As 2016 came to an end, I was taking stock of notes I took through meetings and conferences I attended, including the Emerging Voices in Global Health 2016 training program preceding the Global Symposium on Health Systems Research 2016 in Vancouver. I came across quite a few ‘quotable quotes’: “seize the smaller opportunities you get, you will find bigger ones on your way…”, “we need the energy of the Emerging Voices to tackle the enduring challenges of our times…” “do capitalize on your can-do & must-do enthusiasm when you’re young (as when you grow older you often get (too) comfortable in your ways); and challenge power, wherever you feel it’s appropriate…”, “strike a balance between your research activities and the change you want to bring in the world around you…”; these were the snippets of advice made to the young researchers in Vancouver. I found these words motivating– words which could potentially inspire the future work of young health systems researchers. And so, I decided to collate them as I received them, rather than rephrasing what I heard and losing the essence of the message. I also, subsequently, requested some senior researchers to share their messages once again over email and in person. And, as the new year begins, and we seek to start afresh, some of us, perhaps looking for redemption from our hedonistic ‘New Year Celebrations’, I share some quotes by senior researchers. These have been presented alphabetically according to their first names.
“Health systems research is about problem solving and skills that enable innovation and creativity, which are not the purview of a single discipline or topic; therefore, young professionals should persevere and gain the knowledge and expertise that excites them – and then learn to apply them in real world settings. It is ok to be bold and try new things – it is ok to persist and explore – but it is not ok to accept the systemic inequities and social injustice in this world.” Adnan Ali Hyder, Professor at Johns Hopkins Bloomberg School of Public Health
“First, don’t be afraid to be different, but respect viewpoints that differ from yours. We are a diverse community, have different histories and viewpoints. Without further dialogue, we can’t keep learning and constructively engaging with the complex, nuanced and contextual nature of health systems we care about. Second, nurture relationships, they will evolve overtime and anchor you in ways that are currently unforeseen. We are a nascent community, one with its own inequalities and frustrations. We need to work harder with a longer-term vision of realizing just health systems and societies and not get consumed in short term tactics guarding false boundaries and dominions. Third, don’t wait for funding or approval to pursue what is important. Funding can be insecure and fickle; institutional norms that define advancement maybe not always be fair or relevant. Be mindful of the compromises made and safeguard what you value. Our field needs critical thinking, credibility, creativity and passion to sustain the unpredictable, messy, political worlds we have to navigate.” Asha George, Vice-Chair of Health Systems Global
“Make the most of any opportunity that comes your way; focus on doing it to the best of your ability, and other opportunities will come.” Anne Mills, Professor at London School of Hygiene and Tropical Medicine
“Health systems research is often inter-disciplinary and collaborative, involving teams of researchers with complementary areas of expertise. If you can, choose research topics that are not just important and policy relevant, but that excite you and keep you motivated. Become an expert on previous research on your topics of interest – and consider developing a research agenda to help guide you on what opportunities to pursue and the role you want to play in research teams. Also, be on the lookout for surprising, counter-intuitive findings – these are often the most interesting!”
David Hotchkiss, Professor at Tulane School of Public Health and Tropical Medicine
“As health policies and programs “mature”, there is a tendency for policymakers and implementers to accept their gaps and problems partly because changing “mature” policies is seen as too hard and there are minimal incentives for them to do so – just as it was before in other sectors such as the telecommunications and the transport sectors – and just as these sectors were challenged and then transformed by, among others, young research-driven innovative people who challenged the accepted thinking, young health researchers such as the Emerging Voices should similarly intensively study and challenge, if necessary, and propose innovative and disruptive, if needed, actions and transformations for Universal Health Coverage.” Eduardo Banzon, Principal Health Specialist at Asian Development Bank
“Young health system researchers should conduct impactful research and use knowledge translation tools to impact policy and practice. They should produce research that is connected to real world health systems and priorities and that is grounded in the practical understanding of political contexts and constraints. They have a role not only to respond to policymakers’ priorities but also advocate to shape policy agendas and influence action. They should support interdisciplinary collaborative research work and should also partner with policymakers and policy implementers in creating and applying new knowledge.” Fadi El-Jardali, Professor at American University of Beirut
“If one accepts that health is a human right, one can only assess the present situation of global health (and its enormous inequalities) as a massive and continued human rights violation. Young (and older) health systems researchers must find a middle ground between assuming that states will continue to behave more or less as they currently are (which leaves little room for improvement), or assuming that states will live up to their domestic and international responsibilities (which seems unlikely to happen). In this uncomfortable position, it is important to be aware that whatever solutions we recommend, they will shape the future, one way or the other.” Gorik Ooms, Professor at London School of Hygiene and Tropical Medicine (LSHTM)
“First – frame research questions in terms of what you see and experience, even if this does not match how the same issue is discussed in the literature. Health systems research is a new field and it needs new perspectives on old problems. Second – think about the many written and unwritten rules and norms of global academic practice. These don’t come from a higher power, but are/were made by people working in specific social and cultural contexts. Many rules are rooted in good sense and fairness. Others reflect convention at the expense of relevance, and deserve to be questioned. Third – challenge yourself consistently on the quality of your own outputs – as research professionals we have a responsibility to be rigorous and credible.” Kabir Sheikh, Chair of Health Systems Global
“Be persistent and develop ideas over the long-term – adopt and fight for the practice of ‘slow academic scholarship’. Build on the work that has gone before – recognize it and add to it. Recognize that health system software (values, norms, relationships, trust, power) is always important – make it the focus of future research, not just the unanticipated ‘factor that matters.” Lucy Gilson, Professor at University of Cape town and LSHTM
“My advice for young researchers in health systems is to think about the three areas of ideas, people, and writing. Try to find one good idea that changes the way health systems are understood; seek out people who can collaborate with you and expand your capacities and tell you when you are wrong; and pursue excellent writing that is clear and succinct and makes sense. These three pursuits of ideas, people, and writing will help you develop in synergistic ways; and weaknesses in one area will diminish your capacity in the other two.” Michael Reich, Professor at Harvard T.H. Chan School of Public Health
“It is very dangerous for health systems researchers to focus on building evidence that advances Resilience as an approach to comprehensive health systems strengthening without interrogating its added value. Just like the agenda on Structural Adjustment Programs advanced in the early years, Resilience could blindfold researchers as a magic bullet to addressing the current challenges of health systems. The rational is still not clear for abandoning a more comprehensive approach to health systems strengthening to now Resilience, which is also variously interpreted as evidenced in the various sessions at the conference. Resilience is very capable of turning into the new ‘conspiracy theory’ bred through the current system of dis-empowered states and the strong private sector.”
Moses Mulumba, Executive Director of Center for Health, Human Rights and Development
“Seeing young researchers emerge at the Global Health Symposium might be the best part of a very impressive event, I think. A new generation is coming through the global health community, and it has a rich contribution to make from almost every culture and every continent. It inspires me. Perhaps we could draw more on the energy created by the very best of these younger minds. There is a new generation of health researchers and policy makers now coming through and they will take the science and the practice of global health in new, exciting directions.” Peter Annear, Professor at University of Melbourne
“For young researchers and activists from the Global South, I have a triple advice: i) make sure that your research and advocacy is deeply rooted in your local or national realities; ii) make sure you know the evidence around your topic very well, and that your contribution is connected to that evidence; iii) don’t be boring (when you make your presentation, especially when it is an oral presentation).” Wim Van Damme, Professor at Institute of Tropical Medicine
Learning lessons from more experienced scholars and practitioners can certainly help us shape our ideas better. As the saying goes: “it takes a wise man to learn from his mistakes, but even a wiser man to learn from others” (before my “Women in Global Health” EV colleagues take offense, this certainly applies to women too!). By the way, I had aimed for a perfect gender balance while requesting the senior researchers to share their quotes, but not everyone responded, so you might have observed a bit of imbalance.
Having interacted with the Emerging Voices & young health systems researchers from more than 50 countries for a couple of weeks in Vancouver, I feel that each one of us has at least one skill and expertise we can capitalize on. Some are good on paper, others are very eloquent on the stage, still others make excellent policy brokers, at national or even global level. We need to recognize what we’re good at, and make the best use of it, to have an impact in the world around us. As you might have noticed, the world is witnessing major crises, which is why global health, even more so than in the past, has to be political. The energy of young people, including researchers from all over the world, will be needed to fend off catastrophe in the coming decades. In other words, passion is a must now. Youthful passion inspired by wisdom, let this be the motto for the new year.
2017, here we come!