25 years GCSP: Health and Inclusion - Episode 2

Ms Ashley Müller: Welcome to episode 2 of this mini-series on Health and Inclusion. I am Ashley Müller with the GCSP and in this episode, Fleur and Johanna look at diversity and policy.

Ms Ashley Müller: Welcome to episode 2 of this mini-series on Health and Inclusion. I am Ashley Müller with the GCSP and in this episode, Fleur and Johanna look at diversity and policy.

Fleur Heyworth: So within these systems that you mentioned, we need to shift them. What is visible and who is visible within that system? And from a gender perspective, we've developed a policy brief recently on applying a gender lens. And this is really encouraging us to think about the different needs of people, whether they be men, women, boys, or girls or those affected by socioeconomic status, ability, disability, ethnicity, race, and age. And some of those differential needs are not always visible. I would suggest, and those people don't always have the access to the rights and benefits of any policy, are the ability to participate in developing, implementing, and evaluating those policies. Do you think these kinds of lenses need to come into play more strongly? We need to gather disaggregated data, we need to see who's missing what we're not seeing before we can really design better systems?

Johanna Ralston: I absolutely think so. And it's a fairly, sort of abstract concept for what really is basically, are we, in a strange way, do our systems serve the customer well? I mean, we almost take some sort of for-profit language around that and think about who is the end-user? And how are they being served? In the end, what was striking about NCDs, in general, was that in particularly from middle-income countries, about 20 years ago, you know, countries were starting to say, wait, our main challenges is not so much infectious disease, so much the sort of the challenges that donors are saying are the major challenges if we really are having a transition to chronic disease, and health systems that had been built up largely around infectious disease largely around challenges that were very much, you know, of the of the late in the last century and early in this century, and had not really recognised this transition. So there was a data mismatch at the outset, and a demand sort of muffling at the outset that has helped contribute to our current situation. But also, that's pretty typical. In this kind of way, a lot of sort of global strategies get implemented at the national level without that level of understanding and hearing, perhaps the local realities. And so I think it's a model of understanding and listening to, again, that end user. I think that there's also a piece here about what are the lived experience realities that are affecting the affected in a way what are data there that are not being captured and existing, an existing sort of mechanisms and surveillance systems that we have. And that has to do with, I think what you're speaking about, which can be seen as empowerment, it could be seen as a sort of, again, better articulation of the needs of the end-user. I think we see that a lot in the patient space in global health, where the individual with lived experience is often not consulted, quite frankly, or consulted in a very kind of, a little bit as an afterthought. Helen Clark is overseeing the Independent Advisory Board look at how the COVID, WHO, and the COVID response and Helen Clark was a brilliant and wonderful person. I'm extraordinarily lucky that she's doing that but I did, you know, raise that point of, you know, do you have individuals with lived experience of COVID on your, on your committee because what we wind up a lot of times is with it with committees of experts whose expertise is absolutely not to be, you know, is airtight. And yet that expertise of lived experience is often missing in a lot of these commissions, and it's something that we need to do. 

Fleur Heyworth: It's taking that diversity and inclusion argument a step further isn't it, to say that it's not just within our organisations, it's who we consult, as well integrate into our decision making policymaking. And also seeing from a practical tool point of view, that design thinking of putting the person who you're trying to meet the needs of at the center of the policy design and development is critical. And we're certainly using empathy mapping, and many tools are publicly available now to really try and help participants to think in that way. So Johanna, I think we certainly established a need to build back better, we need systems that talk to each other. We talk about holistic security at the GCSP really trying to see security as not just about military or state needs, but about human security needs, applying these different lenses, joining the dots across different thematic areas of expertise. And we certainly valued this discussion today and hearing how health is playing out, both in terms of health outcomes, but also in terms of poverty and inclusion, the inequality that we're seeing that's growing, and what we need to do about it. Do you have any takeaways for our listeners, and if they were to go away from this podcast, and to think about one thing that they could do to try and within their sphere of influence that would make a change? Do you have any thoughts on what actions might be? 

Johanna Ralston: Well, that's a wonderful point. So I think, first of all, I just want to say from a health perspective, individual health security, I would say is universal health coverage in many ways, it's really having access to the health system. So that and so if one, if you have that, then, first of all, just the first thing you can do is be very grateful for that. And the second is to do what you can to try to improve that health system and improve access for others. The other is to, what's interesting, in some ways in this space is that once you boil down to how much of this is also driven by food and by physical activity, the solutions become, in a strange way, incredibly simple and there are solutions that we can all share, if we have access to them, the access is a problem, but the solutions are to eat a healthy diet, to move around. To take a long walk and to be really grateful for that. It sounds like it's an incredible privilege that we all have to, to eat well, to commute to, to live in a community with one another. Those are really the solutions at the individual level that I hope we all appreciate, and will work to make possible for as many people as possible in the world.

Fleur Heyworth: Absolutely. Thank you so much Johanna. It's been an absolute pleasure to speak with you. And I hope that technology and this democratisation of information, making it more free and accessible, whether it's a workout video, or a food plan, or allowing people to collaborate and bulk order healthy foods and grow their own and learn and figure out how to do things more locally. As you said, I think the solutions are out there. We just need to have the agency and the determination to find them. On this 25th anniversary Johanna, I know you've been a close friend of the GCSP. And now Associate Fellow, you've directed a course, you've written articles. And you've certainly helped to grow our network. Do you have any thoughts on the value of a centre like GCSP, as it celebrates its 25th anniversary?

Johanna Ralston: So, I have a huge amount of appreciation for the Geneva Centre for Security Policy GCSP. And the reason I said the name, you know, sort of spelled it out was to, to clarify that when I first came to GCSP I had no experience in health security, or I didn't realise I was a non-communicable disease person, I've been really focused in that area for a long time. But I was also confronting the fact that I was needing to step back from my content area and really think more broadly and holistically about global health. I was, I felt like I was sort of saying the same thing, doing the same thing really needed to take a bigger view, coming into sort of looking much more broadly at global health security itself was incredibly valuable. I learned a lot, I hope I provided some useful input from my own background and areas of expertise. But what I thought was most important was something that I think the world needs much more of, and especially in a way, the world of a place like Geneva, where there's lots of thought leadership, which was it was to step out of my comfort zone, I did not know much about the security area. My father was a military historian. So I grew up with a bit of, but I really did not know much about this. This area certainly was not, there was much that was unfamiliar to me. And in fact, there was quite a bit that was uncomfortable for me. And I say that in a very deliberate way, I think we need to be uncomfortable in order to be able to work across sectors and to work effectively to address the kinds of societal problems that we have the kinds of existential threats that we're facing, facing, we cannot sit in our own comfort zones, our own areas of expertise, our own familiar silos. And to do so is to be sometimes uncomfortable. And I thought that there was an ethos, a spirit at GCSP, of being uncomfortable, of being creative, of saying, okay, you don't know what you're doing, do it anyway, jump right in, why don't you go write a paper on this, teach a module on that, go engage with these individuals or those individuals and that very spirit, which is harder as you get older, when you're established professional, you're supposed to not show that you don't know what you're talking about, was so incredibly valuable. And very much I think Christian plays a big part in that I think he's got a great vision, I think there's just an energy and environment at GCSP that contributes to that. It's also taking advantage of the fact that Geneva is a place where lots of different people land, and then bringing those people into this sphere. So I think those are the things that I'm so tremendously grateful for, and that it really, in fact, significantly altered my thinking and the kind of work that I do. And so I just really, really hope and look forward to the next 25 years of GCSP to not grow old and comfortable and middle-aged, but to keep that sense of stay uncomfortable. Because by staying uncomfortable, we can solve the kinds of problems that really really need cooperation and collaboration and discomfort.

Fleur Heyworth: Amazing. Thanks so much

Ashley Müller: That's all we have now for this mini-series on health and inclusion. Thank you to Ms Fleur Heyworth and Johanna Ralston for this important conversation. In the meantime, don’t forget to subscribe to us on Apple iTunes, follow us on Spotify and SoundCloud. Click the next button to get the next episode and discover more from our 25th anniversary special podcast series!

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