Day 4 - Let's distinguish health from health care: what factors truly determine our wellbeing?

James Leigh, Curtin University

Let me set the scene for you: the sun was back after days of clouds, the mountains were clear. I’d eaten my wholesome, ritualistic French breakfast consisting of croissants, Nutella, milk bread and yoghurt cake; and I’d dusted off a coffee. I was ready.

Today marked the fourth official day of the 72nd World Health Assembly (WHA72) in Geneva. Having reached the back end of the week, I had very mixed feelings. On the one hand, I was extremely excited about the upcoming meetings with civil societies, non-government organisations and World Health Organisation (WHO) staff to further enhance both the breadth and depth of my understanding of global health priorities. On the other hand, I felt a strong sense of bewilderment and sadness as the time in Geneva flew by, and I tried to absorb each opportunity without it escaping me.

My Thursday consisted of three predominating events, coupled with a range of meetings and exploration to fill the time in between. Beginning with a breakfast at the Restaurant Vieux-Bois, sponsored by NCD Child, I was involved in discussions to promote youth-led efforts in addressing non-communicable diseases (NCDs). I was especially touched by the young speakers from Indonesia, South Africa and Kenya who discussed their advocacy in the fields of tobacco control, mental health and access to medicines, respectively. This event was critical in its empowerment of myself and fellow youth delegates from other countries, to voice and act on our public and global health concerns. The event also provided an ideal environment to network with fellow delegates with similar interests from all over the world – newbies and veterans – whom I’m hoping to reach out to going forward with the Assembly and my policy proposal.

The subsequent two events occurred after lunch and just prior to dinner; discussing the equities, innovations and financing of universal health coverage (UHC), and community engagement in the facilitation of health, respectively. Instead of boring you with a chronological recollection of these events and their major takeaways, I instead want to expand on the overarching lessons of my time at the WHA72 and how it has influenced my malleable perception of the vast breadth of issues at large in our world.

UHC has been the central theme of WHA72 and is an all-encompassing concept that applies to every country regardless of wealth, environment, climate or culture. Although targeted at impoverished, developing nations, UHC can be contextualised to Australia and other developed nations. With respect to our homeland, universal health coverage is necessary for our marginalised and vulnerable populations; namely, our Indigenous and refugee and asylum seeker populations.

Another key theme of WHA72, has been the inter-relationship between climate change and health, which gained a lot of traction with multiple events delving into the issue, and will only increase in significance at the Assembly. Though traditionally being labelled as an environmental issue, climate change is now acknowledged as a problem for everyone and every sector – health being no exception. Issues such as disaster response, extreme weather events, and rising sea levels affecting agriculture, are but a few of the examples where our planet’s changing climate is disabling health security. For myself, with no exceptional understanding of climate change, it was highly confronting to discuss the health catastrophes due to climate change and to hear from people directly impacted by such events, such as Fijians. I feel privileged to have had this revelation, as I can now better appreciate the extent of the climate’s impact on health and utilise this knowledge in my everyday life and future as a medical practitioner.

Synthesising these two key areas of action, I have developed a profound appreciation for the concept of “health” and how it differs from “health care”. Health incorporates every aspect of life – be it diet, exercise, safety, culture, spirituality, education, hygiene, etc. Health care, on the other hand, refers to the specific reaction to an abnormality in health. Proactive measures target the health of people, whilst the reactive measures come under the health care umbrella. WHO Director General Tedros’ mission of universal health coverage assumes the proactive approach – investing in primary health care and infrastructure and education to prevent health abnormalities. This then reduces strain on healthcare and more expensive practices. This distinction has been my key take-home message from the week so far.

Having learnt so much already, I'm very eager to see what tomorrow brings as my final day at the Assembly.

Day 3 - It's health, not mental health

Melissa Speed, Central Queensland University

The third day of the 72nd World Health Assembly started off as busy as ever! Greta, Wills and Billi were off to a breakfast side-event on Ebola, Pandemics and Biological Weapons at the Intercontinental, Geneva. Meanwhile, James and Ali headed to the Palais des Nations, with James meeting with a few experts in the field of child and adolescent obesity. My schedule for the day was focused on my passion area: mental health. While there were only two official events scheduled for the week that were focusing on this issue, I was extremely excited as a result of the anticipation.

This first event ‘Harnessing Global Momentum in Mental Health’ was coordinated by the World Economic Forum. This event booked out so quickly that I was placed on the waiting list, but luck was on my side, as there was a spare seat available when I went along anyway in the morning. Score!

The event was themed around positive mental health within the workforce, destigmatising mental health, and some of the innovative technology that is being implemented in this space. The panel was filled with knowledgeable and passionate people, which made it the most engaging side-event I had been to so far. It was great to see the event filled with high-level attendees who were all so passionate about mental health, which highlighted for me the importance of this issue and the need for more urgent coverage globally.

One of the highlights was the moderator, Poppy Jaman - CEO and founding member of Mental Health First Aid England, who is heavily involved in the Mental Health Alliance UK. She touched on ‘This is Me’, a business-led campaign aimed at supporting organisations and employees to talk about mental health. As one in six employees suffer from mental illness in workplaces, it helps to bridge the gap and encourage workers to share and unite about their experiences. Poppy’s comment, that one in one people have mental health and that mental health needs to have a positive association as it is about health, was an enlightening way to consider this issue. She talked about the need to address stigma by transferring the focus on mental health in healthcare to everyday life and the workforce, as we normalise discussions on mental health.

I was also privileged to learn about some very new technology, which has become the first FDA approved digital medicine. Panellist Bill Carson talked briefly about Abilify MyCite: a pill with an inbuilt sensor that digitally tracks a patient’s ingested medication. It works by sending data from the swallowed pill to a wearable patch. This patch will then transmit information to a mobile app or a web-based browser that the patient’s caregiver or doctor can access. It has been approved for schizophrenia, acute treatment of mania, mixed episodes that are associated with bipolar I disorder, and as an add-on treatment for depression. I loved hearing about this new and innovative technology! Especially as this would be perfect for those in rural and remote areas with less access to ongoing medical treatment and services.

Overall the panel was amazing, with some very inspiring speakers. My key takeaways were the importance of considering the mental health of all people, and of engaging both the public and private sectors to invest in mental health for a more productive and healthy society.

Next up, was the WHO technical briefing ‘Mental Health – time to scale up’. The event was packed, prompting Billi, James and myself to arrive half an hour early to ensure we had a seat. The panel included Her Majesty Queen of Belgians, and as a result, security around the event was insane. This briefing provided nations with the platform to share their success stories, which was very encouraging. However, the biggest downfall identified consistently by speakers was the lack of funding for mental health globally.

Even though Australia is so privileged, and has a mental health and suicide prevention plan, we can do better. The is a need to shift our priorities to recognise that suicide is a silent killer, the second highest course of death globally in young people, and an enormous problem still in Australia, particularly in rural and remote communities. There is a need for action in innovation, development of community services and the pressing need for better funding. Every country should be rethinking their health funding with most countries only allocating 1-2% of their health budget to mental health, not enough given the seriousness of the issue. We need to work together in Australia, and globally, to break the silence around mental health and suicide!

Day 2 - Technological Development, Public Engagement and the Broad Scope of International Cooperation

Wills Pritchard, Sir Walter Murdoch School of Public Policy and International Affairs

The most common theme of my 72nd World Health Assembly experience has been the need for more expansive collective action on the most challenging global health issues currently experienced by member states. Whilst it is hardly surprising that such a message would be so strongly advocated, the immense range of global health issues to which this applies was particularly striking, and this was demonstrated in numerous settings throughout day two.

Two key elements stood out: firstly, the wide range of challenges that the World Health Organisation (WHO) is currently responsible for addressing; and secondly, the ongoing institutional challenges it faces, such as maintaining public trust and advancing evidence-based practice.

In terms of the former category, it was readily apparent that the collective action problems faced by the WHO reach far beyond the headline issues, such as anti-microbial resistance (AMR) and climate change. For example, the nuanced issue of how best to develop and implement emerging medical technologies was a subject that was expanded upon through a number of technical briefings. Within these it was made clear that the potentially transformative effect of data collection and health information systems is well understood, however, there remains a substantial deficiency in the WHO’s current capacities to manage the ethical and security dimensions that inevitably arise in their implementation. Similarly, the strong interest shown in artificial intelligence (AI) and machine learning, in both clinical and analytical settings, was largely discussed through the lens of how they can be responsibly managed and, critically, equitably deployed. It became readily apparent that a robust global health governance structure was an essential component of the incorporation of these technological developments not only in the establishment of ethical codes of conduct, but through being able to cut through the hype that often accompanies them, a phenomenon that has previously been counterproductive. 

Another arm of the WHO’s operations that was discussed in some detail, was how best to prepare for and manage humanitarian crises from a health care perspective. Particular emphasis to this end was placed on the implications of these events on universal health coverage (UHC). It was encouraging to see key representatives in attendance affirm that objectives concerning peace, security and equity cannot be disentangled from those of UHC and emphasise the need to take an intersectional approach for more holistic international cooperation. While the discussions of technological change were typically concerned with centralised approaches, those regarding humanitarian crises placed considerable emphasis on the empowerment of communities to develop resilience in managing these crises. Local capacity building largely in human resources for health (HRH) was a central consideration in this policy space, with the expansion of locally derived expertise being an essential component of providing continuity of health services after the initial shock of these crises dissipates.

Interestingly, whilst there was some future focus to these discussions, they were heavily oriented towards the humanitarian crises caused by armed conflicts and geopolitical violence. Consequently, little mention was made of the intersection between humanitarian crises and climate change, both as an imminent threat to human safety and an accelerant of insecurity. Whilst the global health response to climate change driven humanitarian crises will no doubt be considered in great detail elsewhere in the 72nd WHA, greater cognisance of these linkages would have been highly beneficial in this setting.

Finally, the importance of building legitimacy and trust in the WHO was a part of all the discussions I observed on day 2 of the 72nd WHA and was crystallised in a youth-oriented discussion concerning tokenism and hierarchy in global governance settings. Cognisance of how the current design of global governance institutions may be shaped by inherently unequal structures (both economic and cultural) is absolutely essential in fostering legitimacy going forward. More broadly, the required responses to these institutional challenges - such as greater public engagement, inclusion and the greater advancement of evidence-based practice - can only be achieved through sustained and increased cooperation on the international level; an area in which the WHO plays a central role.

Day 1 - "Young people are biologically revolutionary, if they’re not then it is a contradiction”

Greta Bartels, RMIT University

Day One, started with a quick walk over the border from France to Switzerland; as Uber is not allowed to operate in France. Our Uber picked us up next to a green paddock and dropped us off, with stark contrast, at the beautiful Intercontinental Hotel.

The first item on the agenda was a meeting with Peter Varnum and Craig Hodges, who both work with the World Economic Forum in the area of mental health. This meeting kicked off a theme we have begun to notice: we’re constantly learning about health issues that we had no previous knowledge of and/or no idea about the depth and severity of the issue. For myself, doing an international studies degree, and therefore having no medical background, hearing about other pressing health issues – such as antimicrobial resistance - over the past two days has been incredibly concerning. That topic in particular, was mentioned at the pre-WHA72 briefing for delegates and again during the opening sessions of the Official Plenary. Learning about how antibiotics are being abused has been eye-opening, whether preventatively in cattle feed or over-prescribed to patients with no real need, and has emphasised how seemingly independent acts like these all contribute to significantly increasing the risk of super bugs.

The High-Level Plenary itself was amazing; with each seat having earpieces with multiple different translations and seeing all of the country delegations below, it created such an energy that had us all excited. And Youth representative Natasha Mwanza only further increased the energy in the room.

As a young Zambian woman of only 18 years of age, Natasha began her speech explaining that she wouldn’t be using a large amount formal language, but that we would “get the point, right?”. This was met with a huge amount of applause and welcome from everyone in the room, an attitude that continued throughout her speech. A point she discussed that really stood out to me, was the need to create a youth-friendly arena rather than an arena with a youth-friendly area. With over 50% of the world population under the age of 30 years, I couldn’t agree more; we are an essential part of creating the solution to our global problems. We’ve been lucky to be able to engage with quite a few other youth organisations while we’ve been here, which has been incredibly insightful and engaging. The question of youth engagement was also brought up at today’s meeting on community and civil society engagement for the Global Action Plan on SDG 3: Universal Health Coverage, demonstrating how important youth involvement and engagement is in the health arena.

Interestingly, as we discussed in our Uber ride back to our hotel, the civil society and community events tend to be more heavily attended by females, whereas the more governance-focused events are more heavily attended by males. For our last session of the day this was particularly evident. Eating more delicious desserts and drinking fresh juices, we heard from community health nurses from Liberia and Uganda, among others, sharing their experiences in educating their communities about good health. The Ugandan Minister for Health, Dr. Jane Ruth Aceng, highlighted to the audience that there is a real need for community health nurses to be paid, yet another issue to add to the complex problems. What was interesting was the majority of the audience was women, and those that were very annoyingly talking throughout the presentation were mostly men. It will be interesting to see if these trends continue throughout the week.

Finally, I’m super excited to start hearing more about humanitarian crises and climate change in tomorrow’s sessions, as these relate directly to my policy paper topic and will provide me with ideas and information to support my recommendations for the Australian context.

Expanding my horizons: reflecting on the Global Voices experience

Rebecca Field, Curtin University

Grateful and motivated…and a little jet-lagged. That’s how I feel following a week in Paris as part of the Global Voices Scholarship Program.

Just past the half-way point of my PhD, visiting the OECD felt like an opportunity for me to lift my head up, look around and expand my horizons. The life of a PhD student can be really isolating. Most days it’s just me, the screen and a cup of coffee. I entered the Forum being a little bit unsure if I would ‘fit in’. I’m a social worker and a qualitative researcher that can barely use Excel, let alone have an intellectual understanding about trade and economics. I didn’t feel I had anything to contribute. I wasn’t sure I had a place at the same table.

 Attending the OECD Forum 2019 was enlightening and inspiring. It was wonderful to be immersed in a space dedicated to understanding, developing and sharing progressive ideas, policies and practices with the hopes of inclusive growth towards global well-being: “Better policies for better lives”. This was exactly my motivation for starting postgraduate study. It was almost unbelievable that there would be an organisation on such a level pursuing the same goal. Thanks to the Global Voices networking we had meeting after meeting with OECD staff. From one of the Deputy-Secretary General to a student interning for a few months, all were committed to that same goal. The OECD renewed my faith in multinational organisations.

The Global Voices team achieved exactly what they claim to do: “Connecting young Australians to the world...” But it goes even further than that. I have returned to Perth connected to five other scholars. I have met people with skills, knowledge and experience I would never have: an esteemed law student from Brisbane, a vegan economics student from Melbourne, a passionate future teacher from regional Queensland, an experienced policy influencer in Sydney and a totally talented social media guru from Adelaide. What do you get when you put these people around a table? The most engaging and thought-provoking conversations. I am grateful to them for sharing with me and helping to expand my horizons. I now I have contacts around the nation for life, I know can work together on common goals and support each other.

I also feel more connected within myself. On Thursday 23 May the eight of us sat down with the Tamara Krawchenko and Anna Piccinni, who are policy analysts at OECD. This was one of the highlights of the experience for me. I listened to these two accomplished women share findings on migration research and policy development. Their work had many similarities to what I’ve been working on for the last two years, which I was able to share with them. Yes, I do fit in. I do have something to contribute. Furthermore, we had candid conversations with OECD staff and other diplomats day after day. I felt honoured and respected that people would be so open and honest with us. Thus, this experience reaffirmed the important contribution that myself and other people under 30 can and should make to our society. Now the question is: what will that look like? Thanks to Global Voices I now feel like it could be locally, domestically or internationally.

Wrapping up the OECD Forum 2019

Brandon Barrio, Queensland University of Technology

Yesterday we saw the conclusion of the official OECD forum. It was a truly eye-opening experience which exposed me to a range of different viewpoints and cultures which I had yet to experience. Some of the key takeaways that I realised from the OECD forum was the focus on technology, particularly AI, and the importance of understanding emotions. The theme of emotion was something I was particularly sceptical on prior to attending the OECD forum, which was most likely attributed to my background in the law. However, after engaging with the presentations and participants at the forum, I have realised the importance of having high emotional intelligence to identify problems and subsequently create appropriate evidence-based solutions. 

However, my learning did not stop with the OECD conference, as this morning we were fortunate enough to speak with Brendan Berne, the Ambassador for Australia in France in his picturesque living quarters at the Australian Embassy. During our discussion he shared his insight into importance of the French and Australian relationship, particularly in light of our new submarine contract. Brendan also shared his insight into Australia’s historical relationship with a variety of countries. Most interestingly to me was our discussion on China and the impact that this economic giant may have on the international trade landscape in the years to come. We were also fortunate enough to receive some inspiring career advice from Brendan, of which the most notable comment to me was to do something that I am passionate about, because passion drives innovation and innovation is what makes you stand out.

This inspirational messaging continued throughout the day to our meeting with Josee Touchette, the Executive Director of the OECD. Josee reassured us of the importance of the youth voice and how we are the key to creating solutions to develop the ‘glue’ that ensures all groups in society feel enfranchised and cared for by institutions. Personally, as a law student myself I found her insight into the transferable skills she learnt from her law degree, such as the ability to ask probing and analytical questions, to be extremely interesting and motivating.

Last but certainty not least, we also met with Anthony Gooch, the Communications Director of the OECD. This meeting was particularly interesting to me because we were able to reflect on the key themes of the conference such as distrust in institutions and the concept of ‘emotion’. Anthony also allowed us the opportunity to discuss our policy papers and our justification behind our elected topics. The discussion of ‘populism’ and topics such as immigration were also intriguing to me as they are also rather controversial issues within Australia.

Overall, the OECD forum and accompanying meetings I have experienced through the Global Voices Scholarship have been extremely enlightening. I am looking forward to what tomorrow brings and using the knowledge I have accumulated throughout my trip in Paris in developing my final submission of my policy paper.

Adding Emotion to the Mix

Isabella McDougall, University of Sydney

“It’s crucial to add emotions to the policy making mix, if it doesn’t connect with peoples dreams, the policy will never have traction.” This was a defining closing remark made by OECD Secretary General Angel Gurría during his opening address at the 2019 Forum in Paris.  

The theme of this year’s Forum, ‘World in eMotion’ is reflective of the immeasurable opportunities of digitalisation and globalisation today and into the future, and the need for people’s emotions to interact with this new wave. The Secretary General impressed upon the audience that there is an urgency to  harness the inevitable change occurring around us, rather than be driven by it. We were asked to consider digitalisation and globalisation as a catalyst to create and deliver inclusive growth, sustainable growth and improve the lives of all in society. Conversely, as this progress presents itself we must be very aware that it comes with an array of challenges. Globalisation and digitisation are producing dangerous fault lines in our society that is driving fear, anxiety and distrust in the standards and norms we are accustomed to. 

The Secretary General’s opening remarks moved me to investigate how I live my own life and my emotional response to policies and initiatives happening around me and for me. In this ever transforming world, the OECD Forum 2019 call to action transcends the two day event, “What can I do? What can we do? What can we do together?” now and into the future. 

Reflecting on the first day of the Forum, a striking feature was the interactive nature of the panel and workshop discussions that sought to engage the perspectives of all thirty-six OECD countries. Further too was the percentage of female speakers ,at 40%, an OECD record, and the strong youth engagement from Canada, Brazil, Germany and Australia. 

As someone who is currently in the professional environment, I am learning and experiencing leadership styles amongst teams, managers and executives. A session which strongly resonated with me, was ‘CEO Activism and New Leadership’ featuring CEO of Engie, Isabella Kocher and CEO of Randstad, Jacques van den Broek. 

These two CEOs of leading Fortune 500 companies spoke on the qualities of what makes effective and successful leaders today. In a simplistic view, they are listeners, optimistic, and hardy people. To drive growth and people, they spoke of their belief in the need for purpose, to have courage and be patient, especially if you seek to reform the agenda. Ms Kocher surmised, there is no point being a sole CEO activist, rather those fortunate enough to be in executive positions need to share. Sharing will deliver action and action brings hope and change. 

While these are only a few take aways from day one of our four day opportunity here in Paris, it is clear that this event will have a lasting impact. One that will require me to consider and reflect on how to incorporate emotion for good into my everyday. 

90jours: The innovative smartphone app tackling climate change on a micro-level

Erin Gear, University of South Australia

This year sees the OECD hosting its 20th annual multilateral forum in Paris, which I have so fortunately been able to attend. The OECD is a dynamic intergovernmental organisation comprising of 36 member states that aims to achieve equality and well-being at a global scale by providing the framework to shape better domestic policies.

Highlights from the second day at the OECD Forum included meeting with the Deputy-Secretary General Ulrik Vestergaard-Knudsen in the Chateau, sitting in on discussion panels on the role of media in reinvigorating democracy and achieving the United Nation’s sustainable development goals, as well as meeting with Australian delegate and Deputy Permanent Representative at the OECD, Simon Cramp over lunch.

This year the OECD has placed a particular emphasis on including youth voices in their discussions on preparing for, and safeguarding the future, with twenty-somethings from the likes of Canada, Sweden, Korea, and of course Australia, in attendance. The Forum has been progressive and inclusive between generations, with near equal representation between men and women. This diverse and equitable representation has enabled participants to come together to discuss and produce unbiased and realistic ideas for the future of OECD nation countries.

One aspect of the second day I would like to draw attention to is a session that was not originally on my agenda to attend, but I am so glad I happened upon it. The OECD’s Better Life Index branch hosted a civic innovation hub that provided entrepreneurs with projects in sustainability, equality or inclusivity, a platform to share their work. Elliot Lepers, a digital designer and environmental activist, introduced his enviro-friendly app, 90jours, which challenges and motivates users to practice more sustainable living. Much like the 90-day mindfulness, weight-loss and budgetary challenges we’re all familiar with, 90jours is an app that customises daily eco-friendly challenges based on users’ level of motivation.

More than 600,000 people have already downloaded the app and pledged to take the challenge, which is specifically designed so that users are able to continue practicing their new environmentally sustainable habits. Climate change and the destruction of our environment is an overwhelmingly large and complex issue, and 90jours provides a platform that demystifies it by bringing it to the individual, micro-level, to find solutions in the everyday. The philosophy behind the app is to inform people of better habits for sustainability, and to provide them with the tools to continue on an environmentally-friendly life path. While this app is in French, it has undoubtedly sparked an interest, and English versions are sure to come soon.

In a time of social, economic, political and environmental uncertainty, it has been incredibly uplifting to be able to discuss the direction of the future with innovative, like-minded thinkers at the 2019 OECD Forum.