Advancing Global Health Equity: The Voices That Matter
Author: Heather McCulloch
Introduction
As I write this blog for World Evidence-based Healthcare (EBHC) Day, Australia approaches the 2023 referendum on amending the Constitution to establish an Aboriginal and Torres Strait Islander Voice in Parliament. The significance of the Voice transcends national borders. The Voice acknowledges a broader global health equity concern, emphasising the imperative of evidence-based approaches and inclusive partnerships in promoting the well-being and health of marginalised communities worldwide.
The Voice
The proposed Aboriginal and Torres Strait Islander Voice is a body that may make representations to the Australian Parliament on matters relating to Aboriginal and Torres Strait Islander peoples. The introduction of the Voice is firmly grounded in the core principles of public health and the interconnecting principles of equity, access, empowerment, community self-determination and intersectoral collaboration. It encompasses an understanding of the social, environmental, economic, cultural and political determinants of health.
Enshrining the Voice to Parliament will advance global health equity by recognising and empowering First Nations communities, addressing health disparities and promoting principles of genuine community engagement that can serve as a model for other nations and international development efforts. The Voice is backed by the evidence that direct involvement of Aboriginal and Torres Strait Islander peoples in the design and implementation of laws, policies and programs that affect them results in better outcomes.
Listening to the voices that matter
The body of evidence includes a systematic review on the association between alcohol restriction policies and rates of alcohol-related harms in remote Australian Aboriginal and Torres Strait Islander communities. Most of the studies included in the review indicated a degree of reduction in harm, but often these gains were later reversed. While the overall quality and certainty of the evidence was limited, one robust finding emerged: policies and programs that authentically engaged with the community, involving collaboration in the design and execution of initiatives, demonstrated better outcomes.
In editorial accompanying the systematic review, Kathleen Martin, an Arrernte woman from Central Australia and a lecturer in Indigenous Health at Flinders University, asks why are we not listening to the people who matter? She writes:
It was striking that the impact of community engagement that we observed in our synthesis of multiple sources of evidence was not more heavily emphasized in the studies we reviewed. Rather, there was a general pattern of interventions being imposed without authentic consultation. That the ethos of self-determination is still not being prioritized may partly explain the long-standing nature of alcohol-related harms and other problems experienced by Aboriginal and Torres Strait Islander people to a far greater extent than other Australians.
Partnerships for Purpose
The need for community engagement and authentic consultation is underscored in the 41 blogs from 18 countries that were published for the World EBHC Day 2022 campaign. The campaign, Partnerships for Purpose, aimed to facilitate discussion and enrich collective wisdom around forming, developing, maintaining and assessing evidence-based healthcare partnerships by creating a forum for the global evidence community to exchange experiences and learnings.
Bianca Pilla, Professor Zoe Jordan, and I conducted a reflexive thematic analysis of these blogs. Our objective was to delve into the perspectives shared by World EBHC Day 2022 bloggers regarding the challenges, facilitators and outcomes associated with partnering to promote and support evidence-based healthcare. It was evident that the global evidence community strongly advocated for embedding equity, diversity and inclusion for better partnerships that had better outcomes.
Blog authors highlighted the importance of establishing and sustaining inclusive partnerships. By cultivating relationships with partners who have historically been under-served, this approach results in outcomes that not only benefit marginalised communities, but also lead to enhanced healthcare outcomes that extend beyond these communities:
We must build and sustain relationships with partners whose needs have been inadequately addressed and whose expertise has been insufficiently utilized. A greater emphasis on meeting the needs of historically marginalized communities will broaden our perspective and help ensure AHRQ’s reviews support improved healthcare outcomes for all.
Inclusive partnerships are not just a necessity, they are fundamental. They commence with mutual respect and recognising the value of all partners and their contributions, underpinned by a genuine effort to understand the communities being served. As noted in the blog about the World EBHC Day 2022 webinar:
For me, this speaks to how we value others in a partnership, which needs to be the very starting point. Outcomes may not be entirely equitable, no matter how hard we try, but listening to and respecting partners is fundamental. What will make a truly successful (equitable) partnership is the work we put in at the beginning to gain a real understanding of the humans we are working and interacting with.
The global shift to advance health equity
The imperative for equity, diversity and inclusion in EBHC partnerships highlighted in the 2022 campaign blogs reflects a global shift in research practices, emphasising the need to counter helicopter research with equitable partnerships. The term ‘helicopter research’ (also referred to as ‘parachute science’) describes the practice of researchers from privileged countries (or high-income countries) undertaking research in marginalised communities or low- and middle-income countries without meaningful collaboration with the community. This approach often results in an incomplete grasp of the challenges and needs of that community, with contextual nuances left unrecognised and unacknowledged. In an effort to end helicopter research, journals such as Nature have introduced author guidelines on inclusion in global research. These guidelines encourage authors, editors and reviewers to embrace the Global Code of Conduct for Equitable Research Partnerships when developing, conducting, reviewing and communicating research.
The campaign for World EBHC Day 2023, Evidence and global health equity, was developed in response to the reflective thematic analysis that underscored equity, diversity and inclusion as foundational to successful partnerships in evidence-based healthcare. It acknowledges the global shift and the imperative to advance health equity through evidence-based approaches and the need to listen, respect and value the voices that truly matter.
Igniting conversation to advance global health equity
World EBHC Day is more than a date on a calendar. It serves as a global platform for dialogue, knowledge sharing and expertise exchange. As a world awareness day, it has the potential to shape the social and political environment that supports change at the policy level. It is also a reminder that the conversation is ongoing, evolving and amplifying.
In a similar vein, the 2023 referendum signifies more than a vote to amend the Constitution to advance health equity among Aboriginal and Torres Strait Islander people. It is symbolic of a broader global health equity concern, emphasising the imperative of heeding the evidence by actively listening to the voices that matter and engaging meaningfully with marginalised communities who often bear the brunt of health disparities. Whether Australians vote ‘yes’ or ‘no’ to constitutional changes does not signal an end to our advocacy, dialogue, education and awareness efforts. The referendum has ignited conversation that will continue, evolve and grow, transcending national borders.
Conclusion
In October 2023, the referendum and World EBHC Day act as catalysts for change by providing a space for dialogue and the exchange of knowledge and ideas on evidence and global health equity.
Just as the referendum outcome is not the end of this conversation, the World EBHC Day 2023 campaign represents another chapter in a continuing story. Both events are a step towards the same goal: fostering a more inclusive and equitable world where the ideals of health equity are championed and practiced.
After the referendum and World EBHC Day is the moment when we take a collective breath, gather our strength, and continue the journey towards a more equitable and evidence-driven world of healthcare.
References
Dudgeon, P., Calma, T., & Holland, C. (2023). Enshrining a First Nations Voice to Australian Parliament will improve Indigenous health. The Lancet Global Health. https://doi.org/10.1016/S2214-109X(23)00466-7
Global Code of Conduct for Research in Resource-Poor Settings. (2018). https://www.globalcodeofconduct.org/
Hines, S., Carey, T. A., & Cibich, M. (2022). Association between alcohol restriction policies and rates of alcohol-related harms in remote Australian Aboriginal and Torres Strait Islander communities: A systematic review. JBI Evidence Synthesis, 20(7), 1610-1637. https://doi.org/10.11124/JBIES-21-00055
Katz, R. (2023, October 12). The Voice referendum: An opportunity to close the gap on Indigenous health. Lens, Monash University. https://lens.monash.edu/@medicine-health/2023/10/12/1386212/the-voice-referendum-an-opportunity-to-close-the-gap-on-indigenous-health
McIntosh, K., Messin, L., Jin, P., & Mullan, Z. (2023). Countering helicopter research with equitable partnerships. The Lancet Global Health, 11(7), e1048-e1049. https://doi.org/10.1016/S2214-109X(23)00278-4
Martin, K., Hines, S., & Carey, T. A. (2022). Alcohol restrictions in Australia: Why are we not listening to Aboriginal and Torres Strait Islander people? JBI Evidence Synthesis, 20(7), 1608-1609. https://doi.org/10.11124/JBIES-22-00244
Nature. (2022). Helicopter research: Who benefits from international studies in low-income countries? Nature. https://doi.org/10.1038/d41586-022-01423-6
Purtle, J., & Roman, L. A. (2015). Health Awareness Days: Sufficient Evidence to Support the Craze? American Journal of Public Health, 105(6), 1061-1065. https://doi.org/10.2105/AJPH.2015.302621
Umscheid, C. (2022, October 12). AHRQ's Evidence-based Practice Center Program: 25 years of partnerships to support evidence-based decision making. World EBHC Day. https://worldebhcday.org/blog/2022/ahrqs-evidence-based-practice-center-program-25-years-partnerships-support-evidence-based
World EBHC Day Steering Committee. (2022, September 22). Webinar recap: Equity in global health partnerships. World EBHC Day. https://worldebhcday.org/blog/2022/webinar-recap-equity-global-health-partnerships
To link to this article - DOI: https://doi.org/10.70253/BESX1586
Additional resources
Editorial in motion (short video): Alcohol restrictions in Australia: Why are we not listening to the people who matter?
Conflict of interest
Heather is a member of the World EBHC Day Steering Committee
Postscript: The Australian referendum of 14 October 2023 on an Indigenous Voice to Parliament returned a majority ‘no’ vote.
Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.
