A global health student on community health… same deal, smaller scale

My name is Ariela and this September I started a fellowship with the McMaster Health Forum. Inspired by my experiences overseas and a passion for international health policy, I decided I wanted to learn and experience how evidence-informed policymaking happens. My first major encounter with the Forum was a stakeholder dialogue in early October on “Neighbourhood-Based Approaches to Addressing Poverty Concentration and its Impacts on Health in Hamilton.” Last year, I spent four months on an Embedded Learning Experience in a rural community in the Upper-West region in Ghana where I gained an appreciation for community-based health interventions, but all of my formal learning at school so far in terms of healthcare governance and decision-making has focused on a global perspective. I figured that participating in this dialogue would grant me that missing piece: healthcare governance at the community level.

I read the issue brief to get myself set for the dialogue and I felt comfortable with the themes… the social determinants of health, health isn’t just the absence of disease, etc.  I wrapped my head around the major concepts and really, not such a far cry from everything I had been exposed to both in the field and in my global health classes. Understanding that poverty leads to poor health, child development and social outcomes, and that concentrated poverty made the situation even worse wasn’t challenging for me. But, figuring out how the options presented in the issue brief would lead to actual action was not something I could figure out on my own.

So I was granted the opportunity to help support the Forum staff as part of the dialogue secretariat, tasked with taking notes on the discussions throughout the day. When the dialogue began and I looked around the table, what impressed me most about the choice of stakeholders invited to participate in this dialogue was that anyone could see that each individual had a truly vested interest in coming up with solutions to the problems we discussed.

In the afternoon, participants got to the real meat of the discussion, what everyone thought of the options that were presented in the issue brief and how everyone thought we might be able to start moving forward with them. At this point, while feverishly taking notes and trying to get a grasp on all of the perspectives and ideas on the table, the similarities between global health governance and community-based decision-making became remarkably apparent.

The first connections that I noticed focused on the limitations of healthcare governance and decision-making. I learned in a theoretical context all about the fatigue with formal meetings and the inefficiencies of global conferences and summits without clear mandates. Certain stakeholders around the table echoed the same sentiment. Some felt that there were “just too many tables” and that “we need to figure out the issues we are all dealing with” and how to get from “our goals to reality.”  The week before the dialogue there was a seminar in my Global Health Governance class that focused a fair bit on the importance of accountability. Interestingly, exploring options for vertical and horizontal accountability measures was a prominent theme throughout the day. Some stakeholders were optimistic when the potential for horizontal accountability measures was proposed, emphasizing coordination at all three levels of government. But then, someone said, “well, what happens when there’s a change in government? What about sustainability?” I’m fairly certain that the same point was raised in my global health governance class as 20 undergraduate students sat around the same table struggling to understand how global health policy and law could hold some sense of accountability or “teeth.”

The parallel I was most interested to see can be expressed in a quote from the day: “We are an elite group that can’t act without community support.” This humble and down-to-earth perspective reminded me of Margaret Chan’s address at the World Health Assembly as she implored healthcare professionals and policymakers around the world to “remember the people.”  I believe that whether global or local, solutions need to be grassroots, but we need to make sure that the right champion is at the table pushing for evidence-informed solutions and following through with evidence-informed policy implementation.


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