United Kingdom-based Nigerian researcher and urban epidemiologist, Prof Tolullah Oni, speaks to EMMANUEL OJO about her work
Your profile indicates that you’re a multifaceted professional, from medicine to architecture. Can you throw some light on what you do?
I trained as a doctor but I felt I wanted to do more. I studied medicine at the University College, London. During my medical training, I took a year out to study international health and that was my first proper introduction to public health and preventive medicine. After I finished my medical training, I actually worked as a doctor in different fields – in general medicine, emergency, infectious diseases. I was working on HIV and tuberculosis and was looking at how they interact with other diseases like high blood pressure and so on. I realised that there is just a little we can do in the clinic. All we can do is just tell patients to lead a healthy lifestyle but the factors that determine whether people can do it lie in the environment and I got frustrated by being in the clinic, seeing people coming with diseases that we can actually prevent, but which we don’t prevent; we just wait for them to happen. Then we begin to say we don’t have enough resources to treat these diseases. So, I started rethinking what my role as a doctor should be, beyond being in the clinic.
I remembered that during my medical training we were told that 80 per cent of factors influencing health are outside of health care; so, I thought we should look at that. Who are those in the 80 per cent? They are the architects, the planners, the environmentalists, the local government authorities and those other people that really shape the environment and determine if it’s healthy or unhealthy. So, it occurred to me that I should go beyond just telling my patients that their blood pressure is high, they need to work at it more, etc.
So, in my research, I wanted to improve on how to design health into the very fabric of our city, so we don’t just think about hospitals and clinics when we talk about health. I felt we should also start talking about the public faces, the roads, the greens, the air we breathe, the food we eat. This is about the health of our city.
It is amazing that we tolerate unhealthy cities and we are surprised when people fall sick. From my medical perspective, I realised that what I was doing was a practice. People say that I don’t practice medicine anymore but I say, no, I still practise medicine. I just practise public health medicine. I don’t treat individuals anymore, I treat cities now. So the cities are my patients. I can diagnose a city and know what the problem is, what to do to improve it, what medicine to be given and all that.
Was that what inspired your interest in architecture?
The architecture bit is interesting. My primary job as a physician is that I work at the University of Cambridge, where I am a clinical director of research and what I do there is that I lead a programme in epidemiology.
My secondary affiliation is with the University of Pretoria, South Africa and there I was offered an extraordinary professorship. I deliberately asked for it to be in architecture instead of health, because that is the environment in which I have been spending most of my time. The whole point was if we understand that environment is important to us, then there should be health expertise within that. So, that was how I ended up with professorship in architecture. I never studied architecture; that’s just where my appointment is. My appointment is in the department of architecture.
Was it easy requesting for professorship in architecture, knowing that you don’t have a background in that field?
When you get to a certain career height, the professorship is based on what you’ve achieved and the alignment of the work you do with the work that happens in the department. I was offered that based on the work that I had done.
You said you’ve graduated from treating humans to treating cities. What exactly does that entail?
The approach is the same as how you have a patient present in the hospital and you take medical history, social history and all that; how you try to understand what the medication history is; what has worked and what hasn’t worked. That’s how you are taught how to clerk a patient. So, when the patient is the city, it’s the same process of clerking a patient. The difference, however, is that when a city is the patient, it doesn’t complain when it should complain and then it becomes an emergency case. And this is where data becomes important.
Talking about a city being liveable or prosperous has to do with people because there are no prosperous cities without healthy people. Working in Lagos and other region, one of the things I love is that this is a young population. I was in Lagos a few weeks ago and I asked some young people what the average age in Lagos is and they all guessed higher. The average age in Lagos is 18. Half of the population in Lagos is 18 or under. The majority of people are young. So, creating a healthy environment is important. When people are young, one key thing to look out for is their health. We have to create a health plan and this is not the responsibility of only the Ministry of Health. Other ministries in charge of urban planning, food and agriculture, environment should also be involved.
Taking air pollution as an example, in just one year, Lagos State lost about two per cent of its GDP because of air pollution, which led to sickness and the death of some people. The key problem in a lot of cities is that we don’t even have the presenting complaints because we are not measuring and we have normalised unhealthy things.
In Lagos, for instance, 60 per cent of the deaths due to air pollution were in children under the age of five. How do we normalise this? I let people know this.
At what age did you become a professor?
I am 42 right now. I lived in Cape Town for some years and when I left Cape Town, I was an associate professor; so, I was about 35 and I was already a medical specialist at that time.
You’re no doubt a high-flyer. Are there challenges that come with this rise for a woman?
The biggest challenge is the expectations of others.
How do you mean expectations?
It shouldn’t be a surprise to have women in high-flying spaces as much as men but because of the reality that women are not well represented as much as men, especially in the academia. I don’t engage with it. I don’t think it’s something to celebrate in the 21st century that we are in now. I don’t think that’s something to celebrate, to say that I am the first woman doing a particular thing. It will be a shame to celebrate. So, some of those expectations are one challenge.
There is sometimes a challenge of how women communicate in the workplace. There’s a motherly expectation of women in leadership position and I think it’s a societal thing but that’s how it plays out in the workplace. The notion is that women are more caring and more nurturing but I refuse that. I think every human needs to be empathetic. But everyone expects women to always be softer.
Have you faced any form of gender discrimination by your male counterparts in your career rise?
Well, maybe I didn’t notice but I have experienced the opposite of it. The people that have supported me the most and all my mentors along the way have been males. So, I think this is an important thing. I’ve always been grateful to the people who have mentioned my name even when I wasn’t in the room and these people have predominantly been men and it really didn’t take anything from them really. We need to learn how to bring others up.
How do you manage all of the many responsibilities you have, not neglecting your personal life and relationships that matter to you?
It’s a work in progress. It’s a constant striving. It’s a challenge. I have my research going on in Cambridge University, I got another research group in Pretoria in architecture, I have another appointment in Cape Town, I have work and researches going on in South Africa, Nigeria, Ghana, Cameroon, Kenya and so on. It’s very difficult. It’s not without challenges but the thing I find helpful is having good colleagues. You have to be able to trust the people you have with you and have good rapport with. The thing that drives me is the urgency of the things I have to do and in finding people to collaborate with. I’ve spent a lot of my time building that trust, relationships and collaborations. It’s a challenge.
I talked around your questions as a politician (laughs). I live in three cities and it’s constantly very challenging and it’s beautiful to have a very understanding other half, not only understanding but also someone who challenges me to become better in achieving that required balance.
My husband understands the drive and what drives me. I’m rarely challenged but he challenges me. We have good sense of collective identity but we also have our individual identities because it’s important not to lose our individualities even as we work together. Sometimes when travelling, we plan the trip together so that we can find some time to communicate and bond even as we work, so as to make sure that the other person doesn’t suffer. Sometimes, he tries to call me out because I’m always driven by many projects. Another thing I’m learning at the moment is how to delegate and it’s been really helpful. It’s a journey in search of balance.
Many ladies in a bid to toe that path of career have had to give up family for career or vice versa but you seem to have been able to manage all well. What’s your advice for younger ladies trying to build a good career path and are also burdened with striking a balance with other important aspects of life?
One thing I learnt, maybe late, which I wish I knew earlier, was that there is always more option on the table than is offered to you. If someone says that there’s a job somewhere, it doesn’t mean that you have to do it or have to go there. If that’s the job you have to do, you can propose how to do it and still achieve the job and not compromise your partner. People would give you options A or B but I would propose C and say what about that? If you have a skill, find your niche and you have to know that the job is lucky to have you and not just you trying to keep the job.
There are a lot of things which have shaped our lives which our upbringing and all of that have contributed to, not just the technical aspect of our training alone. Like for me, I have a rich cultural background, which is due to different places I have lived in and which has helped me to be able to work in many parts of the world where I have worked. That’s my experience and that gave me a niche and helped me stay in a stronger negotiation position.
The niche is a combination of our technical training and our life’s experiences. Also have self-worth. Also, part of the things you have to learn is how to stalk people legally. Use social media platforms to reach out to those mentors and people that will help you navigate in your career paths.
What’s the meaning of your name ‘Tolullah’?
(Laughs) Tolullah is actually my brand. It’s such that when people hear the name, they have to ask about my origin.
What part of Nigeria are you from?
I’m from Ekiti State.
