Fighting for Every Breath: a conversation with Leith Greenslade

The episode opens with Leith Greensalde recounting her journey from rural Queensland to international global health work. After starting her career as a political adviser to senior Labor politicians including Brian Howe, she moved to the United States for graduate study at the Harvard Kennedy School prior to Labor's anticipated 1996 election loss. Following a brief and unsatisfying return to work with Labor in opposition, and business studies in Hong Kong during the handover to China, she eventually settled in New York to work in global health during what she describes as the "golden era" of funding and institution-building in the 2000s.

Her work with major institutions including the Gates Foundation, Gavi and the Global Fund gave her a front-row seat at the creation of the modern global health architecture but also left her frustrated by what she saw as narrow focus and bureaucratic limitations. This led her to found Just Actions, a platform focused on ten high-impact but neglected issues, with childhood pneumonia as the flagship cause.

Leith explains that pneumonia has been the leading infectious killer of children for decades, claiming approximately 500,000 lives annually — more than HIV, malaria, and tuberculosis combined. Yet it has consistently been overlooked by global health agencies and funders. She attributes this neglect to several factors: children in low-income countries who are most affected have no political voice, the disease has multiple causes with no single solution, and unlike other major diseases, pneumonia lacks a dedicated global fund or agency to coordinate efforts.

The conversation explores the multiple barriers children face throughout what Leith calls the "pneumonia journey." Many families do not recognise the symptoms or understand the urgency of seeking care — in many countries there isn't even a word for pneumonia. When children do reach health facilities, diagnosis is difficult without rapid tests that can differentiate bacterial from viral pneumonia. Essential treatments like amoxicillin dispersible tablets (child-friendly antibiotics) and medical oxygen are frequently unavailable due to market failures and the absence of coordinated procurement systems.

Leith's advocacy during the COVID-19 pandemic brought the issue of medical oxygen to global attention. She describes families across Latin America, Asia and Africa being forced to source oxygen on black markets while the global health community was slow to respond. Her work with the Every Breath Counts Coalition and the subsequent Lancet Global Health Commission on Medical Oxygen Security revealed that 70% of people worldwide who need oxygen do not receive it — a gap far greater than for other essential medicines like HIV/AIDS or malaria treatments.

The discussion turns to regional issues, with Leith noting that Asia is actually the worst-affected region for respiratory conditions when including India, driven by pollution, crowding and smoking. She acknowledges the particular vulnerability of Pacific Island countries, which experienced oxygen shortages during COVID-19, while praising the support provided by the Australian government and universities in the region. She highlights the work of Professor Fiona Russell at Murdoch Children's Research Institute as an exemplary case of Australian leadership in pneumonia prevention.

Despite the challenges, the conversation includes discussion of promising innovations. New RSV vaccines and monoclonal antibodies could potentially eliminate RSV as a childhood killer, while WHO's recent Integrated Lung Health Resolution represents the first coordinated approach to addressing both infectious and chronic respiratory conditions together.

The episode also examines the current global health funding crisis, which Leith views not as a catastrophe but as an opportunity for necessary reform of what she sees as an unsustainable system built in the 2000s. She argues that the proliferation of large international organisations created inefficient “middleman” layers while fostering unhealthy dependence, particularly in African countries where entire health systems became reliant on external funding. The current constraints may force more effective prioritisation and potentially allow countries to regain greater control over their health systems.

Leith remains optimistic about achieving the Sustainable Development Goal of ending preventable child deaths by 2030. She notes that global child mortality has already halved from 12 million to 5 million deaths annually, and believes that with focused effort on diseases like pneumonia that kill the most children, the world could achieve what she describes as guaranteeing the survival of most children regardless of where they are born — something our species has never accomplished before.

Devpolicy Talks is the podcast of the Australian National University's Development Policy Centre. Our producers are Robin Davies, Amita Monterola and Finn Clark. You can read and subscribe to our daily blogs on aid, international development, and the Pacific at devpolicy.org. Follow us on Facebook, LinkedIn, Instagram, and Twitter. Send feedback or episode ideas to devpolicy@anu.edu.au. Join us again in a fortnight for the next episode of Devpolicy Talks.

Resources and Further Reading

Every Breath Counts Coalition

Lancet Global Health Commission on Medical Oxygen Security

Just Actions

World Health Assembly Integrated Lung Health Resolution (2025)

Devpolicy Talks is the podcast of the Australian National University's Development Policy Centre.

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