Listen to health economist and global health leader Dr. Felicia Marie Knaul sit down with Editorial Board member and Podcasts Editor Megan Vahdat to discuss her work advancing health equity, shaping health systems around the world and drawing on personal experience to drive meaningful change.

Megan Vahdat: I’m Megan Vahdat, and this is Bruin to Bruin– a podcast that interviews influential members of the UCLA community. Dr. Felicia Marie Knaul is associate of the chancellor at UCLA, a distinguished professor of medicine and director of global health at the UCLA Jonsson Comprehensive Cancer Center. An internationally recognized leader in global health, health systems and health economics, her work has focused on advancing health equity, expanding access to care in low- and middle-income countries and promoting gender equality in health leadership. She is also the founder and president of Tómatelo a Pecho and serves on Lancet commissions focused on violence against women and children and cancer and health systems. Thank you so much for joining us today, Dr. Knaul.

Felicia Knaul: Megan, thank you very much for having me on today.

MV: We know you today as an incredible health economist, global health scholar, author and activist, as well as a prominent leader on our campus. This podcast is typically listened to by our large undergrad population, so I wanted to start today’s interview from the very beginning of your impressive career. Can you tell us a little bit about what you were like in college? When you think back to your own undergraduate years, could you have imagined the life and career you would go on to build?

FK: So no, especially not at the beginning. And hello to all of our amazing undergrads. Our undergraduate community is so inspiring to me and to the chancellor, and I’m sure to our city and our community as well.. So no, it’s wonderful to be speaking to the undergrad community. And so actually, my undergraduate experience was probably a little unusual. I went to sort of a special high school, the University of Toronto schools, which, you know, prepped us to go into good universities, including the University of Toronto.

My father became ill with cancer during my, in Canada, that was the Grade 13 year when there was still Grade 13, in February of that year. And so I spent most of those months in the hospital with him. And I finished, but I didn’t finish. They let me finish, but I didn’t quite finish. And you know, after being with him in the hospital, I went into what I thought I was going to do because I had planned to sort of follow in his footsteps and study business, commerce, and you know it didn’t go well at all.

Which I think happens to a lot of our students for different reasons. That you think that what you are studying is what you’re going to want to study all your life, and it doesn’t quite work out that way. And so between that and how hard it was really for me to study after a loss like that and to adjust to going to school, I realized that I really wanted to focus on something that had to do more with human rights and international development, which was a big shock to myself and my family.

Yeah, my father had a background in studying finance. My mother actually didn’t have an undergraduate degree. My mother only finished basically primary school and then went to secretarial college. My family hadn’t done anything in low- and middle-income countries. That wasn’t the way we, you know, had thought about it. We can talk a little bit more about the family history and where it came from in a minute. I’ll just finish sort of the undergraduate part of it because I completely changed not only majors but the campus.

So my father had studied in the downtown core of the university, which was the prestigious part of the university, but there was a really interesting program in international development, and sort of this satellite campus that people wouldn’t go to if they didn’t have to go to that campus. But I really wanted to study that, so I switched to the other campus and I went and studied international development. I ended up switching out of that as well and getting it as a major because in the end I wanted to go work in Guatemala with street children and they didn’t approve that, [which] is what I would do.

So I studied as part of my major and then I focused on economics because I met an amazing economist, Albert Berry, who was thinking a lot about poverty and equity and that sort of became the way that I knew I could do my work. But you asked me sort of where this came from, and it was certainly my father’s experience and passing of cancer when I was 17, and then as I turned 18. But you know, as I’ve shared, my father was a concentration camp survivor. He was 15 when the family was taken, and eventually he was branded in Birkenau, the outer camp of Auschwitz, where my grandparents were murdered. And so, I think, what was permeating for me was the idea that I wanted to really devote myself to something that would make the world a better place for those who didn’t have the opportunities that I had had, and to sort of fight against certain injustices.

And I just wasn’t cut out, I guess, at the time to do “orgo.” We called “orgo” organic chemistry, so I went into international development with a focus on economics. But you know, for undergrads, just to say that changing is okay, it’s a good thing. I mean, the idea of undergraduate education is to be exposed to different things and have the chance to be able to see what really moves you in terms of what your career is going to be, or just what will open your mind and teach you how to think in the world and act in the world in a way that’s effective. That’s what undergraduate education is supposed to give you. And so, if it doesn’t, you know, what you initially start in isn’t what you end in, that’s just fine. It meant you learned along the way.

MV: It seems like you’ve shifted career paths a few times, but throughout those changes, there has been a consistent thread of drawing on your own experiences to shape the work you pursue. You just spoke about your family’s lived experiences with antisemitism, and dealing with grief and illness within your family as a kind of driving factor in your career. You’re somebody who had an emphasis on learning inside of the classroom, but also taking that to real people and real communities. You just mentioned wanting to work in Guatemala, and your doctoral dissertation was titled “Young workers, street life and gender: the effect of education and work experience on earnings in Colombia.” And I’m curious, can you tell us a little bit about that? Those experiences in particular, getting to study youth as a research topic, getting to be on the ground and working with communities that seem to be such a central focus of your career, even as an undergraduate, like you just described.

FK: Of course, so I really wanted to work with at-risk youth, and that was because of my father having had the experiences he had and the tragedies that he had. That was because of the experience that really started for him in his early- to mid-teens of, initially antisemitism, and then one of history’s darkest moments, which was the Holocaust. So I really wanted to do work with youth. Guatemala was, because at the time, it was a country that had suffered horrific human rights abuses, and so I went to work with street children in Guatemala City with an NGO and to pick up Spanish. But, to learn what it was to work with these highly at-risk youth in a place where their very existence was at risk. And in fact, we did lose some of the kids, not to illness, you know, but to abduction and gunshots and what you never want to think can happen. And so that was reality I went to work in.

And then I worked in the Dominican Republic, and eventually I went to Colombia, where there was a lot, a lot of work had been done on street children, the so-called gamines. But I also wanted to work on this sort of larger context, which was child workers. And so I did some in-depth survey work, both with children living on the street who were doing a certain kind of work, and/or keeping themselves going with certain kinds of work, and then in a sort of a more organized survey fashion in some of the poorest parts of Bogotá on families and how children were working, and in the end, you know what the thesis ended up being.

And this is another sort of interesting point: you may think you’re writing about one thing, but you should learn, and that may change almost entirely what you’re writing about because you’re supposed to be learning from the data, and so I ended up writing a lot about missing young women and missing girls, because most of the kids on the street and most of the child workers were boys, and I just took it you know sort of at face value until this very thoughtful economist researcher Gita Sen, in a presentation I gave, said, “Why?” I said, “You know, what do you mean, why? And I said, “Well, everybody says there’s, you know, four out of every five kids on the street and workers are boys.” And she said, “Why? [They] come from the same families, the same trials and tribulations. Where are the girls?” And I couldn’t answer her, and it was a very obvious question, which at the time when she asked it, just made me very frightened that maybe my thesis meant nothing, but forced me to think about what I was actually seeing in these data. And so a lot of it was about where are the girls, where are the missing women, and where are the missing girls? You know, it turns out that they survive much less time on the street. So whenever you look at a cross section you’re going to see fewer girls because they end up trafficked, or they end up working as domestic servants or almost domestic slaves in people’s homes, which doesn’t happen to boys. And then we were sort of able to show, in the more econometric work, that because the boys can work from an early age and combine it with school with the working kids; they actually do much better than the girls, and sometimes those that don’t work, because they combine the two, and it keeps them in school in some ways. The girls don’t have those opportunities when they’re either trafficked or pushed off or pushed into working as domestic servants. They stop going to school. So that was really what my thesis was about, and not what I expected it would be about.

MV: And as you were doing this research, you’re tackling it through a Spanish-speaking lens. Was that hard?

FK: No, actually, it was incredibly interesting. But I was immersed. So for any of our students who are going to do some time in another country and would like to learn a language, I really recommend that you interact as much as possible with the local community in the local language. Even if people speak English, speak to them in whatever is the language that you’re trying to learn.

MV: Did you ever feel that kind of fear of messing up when you’re speaking a new language? Because a lot of people, or my friends who go abroad, talk about wanting to learn so badly, but then feeling shy that they’re going to mess up, or misspeak.

FK: Oh, I messed up so bad a couple times. Are you kidding? I messed up so bad a couple times. I remember in Guatemala, and I won’t exactly say the words, right? Or you can tell me if I can. But I was in a meeting about the publication we were doing, and my neck was hurting, and so I was, you know, my neck is hurting, and the fellow next to me who didn’t speak English said, “Are you okay? What’s hurting?” And the word in Spanish for neck is very similar to another word. Culo. So “cuello” [neck] or “culo.” And I told all the people in the meeting that instead of saying that my neck hurt, I used the other word, and they were just flabbergasted, looking at me. And he said to me, “So like, where exactly is it hurting?” And I said, “Here.” He was like, “That’s not what you said.” That I did, and I felt awful. But you know, you get through it. People realized what was happening, And also, I’ve made horrific mistakes between countries. Words that are acceptable in one country are not at all acceptable in another. You know, you get through it. It’s not deliberate, and so the suggestion is just work through it. Like really don’t worry about it. My accent is very strong, even though I’m fully bilingual, and sometimes it’s listening. Sometimes I think I don’t sound right, but the way to get through that is to want to communicate your ideas and do the best you can.

If I had insisted on speaking in English or tried to speak in English when I was living, particularly in Colombia, I never would have learned. And I made lots of other mistakes that you know weren’t funny, like thinking I was authorized to spend 30 million when I was authorized to spend 13 million when I worked for the Colombian government. These things happen, but you really have to work through it like any other mistake that can happen. Otherwise, you won’t be able to interact in the same way or flow in the same way in the workplace or in your studies.

And also, overall, what I always found is that everybody that I was working with so appreciated that I was trying. It made all the difference, right? And very seldom have been the times that I’ve been, you know, criticized for my nasty accent. For a while, my kids learned to speak in “Felicia Spanish” and thought it was a different language.

MV: And you had to utilize Spanish, and being a Spanish speaker later on, when you helped design and implement Mexico’s 2003 health reform, Seguro Popular, can you tell us also about that experience and the central structural issues that the reform was trying to address?

FK: Yes, of course, and I can link it back a little to the experience I was telling you about in Colombia. So I went to Colombia to do my doctoral thesis work, but I was working with the government on some of my research, and they started working on what is one of the most elegant health reforms in the world: the Ley Cien, the Law 100 I guess you would translate it as. And so I was invited to work for the National Planning Department on that health reform. So that’s the other thing I would say to our students: if you get an opportunity like that, take it. So I, as a Canadian, would never have gotten an opportunity like that probably in my own country, home country, Canada. I was in the right place at the right time, and I was willing to try it in Spanish and give it all I could and work long, long hours that I could do at that time, and so that’s where I learned a lot about health reform.

Fast forward a few years, I’m living in Mexico now. The chancellor, Dr. Frenk, is the Secretary of Health, and I have the chance to think through a lot of these ideas, with him, with President Fox, with their teams. In the case of Mexico, this was an incredible opportunity, and we had also another piece, because you kind of put all these experiences together as you go through life. So we had been in Geneva and Switzerland working at the World Health Organization just prior. So between Colombia, there was some Mexico, and then there was some Geneva.

MV: You really traveled the whole world through your advocacy.

FK: Too much, too much. Well, the advocacy. This was more like following around making sure we’re in the same place. Well, so Colombia was me. Going to Mexico was my choice, but Dr. Frenk was there. Geneva was accompanying, later on, him. But yes, a lot of moves, a lot of moves, too many moves, many too many moves. But now we’re home in Los Angeles. This will be, this is the major move. We are where we should be. I think we will probably always live in more than one place at the same time. But I don’t think we’ll make another major transition like this again. I think we’re here to stay. I hope we’re here to stay. It’s the idea. So Mexico, what was the idea? So we were pulling in a lot of the research that we had done at the World Health Organization in a report that was published in 2000 The World Health Report. The World Health Organization does annual reports like the World Bank does, the United Nations does. So that World Health Report, designed by Dr. Frenk and Chris Murray, and I participated in that and others, including a very close friend now, Dr. Emmanuela Gakidou, and we were working on analyzing health system performance.

And one of the major pieces of that was looking at what we called “financial protection.” So, how families were facing impoverishment and financial catastrophe because they didn’t have health insurance. A lot of the Seguro Popular reform in Mexico was designed to guarantee that the 50% of the population that didn’t have access to social security. Normally you get social security based on where you work, having a salary job, and they didn’t have a salary job for any number of reasons. They were unemployed, or they weren’t working at all, or they were doing caregiving, or they were taxi drivers, or they worked in the so-called informal sector. So they didn’t have access to the social security. They needed a way to be able to have access to pooled public insurance, and this gave them that, and tried to give these 50 million people, now a little bit more, the opportunity to be able to have the same kind of public investment in their health as everybody else was getting.

So where you work should not determine your access to healthcare. And through that reform, increasing investment, public investment in health, increasing and improving infrastructure. The idea was that it started with the poor. It started with a package, and that gradually expanded as more money was available, more families came in to be part of the reform in the Seguro Popular until there was pretty much universal coverage. But I think the other part that was really important and really elegant about that reform is there was what we called a ‘basic package’ that covered a lot of aspects of healthcare, but not the so-called financially catastrophic ones that we had to aggravate. And I’ll explain that in just a second. So there was a special fund for things like cancer, HIV/AIDS, and other diseases and illnesses and health conditions that were so expensive for the system and for the families and the way that they had to be treated couldn’t be aggregated into one fund because it was pretty much in tertiary-level care. So that was one innovation.

MV: So you’ve implemented your economic background to really understand this public health perspective in Mexico as well.

FK: Well, because in the end, I studied, I didn’t study health. I studied labor and development, but I applied it to health. So that’s exactly what a lot of what I do and a lot of the reform was about. But it was also about entitlement to a package, a guaranteed package of care, very different to what’s going on now in Mexico.

MV: And you were also focusing on working populations like you were just mentioning and supporting their access to healthcare. You would typically associate that with older people who have careers and livelihoods that they needed to maintain. But while you were serving in Mexico’s Ministry of Education, you also helped design and implement Sigamos Aprendiendo en el Hospital, a national program that established officially-recognized schools inside tertiary hospitals. What motivated you to focus on that particular avenue as well, in addition to what you were doing, taking this economic perspective and applying it then to public health?

FK: You’re right. This is a very different perspective, and this is the project about which my whole professional career I am most proud, and without question. And I was in Mexico just last week, and I always check, and someone said those hospitals are still there, and those schools in those hospitals are still there, and we’re improving the schools and the schoolrooms. And I was thrilled. I have to think back, I don’t know exactly what pushed me to do it, except that in one particular visit, I realized that the Seguro Popular was allowing a lot of very poor children and their families to get access to healthcare. But that those children and their parents were often functionally illiterate, so they couldn’t even read the prescriptions that they were receiving, and seeing that I thought “How are they getting this very high-level care?” For example, for cancer, for acute lymphoblastic leukemia and other cancers, but we weren’t able to offer them the chance to stay in school. And what would happen? In order to speak to the families, they’d say, “Well, we’re not going to get to be back in school.”

And there was also discrimination, stigma associated with a number of illnesses, conditions, and diseases, and somehow the idea that this program could grow came, and then I was very, very lucky to have the strong support of the president, of his spouse of Marta Sahagún de Fox, and of the Ministry of Education, and, of course, the minister of health had no choice but to support me, right? And it grew into a beautiful program, but it was by far the most interesting and rewarding program I have ever put into place. And in the end, the lesson at the end was really the hardest one, but I think it was a really important one, which was when I had to realize it was not my program. It was the program that belonged to the health and education sector, and so when we left government, it was time for me to really step aside and just hope and pray that someone else would take over and manage that program.

We did one major policy move at the end that was really also quite key. Like many countries, there’s a national public education system in Mexico, and so the schools that we initially put in were just because we wanted to put schools into hospitals, but they weren’t officially registered as schools. We managed to have the law adjusted so that those were deemed also officially schools, which meant that by law they would get a teacher, they would have a classroom, they would have books, and they would have materials, and that cemented the program into something that really couldn’t be couldn’t be moved, couldn’t be underfunded or unfunded or changed.

MV: And that’s still ongoing today, like you just mentioned?

FK: When I go see hospitals, when I go walk through hospitals now, which I do every so often. Yeah, they’re still there.

MV: And you mentioned having to step back because of leaving government altogether. But what, in your mind, prompted you to know that this was your time to leave, although the program would still go on to persist without your leadership?

FK: I don’t know if it was my time, but I knew that it had to be somebody else’s. When there’s governmental change, you don’t have the same role that you had before, right? And I think if you care enough about a program or a policy, and you don’t think that you own it, but rather you believe it’s for the benefit of someone else, it’s not about you. So believe me, I didn’t want to step back, and I’m sure I could have done more. But I had to let others take it over to guarantee that it would continue.

MV: You value that kind of human lived experience, patient-centered perspective – trying to see through the lived experiences of the children battling illnesses who also receive access to an education, the working parents and patients who were trying to manage the financial implications of their careers. But in 2007, you encountered the health system not only as a researcher and a policymaker, but as a patient yourself. Your own breast cancer experience became a turning point in your work, it seems. How did being a patient itself change the way you understood health systems as a researcher?

FK: It’s a great question. Megan, it relates back to what I experienced with those children as well. I didn’t know it at the time, right? But the power for other kids who were thinking of dropping out of school, who didn’t think about how important it was. Seeing a child with cancer insist on continuing to go to school. We even had a child who was terminal and passed, but before passing, said, “I am going to give my secondary school diploma to my mom, even though I won’t be alive when she takes it.” The message that that gave to Mexican kids about the value of studying and completing their education and going on was huge. So I think I was probably a little bit prepped by my work with kids and Sigamos Aprendiendo to think about what I could do when I got breast cancer. It was the last thing that I expected would happen at 41 on my first baseline mammogram, and the first couple of months, I did anything but advocate. I actually refused treatment, and we can talk about that more.

But there was day where it suddenly occurred to me that, and I was taking a long walk near our house, which we still have in Cuernavaca, and I thought the only thing worse than going through chemotherapy is not being able to do it because you don’t have enough money to do it, or you have no place to leave your kids. Which is I think the reality, even if women, people, can get access to care, they often have no way to care for children or other family members, and they can’t make the choice to actually even care for themselves. And so that really spurred me to think, and then I quickly realized that I had the voice I hadn’t had before.

You don’t get this kind of a voice, I think, by studying. Sometimes you get it by having a particular job. But when you have an experience like this and you choose to live it the way we did, it does give you a kind of voice that allowed me to push forward the causes that I believed in, and interestingly enough, the year that I was diagnosed, breast cancer was included in the Seguro Popular as one of the incoming diseases. So, as of the year that I was diagnosed, every woman in Mexico had the right and access to the same care I got, regardless of her level of income.

I realized all I had to do was get these women to go and get care and be diagnosed, which wasn’t the case in almost any other country in the world, other than Canada and a few others, right? They would get the care, and we even had Mexicans who would come legally in the United States, documented and working here, would go back to Mexico because their access was so much better than they could get even here. So it was this incredible experience. And what I learned, though, from my own journey, but even more so from sort of walking different hospitals, like I had done for Sigamos Aprendiendo but walking different hospitals and talking to women who were living with breast cancer in different phases of their illness.

I learned about how our primary care system was failing by meeting a woman who had been diagnosed with a tumor that was like the size of an orange, and trying to figure out how, if you had all this regular care, you had young children, you’d be going for pre-nat, you’d be being in and out of our primary clinics, and no one had ever checked you. How was this happening, right? And I would see alternatives from that – that we didn’t have access to mammograms for everyone, but you didn’t need a mammogram to diagnose her cancer earlier than it was diagnosed. So how could we train up our primary care health system, our nurses, our health promoters, our primary care physicians to understand that poor women could also get breast cancer and that there was a lot that could be done? I learned about palliative care and how we had forgotten to include palliative care and pain relief in our health insurance program.

When I think, I don’t know quite how, but we did, and I found that by actually meeting a woman who was at the very end of her life, and the hospital wouldn’t keep her in because she wasn’t covered for palliative care, and then found out that we didn’t have morphine for children or morphine for anyone who required morphine in the country. So the journey that we began to see was one where the health system wasn’t seeing how there’s what we call a continuum of care. So it’s about primary prevention, it’s about early diagnosis, it’s about appropriate treatment, it’s about long-term survivorship care because we survive a long time and need lots of kinds of care, and that’s true of many diseases. And we also need end of life care, right?

And the system has to be able to provide and go with you through that whole journey without blocking you from you know moving through it and also moving back and forth. You might be in treatment once, come out of treatment, and then go back into treatment. And the system has to help you to do that, particularly on the survivorship part of the journey, which can be a very long one. That’s changed a lot, informed a lot of how Dr. Frenk and I think about organizing health systems. And we have a Lancet Commission. The Lancet is a leading medical journal that’s precisely about this cancer and health systems, and we’re actually going to be giving part of the presidential address at the association, the American Society for Clinical Oncology Association. Huge meeting, cancer meeting in early June, late May, early June, with Dr. Eric Small, who’s the president of ASCO, who is a physician at another UC. So it’s an incredible opportunity to be able to help our oncologists to think of that long journey and help our health system leaders to think about where they can make change.

MV: And to use your own voice as somebody who has experienced illness to promote these changes as well— the voice that you reference that you developed on a deeper level after having dealt with illness yourself, and you’ve opened up about these conversations so honestly and vulnerably, not just in this podcast, but in so many different other mediums as well. Breast cancer in particular is surrounded also by so much silence, stigma, and kind of taboos about women’s bodies. How can we create conditions for women to feel more open about their own bodies and to have these types of conversations in order to enact the positive change that you have referenced?

FK: I think in the United States and Canada and a few other places, it’s no longer taboo to talk about breast cancer. I think we do speak about that. Far fewer people speak about cervical cancer. Now, cervical cancer is becoming much less common thanks to the HPV vaccine. We’ve written about how it’s almost at risk of becoming, we call it a neglected tropical disease, but really, it’s a neglected disease of the poor.

Once the HPV vaccine is really fully rolled out, the question is who didn’t get it, right?

And so then it becomes really a disease that affects those who did not have access. And we tend to think much less, and we tend to stigmatize diseases that are only those, that are experienced or primarily experienced by individuals who are poor, but there are other reasons why cervical cancer has been so stigmatized over the years, and any OB/GYN cancer as well.

So I think we gradually became, thanks to many outspoken advocates who were comfortable and/or took the leap of speaking about their breasts, but we don’t speak necessarily about other parts of our bodies or diseases that are associated with infection. We’ve got to get past that. There are so many highly stigmatized illnesses, and mental health is probably one of the most important. The other thing to say about this is what’s tremendously stigmatized, also, are certain risk factors, and particularly violence against women, violence against children, highly stigmatized, not spoken about.

And what we know is illnesses, health conditions, diseases that are hidden and not spoken about, they will never get the resources, and the individuals who suffer will never get the help that they require and they deserve and they need. It’s sinister, because the perpetrators don’t hide it often, but those who have suffered it do. We have another major Lancet Commission on ciolence against women and children, because, if I can transition to that I very fundamentally believe that if we can manage that risk factor, we will reduce the burden of mental illness, for example, in our communities by you know 30 or 40% easily if we can just deal with that risk factor, and we haven’t been doing that. We’ve been looking instead at what happens to the person because of what they suffered before. We have to do that. We also have to try to prevent the fact that it ever happened.

MV: And what are mechanisms to even go about preventing that on a larger scale? What are you seeing in your own research?

FK: So, it is so common that we are speaking about one in three women, about one in five girls, young women, and about one in seven boys.

MV: Globally?

FK: Globally, but it’s slower in some countries, it’s higher in others, but it is everywhere, in rich communities and poor communities. It is everywhere. To affect that many people, there have to be a lot of perpetrators, and there are a lot of perpetrators. So what we’ve been thinking about and working on with colleagues who have done incredible pilots and trials on this is how can you think about educating and preparing young men differently. And also how we can think about ending the scourge of violence against boys, because we know that there is an intergenerational transfer of violence. So we also need to think about that part. Very rarely discussed. So I strongly believe that we can change attitudes. We can change the way we educate. We can change what is considered the norm and acceptable in our societies the way that we have not done. Child marriage is still considered absolutely acceptable in many communities. In fact, in many states in the United States, child marriage is legal, including California. We need to change that law, right? Because it’s impossible for a child to consent. So these are the things that we can change. They’re incredibly amenable to change. There will be some aspects of these that are very refractory, but it’s been so ignored for so long that there’s so much we can do. A lot of what we’ve been doing on the campuses is incredibly important. Sexual harassment is no longer accepted on our campuses. There are many ways that people of any gender can come forward and insist that their rights be respected, and that there are appropriate ways to protect them, to help them to heal, and to deal with what they’ve suffered, and to deal with the perpetrators in ways that are appropriate, depending on who they are and what they’ve done, we just we really need to work on making that more generalized. And so, if this is something that our students have been fighting for for so long and considered to be the norm and the standard of behavior in our university, in UCLA, we need you to go all out, all over the world, and all through the communities and say that this is the standard, that it is entirely unacceptable, and that we won’t accept it anymore.

MV: Your career has spanned advocacy for so many groups. You just mentioned tackling this pressing issue of violence against women and children. I had not yet recognized the prevalence of that on an international scale, and I’d imagine that our student body would feel the same way as well. You’ve discussed advocacy for victims of sexual harassment on our campus, and you also discussed the importance of advocacy for women in Mexico receiving palliative care. And you’re a very vocal advocate as well for Jews who are experiencing overwhelmingly high levels of antisemitism today. At a university like UCLA, which is committed to free expression, but also navigating the immense concerns about antisemitism that are so present and are debated so thoroughly in our campus, within our newspaper, and beyond, how do you think institutions should protect the open dialogue that you champion, that you were talking about earlier as well, while also respecting and responding clearly to hatred and discrimination that’s felt by so many students on our campus as well?

FK: First, for me, the norm is that speech cannot be violent against anyone. I would feel the same way that I do about antisemitism or a so-called horrific no-Jew zone, as I would feel about a no-Asian, no-Black, no-Brown, or no-anything else zone. It is not something that is acceptable in this community or in any community, and that’s something I’m able to try to uphold. You know, Dr. Frenk’s family, my father-in-law, who I loved very dearly, they escaped very luckily before the war broke out and ended up in Mexico, a country that was willing to receive them. But with all of the trauma of having had to flee their home.

MV: What year did they flee?

FK: In the early 30s. And when did they arrive in Mexico? You’re going to have to ask Chancellor Frenk exactly when they arrived in Mexico. But I can do the math for you in a little bit, thinking of my father-in-law’s age. He was six when they arrived, and his sister was four. They were little. How many years? Took them a good year at least to probably get visas and get where they were going. But it was largely yes because of antisemitism, but also because of their political views that they ended up fleeing. And they were very very lucky to find a country, Mexico, that was willing to accept them because there were many countries in the world that wouldn’t accept Jews, as we know around the world, boatloads of Jews that wouldn’t allow them in. Mexico was different, and one of the reasons why we’re so proud to be residents of Mexico and Chancellor Frenk, a citizen of Mexico.

So, what can we do, and what are we doing? First, and this is very much the chancellor’s work and the leadership team at this university, but we have in place now very clear roles around time, place, and manner, and what can and can’t be done. We have an amazing individual leading a lot of the campus safety and community safety, Stephen Lurie. We know that we have layers when we have to deal with students who are violating those norms. Layers of individuals who speak to them. We don’t start with our police force. We start with peers and people in the community. The way we did with COVID, right? We didn’t, you know, go with a police officer and say you need to put on your mask. Peers can go and say, “Would you please put on your mask? You’re part of this community.”

MV: And by peers, you’re implying fellow students?

FK: Fellow students, they are exactly part of the process of speaking when we have protesters, when we have other people who are violating time, place, and manner, and they will speak to the individual, offer another route, and then if the individual refuses, then you have another, the next layer, right? Which is our own campus police and security personnel, and then we have other layers, of course, if this continues onto work. But the fact is that having that first layer is often, you know, the way of de-escalating, discussing, and figuring out a way to have dialogue. So having those layers in place to deal with this, I think, has tremendously changed the way our campus operates. We cannot stop people, and we should not stop our students or others from being able to express themselves.

But how you express yourself, where you express yourself, and under what conditions, that is what I think we have to manage, and we have been managing. That doesn’t mean it isn’t still here, and we have, and we will continue to have some very difficult moments, without question. But I can only hope that, in particular, that our students, our undergraduate students, can grow into leadership positions, and take advantage of all this university has to offer, including our communications and the newspaper and this podcast and the way that you have opportunities, undergraduate students, to engage with learning about how to do this sort of work, right?

That is what will, I think, help you all to become the kinds of leaders that will be able to deal with very painful and difficult situations. I have no question in my mind that there is suffering on both sides of that border, and many others. I guess I firmly believe that listening to, understanding, hearing what that suffering is all about will help us to come to a place of peace and mutual understanding. And not listening is not going to get us there.

MV: Also, you mentioned that students should engage in all levels of leadership at the school and listen to resources to try and gain a greater perspective about this, the nuances of all the different political issues that are so thoroughly debated on campus. But where should we really be turning to? Like if a student on campus is experiencing antisemitism or Islamophobia, or anything along those lines, what do they do in that situation? You mentioned a peer would intervene, but how do they know how to reach out to that peer or something along those lines?

FK: So that idea of peer intervention is primarily when we have some kind of a protest or a violation of time, place, and manner, because there has to be a point at which you can come in and speak. Can you speak to peers? Yes, of course. And we have spaces, Title VI, where you can come and put forward an experience and have that appropriately reviewed, dealt with, and you receive the support you need.

We also obviously have our student services, which should be able to provide support because this is a kind of trauma, right? There’s no question. This is traumatic, and you need to be able to work through and talk through the trauma if you experience it. But what I want the students to hear is that we need you to come forward and talk about it. And if something has happened that violates your rights, to be able to formally lodge a complaint and description of the incident because without that we can’t do anything about it. It becomes very difficult. It becomes hearsay and talked about. So if you’re experiencing the same way that we talk about if you’re experiencing sexual harassment, come forward. We must report this, and in reporting it, you must be listened to and heard, and you must receive the support that you need. And if you don’t, myself, the chancellor, the leadership team, we are here to listen and to help you to receive that support and that guidance.

MV: A lot of us have appreciated the wonderful opportunities to be a student here, like you were mentioning, and for the opportunity to try to grow into a type of leader who will advocate for the morals that you’ve ascribed to throughout your career and encourage our undergraduate population to pursue. But we’re facing a lot of the issues on campus as well. We just talked about, religious hatred and political dissent that has turned violent in the past. We also have to deal with the more subtle logistical issues of the school, like lectures with 700 students, tech glitches, a Canvas outage that happened a few months ago, financial struggles, and housing and safety issues, and the Daily Bruin has also done some extensive reporting on alleged financial mismanagement within the university. Now that you’re wrapping up another year on campus, what do you think is the biggest problem with how our institution is run today, and what should we do to combat it going forward?

FK: That’s an interesting question. So I strongly believe in dialogue and discussion, peaceful. I think we have a tremendous amount to learn from each other, and we should spend as much time as we can doing so, because the majority of people on this campus, the vast majority, are incredibly gifted, and there’s a lot to learn from each of them: students, faculty, and others. You don’t get to be part of UCLA if you don’t have that. Another is as we think about these hardships that we’re going through. I sort of encourage us to think about other parts of the world, the sorts of places where I do a lot of my work, where power outages are multiple times in a day, or power outages mean not being able to study and go to school. I’ve seen difficulties in maintaining ventilators for children who are on ventilators. Those are the sorts of problems that many, many in our world suffer all the time. And I think if we can keep those in mind,

MV: To recognize our privilege.

FK: Privilege, and also be inspired by the opportunities that we have, say by that privilege, in order to find the sorts of resilience that’s required to take full advantage of all these opportunities and be able to apply them to making this world a better world. There is no question that higher education in this country and in other countries, trust is waning, and that in this country we have an issue of financing. There’s no question. But I have also seen us be incredibly creative about that. And furthermore, there’s sort of this economic theory where you can be in an equilibrium, and it’s very stable, but it’s not ideal. And you need to be sort of shaken out of it in order to think beyond and be creative, and really think about how you can remake yourself and remake the world and the institutions in which you’re in.

And I think we have no choice but to choose to see that this is an opportunity. The kind of shakeup that we’re seeing in higher education and in many other aspects, it’s not the first time we saw it during COVID, and we will see it again. And we have to accept, and understand, and lament, and be kind about the suffering that is part of that. But also realize how much we can learn from it. We would never have the kind of telemedicine we have now. We would never have the kind of opportunities for insurance were it not for the pandemic that we went through and all we learned from that. We will make higher education new, better, and different as a result of what we’re going through now.

MV: Is there a particular area of focus that we should be focusing more heavily on the issue that you think is most pressing on our campus?

FK: I would like to see you all do as undergraduate students is openly speak to each other with respect and decency. And to think carefully about what you are advocating for and what it means to others around you. But most importantly, just to listen to each other in a non-confrontational, non-violent, appropriate way of speaking, and therefore, with that, I believe that you will be able to help define the solutions we need in our world.

MV: And you speak often about these campus issues of mutual respect and honesty, and finding those areas of common ground and human decency in your conversations. And after tracing so many of these heavy topics today, and about your public work and your beliefs in our institution, I also wanted to ask briefly about the personal details that have shaped you along the way, because it seems those aspects are of equal importance to the image of your life. And we have so many UCLA students on this campus who are ambitious, but also a little bit uncertain about who they are becoming and the kind of life they want to build. So, Dr. Knaul, to finish off today’s interview, I wanted to ask you the final question that I propose to every guest on this series. What’s the number one piece of advice that you would give to undergraduates?

FK: I want to give two, given the preamble. So, well, actually, I might even give three or four. One is to take full advantage of every opportunity to learn that exists on this campus. Whether it’s through advocacy and engagement in activities, or if it’s through different classes, take advantage of all of them. This is a time in life when you can do it, and you’ll find the time, you’ll find the resilience. But it’s really what the experience is so much about, and what’s so great about this campus.

As you go through that, and as you have a career and go on with your lives, I think it’s really important to have some activities that take you away from it. Mine happens to be riding a horse or being with my dogs, and that takes me out of the space of difficulty and pressure. And you know sometimes when you are working and in spaces that are incredibly difficult, you need that. The other is to remember the inspiring moments and the beautiful moments in your life when you have been lucky enough to truly enjoy your life. I’ve written about some of those. Those keep you going, and I think you were hinting at one other that I think is really important, which is, I think there are some voices that you have to choose between family and career, and there’s still some of that there. In today’s world that should not be the message for someone of any gender. If we speak about it in the old way of thinking about it, men didn’t have the opportunity to say, “I’d also like to participate in caring for my children and my family members,” because their work wouldn’t have allowed them to do that. And for women, they had to choose to do the caregiving part and not have the career. The ideal situation is one where gender doesn’t determine those roles, and so when you can enjoy and have the opportunity to be part of a family, however you choose to make that family, and at the same time fulfill your career goals. I do believe that that’s possible, and I very very strongly believe that that decision is not or should not be based on gender, and there’s a lot we can change about that still in so many parts of the world.

MV: Thank you so much for your time and for your invaluable advice, Dr. Knaul, that I’m sure so many students will appreciate.

FK: I’m looking forward to meeting more and more of you. Thank you for everything. Thank you, Megan.

MV: This episode of Bruin to Bruin was brought to you by the Daily Bruin podcasts. You can listen to this episode and all other Daily Bruin podcasts on Spotify, Apple Podcasts, and SoundCloud. The audio and transcript of today’s interview are available at dailybruin.com. I’m Megan Vahdat. Thank you for listening.