support. She had a very positive experience where her state had really started investing in health. And I think that having that comparison for her though of, "I'm seeing all my colleagues fail, not because they're not trying as hard as me, but because they don't have the institutions around them to enable this."
And also because they don't have the connection between the local and the international that she was able to get in her state. And she had lived through the transformation in her state where they initially weren't as connected and weren't having a local government that was as enthusiastic about healthcare. So recognizing that there are these positive stories that we can look to, but the positive stories require institutions and people to align and they don't happen everywhere.
Max Du:
Did that change your view and approach on your subject?
Eliza Ennis:
Yeah, I think for me, the question that I have always run into with global health is this balance between the local and the global, and particularly thinking about how do we center community leadership and people like this amazing woman who is distributing far more contraceptives but also supplies for safe labor and all of those things across her community than had been happening before. And also, how do we connect that leadership with the giant pots of money that exist in the world?
I think one of the cynical things, and most people in global health I think will say this, is that there's a few people and organizations and governments, including the US government, that are the major funders for global health, and we need that money in a lot of ways in global health. But also because they have those pots of money, they often get to decide the direction of the health agenda rather than it being community-led. And so thinking about ways in which we can identify community leaders and give them charge of those pots of money and make it a sustainable and well-functioning connection between those actors and ideally eventually make it all community sustainable so we don't have to rely on these big pots of money.
But I'm also really excited about ways in which we across the world can share stories and can share ideas about what works and what doesn't. And a lot of that does happen through these international actors. And so how do we have conversations that are maybe facilitated by the World Health Organization or the UN, but are led by communities? And I think there's been more and more pushing for this in the global health context and community in general, but I think hopefully that will continue to be a trend.
And as truly horrific as it is right now to see millions of dollars being pulled out of global health on the US side, I mean, it's leading to thousands of people not getting meals that they thought they were going to get the next day and all of the vaccine trials that are falling apart and things like that. But maybe there's some piece that will enable communities to push more for their agendas rather than having the US and other international actors push those agendas onto people.
But it's also not something that can change overnight. And so the destruction of international aid right now is I think really leading to real consequences. So that's unfortunate.
Anson Zhou:
It's a very timely discussion that we're having right now, because I think on one hand, the dollars, like you mentioned are so critical to keeping communities healthy, being able to access resources. But at the same time, no one knows the users better than the users themselves, but the solution is not to just pull the money out of the way.
Eliza Ennis:
Exactly. I mean, I think that's a super fair point of like you can't pull it out immediately, but I also think that global health community has often thought that this money will keep going forever. And a lot of foundations have expiration dates. They're supposed to spend all their money by a certain amount of time, and governments, as we've seen, fluctuate in terms of whether or not they're in favor of global health. And so we need to think about how do we use the money that currently exists, but also how do we build sustainable community-led solutions?
So, social enterprises have been doing a lot of amazing work. There's some really, really great organizations thinking about access to menstrual products, for example, where communities are making the products themselves and that's employing a lot of people, but then it's also being sold within the community and fulfilling a real health need. But then we think about all these bureaucratic challenges of importing drugs between different areas and not having centers of local manufacturing in Africa for lots of pharmaceuticals.
And so they're dependent on all of these imports, which then requires this international money. But if we could build up local manufacturing, we wouldn't have that reliance. So I think there's a lot of things we could do in terms of sustainability.
Anson Zhou:
And I think this all goes back to what you brought up before with horizontal integration, even thinking about the value chain-
Eliza Ennis:
Totally.
Anson Zhou:
... and all the pieces that feed into that. I think we've had some really awesome discussion about global health and different solutions that we're trying to implement to solve those problems. And we also talked about how the US has a lot to learn from global health as well. And I know you've done some work with social and health programs, particularly in San Francisco with substance use, and there's a lot of health policy issues back home, like right in our backyard. Could you share a little bit about the work you've done there?
Eliza Ennis:
Yeah. First chunk of my dissertation, the first two chapters is going to be focused on substance use and HIV and hepatitis C. And that stems out of work that I've been doing with I guess a lab at Stanford, but also going back to high school, I was involved in a program called Project Echo, which focused on providing specialty care to essentially educating physicians in rural areas on specialty care for particular populations. So with that, we were looking at substance use and ways in which we can improve access to buprenorphine for individuals in New Mexico. So I was always interested in this area.
And then coming here, San Francisco obviously has a huge need for harm reduction programs and for programs that can support both on the health and social sides of drug use. And so we've been looking at ways in which we could provide integrated solutions for addressing substance use and overdose as well as HIV and hepatitis C. And so I've built a model of San Francisco with all the people in San Francisco, both who are drug users and who aren't, and everyone who is infected with disease and who isn't.
Then I can run that model over a 10-year period or a 20-year period and see what would the world look like if things continued as they are. And then I can add policies to it and say, "What do we think we'd save in terms of number of lives or infections averted or even costs around particular interventions?"
And so the biggest one that we've been looking at are called supervised injection facilities. They're also sometimes known as overdose prevention centers. And these are brick and mortar facilities where people can go, and they are observed by a nurse so that if they do overdose while they're using, that overdose can be reversed on site. There's been very, very low mortality.
Any area that has an overdose prevention center, there aren't really deaths associated with that for the most part. And so it's really saving lives immediately, but then it also connects people to services for the longer term. So it connects people to medication for opioid use disorder, which can be buprenorphine or methadone, that help people get off of heroin or fentanyl or other addictive substances. And then also social services that can connect people with housing.
Over 60% of the population of drug users in San Francisco are unhoused, so that's clearly a huge issue. If people aren't housed, their belongings could be taken off the street and then they now don't have their HIV medication, or they don't have their buprenorphine, which they were using to not use drugs. And so things can be taken away from people quite quickly when they don't have housing to support them.
And so thinking about integrated solutions, so first we're looking at overdose prevention centers, and then now we're actually adding in housing and thinking about different housing options, and we're able to test out lots of different types of policies to see what might work. And two weeks ago, I went and visited with the San Francisco Department of Public Health, and we went and we interviewed people on the street and talked to them about what types of programs they would be excited about joining.
I think there was a survey several years ago where 85% of people would want to attend an overdose prevention center, which just shows how much change they could have if people were using this regularly. We wouldn't have the hundreds of overdose deaths that we're having every year right now. So there's huge opportunity, but there's also a huge amount of stigma often that comes from the government level.
In 2022, for example, the California legislature passed a law that would enable pilot programs for all of these supervised injection facilities to exist across the state, but it was vetoed by Governor Newsom. And so, one of the things we're looking at is how do we understand what people's concerns are about these types of sites and build that into the model so that we can address some of those concerns. So one big concern is if this exists, then maybe people will feel like it's okay to use drugs in public settings.
Well, one of the things that's great about an overdose prevention center is it is a closed facility, and so people aren't out on the street using, they're in a safe space. But also if you're walking your kids to school, you don't have to worry about someone injecting and overdosing next to you. They're in a safe facility able to do that elsewhere, and so trying to counter some of that stigma, I think with building the model as well.
Anson Zhou:
That makes a lot of sense. And I think that really puts into perspective how modeling actually gives us some answers. I think one thing I was struck by when you were giving us the background on this project is how much you talked about homelessness and socioeconomic status, and I guess we call these social determinants of health, as now we know to be really key indicators and drivers for health outcomes for people.
Eliza Ennis:
Exactly.
Anson Zhou:
Substance users. And I'm curious, when you were talking to the Department of Health and from the policy side, trying to convince politicians that these are indicators we need to take into consideration when building policy, how do you get buy-in from them? Because you mentioned Governor Newsom, for example, vetoed some of the legislation trying to tackle some of these issues. How do you convince them to get on board?
Eliza Ennis:
I mean, that's a great question and I would love all the answers. I would love your suggestions too. I think the two pieces that I've landed on so far are how do you make sure that you meet people where they are at in terms of their understanding of the issue and the issues that they care about. So this is for lawmakers, but how do you also stay true to the issue that you care about and the way that the community that's most affected thinks about the issue? And so you have to sort of bridge the gap between those two pieces.
For me, when I'm talking to a lawmaker, it might be that the thing that they really care about is housing. There's lots of people, particularly in San Francisco who recognize that housing is a huge issue. And so housing might be the angle and thinking about how do we have better housing for all of San Francisco residents?
And this is going to help people who are substance users, but this is also going to help other people who don't have sustainable housing or who are struggling to meet their monthly rent. But we can also think about it from the perspective of the users and saying, you know, the population that's affected. And the point to them is making sure that they're valued as people.
I think often people walk down the streets of San Francisco and totally ignore or pretend to ignore that they see people who are homeless sitting on the street, and I think that that dehumanizes people, like they want to be seen as individuals. And so when you're having a conversation with a lawmaker, how do you start with, "Housing is an issue and a priority for you." And one of the main communities that is affected by this is the substance using community. And one of the reasons why they're not able to get connected to housing right now is because there are sober housing requirements. And it takes a while for someone to be able to start using buprenorphine or methadone and get off of drugs.
And so how do we have transitional housing agreements "where we can both satisfy your need as a lawmaker for having good housing for the communities of San Francisco, but also recognize one of those communities is this community that you are stigmatizing or less excited about having policy reform around?" And so how do you frame the policy so that it meets both needs? But I still have lots to learn, so I'm hoping that other people in Knight-Hennessy and across Stanford can also help me with those conversations.
Max Du:
It's a whole journey. And the thing that struck me when you were saying that is, first of all, seeing people as people, it doesn't matter what state they're in, they're all humans. And this idea of community, and I just want to circle back as we're running up against the hour, I want you to think about coming from your small town and this tight-knit community. And as you went through your PhD journey and thinking about your family legacy and social justice, has your perspectives on this small town changed or evolved as you have grown up and gone through your PhD program?
Eliza Ennis:
Yeah, I mean, I think honestly, I'm just incredibly lucky. I feel so lucky in many parts of my life, but I think that community is the part where I feel the luckiest. And I think that the ability to have grown up really connected to my neighbors, and you know, it's not just friends with my neighbors, the other kids in the neighborhood.
I have so many friends who are 50 and 60 years old, and I truly value them as friends and like I really enjoy that we get to go on rafting trips together. We often have rafting trips where there's 50 and 60 year olds and also 20 and 30 year olds, and it's a totally mixed group. And we sing campfire songs together and we row down the river and we surf rapids and all of those things altogether.
So I think for me, my perspective on my community growing up hasn't changed in terms of I'm still so, so grateful for that. But I think I just try to seek that out in other places and also try to make that as possible as it can be for others. So seeking it out in other places for me right now often is how do I organize an outdoor trip where I can get a bunch of people together and feel some of that close connection that happens when you feel like you need to rely on each other, whether you're in a Lost Valley Loop and you get cut off with a snowstorm, or if you're rafting down a river and you're in the middle of the wilderness.
So you feel this connection with the people around you because you all rely on each other to make sure that you have dinner that night. But I think that's a really been a wonderful way to connect with people. The Stanford Alpine Club had an all women's back-country ski trip a couple of weekends ago, and I'm a big back-country skier. This is where you ski up and then ski down. And so that was a really awesome, awesome trip and way to connect and bond with people.
But it was also a way to think about like, how do I keep actively making these connections in my own life? But then I also want these to exist in my work. And I think that that can be through doing fieldwork. Hopefully with the Colombian fieldwork this summer, I'll be able to make some of those connections with community there. But then also in policy recommendations, how do I make recommendations that make people all feel recognized and part of community rather than know, oh, this is an individual with a particular problem and this is how we need to address it.
But there's actually incredible community organizing that's happening to support people right now, and how can we institutionalize pieces of that to make sure that people feel supported in housing and social needs and health needs, and that when someone walks into a doctor's office, going back to some of that horizontal integration, if they can be known by that doctor's office. And so they ask about their HIV status, but they also ask about their family, and they address the fact that maybe they need additional food that week.
That's a very different type of doctor's visit than it happens a lot of the time where people just focus on one issue. So, how can we think about people as full people and communities as full communities and be able to support each other when we need to?
Max Du:
It sounds like you want to bring this magical thing of a personal connection to every aspect of your life.
Eliza Ennis:
Very much so. Oh, if everyone could live in Lost Valley loop, I mean, that would maybe break the magic if everyone lived there, but I'm hoping everyone can have a Lost Valley Loop in their own lives.
Anson Zhou:
Before we wrap up, we have a tradition on this podcast.
Max Du:
Uh-oh.
Anson Zhou:
We're going to run through a couple of brief questions. And the first one is, as many of you know who are listening on the podcast, when you apply to Knight-Hennessy, we ask for eight improbable facts. And we find that's a really interesting way to learn about a person and solicit information that we otherwise would not know. So Eliza, could you share one of your interesting and probable facts with us?
Eliza Ennis:
So one is that I was the go-to irrigation fixer in my family. So the pipes would freeze every winter, and these were like running all through the yard and ground, and they'd freeze and break in random places. And so every summer I would dig up the entire irrigation line, and then I would find the breaks and fixes. So my improbable fact is that I know the PVC section of Home Depot very well.
Max Du:
I love that.
Eliza Ennis:
So, that's one. And then the other is that I have been mentioning my love for the outdoors. And so I rode the Grand Canyon, which is the Colorado River that runs through the Grand Canyon, and it's 225 miles-
Max Du:
Whoa.
Eliza Ennis:
... and I rode the whole thing, and I'm going to do it again in June. So I'm very excited. It's an incredibly hard permit to get. But one of my friends was able to get a permit again, and it is the most magical thing. I would recommend it to everyone.
There's side canyon hikes where you can experience magical waterfalls and slot canyons, and you're out in the middle of the desert, but along a river for 18 to 21 days.
Max Du:
Whoa.
Eliza Ennis:
And it's so magical. Also, really nice to not be on your phone for 18 days.
Max Du:
Are there pit stops or anything like you can...
Eliza Ennis:
Oh, so many pit stops, but the pit stops are all campgrounds. And by campgrounds, I mean, little sandy beaches that you set your tent up on. But the pit stops are like magnificent Red Wall Cavern, which is just this huge like football field sized cavern that you can hang out in for the day.
And then there's Elves Chasm, which has these trickling waterfalls that you can climb up a little thing and jump down into a big pool of water. And so those are the pit stops. But you can stop at Phantom Ranch in the middle and refill your water buckets. And there's some commercial trips. We were on a private trip, so we just row ourselves down. But there's some commercial trips that go down faster, and so you can also beg them for ice at the end of your trip as all of your ice has melted, and so you can try to keep your produce fresh.
Anson Zhou:
Well, I'm very excited for you.
Eliza Ennis:
Thank you.
Anson Zhou:
I don't know if I would survive if I went on [inaudible 00:51:17].
Eliza Ennis:
Oh, you would. It would be great. It would be great.
Anson Zhou:
Maybe in the future.
Max Du:
It's going to be beautiful.
Eliza Ennis:
So beautiful.
Max Du:
Another question we want to ask is, I think we're right past the, I guess Knight-Hennessy application season, but we're rolling into the next one. For people who are interested in applying to Stanford and Knight-Hennessy, do you have any advice for them?
Eliza Ennis:
I think this is advice to all people, whether or not you're applying to Knight-Hennessy, but it also very much matters for Knight-Hennessy is like be true to who you are. I think that in the applications, like with the improbable facts, I had so much fun just listing off random facts to my friends and them saying, "That is really embarrassing. Please never tell anyone that. Do not write it on your application."
So they would help me curtail it a little bit, but being true to who I was in those conversations and initial brainstorming and thinking about know what are the things that make me quirky and silly, I think everyone deserves to be silly in their lives. I think that's true also in general at Stanford is like making friends with people is often about being true to who you are.
Max Du:
We all need a chance to be silly and feral and a little bit crazy. We're all a little bit crazy. And we have one just closing question, which is thinking about your time in the Knight-Hennessy community, how has that helped you in your personal or professional endeavors?
Eliza Ennis:
I think it's helped in a lot of different ways. I think first is that maybe coming into a PhD program would feel a little bit lonely and like I was stuck in my own research. And so Knight-Hennessy has been really helpful for how do I think actively about how to apply that research right now know, particularly with all the funding cuts going on right now, a lot of my professors are like, "Just put your head down and keep doing your good work."
And I believe in a lot of that. But I also think there's lots of things that we can talk about right now and that we can collaborate on Stanford campus and across Palo Alto. And so Knight-Hennessy has been really enabling for me to think about how does my research apply in the future to making real policy, but also how does it apply right now? And I think that hopefully that's something I can carry throughout my career is how do I think about next steps in the future and what the most perfect policy could be.
But also how do we start making change today? And maybe it's not fully tested in every possible model that we could have set up. But we can think about collaborations across different sectors and think about working with my law school friends and working with my med school friends and working with my business school friends to make something happen right now. And so the focus on action and the focus on what's happening in the world has been really important.
Max Du:
Finding community and finding diversity of ideas, like all of that. This has been such an amazing time with you, Eliza, thinking about the horizontal integration, thinking about your community and how that spread to everything else that you're working on, which is absolutely beautiful. I feel like I learned so much from this hour, and it's just been such an amazing time with you.
Anson Zhou:
Thank you so much. Any parting words for us?
Eliza Ennis:
No, just thank you guys so much. I feel like you're so good with asking questions and figuring out how to have a good conversation, even on an early Monday morning, so Thank you both so much.
Anson Zhou:
Thanks, Eliza.
Eliza Ennis:
Excited also for everyone who's applying for the Knight-Hennessy.
Max Du:
Yay. Thank you so much.
Eliza Ennis:
Yay. Thanks.
Sydney Hunt:
Thank you for joining us for this episode of Imagine the World where we hear from inspiring members of the KHS community who are making significant contributions in their respective fields, challenging the status quo, and pushing the boundaries of what is possible as they imagine the world they want to see.
Willie Thompson:
This podcast is sponsored by Knight-Hennessy Scholars at Stanford University, a multidisciplinary, multicultural graduate fellowship program, providing scholars with financial support to pursue graduate studies at Stanford while helping equip them to be visionary, courageous, and collaborative leaders who address complex challenges facing the world. Follow us on social media at Knight-Hennessy and visit our website at kh.stanford.edu to learn more about the program and our community.
