A Southern California native, Sofia Gruskin, JD, MIA, has always felt at home in Los Angeles. The city drew her back in 2011, after 18 years at Harvard University, to launch a health and human rights program at the USC Institute for Global Health, part of the Keck School of Medicine of USC. Now, as the Institute’s director, she is working to steer interdisciplinary research and education to confront inequality and the many forms it takes around the world — and here at home.
Doing global health differently
In global health, the scope of work is naturally broad. “We are concerned with health and wellness — and illness — without a concern for borders, and whether it’s in Los Angeles or Lagos,” said Gruskin, who holds a joint appointment in preventive medicine and law at the Keck School and the USC Gould School of Law.
Global health work benefits from L.A.’s diversity, Gruskin said. “There are so many immigrant communities and languages spoken, even at our hospital.”
While the region “certainly has its own unique problems,” in many ways, it is a microcosm of the rest of the world, she said. “Our colleagues are working on many of the same issues here as they are abroad, like leprosy and tuberculosis.”
With the Institute for Global Health, she said, “I see an opportunity to do global health differently.” She is building on its legacy to foster interdisciplinary work in new ways — something she said can set USC apart. As the Institute approaches its 10th year at USC, it will expand its research collaborations and course offerings.
“What is unique is that everything we do has a focus on addressing inequality, which inherently requires working across disciplines,” Gruskin said. “Our work involves multiple units of USC: not only medicine but social work, anthropology, communications, journalism, policy, law and more.” For example, faculty from six USC schools steer the Law & Global Health Collaboration Gruskin co-founded in 2016 with Alexander Capron, LLB, professor of medicine at the Keck School and USC Gould School of Law vice dean for faculty and academic affairs, and Charles Kaplan, PhD, USC Suzanne Dworak-Peck School of Social Work associate dean of research.
She approaches teaching in the same way — bringing students from various degree programs together in her cross-school course “Global Health, Law & Human Rights” to broach complex challenges.
“We ask, ‘How can you work across disciplines to solve global health problems?’” Gruskin said. “Students need the tools to see and understand that the people they work with often think in different ways, even though they use the same words.”
Working for decades at the intersection of law and health — from the grassroots level to the highest echelon of international governance — Gruskin has witnessed great achievements in treating and managing pervasive diseases like HIV, malaria and tuberculosis when the rights of patients are recognized. But people are still dying and suffering from preventable diseases.
“I’m struck by the fact that a lot of the issues we looked at in the 1980s haven’t gone away,” she said. “They just manifest differently.”
Her work today focuses on understanding why — and what can be done. This involves uncovering the connections between complicated issues, often bringing in matters of gender and sexuality, and binding them to human rights frameworks to hold governments accountable.
It’s how Gruskin began her career. After law school, she worked with human rights organizations including Amnesty International to get HIV and LGBT issues on their radars. “Back then, organizations recognized oppression based only on things like political party and ethnicity,” she said. “It took HIV to open up that conversation.”
In doing so, the HIV/AIDS crisis also sparked discussion about stigma and discrimination and how they contribute to health disparities.
“If you’re going to face stigma right when you walk in the door, you aren’t going to access treatment even if it is available,” Gruskin said. “In terms of solutions — it’s not only about changing the law, sometimes it’s about changing the receptionist at the front desk.”
And then there are the policy and institutional roadblocks to contend with.
Even a doctor’s office can be the very barrier preventing people from seeking health services. Until recently, the world’s go-to disease handbook, the International Classification of Diseases, has long considered being transgender a behavioral disorder, said Gruskin, who worked with partners from around the world to revise the handbook. The new edition, which launched June 18, now categorizes being transgender as a sexual health condition.
Much of Gruskin’s work, including an ongoing project that spans 20 countries, investigates barriers to accessing care — including criminalization and discrimination around drug use, gender identity, reproductive health, sex work and sexual orientation. The project found, for example, that people in Indonesia were not able to attend school or complete their degrees due to their tuberculosis diagnoses — or were asked to leave work, without pay, until their treatment was complete.
Bringing the world to USC
Closer to home, Gruskin said she hopes to leverage USC’s culture of diversity to broaden the range of global health research and experiences on campus even further. “We have plans to bring in senior scholars from other countries to do residencies here on campus,” she said. “I want us to be not just another university that sends its people out into the world, but one that is known for bringing people in.”
Some of this global-to-local work began this summer. The Institute for Global Health is connecting USC students and faculty to Los Angeles Mayor Eric Garcetti’s office to support the city’s efforts to comply with the United Nations Sustainable Development Goals — a roadmap for global development.
“The way sustainability needs to be ensured goes beyond economics and greenhouse gases,” Gruskin said. “We need to bring in all the health and social dimensions.” Here, for example, that means homelessness is a high priority.
With the city government mobilizing around the SDGs, and USC supporting a new vision for global health research and education, Gruskin said she is optimistic about the work that lies ahead. “We can make Los Angeles an example to the world.”
— Paul Boutin and Larissa Puro