Webinar - Moving to Equity, Full Agency, and Greater Cultural Awareness in Health: What, How, Now!

Background

The CoVID-19-pandemic has once again dramatically highlighted how a single global disruptive event can affect people disproportionately as a result of age, gender, economic situation, and social, political and cultural environment.

The equity divides in our society are not new, but have grown more apparent during this crisis. Equity concerns in health have long occupied citizens and patients, practitioners and policymakers as a subject to tackle at the heart of governance.

In this fourth webinar in a series hosted by the Global Health Governance: Building the Reset campaign,we will focus on the concrete question: Equity and new agency in health : What, How, Now?. It will tune in on foundational work of what can and should be done to move beyond mere lip-service regarding new ‘equity agendas’. Which concrete mechanisms should be put forward to improve on people’s agency and all individuals’ capability to realize their right to health?  Which tables should be turned, and which dots connected to address issues of equity and agency with new vigor and urgency now, and what concrete governance actions may need to be foregrounded to make this happen?

Recording

Summary

The fifth webinar in the series Global Health Governance: Building the Reset, was fully devoted to facing the vexing subject of inequities and moving towards new ‘agency’ in global health. The conversation could not be more topical. On July 18, UN General Secretary António Guterres in his Nelson Mandela lecture slammed the persistent inequities, structural inequalities and the associated problems of economic instability, corruption, and bad health for many people around the globe. CoVID19 has dramatically highlighted once more how the same people bear the burden all the time, and how structural change appears hard to achieve.

The webinar explored ways to move beyond equity rhetoric to actionable governance changes and evoked some of the efforts and critical thinking currently underway.

Physician and public health change agent Hugo Flores Navarro - speaking in part on behalf of the Community Health Impact Coalition - sketched the situation at the CoVID19 frontline in Mexico. He stressed how inequities within and between countries are firmly linked to neoliberal policies that have held sway over the last few decades. He underscored how anti-CoVID19 measures too painfully had laid bare the cascading inequities that surface once people try to protect themselves. He underlined, how governments - having fallen prey to large privatization moves - appeared at a loss, unable to deal with the emergency fallouts. At the same time, he stressed how the CoVID19 pandemic also offered the world the opportunity to take stock. He urged global organizations to do so and draw a country by country comparison of what factors make a difference in dealing with inequities.

Stephanie Topp (Associate Professor of Global Health and Development at the James Cook University, Australia, and Associate Research Fellow at the Nossal Institute for Global Health at the University of Melbourne) together with her colleague Marta Schaaf (senior global health justice advocate and former Director of Programs at the Program on Global Health Justice and Governance, Columbia University) drew from their seminal research on community health workers as frontline workers around the world.[1]  This work has focused on three ‘bridging roles’ (service extender, cultural broker and change agent) commonly attributed to community health workers around the world. Steph and Marta entered in depth into the (governance) factors which tend to advance or prohibit these roles in practice. And concluded that notably the role of ‘change agent’ was challenged in practice and that many of the disparities one could find appear to be structural and often ‘shared’l, which would allow for more global collective action in finding better alternatives.

Chisomo Kalinga (postdoctoral Fellow Social Anthropology University of Edinburgh and blogger on decolonizing global health) moved the conversation to the importance of giving much more due to the ‘granularity’ of narratives in communities. She reflected on the praxis of ‘eavesdropping’: and the importance of much more nuanced listening to people in their daily relations, and different, local narratives, expressing their basic concerns. She made a plea for creating much more space for this type of ‘listening’, and for more radically ‘dismantling’ the structural barriers which currently keep dysfunctional systems and institutions in place and cause health systems often to be ‘four steps behind’.

Leading commons thinker David Bollier (Director Reinventing the Commons Program at the Schumacher Center of a New Economics and cofounder of the Commons Strategies Group) introduced the potentials of commons thinking and practice as a rich, alternative conceptual framework beyond the limits of state and market reasoning. With a range of practical examples, he illustrated how ‘commoning’ as a social system, and a set of practices and relationships, may provide ways out of the deadlocked health systems attempts to deal with inequities, by introducing new voices and narratives and open up the space for horizontal, mutual solidarity to emerge.

A crucial set of exchanges followed, introducing a range of practical examples of change already happening. Participants zoomed in on both the need to ‘dismantle’ dysfunctional and prohibiting structures inside health and beyond; and at the same time to ‘create’: to build the spaces and preconditions for more inclusive and equitable alternatives to emerge.

[1]Marta Schaaf, Caitlin Warthin,Lynn Freedman,and  Stephanie M Topp, ‘The community health worker as service extender, cultural broker and social change agent: a critical interpretive synthesis of roles, intent and accountability,’BMJ Glob Health. 2020; 5(6): e002296. Published online 2020 Jun 15. doi: 10.1136/bmjgh-2020-002296

Our presenters

Hugo Flores Navarro,

Hugo Flores graduated from Tec de Monterrey medical school in Mexico and started working in rural Chiapas, one of the poorest states in Mexico in 2010. He is co-founder of Partners In Health Mexico and worked as executive director from 2011-2019. During that time developed and supervised projects in primary care, mental health, maternal health, non-communicable diseases, community health workers, referral networks, and surgery. Hugo is also interested in social medicine education for health workers of all types and helped develop a diploma in Global Health and Social Medicine for doctors and nurses in Mexico. He has also partnered with global health initiatives at Notre Dame, UCSF and Harvard. 

Marta Schaaf 

Together with Ciatlin Warthin and Lynn Freedman, Marta Schaaf and Stephanie M Topp recently published: The community health worker as service extender, cultural broker and social change agent: a critical interpretive synthesis of roles, intent and accountability, BMJ Global Health 2020;5:e002296. doi:10.1136/ bmjgh-2020-002296.

Marta Schaaf, DrPH and MIA, has worked at the intersection of health and human rights for 20 years. She started her career as a program manager in the NGO sector, and over the past ten years has worked in academia, first as the Deputy Director of the Averting Maternal Death and Disability Program at the Columbia University Mailman School of Public Health, and then as the Director of Programs at the Program on Global Health Justice and Governance, also at the Mailman School. Marta is currently working as a consultant, primarily for WHO. She has particular expertise in health systems research, accountability, SRHR, maternal health, and HIV. She holds a Doctorate in Public Health, a Master's in Public Health, and a Master's in International Affairs, all from Columbia University.  

Stephanie Topp

Steph Topp is an Associate Professor of Global Health and Development at James Cook University, Australia, and an Associate Research Fellow at the Nossal Institute for Global Health at the University of Melbourne. Her research and teaching focuses on health service and health system strengthening, and in particular the relationships, values and norms that influence health policy, health service design and implementation throughout the system.  She has a long-standing interest in health resources for health and community health workers stemming from eight years living and working in Zambia on integrated service delivery models for primary health centres.  Before she started working in global health, she worked on Indigenous social and health policy in Australia. 

Dr. Chisomo Kalinga

Chisomo Kalinga is a Wellcome-funded medical humanities postdoctoral fellow in the department of Social Anthropology, University of Edinburgh. Her current project examines how indigenous, traditional and modern literary practices (performance, form and aesthetics) are used by ordinary citizens to address issues of health and wellbeing. She is also collaborating with colleagues at the University of Malawi and Malawi University of Science and Technology to launch the first medical humanities network for Malawiana studies. Her research interests include disease (especially sexuality transmitted infections), biomedicine, traditional healing, and witchcraft in African writing and narratives.

David Bollier

David Bollieris an American activist, scholar, and blogger and one of the leading thinkers on the ‘commons’ movement. His work focuses on the commons as a new paradigm for economics, politics, and culture. He is Director of the Reinventing the Commons Program at the Schumacher Center for a New Economics [www.centerforneweconomics.org] (Massachusetts, US), and cofounder of the Commons Strategies Group, [www.commonsstrategies.org] an international advocacy project.  Bollier has written eight books on various aspects of commons.  His most recent book (with Silke Helfrich) is Free, Fair and Alive: The Insurgent Power of theCommons [www.freefairandalive.org].  He lives in Amherst, Massachusetts (US), and blogs at Bollier.org.