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When she considers how far she’s come, Dr. Paula Johnson sees the path that brought her from being a public school kid in Brooklyn to being the first Black woman president of Wellesley College and a tireless advocate for equity in medicine. It’s a path that refined her life’s work into a simple question: “How do we improve the health and well being of all women, particularly those who suffer the most inequity?”
It started with her grandmother, even though she didn’t realize it at the time.
“My grandmother’s psychiatric illness through a good part of my childhood was, when I look back, a motivating force,” Dr. Johnson says. Motivate it has: She is a member of the National Academy of Medicine and the American Academy of Arts and Sciences. She founded the Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital, and she has received several honorary doctorates and awards for her lifetime of work.
But before all of that, her family struggled for years to get her grandmother the medical help she needed, and that experience turned out to be the first step of a journey that would eventually make her a force for women’s health. Dr. Johnson left Brooklyn and went to Radcliffe College at Harvard University, following her interest in science toward the field of medicine. While in college, she happened to take a small seminar course taught by Ruth Hubbard, the first woman to be tenured in the biology department at Harvard.
“She was a remarkable trailblazer,” Dr. Johnson recalls. “She had moved away from her basic science and started teaching more about some of the societal and social issues having to do with biology, and she taught a course called Biology and Women’s Issues. It was transformational in a number of ways.”
Dr. Johnson says that the class opened her eyes to the ways that science could be biased, not only in the identity of the scientists doing the research but also in the studies themselves. The construct was overwhelmingly a male one; men were the ones doing the studies, men were the ones used as subjects for the studies, and women were largely ignored despite making up half the human population. The connection between what she was learning and what her grandmother had been through was clear.
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“It was just exciting, the people in the class were exciting, and [Hubbard] was exciting,” Dr. Johnson says, explaining how much that one course motivated not just her but many other students to go on to careers in science and medicine that focus on inequality and gender differences in health. That class, combined with other opportunities for public health work in college, created “formative and powerful experiences that really have informed the work that I’ve done through my life,” she says.
Simply put, Dr. Johnson saw a need: Women were not represented in health care in a way that addressed their unique issues. For most of the history of medicine, the field was by and for men. When women patients presented differing symptoms than what was expected from male-centric research, their conditions would often go overlooked. For example, cardiovascular disease in women is frequently underdiagnosed and untreated even today, and the prevailing wisdom is that heart disease is a “man thing,” even though cardiovascular disease is the number one killer of women worldwide. This very clear failing of health care for women was one of the reasons Dr. Johnson became a cardiologist.
“It was in cardiology that these issues were being a bit better defined,” she says. “The first papers started coming out about these [gender] disparities, and cardiovascular medicine felt like a rapidly evolving field that we really had a good measurement of what some of these disparities were.”
Dr. Johnson didn’t limit herself to cardiology, though. One of her early attending physicians was an early pioneer in clinical epidemiology, and she trained and researched in that area to expand the scope of what she was trying to do for women and minorities.
“I looked at the intersection of race, ethnicity, sex, and gender in cardiology care,” she explains. “Later, that led to a larger vision for me around sex and gender and how that intersected with race and ethnicity. There was so much biology that had not been done, or that was being done poorly, that developing that construct was very important.”
The work was not without challenges, and Dr. Johnson acknowledges the hurdles she had to overcome in this emerging field.
“When I started my academic career, there were no faculty in cardiology who did the kind of research that I did,” she says. “I straddled two different worlds, which was not that common. That was different and took some real work in those early days.” She says that she encountered confusion and resistance from many people, but she was persistent in her advocacy for women’s health, and some of those people who questioned her became partners in her work years later. The lesson there, she says, is that “you don’t have to persuade everyone at the beginning, and you do have to have a thick skin.”
The challenges Dr. Johnson faced as a woman in medicine who was fighting for women in medicine further illustrated the need for women on both sides of the science. While it’s important that medicine includes women as subjects when studying different diseases and treatments, it's equally important that women be the ones doing the studying.
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Women have been an increasing presence in medical research and public health fields. Still, Dr. Johnson points out that despite studies that show that women and minorities have more novel ideas and unique links between concepts regarding health care than their white male counterparts, those ideas are more frequently discounted. Dr. Johnson sees her role as president of Wellesley College as an opportunity to help future researchers in these fields achieve their full potential.
“Doing that work is the true joy of training the next generation of scientists and clinicians who are going to be doing science differently, who are going to be translating science into care differently,” she says.
Dr. Johnson also illustrates the need to put the research to work, advocating for policy changes that increase equity for women in health care. She has had a hand in effecting change across many government policies, including the coverage of birth control under the Affordable Care Act. In 2016, the US National Institutes of Health made a new policy that sex had to be included as a biological variable in all of its science, an update that Dr. Johnson actively worked for. “That was a profound change,” she says.
She also recalls a 2017 report in which she helped to shine a light on sexual harassment of women in engineering and science, leading to policy changes across disciplines and, as she puts it, making people think twice about the culture of these fields. “That is so critical. Because I’m training the young women who are going to go into these fields, we don’t want them to be harassed out of them,” she notes.
Dr. Johnson sees her own path of both higher education and medicine as a way to do the most good as the movement for women’s health heads into the future. This, she says, is the most rewarding thing about her work.
“It’s really being able to make a difference, not only in the body of knowledge and who we are influencing today, but that multiplier effect of what that might look like moving forward,” she says. “I’ve been fortunate to have two parts of my career that can make a difference, not only in the lives of people we serve but also in what the future of science, medical care, and the workforce looks like. It’s really being in the business of hope for the future.”
From looking back to looking forward, Dr. Johnson hopes that her legacy continues to be one of change.
“I’ve chosen to do important work that has changed the lives of whoever the work touches, whether it’s newly minted scientists, clinicians, patients, students, and faculty,” she says. “It is hard work. It’s not something you can do in a year, but a long-term commitment for doing that over time. I would like to be remembered for the important changes we made in higher education, the important policy changes we made in the way science is done, in health care, and in women’s health care. And obviously making a difference in the lives of women, in all dimensions.”
