Expert: Pharmacists Can Bring a Social Justice, Public Health Lens to the Pharmacy Profession

As a part of Pharmacy Times® Women in Pharmacy series celebrating Women Pharmacists Day, Pharmacy Times® interviewed Vibhuti Arya, PharmD, MPH, FAPhA, a trainer and leader of Curating Brave Spaces; the global lead, Gender Equity and Diversity Workforce Development at the International Pharmaceutical Federation (FIP); and a professor at St. John's University, on how her background helped to shape her professional goals, work, and efforts in pharmacy, as well as the role of mentorship throughout her career.

Pharmacy Times®: What inspired you to pursue a career in the pharmacy profession?

Vibhuti Arya: So I'm actually a first gen immigrant from India. When I moved to Washington Heights in New York, one of the things that we got exposed to was medicine and medical education; we didn't really have much financial capital or social capital. I happened to actually come across a recruiter from St. John's, who recommended pharmacy to me, and so we were like, ‘Sure, yeah, okay, I'll apply.’

So I kind of happened to fall into pharmacy, but very quickly found my way into understanding how it fits into public health. So I think that for me, the arena was more about public health and education and social justice, and pharmacy was one way that I could envision that in terms of access, and what it meant for people to get access to not only care but pharmacists and other countries and globally, I would say, play different roles, very different from the system we have in the US.

So for me, it was it was a little bit more like a community partner and somebody you go to for health advice, and just somebody who's a little bit more comprehensive. So I think in pharmacy school, quickly, I found policy and bringing my social justice lens and public health lens into the profession, which is what sort of became my career track.

Pharmacy Times®: How has your background, perhaps even your childhood, helped to shape your professional goals, work, and efforts in pharmacy?

Vibhuti Arya: Yeah, I think that I very much through my own lived experiences and the communities I grew up in very much so was exposed to what we now know to be social determinants of health, in a very sort of real visceral every day, critical examination way that impacted people's lives, my life, my family’s life, my friends’ lives, and family units in our communities, and how social determinants of health have impacted us all. So I think for me, it was never a question of abandoning social justice as a central principle for my work, but really, it was about centering my work around that. So it wasn't some ancillary thought or abstract sort of theory, but more about how we can infuse our profession of pharmacy with public health principles and social justice principles, so that pharmacists are there to care for patients in a very intentional, deliberate, and effective way. So I would say having lived experiences and growing up the way that I did, really, really shaped how I centralized social justice into my work and continue to do so today.

Pharmacy Times®: What has been the role of mentorship in your career, and why can mentorship be particularly impactful for women in STEM fields?

Vibhuti Arya: So I will say, I think I joke that it took a global village to raise me, which is very true, certainly from again, all of my lived experiences as an immigrant, as a woman of color, and predominantly, we are in what I would call identity affirming spaces, and then navigating through spaces that perhaps weren't. So there's been a lot of experiences that have influenced me and some really key mentors who to this day, I turn to for advice and counsel, and we banter a lot about all the principles in the world, everything that's happening today. But I think that having somebody who affirms you, who believes in you, who supports you, and really provides a lens that helps you discover who you are, rather than their version of you or what they expect you to be.

So I do think that having a strong community and I come from a very, very strong communal sort of lens where there's an extended family, and there's an extended community, I would say, to support you in the things that you do. And I didn't grow up fearing asking questions, or any of that stuff, actually, it was very encouraged. So I would say that the mentors in my life who have shaped me, have encouraged a lot of discovery, curiosity, and supporting me and who I am even when I dream big or perhaps when it's alien to the world, or maybe too radical. And so I do think that the role of mentorship is huge, and that's why it's really important for me to serve as a mentor.

I also think, representation matters, right? Knowing that there are people who may look and sound like me or may have other perspectives to bring that it's not just homogenous, encourages all of us in a very subtle and also very overt way to bring all of who we are, to our work, and to our everyday lives. I think that when there's a lack of diversity or lack of representation, whether it be race, ethnicity, gender, sexual orientation, etc—there's a lot that can go missed, and there's a lot that can be discouraged. So I think that's really important in terms of the mentorship and representation.

Pharmacy Times®: Did you observe any female colleagues in science and education being impacted professionally by the demands of the pandemic, and what did that impact look like?

Vibhuti Arya: Yeah, I mean, the short answer is yes—in a resounding manner. I think that I'm also engaged with the International Pharmaceutical Federation, or FIP, where I serve as a global lead for equity workforce development, and one of the things that we've noticed certainly—the World Health Organization also had a report out during the pandemic—but over the course of the past few years, we've certainly noticed how gender differences exist in terms of impact from the pandemic, who tends to take on a lot of thankless jobs. There's certainly a wage gap as well, certainly, and the nuances of gender diversity, it's not just a men and women situation, so I tend to not stick to just the gender binary, but really looking into the nuanced ways in which we can define gender diversity and look at and be a little bit more comprehensive in the way that we look at this. But I certainly do think that there is a major difference and more of the world perhaps is talking about it.

There's a lot of other, quote unquote, jobs that we do, that traditionally, we know have landed in—using the gender binary—more on women than men, certainly, in being caretakers, certainly in being more in supportive roles. For example, the amount of women who I know in academia and in pharmacy that, just even alone in our networks, who were asked to review articles, for example. And how much time it took away from our actually writing and authoring papers that we were just reviewing papers, how many times we get asked to do secretarial work—I don't mean that in a disparaging way—but really the support systems and the support work, but that are not always in the forefront when it comes to getting recognition and when it comes to getting compensation.

So I know that many, many people, certainly mothers, but also, daughters and sisters, and the ways that our roles in our families turned to caregiving, and all of the indirect ways in which we end up caretaking for families and friends and members of our family even extended, that tends to fall—at least through the reports that I've read—traditionally on women rather than men.

So I think that, in particular, there has been a lot of offending of daily lives in the pandemic, certainly trauma, collective trauma has had a huge impact on all of us. I do think looking at gender from a very binary lens actually ends up hurting even men, right, and if I dare say that, because there are ways in which we don't get to live, no matter where you fall on the gender diverse spectrum, in a human way, that allows us to, again, be all of who we are and experience and feel things and be able to experience and be able to express things in a certain way.

Falling into a lot of gender norms or gender roles, traditionally, it's not just what we do, but also what we don't get to do, and I think that that falls in both ways. So which is why in our work, we really, really advocate that it's not just a women's issue, it's not just an issue of anybody who's marginalized. But actually all of us who have privilege, in many ways, need to be engaged in a very intentional and deliberate way. So that it's not just falling to the efforts of those who have marginalized voices. That was a lot. But I hope that helped to understand I think that there has been disparate impact on women, for example, versus men, certainly from the pandemic, but that all of us have to do our part in making sure that we can kind of tip it a little bit better.

Pharmacy Times®: As we move forward, what are your hopes for the attention and focus paid to supporting and calling attention to some of these gendered roles in the pharmacy profession?

Vibhuti Arya: Yeah, I mean, I think it's nuanced in the fact that we have to sort of look at our traditional roles, and we have to look at policies and processes, and, frankly, the infrastructure. We still know, particularly, for example, in academia, not a lot of women, and certainly women of color, who are full professors or are tenured, and there's leadership aspirations and who makes it to leadership, there's a lot of nuance there in terms of how we get there. You still hear conversations around women not being able to make certain ranks and positions because they're going to go on maternity leave or whatever, even if a person does not want to get pregnant. So there's a lot of gendered roles and stereotypical preconceived notions that we battle through, and I would say still in these sort of traditional systems, but I also think that a lot of times—we were at a conference, and we were talking about gender diversity and equity and around the table there were fewer men than women—I'll just use the binary to start with—and it was interesting because a lot of the men who were in the room as we were all introducing ourselves, they had fancier titles, they were all in leadership roles, deans, assistant deans, associate deans, or chairs. And you heard the stories around of the women in there. Some of them started a career over some of them were balancing caretaking for family and being mothers, some of them were balancing just, all sorts of things.

It just was such a stark difference where none of us had secretaries and none of us had assistants none of us had held. Honestly, a lot of us ended up taking on those positions as well. So it was just a really great moment of just sort of taking in that sort of dichotomy that was existing right there in that room. This was a global group, where, on one hand, you've got people who've got really great titles, and they're further along with similar years of experience, by the way, but they happen to get to the leadership positions, they're able to attend conferences and meetings, because they have somebody at home taking care of their kids, and they have somebody at work, taking care of their calendars, and all of this kind of stuff that may seem ancillary, but actually makes a lot of difference in terms of how you can free up time that would focus on other efforts to again, gain more recognition, and productivity hours, for example, or write articles and all of that kind of stuff in professional endeavors.

So I do think that part of what needs to be recognized is the representation around all of these structures. How many people do we have that represent diversity of voices, again, not just race and ethnicity, but gender diversity, and looking at different ways in which we think about diversity in a more comprehensive manner. So all that to say, I think that we need to really critically examine these structures that have, I would say, are quite antiquated in some ways.

Pharmacy Times®: What are some moments from your professional career that significantly impacted how you view the pharmacy profession and your role in it?

Vibhuti Arya: Yeah, I would say those moments continue to happen. But one of the themes that I've noticed is, I often will say that I feel like such an alien around some groups that I'm part of, because some of the thoughts or ideas that I may offer, both because I also teach meditation, and there's a whole like healer side of me that engages in a lot of human-centered activity that I think is essential, at least for me from my practice, and aligns with my social justice principles.

I will say, I think professionally, I've been around a lot of tables where a lot of the things that I end up offering thoughts, ideas, potential solutions, etc, can be seen as quite alien, or I will use quotes as radical or something that's like, way too futuristic, perhaps, or even being heckled at for many of these things. I remember when I used to talk about meditation even like 15 years ago, I mean, I definitely received some heckling, or when I would talk about people-centered responses or human-centered things, and not just like metrics.

So I think that what I've noticed is sometimes—while it may feel very isolating to be in a room and often be the only voice advocating for something—it is really important for me to stand firm on my ground and make sure that I continue to do that, even if I'm the only one doing it. Perhaps 10 to 15 years later, a bell might ding or somebody might be like, ‘Maybe there's some truth to that, or maybe we ought to think of it this way.’ And no judgment and nothing malicious about it, but I think people have, it's just, perhaps the time or experience that focuses on that or that informs informed informs that opinion.

But I do think that I've learned to never get caught up in the hype, good or bad, but stand firm on my ground, for what I know, aligns with my spirit and my principles, even if I'm isolated, even if I'm being ridiculed, or the only one in the room who feels that way, and making sure that I continue to do that because it likely is making more of an impact than I think, and perhaps someday it might be more on the main stage of conversation. The diversity issue certainly has been one for my career, certainly lots of social justice principles and conversations around public health and how pharmacy is integrated within public health.

So I think that's what I would say is that I've had really great support systems in my community, with my family and mentors and students to remind me and reinforce that standing true to my spirit and principles is really important because even when you don't think it's making an impact, it likely is in some sort of way. And it's just aligned with who I am. So I'm okay with that. Even if it doesn't make, even if it doesn't maybe have the same reception that it might 10 years later.

Pharmacy Times®: How do you manage your reaction in situations where you are confronted with other people's biases in a professional setting?

Vibhuti Arya: I think it's a two-pronged approach for me. One is as an individual, what do I do to cope? And I think the other one is, how much am I continuing to grow the collective. It's really, really important cause I come from that sort of, I don't know, background or whatever you want to call it. But that's really important to me, it's not just about me, and what I represent, it's about the collective. As much as I can stand my ground and know what I'm doing, it's really, really, really important for me to know that I'm growing the collective in some way, shape, or form. And what that means is sometimes getting in front of conversations and leaving them so that people are amassing people behind you, but that also means stepping back when necessary, and letting the light shine on somebody else. That means amplifying messages, and that also means creating a collective that's supportive of one another, because at some point, one of us will get burnt out. So it's really important to understand that we have people who support us through all of it to celebrate the good stuff, but also when we're feeling down or when we're feeling discouraged, so somebody can remind you to have that hope to continue things forward.

I do think, for me, personally, having humility around it to remind ourselves that we're such a small speck of sand in this vast humanity that we can't take ourselves too seriously. It's important that we do our best and we don't assume things, but that we do come together as best as we can with that humility to engage in principles of deep listening, to engage in doing the work that we can always grow from, but also call the spade a spade, right? To make sure that we're not compromising our own integrity no matter what. I always tell students this that it's what happens in the dark when nobody's watching. It's not just when people are listening, you're not performing for anybody else but you. And that integrity is really, really important to me.

I do think it's not a privilege I take lightly to be part of someone else's journey, no matter everything that we interact with everyone that interacts with us, and vice versa, we all have an impact on each other. So for me, it's always keeping that in mind. And how do I evolve everything that we can touch can change, everything can change us? So how do we keep going in that in that constant change.

I invited a student—I have my student Rabia Hassan with me, who's one of our students in our PharmD program at St. John's. It's been such an honor and privilege to be in conversations with her. This is one example of how it's so beautiful to create this collective and engage in deep listening with each other. It's not just me imparting anything on somebody else as a student, but it's about how students shaped me and how I learned from them as well. So I think it's such a privilege to be part of their journey, and we learn from each other.

So I think just holding that core principle, perhaps at the center, is really important. So I would say, individual coping mechanism and how you can recover and be resilient. But also sometimes you just need to sit in the sadness and sometimes sit in the anger. And that's okay too. Because if you've got that collective, they'll remind you, and validate and affirm that what you're feeling is okay, and not to dismiss it. Just like fire can consume you, it can also be used for alchemy and transformation. So I hold that duality and make sure that I can always come out of it better. But it's not always easy and that's okay too.

Pharmacy Times®: Any closing thoughts?

Rabia Hassan: Dr. Arya’s wonderful, I’d like to start off with that. She really inspired me, and I know other students, to really think outside of our textbooks, our PowerPoints, and our notes to really think about how, as pharmacists and as pharmacy students, we could really change the world. I know that sounds very dramatic, but even just having the basic conversations about what's happening, and how we could start thinking about little changes here and there—I think that is really impactful. It has really helped me in the last 4 weeks because I've been her student for the last 4 weeks—I'm in rotation—and I really do hope that the changes that we're talking about and hoping for right now that they continue to happen, and I see them in my career in a few years.