Q&A with Dr. Rafael Pérez-Escamilla

Published: October 4, 2021

This year for the Philip R. Nader Legacy of Health Lectureship, we are very excited to introduce our keynote speaker, Dr. Rafael Pérez-Escamilla. His extensive career in the field of public health has created significant change and better understanding about maternal and child health and the link between nutrition/nutritional interventions and early childhood development. He has also been a key player in global household food security and has served as a keynote speaker and advisor for many projects that aim to achieve food security across the world, especially in areas that have historically had greater levels of food insecurity.

With a diverse background in chemical engineering, food science, maternal-child nutrition, and early child development, Dr. Pérez-Escamilla has a unique perspective on the public health problems facing the world today and how we can work to bring awareness to these issues to create a change of approach. In his lecture, “Responsive Feeding and Childhood Obesity Prevention: An Equitable Nurturing Care Perspective”, Dr. Pérez-Escamilla delves into the relationship of these factors and the multi-faceted approached that needs to be taken with a complex issue such as childhood obesity.

Dr. Pérez-Escamilla graciously took the time to answer a few questions we had for him about his experiences in public health, how and where he sees the direction of public health heading, COVID-19 considerations, and tips for individuals considering a future in public health. His answers and insight into these questions can be found below.

1. How did your interest in public health begin? Relatedly, what path did your research take? Did you always think you’d be studying maternal and child health feeding, early childhood development, and household food security?

Actually, my path to becoming a public health practice scholar has been a bit unusual. I have a bachelors’ degree in Chemical Engineering, a masters’ degree in food science, a doctorate in maternal-child nutrition and a post-doc in early childhood development. The common denominator that connects these dots is that since I was a child, I have always wanted to improve the health and wellbeing of populations through healthier foods and improved nutrition. At one point I decided that for my work to be highly impactful, I needed to focus on preventing bad things from happening and promoting health since the beginning of life. That is when I found my call to become the maternal-child public health nutritionist that I am now.

2. What large-scale public health problems do you see specifically now for infants and young children during the COVID-19 pandemic vs. before the pandemic? With regards to public health, what do you want to see being done now, especially in a time like this?

The pandemic can be seen as a social X-ray that clearly uncovered how incredibly inequitable and unjust the world in which we live still is. The pandemic has been particularly harsh among low-income mothers, their infants and children, and families as they have become much less likely to have access to proper housing, food, health care, childcare and education, and stable jobs with livable wages. Furthermore, the pandemic has had a strong negative impact on the mental health of caregivers and children. Moving forward we need to invest heavily worldwide to build much stronger public health workforce, infrastructure, and surveillance systems to be much better prepared to address the needs of caregivers and children the next time another pandemic like Covid-19 hits.

3. Do you have a favorite research project that you’ve worked on, or one that stands out to you?

Tough question! In some ways my “favorite one” is the global project that I lead to empower policy makers understand how to improve the environments to enable and empower women to breastfeed for as long as recommended is. This project known as the Becoming Baby Friendly initiative (BBF) (wwww.bbf.yale.edu), which is based on a systems-thinking highly inclusive participatory methodology, has been implemented in 8 countries across five world regions with powerful results. For example, Germany has just launched their new national breastfeeding program based on BBF, and in Mexico improvements in breastfeeding outcomes have corresponded with the initial BBF application in the country in 2016.

4. How would you encourage a change of perspective among childhood obesity prevention?

In my view, it is crucial that we position the management and prevention of childhood obesity as a key goal of the nurturing care agenda. It takes a whole village and more to properly address the childhood obesity pandemic. Childhood obesity is not the result of irresponsible parenting but rather of the default systems that prevent families from having access to affordable healthy nutritious foods at home, school, and other settings. Much more attention needs to be paid by society as whole to food security, health security and responsive parenting for all during gestation and the first years of life no matter the social class in which the children are born. Obesity in childhood not only affects the present and future physical wellbeing of people but it can also leave indelible psycho-emotional scars because of bullying and other forms of social rejection.

5. As the rates of childhood obesity have risen over the past years (especially during the COVID-19 pandemic), how do you think research and public health interventions should be focused to tackle this issue?

There is no doubt in my mind that the so called ‘Fist Food System’ needs to be transformed to improve maternal-child health, including the prevention of obesity and its transmission from one generation to the next. Currently this system is quite unhealthy as it is loaded with relatively cheap ultra-processed foods and sugar sweetened beverages. As part of this transformation, the food industry needs to be prevented, through legislated regulatory measures as voluntary self-monitoring has not worked, from marketing these unhealthy products during infancy and early childhood. Governments must invest much more in protecting, promoting and supporting breastfeeding globally which among many other things is key for reducing the risk of childhood obesity and fits squarely within the nurturing care framework.

6. Regarding the COVID-19 pandemic and low socioeconomic status (SES) countries that have seen a lower number of cases and deaths due to the virus, what have these countries done to ensure that food security among their country remains equal and is not disproportionately skewed?

The countries that provided social protection to those in need, including cash transfers, access to food assistance and unemployment benefits since the start of the pandemic have been able to cope much better with it. This is because families in these countries were mor likely to practice physical distancing as needed and provide nurturing care to their young children during this major humanitarian crisis. These are the countries that have also been more likely to mitigate food insecurity and that have guided their covid-19 management policies based on science and not misinformation and political interests.

7. During your work as a public health professional, what change have you seen in the field of public health that gives you hope for increased knowledge and change in the realm of maternal and child health?

By far the COVID-19 pandemic has opened the eyes of the world to the need for investing massively in building the public health workforce and the surveillance and implementation and evaluation infrastructure needed to rapidly respond to public health emergencies including pandemics and climate change crisis which are oftentimes intertwined with each other.  The pandemic has indeed shown the need to prioritize strengthening the public health systems surrounding women, young children, and their families.

8. Do you have any advice for those pursuing a career in nutrition, maternal and child health, or public health?

I recommend everyone interested to pursuing a maternal-child public health career to learn how to work effectively in interdisciplinary teams using sound mixed implementation science methods. These skills are absolutely needed not only to help identify but also to properly address the many complex public health and human rights threats that hundreds of millions of socio-economically vulnerable women, children and their families face daily. It is also crucial also to learn how to work side by side with the communities conceiving and co-designing evidence-informed maternal-child public health programs through and antiracist, trauma informed and social justice lens. Always remember that pursuing such a career is truly worthwhile given that strong and consistent evidence shows that gestation and the first years of life are crucial for longer team human and national development, and planetary health.

Written by:

Katherine Jones
MPH Candidate
UTHealth School of Public Health in Austin
Michael & Susan Dell Center for Healthy Living