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Health Systems Evidence: “It’s like a fancy google for people who make big decisions.”

The way I see it, the McMaster Health Forum has just taken a big step towards achieving one of its central goals with the re-launch of the expanded and improved Health Systems Evidence database. The official Forum mission statement reads: Our Mission is to harness the best available evidence, convene concerned citizens and influential thinkers and doers, and prepare action-oriented leaders to meet pressing health challenges creatively.

As a health sciences student, the reason I chose to become involved with the Forum was based on a firm belief that policy decisions must be evidence-informed, at a local level and internationally. Now, I truly thought that in a developed country, our leaders would appreciate this fundamental value and policies would remain evidence-informed. There are countless examples that demonstrate that this is not the case. Recently, the Department of Health and Human Services in the United States overruled the Food and Drug Administration’s decision to sell Plan B, an emergency contraceptive, without prescriptions to teenagers under 17. FDA Commissioner Margaret Hamburg said in a statement: “There is adequate and reasonable, well-supported, and science-based evidence that Plan B One-Step is safe and effective and should be approved for non-prescription use for all females of childbearing potential.”

There is ample evidence that suggests that the drug is safe and effective and the FDA decision was overruled based on scientific, not political criteria; if this is a political issue, it should be debated as such. This may be an extreme case, where political and ethical reasoning plays a significant role in diluting the overwhelming scientific evidence in terms of policymaking, but this situation is not an exceptional occurrence. I am impressed with the work of the McMaster Health Forum as an international advocate for the importance of evidence in informing health policy decisions above all other considerations.

The Health Systems Evidence database takes the Forum’s role beyond that of an advocate and provides a practical solution in cases where up-to-date evidence is not easily accessed. Health Systems Evidence is the world’s most comprehensive, free access point for evidence on questions that policymakers, researchers and stakeholders may have about how to get cost-effective programs, services and drugs to those who need them. There are open search and advanced search functionalities in seven languages! It’s difficult to conceive that a regional minister of health in Ghana would think to continue to access evidence on family planning initiatives as he or she drafts a new policy, but with this service, it seems significantly more feasible. When the system was designed, it was destined to be used internationally. So, the interface is very user-friendly. I was most impressed by a comment in a team meeting that the design needed to be “slick but minimal”, so anyone accessing it from less than North-American or Western European high-speed internet could easily access the same up-to-date evidence.

For us, as students destined for jobs in health policy, doing theses and major research projects, Health Systems Evidence is also a remarkably valuable resource. First, it’s easy to use and free, even after you graduate from McMaster and relinquish your rights to all of our journal databases. Second, to produce high quality research in healthcare or in health policy, it is absolutely imperative that supporting evidence is as up-to-date as possible. I consider myself very lucky to be a McMaster student, to have these resources at my disposal and to be at the forefront of health policy innovation internationally. Congratulations to the McMaster Health Forum, and I encourage all of the students reading this to take the time to create an account and take a look around. This is the future of knowledge translation in health policy and will likely be a tool I personally will continue to use academically and professionally in the future.

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Conflict, Canadians and Public Health: Dr. Samantha Nutt, Founder of War Child Canada

‘Tis the season… for term papers, exams and thesis crunch time. But, sometimes, it’s important to take the time to let yourself be inspired and make sure you hold on to that big picture perspective that makes all of those late nights with textbooks worthwhile. So last week I attended Dr. Samantha Nutt’s talk at McMaster. Sam is the founder of War Child Canada and someone I have heard so much about for many years. I attended a mid-sized private high school in Toronto and Sam is one of our most prized alumni. Through the many e-mails from our alumni association praising her work and offering her various awards and distinctions, and through my work with War Child in high school, Sam became someone who truly inspired me. As a young woman beginning my transition from student to professional in global health, I appreciated so much of what Sam spoke about.

Fresh out of medical school and finishing a Master’s degree at the London School of Hygiene and Tropical Medicine, Sam was recruited by UNICEF for a mission in Somalia. She said she thought she would be most useful doing what she was trained to do “healing the sick and the wounded.” However, she shared that her perceived isolation from the fundamental societal issues causing the vast and complex medical problems she was faced with made her feel ignorant, even complicit in the atrocities she was seeing. This feeling certainly rings true for me. In a theoretical context, I’ve studied countless case studies of failed public health interventions that have neglected the underlying social determinants that perpetuate disparities in health. Practically, I’ve experienced it, although not in the middle of a conflict within the “City of Death” as Sam did. But my experience abroad did help me understand that, for example, you can’t address issues surrounding family planning and obstetric care if you don’t deal with issues in gender roles, paternalistic decision-making and stigma. The real dilemma Sam said she faced on her first trip to Somalia was that “none of the interventions we attempted were possible with drugged-up, trigger happy boys running around. We could do very little.” Faced with this challenge, Sam founded War Child Canada – a non-governmental organization that aims to work collaboratively with communities to increase access to education, overcome the obstacles of poverty and create a protective environment for the rights of children and youth – to tackle the root cause of the problem Sam saw. Instead of enlisting in the militia, young men can attend War Child’s youth centres and work to catch up on their education.

Not everyone has to start an NGO to contribute to the global effort to end armed conflict and its devastating results on communities and children. Through all the staggering statistics Sam shared on the trillions spent on military action and the investments of the Canada Pension Plan in arms manufacturers, her message of self-directed education was persistent. Strengthening the connection between public health and armed conflict, Sam referred to the “pandemic of weapons” and urged the audience, or any individual with a vested interest in global health, to take four steps to tackle the root causes of this pandemic. First, social change begins with knowledge and information on current affairs, and critical thinking. Second, Sam urged the audience to give what they can, financially and in terms of expertise and human resources. Sam further emphasized that giving needs to be consistent and wise – contributing to organizations working to address the root causes rather than band-aid solutions to complex global health issues. Third, individuals should change the way they shop and invest and should ask questions of the industry to encourage social change. Before buying that electronic gadget this holiday season, everyone should take the time to ask whether the coltan used in the manufacturing process was ethically mined, or if it has contributed to the ongoing violence and social degradation in the Democratic Republic of Congo. Finally, western individuals must “stop ceding to the idea that life is more relevant here” than it is “over there.” This perspective feeds into that perceived isolation. The term we use to discuss these issues is GLOBAL health… issues in health that transcend both the clinical setting and national borders. It is therefore imperative that we too adopt this global perspective to better understand and begin to address the root cause of persistent armed conflict and its consequences. Sam’s central point was interestingly similar to the final conclusion our global health governance class came to in a simulation of the Forum’s stakeholder dialogue on Addressing Health and Emerging Global Issues in Canada. Both Sam and our global health governance class determined that a significant determinant in global health is understanding that we live in a global village of sorts. Our actions and decisions, both individual and at a national level, have significant global public health impacts.  The most significant next step we saw as we assessed the options proposed in the issue brief, was to begin a process of education, like Sam mentioned. Non-health actors must be aware of global health concerns in order to make informed decisions that are in the best interest of Canadians and our international neighbours.

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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.