Written by Alexandra Sawatzky, PhD Student During the week of April 25, I had the privilege of attending and presenting at two conferences: the Sparking Population Health Solutions International Summit in Ottawa, and the Transforming Health Care in Remote Communities conference in Edmonton. These incredible experiences, although separated by approximately 3500 kilometers, did an outstanding job of bringing people and their ideas together. I had Great Expectations for these conferences, which ended up being exceeded in every way possible.
Tale #1: Sparking Solutions
The purpose of this Summit was to unpack and examine the wealth of knowledge we currently have about population health problems. To do this, individuals were brought together from across various sectors to challenge, catalyze, ignite, debate, stimulate, and accelerate ideas surrounding population-oriented solutions for a healthier future.
Soon after my arrival, I quickly discovered I was one of only a handful of students in attendance. Predominantly, the crowd consisted of government representatives, policy-makers, and researchers – all important decision-makers, and all of whom had substantially more experience than me. Needless to say, I felt a little intimidated.
At the same time, I felt inspired to use this conference as an opportunity to soak up as much information from as many people as possible, as well as continue to develop some of my own perspectives on some of the issues being discussed. I slowly realized that despite my lack of experience, people genuinely wanted to hear my perspectives as much as I wanted to hear theirs.
During the first plenary session, the presenters asked simple, yet provocative questions that encouraged all of us to start to challenge our previously-held perspectives on various population health problems and associated solutions. Questions such as: why the sudden need to refocus and “spark” new solutions? Why do we feel that there are currently no solutions? Whose solutions matter? These provocations proved to be recurring themes for the rest of the conference.
As discussions surrounding these themes evolved, I found myself beginning to think more critically about current approaches to population health research, policy, and practice. As Dr. Mark Petticrew1 expressed in his plenary session, those working in the realm of population health often find themselves to be “prisoners of the proximate,” concerned mainly with the outer layers of population health problems. In reality, these problems possess deep, complex roots, meaning we need to dig a little deeper if we want to develop effective and sustainable solutions. Dr. Petticrew went on to suggest that the entire population health research system needs to be redesigned so that our focus is upstream, or at the root of the health problems that populations are facing.
A major barrier to this whole-system overhaul is the fact that most people (researchers included) are constrained by the limitations of their own knowledge and biases, and have the tendency to be over-reliant on a single way of knowing about the world (their own). In her plenary talk, Dr. Jennie Popay2 said this over-reliance on single perspectives needs to change – we need to make more of an effort to include multiple knowledge sources in the work we do. Indeed, the only way to fully understand the context and complexities of population health issues is by drawing upon the practical knowledge that is intrinsic to the specific populations we work with. We have an obligation to learn from the people who experience the world in different ways than we do.
It’s important to remember that learning about (and from) different perspectives is not about finding out who is “right” or “wrong,” it’s about engaging in dialogue and understanding where the other person’s knowledge about a certain issue comes from, and subsequently respecting that person as a knowledge-holder. Furthermore, new knowledge needs to be co-produced and merged throughout the entire research process, and this sort of “blended knowledge” holds the potential for greater positive impacts and lasting solutions.
Dr. Penny Hawe3 took this idea one step forward and suggested that researchers should not actually be taking credit for the solutions they help to develop. After all, if researchers follow true community-based, participatory approaches, the credit should ultimately go to the community – those groups of people who develop and implement solutions to problems they themselves identify. Essentially, the idea is that researchers should not take ownership, or demand thanks, for the outcomes of collaborative, community-driven efforts. Dr. Hawe emphasized that there is a great deal of humility in thinking about ways to harness the power of a community in this type of research. In order to fully capture and utilize this power, research needs to move beyond the walls of academic institutions and into communities. To breach these walls, communities must not only be in control of the research, but must also be given the credit they deserve.
In the final plenary session, Dr. Hawe singled out my team’s research project as an example of effective and meaningful community-driven population health research. It took me a moment to fully clue in that she was talking about our project, and once I did I felt a wave of gratitude wash over me. To be working with a team that places the needs, goals, and priorities of communities at the heart of everything they do is an immense privilege, and is helping to shape who I am in my research and beyond.
After all this discussion about sparking population health solutions, it’s important to ask what “solutions” even mean in the context of research, policy, and practice. The language surrounding the concept of “solutions” implies that there is an end-goal, or a static outcome that is the result of problem-solving efforts. However, solutions should be viewed as generative processes that evolve alongside population dynamics, and need to be maintained in order to stay relevant and effective.
Continuing to engage in dialogue about problems and solutions in population health is crucial. Individual researchers cannot possibly “solve” complex solutions on their own. Similarly, governments and policy-makers cannot make decisions on their own. Coming together and learning from one another at conferences such as such as this one can serve as an opportunity to challenge each other to spark creative and innovative solutions to population health problems, as well as hold each other accountable to continue feeding the flames.
Tale #2: Transforming Health Care
After a couple days of sparking population health solutions in Ottawa, I hopped on a plane to Edmonton to attend conference number two – “Transforming Health Care in Remote Communities.” In addition to switching time zones, I was switching gears slightly to focus specifically on health and health-care challenges as they pertained to remote communities in Canada, Nordic countries, Greenland, Alaska, Russia, and Australia.
An opening prayer and song from Elder Be’sha Blondin4 set the stage for what would be a humbling, emotional, and inspiring couple of days. This truly was a beautiful moment – to be standing in a room filled with individuals from around the world, with the steady beat of Be’sha’s drum making us feel as though all our hearts were beating as one. Later that day, Be’sha gave an incredibly profound and powerful talk about connecting and reconnecting the land and culture in order to be well. She emphasized that the land provides all that is needed for good health – freedom, and healing. When people are out on the land, they are their best selves. It is therefore important to work on, and help each other achieve this sense of wellness that is intrinsically woven into each and every one of our souls. Be’sha ended her talk by stating that working together in a holistic way will not only improve health and health care in rural and remote communities, it will heal the world.
This theme of holistic approaches to health care was among several other themes that had been brought up at the Sparking Solutions Summit in Ottawa, and that resonated throughout many of the presentations at this conference in Edmonton as well. I found this congruency to be fascinating, especially considering that at this conference, delegates included researchers, clinicians, managers, policy makers, service providers and representatives of industry, non-governmental organizations and indigenous communities from vastly different parts of the world. I think this just goes to show that despite the diversity of geographic locales, we still share many common stories and values when we talk about health and health care within and between populations – remote or otherwise.
When discussing remote communities, it’s important to think the weight of the term “remote,” and what that community is “remote” in relation to. Places that we consider to be remote are in fact places that someone else considers to be home. Moreover, in the context of population health, remoteness is often constructed as problematic, as pathology – it is a barrier that needs to be worked around in order to improve health and health care systems, it is a barrier to improvement. There is therefore a need to design new systems. Instead of trying to adjust current approaches to health care so that they work in remote communities, these approaches need to be redesigned so that the remoteness of a community is a defining characteristic, or core component, of an entirely new system; remoteness should be framed as an opportunity, not a barrier.
Dr. Graeme Maguire5, in his keynote address, said that designing health care policies for “everyone” – using a one-size-fits-all approach – is not effective. Essentially, “remote” should not be used a pejorative term. Just because a community is remote does not mean it is disadvantaged. Remote places are simply just another type of cultural landscape where the environment, community and cultural issues intersect in unique and interconnected ways. Understanding that we need to move beyond anecdote-driven policy that often perpetuates disadvantage, and seek to focus our attention on those who are often forgotten in health care systems.
Transforming health care involves transforming knowledge relationships between the people, places, policies, costs, data, links, and tools that both determine and support the health of communities. Reverse innovation, an idea brought up by Dr. Maguire, involves the multidirectional knowledge translation and exchange within and across groups. Equity-focused health indicators are needed to inform and evaluate inclusive health care policy and practice. Focusing on equity necessarily means focusing on the upstream determinants of health, as transformational change cannot be driven from downstream. There are many barriers to initiating these types of changes, particularly due to competing priorities of different partners, and fragmented systems that make it difficult to work to align these priorities. Furthermore, whether we’re working upstream or downstream of population health problems, the “stream” itself is moving fast. Thus, we need cohesive, collaborative action. We need to foster healthy, supportive partnerships in order to not only navigate through this fast-moving stream of challenges, but to start to redirect it towards more meaningful and lasting solutions.
What happens when partnerships are made between researchers and Indigenous communities, and what is needed to help make these partnerships work? In a word, trust. Trust is fragile. It is hard to gain and easy to lose. It is built upon a foundation of shared values, honesty, patience, and intergenerational humility. Trust is very intimate and needs to be earned.
A panel presentation by the CANHelp Working Group – a group of researchers from the Univerity of Alberta and community partners from the Yukon as well as the NWT – expanded on this essential need for trust between all stakeholders involved in research projects. The panel emphasized that researchers need to balance academic needs for discourse and outcomes with community needs for meeting the goals and priorities they themselves initially set out. Moreover, as partners in research efforts, communities need to hold researchers accountable for their actions. Both the intentions and end-results of research are equally important, and researchers must continue to build and maintain trust even after a project is finished.
Researchers must approach their relationships with communities from a place of humility, with a willingness to learn and participate. I believe that actively working to achieve this balance is a way of showing a community that they can indeed trust you to be a good researcher, and a good person. The overarching theme of this last panel discussion, and of the conference in general, was that it’s not enough to participate in community-based research. Researchers need to participate in community.
Footnotes:
- Mark Petticrew is a professor of Public Health Evaluation in the Faculty of Public Health and Policy at the London School of Hygiene and Tropical Medicine, UK.
- Jennie Popay is a professor of Sociology and Public Health at Lancaster University, UK.
- Penny Hawe is a professor and co-lead investigator of the NHMRC Australian Prevention Partnership Centre.
- Be’sha Blondin is a Sahtu Dene Elder from Tulita, Northwest Territories with forty years of experience in Indigenous traditional healing and living in harmony and balance.
- Graeme Maguire is a professor and head of clinical research at Baker IDI Heart and Diabetes Institute in Melbourne and Alice Springs, Australia.