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Trailblazers with Garry: a conversation with Lena Nanushyan
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"Trailblazers with Garry" is a new series from Global Health Matters, where host Dr Garry Aslanyan sits down with trailblazers — thinkers, leaders, and influencers shaping the future of global health — for short face-to-face conversations, available in both audio and video formats. It’s a chance to get to know the people behind the work and hear their perspectives on the current global health landscape.
In this Trailblazers episode, host Garry Aslanyan sits down with Lena Nanushyan, First Deputy Minister of Health of the Republic of Armenia to speak about her work to strengthen tobacco control, a commitment that earned her a World No Tobacco Day Award from WHO in 2025. She also discusses Armenia's efforts to reduce high out-of-pocket health payments and how the country is moving closer toward universal health coverage.
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Welcome to Trailblazers with Gary, a serious but global health matters podcast. I'm your host, Gary Aslan. In this series, I sit down with Trailblazers in Global Health for short face-to-face conversations, which you can listen to in audio or watch the video. It's a chance to get to know the person behind the work, hear their stories, and gain their perspectives on current global health landscape. Join me as we explore the people, places, and ideas driving global health forward. Let's get started. For this episode, I had the pleasure of sitting down with Dr. Lena Nanushan in Yerma, capital of Armenia. Lena is a dynamic leader and currently serves as the first Deputy Minister of Health. In our conversation, she talks about her work to strengthen tobacco control, a commitment that earned her the World No Tobacco Day Award at WHO in 2025. She also shared about Armenia's efforts to reduce high out-of-pocket health payments and how the country is moving closer to universal health coverage. Throughout our discussion, Lena emphasizes her belief that bringing together diverse perspectives and building strong multi-stakeholder collaborations is essential for lasting progress in health. I hope you enjoyed this inspiring conversation. Hi everyone, it's Gary Asanian, and we are going to record another episode of Trailblazers with Gary. And I'm very, very pleased to be at the Ministry of Health of Republic of Armenia in Yerevan. And the first Deputy Minister of Health, Dr. Lena Nanushan, has joined me for this conversation. Thank you for finding time for this conversation, Dr. Nanushan.
SPEAKER_00Thank you for uh giving me such an opportunity to meet you and also to talk about our uh well health issues in our country.
SPEAKER_01Perfect. And of course, there's a lot to talk about. So let's get started. I'm really interested to know what made you choose a career in public health and also in um working in the public sector and in the ministry. Uh, how did you come to that? Uh if you could share some of that and what challenges and opportunities that brought.
SPEAKER_00Uh well, I I I have to bring you back to the 90s when I have graduated from medical university, and during my studies at university, we were going to different hospitals, having different trainings in medical care in different uh well subjects. And uh during that time, unfortunately, uh I was observing that uh the hospitals were a very bad condition, there were no medication, there were no uh you know money for salaries, no good quality for care. And uh during that time I understood that might be need in my country to have uh you know good maybe managers or uh policymakers that will make a change in environment that uh you know in which the healthcare services are provided. And that was one of the points I have decided to go for healthcare management and public health, uh, you know, taking these studies uh and working in that field. But another one point also that I wanted to mention that I understood that public health gives you opportunity, and also this uh civil service and working in the ministry gives you opportunity to uh with the only change of one policy to have impact on uh thousands of lives or millions of lives. Uh, in case of uh you know working as a doctor, that I had such opportunity to go for that, uh, you will work with one patient, 10 person, 10 patients, or maybe you know, 100 patients per month. But in case of working at the public health and you know, public service with one decision, you can impact many lives. And this was also one of the points that motivated me to go and to have studies and to work uh you know in the at the Ministry of Health and the Parliament. I have worked at the parliament, but I have you know uh also work with the same issues, healthcare issues with different perspectives. I worked from the NGO side, I worked from the parliament ministry and UN also international organization side, and that gives me also, you know, uh experience how best different organizations can contribute to solution of the issues.
SPEAKER_01So the different kind of impact you can have. I think this is a very good point because not everyone immediately sees that that way. So thanks for reiterating that point. And you have been having impact because this year uh we had uh you have received, I mean, unfortunately, I didn't know that you were in Geneva and you received an award for the uh tobacco loss introduced in in Armenia, in here, uh, and how successful they've been in terms of smoking in public spaces, etc. Um, can you tell us more about that and what actually what were the challenges and what where where are things now and how that will contribute to public health in the country?
SPEAKER_00Thanks for uh this question. This is a very important part of my job and also public health in Armenia. Um, so as a public health practitioner, of course, smoking is number one priority for me and also for our ministry, because uh more than half of men in Armenia are smoking. And unfortunately, there are new challenges: vaping, electronic cigarettes, and our uh you know kids and adolescents are already uh using all these new novel products. And uh for us, uh looking for the health issues uh of our population, um we we had a very good support coming from UN, WHO on investment case, which shows that number one priority should be smoking, uh uh tobacco control. Special case, yeah, with analysis of things that will bring more impact, the biggest impact on a health.
SPEAKER_01So using evidence to choose that. Okay, great.
SPEAKER_00Exactly. And the second was the salt reduction because uh we are using a use of salt, yeah. Yeah, we are using uh twice more than WHS recommended. Really, okay. And uh so we have decided that one of our priorities should be tobacco control, and it was, of course, you don't understand that it was uh not an easy job, uh, especially uh you know in Armenia where we have uh industry, uh we have a production of uh tobacco, we were in a very sensitive uh situation, we need to have more economic growth and industry could justify that that uh more jobs will be closed after law, you know, all those justifications, let's say, coming from the industry. But this was a primary goal for the Ministry of Health that we uh did understand that uh this will bring more impact. And and usually in our public service and working at the Ministry of Health, you know, you will not have very soon results. Um and this is a very sensitive issue, you know. You are working in a politics uh where you need to have uh quick results to show that you are working. You made a difference. You made a difference, you have results, you make a change. Uh but in a public health, usually you have uh you know results uh after. After several years, yeah. And it was very difficult to convince yeah, pol policymakers, especially uh government, ministry of economy, parliamentarians that we need to do this because this is a how do you how do you do it? I it was very challenging, but we used to work with our uh partners from WHO, from academia, from health professional associations, public health associations, and to convince uh you know that um we need this. And we brought, uh, of course, with help of our partners, we brought some uh country representatives from neighboring Georgia, from other countries, who showed, who spoke uh with the parliamentarians, with others that you know we we did it a few years ago or 10 years ago, and we haven't any uh reduction of economic growth. We have we do not have uh closed jobs, etc. It was a little bit challenging, but we used uh to use the evidence that uh have been shown in because many countries have passed already through that. We used how they did it and what type of results they have, how imp how the health status improved in their populations, and it it works. Of course, we have some consensus, of course, with them, for example, that not at once the law, the all the provisions will come into force, but each year we will have a new provision that will be step by step. And uh and one more point that I wanted to mention here that it was not only challenging to make that change, to convince and to have the law uh approved, uh that enforcement was uh another challenge, and still it is a challenge. But not only by law you you you uh will have tobacco control, you know, effective tobacco control, but also educating people, providing um quitting services to those who wanna who hear that okay it's bad for your health, you need to give. But what what's the alternative to provide some quitting services to people and to provide education at school, etc. So which we are doing. But another challenge is that still every day you you didn't you shouldn't think that okay, you have approved the law, it's done, public health is done, so you need to go to do another day. No, every day uh you need to work on rework on those old issues because the uh industry is working uh from another side, right? There are new products, uh there are you always have to be on top of it. Yeah, and you you need always to to work on this issue. This is only one example of the work that uh we are working in the Ministry of Health.
SPEAKER_01And do you think that um the public has also changed their attitude towards smoking because of that? Do you think there's been a change or a shift?
SPEAKER_00Um, well, usually as a public health professional, in those cases, um I am looking for data. Right, right. To you know, to present that yes, they have changed or no. In terms of attitudes, but the behavior change is the most difficult part. And because we have also new products, uh, this is also challenging. We wanted to do a study, another study that was has been done seven years ago before the law was approved to compare. To compare its steps uh study. And uh while we will have the leacher, then I will certainly have an answer to your question that how we can do that. So you look into it, yeah. That's right.
SPEAKER_01That's good, yeah. Because very interesting to see how also things change in in societal um and cultural kind of aspect of how this has an impact on on certain points, yeah.
SPEAKER_00Well, yeah, but uh when we are uh looking around uh well as uh you know as uh uh in my community with my friends, I see that many people are starting uh the healthy lifestyle, you know, approach. The healthy eating is very now coming, very being a very, you know, priority or prestige, uh the going to gyms, running, uh cycling, it's becoming more and more precise, and maybe people are understanding little by little that. And also the new generation, they are they are more informed, and all these social media not only you know providing some trash information but also providing the good information. And we need just to be uh in line with all these uh new technologies, things that are coming up on us, yeah.
SPEAKER_01And tobacco clearly continues to reinvent with new ways or new things, so they are not really sort of uh um uh giving up on on promoting it, yeah.
SPEAKER_00Yeah, but but because this is uh huge money, you know, money always matters, and uh and um in contrast with them, you do not have such money to do all this information, marketing, etc. etc. But uh you need also to find all those opportunities that uh you can use uh you know to bring the information to our children that this is uh uh very harmful uh products. The only maybe product that's uh you are procuring and which is uh impacting badly on your health.
SPEAKER_01No, no, and I mean it's uh I I have experienced in this few days how it made already made a difference in terms of how and where people smoke and how that that is a huge, huge achievement. I mean, thank you. Thank you.
SPEAKER_00It was uh an honor for me to receive an award from DG. Yeah, and you know, it's it's also a recognition. Recognition of your work, yeah, yeah. All the work you're doing, it's it's uh not only for the purpose, for the motivation I have in my job place, but it's also recognized. Yeah, great. But it's also give you, you know, some insurance that uh you're in a right pathway, right?
SPEAKER_01That what you're doing makes a difference, yeah. And you of course you were busy during COVID and pandemic and all of that, obviously, as every country. Uh, and um what has been uh some of the lessons and how has the system I mean people speak about resilience and is is there a change in how the system is more resilient towards future pandemics? And and just before we started recording, you told me that you're also looking at pushing for universal health coverage, and how do you combine these efforts together?
SPEAKER_00Um this is also a very important question because uh during COVID we have passed uh not only COVID emergency but also we had a war. And uh we had a war during the peak of COVID. Right. And um lessons learned are uh several, and I'm trying not to forget all of them because you know, usually when the emergency is over, you usually forget all those uh you know lessons learned. The uh the first one that you should always uh count uh lessons learned. You should always remember what were the lessons learned, and to implement all those uh lessons learned into an institutionalized system. Okay, then uh system will be prepared for next emergency. Uh the the second one is that uh you should be always in contact with the international partners, with the countries, with your colleagues to receive all those information that you need to make a decision. In advance or timely. The international cooperation uh also a key. And maybe one more lesson is learned that uh you you should develop the system in a way that it will be prepared for next pandemic, for any type of uh other emergency, and universal health coverage is a priority for us for that reason. Uh when the system is uh you know prepared, when the physicians and nurses are qualified, when the uh you know quality in place, when the drugs are in place are available, when the testing system, when the lab laboratory quality is in place. So it means that the uh system is ready and it's not only universal health coverage, but universal health coverage allows systems to be prepared for any type of disasters, emergencies, issues, etc.
SPEAKER_01So these things are intertwined. You you're not even thinking of them as uh separate things. Oh, this is really good because sometimes I hear people think of, oh, we're gonna do preparedness this way and then universal health coverage that way. But what I heard from you is these are inseparable.
SPEAKER_00It's exactly because you know, at the primary, if you are strengthening primary healthcare, for example, we have several reforms under UHC umbrella, and one of them is the primary healthcare strengthening. If a physician, um family doctor sitting at the primary healthcare setting in our polyclinic, is not aware, uh, is not qualified, uh, doesn't know the you know uh protocols, he cannot identify which one is these diseases, what are the symptoms, and he's not having uh, you know, the tools to inform or to test, have analysis, it means that you will not have any preparedness or response to any type of emergency. That's why, in my opinion, this is these are the almost the same, you know, uh concepts that are very much linked or maybe uh in line with each other. Um another reform that we are doing is the universal health insurance system that we wanted to implement under the university.
SPEAKER_01Because at the moment it's it's a mixture of uh who is covered by what, right?
SPEAKER_00Yes, it's it's a very difficult system that we have, but uh the problem is that we have very high out-of-pocket payments. Financially, it is not uh a burden on people. Yes, exactly. And that's why we are now working and the government to implement this system that will allow with small payments uh by each month people uh you know to skip the catastrophic uh you know expenses that they have you. And uh we're now in discussion with the government, with the parliament, and you know, in public health you're always dealing in a politics system, and uh you need to work with politicians, and I'm also the deputy minister, also, and my position is a political one. And you know, you need to all these UHC to uh work with all partners from the Ministry of Finance, Economy, Parliamentarians, and this is very important for our country because uh um there are some reforms you know that you know that will bring uh the much uh effect on people's life, and you will, as you have said, will make a difference.
SPEAKER_01But I was gonna make that comment and observation that, and I hope that for our uh listeners, those in countries who are tuning in or watching us, I've noticed with you that uh you have you have mastered or you are very astute in terms of how to engage different parts of the government beyond health. Maybe it's a fair uh or not. In the short uh period I've I've known you before and this conversation we're having, I I see I think that's your strength uh in terms of uh how to it might be.
SPEAKER_00Yeah, it might be.
SPEAKER_01So I'm I'm I I might I think I've noticed that. So it's a very interesting observation, it's very useful for others to also think about it because we in health sometimes don't think of how to work with other sectors.
SPEAKER_00Well, health, as uh WH said, as we say, uh health is in all policies, and to make any change, you To work with all partners. And with the Ministry of Finance, you need to talk with numbers, calculations, financial taxes, as you have said, tax collection, etc. With the Ministry of Economy, economy, you should show that, okay, if not tobacco, then they can grow other products that can be, you know, purchased with and will bring some economic growth, etc. So I mean with each partner and communication is a public health profession, you need to have also communication skills and also bring always this is my you know principle that you need always to talk with the numbers uh that are evidence-based and uh that will show that it's it's more professional talk. When you have numbers, it's more you know, base uh for convincing, for showing, because many people unfortunately during this year I met many decision makers, colleagues, etc., who are speaking without any data, without any, you know, just speaking okay, the anecdotally, yeah, unfortunately. But um, I'm always calling with my colleagues also that we need to have data to show. Of course, we can go do some homework to make some studies, assessment, etc., or bring some international experience data, but we need always to have data in our package to show that uh how it will be. And I I think it always uh gives you um credit to promote the policy you are working for.
SPEAKER_01Thank you. Yeah, that's great. Any other innovative plans um within um public health in the country or how you're um um working in different areas? And also you have a unique thing, which is a lot of uh the people um like in Armenia is only a small part of the Armenians in the world. And how do you involve them? Uh if you can uh reflect on those couple of uh issues.
SPEAKER_00Yeah, but uh uh during these 30 years, uh our diaspora, which is huge, uh it's um even two times more or maybe three times more than people are living in Armenia, inside Armenia. Uh so they they were helping in different areas. Uh they helped uh to build American University, which is now uh giving many um you know graduates. Uh that they helped with the um well uh renovations of hospitals, with uh uh you know equipment, with drugs, and still they're helping. But there was one point that we thought that we're not using their capacity fully. And we started to uh work with them to identify who can help us with uh public health decision making, uh, with health policy. And uh last seven years, so we are engaging them uh into the Ministry of Health work, and they are uh usually this the their position is the advisors to minister, okay, and they're helping a lot of with different expertise. Yes, so with uh, for example, we have a group led by the diasporan professional on primary health care. We have uh a diasporan professional uh who is helping with the public health, especially on nutrition, on breastfeeding, on uh healthy uh you know food. So we have different people who are coming sometimes online, sometimes coming to here, sitting in this room, and also helping us to make decisions uh on specific uh areas. And this is also, you know, this is a strength that they have, and they are using their knowledge experience in other countries, helping to build in, you know, public health in the US, in France, in Russia, in other countries, and we are trying to use also their strength and knowledge in Armenia because they have much more experience working in other countries. There they have many less lessons learned in their bigger countries, yeah.
SPEAKER_01Yeah, and bitter sometimes information, data that you it was or they've already tested something somewhere else, so that that's great. Now, global health in general this year, 2025, has been going through some interesting changes. So I'm wondering, um, you've observing, and of course, uh Army is not um immune to that, and uh you're part of it. If you were to give uh one aspect of global health that you think how we approach as an international global community, how we approach these issues, what will be that one aspect uh that you would want to see changed or to see it differently?
SPEAKER_00Um well uh the challenges now that we have faced in different areas, of course, um uh force me to focus on one thing that we need a more uh stronger public health voice. That public health professionals through international multilateral organizations like WHO, um other organizations like uh that we have in the field at working that can you know join all voices, that we need to join and have more um stronger voice, uh, which will help, you know, even in countries like uh it will help also for the Ministry of Health of officials in Armenia, in other countries, to promote the um policies in our at the country level. It's not a matter only on international level, but at the country level. When we will have a more stronger public health uh you know uh voice, it will be a very um big help for me to promote any public public health, it would be matter on uh smoking, on UHC or any other issue. It will be helpful for me also to promote those ideas in my country. And I think uh we need um to use all those uh you know capacities that we have in many countries, these public health institutions, the organizations like WHO to gather together and speak in with one voice, okay, and uh more solidarity of public health. Yeah, and uh I think it will be bring more uh impacts on on the decisions we are making at the country level.
SPEAKER_01Okay, that's a that's a good one. So thank you very much uh for this um great conversation. I learned a lot. Um so um our listeners uh I've been speaking to uh Dr. Lena Narushan, uh the first deputy minister of health of the Republic of Armenia. Uh we hope that you enjoyed our conversation.
SPEAKER_00Thank you. It was really very interesting. Thank you.
SPEAKER_01Thank you. Thank you for joining me for this episode of Trailblazers with Gary, brought to you by the Global Health Matters podcast. The audio and video versions of this episode are available wherever you get your podcasts. Be sure to visit the Global Health Matters webpage for more information about my guest and this series.
