Influencer Izzy Gerstenbluth

Interview June 2021

Could you share with us some information of your family life?
I am married and have two daughters and one sister. I was born in Curaçao. My parents were very supportive in letting me become who I am right now. They were main building blocks, together with the social environment in Curaçao, where I grew up. What I experienced when I grew up triggered me to study Medicine, as there was no equal access to health care for those from a lower social status and there was also a clear racial divide back then in the 1960-ies. My parents and growing up in a multicultural islands where I had to talk at least 4 languages definitely formed me to be who I am now.

Could you share something of you eductional background and your experiences? long have you been an epidemiologist?
I am a medical doctor and later specialized to become a public health physician and an epidemiologist. I have always worked in the public sector at GGD of the Ministry of GMN and my late father used to call me “an idiot” for doing that (btw my daughters agree with him on this. Why? I earned far less compared with other medical professions and certainly worked and made longer hours. I have been in the board of different international boards, as our work was more appreciated elsewhere than in Curaçao. Over the years we have been neglected and our department doesn’t even have a budget line in the budget of the government, even though lots of important people that could give our work more recognition, are not doing anything to address this unsustainable situation.

How long have you been an epidemiologist?
In 1993/1994 we worked on a major Health Survey in Curaçao, where we concluded that the way we were spending money in the health care, needed to be re-directed. This survey became a best practice example of what is essential national health research and also that this should be the foundation to implement adequate health policy. There was a long time in which the full report of our study, The Curaçao Health Study, Methodology & Main Results, was the first book you encountered upon entry of the library at the main headquarters of the WHO in Geneva.

As we have a relative small population of 160.000 people, when we took a 3% random sample of the adult population of the island (about 2500 people), this was manageable, where other countries had to overcome a lot more to do such an extensive study. Because of the sheer numbers of people if you needed a sample of 3%. For Curaçao although managing 2500 respondents was a hell of a job for us, we pulled it off. This resulted in me being asked to speak for different audiences all over the world. I was even invited and installed as a boardmember of the “Council for Health Research and Development” (COHRED) in Geneva. I was apointed at the end of the 90-ies and stayed on till the beginning years of the new millennium, giving an opportunity to the next generation to take a seat. Years after this, I was elected by my Peers in the American continent to serve three years on the Advisory Council on Health Research in the Pan American Health Organization. It was a great experience to participate in these platforms because, here is where smaller countries are given an opportunity to have a seat at international fora and make their voices heard. It was a place where the needs of smaller countries could be brought forward instead of having to accept the agendas of larger countries who had the power. It is no coincidence that COHRED’s slogan was: “Countries first”, It was a wonderful experience to be a member of the board and to actively participate on an international forum directed specifically towards using research for development in the broadest sense widening my own knowledge and understanding the power and importance of essential national health research no matter the size of a country. On the other hand it also created some embarrassing moments, when asked to recount the follow-up of our own work in terms of implementing new policy derived from our findings because that is when I had to admit that until today the government has not done much with the recommendations made.

Over the past year the world has and is still been affected by the Covid Pandemic and you have become a very public figure over this past year, as a spoke person of the “Crisis team” in Curaçao. How has this affected the way you look at public health in terms of “lessons learned” now after this past year?
The past 1,5 year has proven that we lack an adequate public health structure. We, at the department of Epidemiology, knew this for a very long time and this was painfully shown during the Covid pandemic. We did manage to weather the Covid pandemic up to this moment rather well, as the number of active covid cases are down and over 74 .000 people are fully vaccinated against Covid. But because of the lack of a structure, it cost us considerable more time and effort to get things done. My department of Epidemiology consists of three persons, myself and two other staff members, and our team together with some additional help literally worked day and night every single day during 7 days a week. There were times when we went home at 3 am to come back to the office at 7 am.

Has your view on preventive health changed over the years, especially after the Covid pandemic that we slowly but surely seem to climb out of its worst affects locally?
What you can see is that we do build a white elephant, this new hospital CMC, as in the old hospital SEHOS there was so much disinvestment going on and the SEHOS building was in-efficient , that in the end we had no other option then, to build a new hospital. But by not following through on the results of epidemiological studies and the proposals for policy derived from those, we keep placing the horse behind the wagon. We do not invest in creating conditions for healthier living, and keep putting money on the back end of treating disease. And in these times of retrenchment in the budget, the dilemma between the lack of enough funds for the financing of health care and the political desire to have a high qualitative care becomes more distressing without even than investing in adequate cost benefit or cast effectivity analysis.

Over the years we have cut in the health care budget on the wrong budget lines, according to me.
SVB is cutting costs in retirement and nursing homes, this while our population on average is growing older.

While clinical specialists are not being addressed and these specialists obstruct efforts to cut in their income, as their renumeration is based on the volume of their work, this creates perverse effects as their income is determined via the number of medical interventions they do.

The costs of our medicines are much higher than the costs of medicines in Holland and in Aruba because of the central joint purchase of medicines between entities .

Of course there is also waste, but more importantly there are persisting inequities in health and health care that are not being adequately addressed.  We see now is that a Task Force aimed to lower the costs in the health care is using incorrect figures to propose budget costs and there is no deliberation or actual involvement of any stakeholders. Where does that leave the health care if cost-cutting is done without an idea of what the costs could be in the long run and primarily fueled to be able to pay for the white elephant and actually proposing that public health should be driven out of the clinic!.

And what about the wellness branche?
The question is: what exactly is “Wellness”? Public health can be defined as all that is needed to protect and promote the health of the population we serve. Health care is just one part of all of this, and it takes place at the end of the line. Our health depends on jobs, education, sound and safe neighborhoods, healthy living conditions, a healthy environment and equity. All of this based on an integrated policy. But if we invest so much money in a new hospital, that then necessitates upkeep, this leaves almost no money left for other essential parts of this integrated policy. This has not been a priority over all these years and like I have said my department of Epimediology doesn’t even have its own separate budget line .

We have documented proof that low- social economic class is a major underlying determinant of chronic diseases while obesity is a common underlying risk factor for the most common chronic illnesses on our island. Those of lower social economic background do not have the understanding nor the means to enjoy a healthy lifestyle.

And even if you start now with the children of these adults from the lower social economic bank grounds it will take a generation to see a change in the epidemiological lay-out. In the interim period, the costs of healthcare will still be very high because all those with chronic diseases will necessitate treatment. So where do we cut in the health costs?

Even though this is a challenge I am an advocate to approach public health in an integrated manner where we create the pre conditions that people can develop a healthy life style.

This also may include unconditional cash transfers to people in need instead of e.g. food packages. Now, coming back to “wellness”: while public health states that we need to re-engineer our society to create the conditions so that people can develop healthy lifestyles, wellness submits that there is nothing wrong with our society. “Wellness” basically says that society is not the problem, but that it is you who are unable to cope with the stress of our changing society and therefore we will teach you how to deal with the stresses.

That is not public health. That is a coping strategy or a gimmick if you will and the foundation of a new line of entrepeneurship.

You sound like Rutger Bregman advocating a universal basic income for every one?
I am also a skeptic regarding our democratic system. I am an advocate of giving people more authority, I might sound like a rebel. But I have seen too often that what the systems we currently employ does not work.

I want to help make this a better place to live in. I was raised in a Jewish tradition, and one of the key ingredients in that tradition is the obligation to make the world better. A world where we value each other and we do good deeds without fighting among each other. Personally, when I see that injustice is being done, I stand up against it especially also there where we can collaborate and team up forces, to create a bigger impact.

How are you trying also to keep up with your personal knowledge and skills levels?
By reading as much as I can (scientific articles -medical & Public health- as well as books in general and philosophy journals) and interacting with professionals of a wide variety of areas, by participating in teaching of young professionals and participating in conferences and networks. Regretfully, due to the demands of leading the COVID response, there has not been a great deal of time for many of these.

 What are your strengths?
I have this enormous drive to make things better, to enable people to become their best. I am telling people around me in the government in positions in which they could make a difference that I am on my way out, forget me. I will retire soon and it would be such a big pitty if whatever we have built , would totally collapse. This is not because I am irreplaceable. Far from it, but we do not plan for sustainable systems, we do not take care of ensuring continuity and improvement over time on the island. Programs run as long as those who initiated them carry them. 

Too often do these programs fall apart after the primary mover is gone. My drive is to identify young people that are willing to shoulder the burden of the work that needs to be done in the public health area. It is not about me, I am all in to create a structure, that will be sustainable and that there will be some young doctors and health professionals that will continue to do the work without me and maybe even conclude that what I have done was “shit” and that they will make it better. This is my BIG WHY.

Do you have hobbies or interests that you are also passionate about?
Reading, some sports but truth be told: I have not done much of that in recent years and my family.

If you as Izzy would meet a stranger in the bus (let say in Mexico or Columbia) and they would ask you to introduce yourself what would you answer and how would you describe Izzy in one sentence?
Hi, my name is Izzy and I come from Curaçao.

Who are the persons that have inspired you the most in your career?
There are so many of them…but I would say some ordinary patients, during the time I was working as a general practitioner. They were telling me about their lives and although they had nothing, they were brilliant in surviving and they kept helping others. I deeply admire those people that usually are not the ones being honored or decorated but do so enormously much for others and remain invisible.

I have so many good friends that have and keep on inspiring me, with their own passion, knowledge, integrity and humanity.

I am inspired by the students I have had the honor to accompany, by young people who are eager to learn and by their own drive to make things better, not in the least by my own nephew and nieces as well as my daughters who challenge me to keep up with them.

And of course I was inspired by my parents, my sister and my wife. My two daughters. They are both very critical and I am proud of the fact that we always had a lot of humor in our relationships. They are more principle centered that I am and far more disciplined than I am, but not dogmatic in their beliefs.

What is a trait that is still work in progress?
I would love to learn to force myself to become more effective as in this moment in time, because of lack of sufficient staff. I am all over the place as there are so many things that interest me.

What was a defining moment in your life?
My student days in the Netherlands This is the time you define yourself, choose your path, sharpen and polish who you are. The friends you make, the bonds you foster, the things you undertook together, remain essential for you. These are the people who remain among my best friends.

What would you want your Loved Ones, family, friends and others to say about you let’s say 20 years from now on your Birthday party?
That they still love me.

When do you consider that you have been successful in your personal and business/professional life, let us say 5 years from now?
I hope that we are able to create, and this is something that I am really passionate about, an independent structure that is strong enough, able and capable to refresh and renew itself and that is able to develop capacity and retain capacity to take care of continuity of our intentions. Built upon a foundation we created to manage funds for research (ISOG -2000), we created a new foundation called Curaçao Biomedical & Health Research Institute (CBHRI). The intention of ‘Internationale Samenwerking en Onderzoek in de Gezondheidszorg’ (ISOG) was to be able to finance a next Health Survey. This never happened and we want to enable and sponsor young students to do their PhD regarding subject matters that are relevant for Curaçao and the other islands of the Dutch Caribbean. s and we would guide them in this. By enabling them to do their PhD’s, we would not only increase their qualitative level, but also the overall level in Curaçao. Wouldn’t it be nice to bring some of our youth with brains back to Curaçao, the reversal of the brain drain. Not only offering the possibility to do research, but also if we would be able to give them a job. We as CBHRI were the first that obtained a direct NWO grant for a joint project together with the Universities of St t Maarten, Aruba and Curaçao, that is not via an academic entity in the Netherlands but as primary lead academic institute. This is important because if we are successful this would enable us to acquire more grants for essential research as regretfully there are not enough funds for research and thus no opportunities our own young promising students to further their skills , create posts for them and help us elevate our level on the island as a whole and so help ensure a stable development of the country. as much as possible. This is what I will be doing 5 years from now.

More info:
– Curaçao Biomedical & Health Research Institute (CBHRI). 
– Profile Izzy Gerstenbluth on CBHRI
– Publications on Researchgate 

One of the 250 Influencers of Curaçao
Dr. Izzy Gerstenbluth is a passionate, visionary and highly skilled epidemiologist that has caught the attention since he was a student in Groningen, Holland of many in the seventies. Triggered by the lack of access to medical care for those of lower social economic status in Curaçao, he decided to study Medicine with the intention to bring about changes in the health care system in Curaçao. During the past 35 plus years, Izzy has relentlessly worked towards bringing about changes aimed at focusing on the primary health care and in preventive medicine, often seen by others as being rebellious. The Health Care Survey “Hoe gezond is Curaçao” his department made in the early 90-ties, caught international attention and this lead to Izzy being invited to become a board member of the “Council for Health Research and Development”. Izzy stayed in that board till the beginning of the new millennium and later was appointed as member of the Advisory Council for Health Research of the PAHO for 3 years. His vision on the need for an integrated, multi-sectoral policy approach that can have a real impact in the lif e styles and lives of especially those from a lower social economic class has seemed “too far out” for many in government, but after all these years, it seems that the re-prioritization of funds, is the only sensible way to improve the overall health of the people and keep the system affordable over time. At this moment, Izzy is best known because he is the spokesperson of the crisis team dealing with the Covid pandemic in Curaçao, which is managed well, although the department has remained understaffed until today. For the future, Izzy has a clear vision aimed at enabling and retainment of young bright medical students, to further work towards the improvement of the quality of the health care sector especially in Curaçao. Because of all this and his continued ambition to be of service in the health care sector, at times putting in extreme efforts, we dearly love and deeply respect Izzy and consider him part of the 250 Influencers of the island representing the Health sector.

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