HSR2024 Theme

Building Just & Sustainable Health Systems: Centering People and Protecting the Planet

HSR 2024 Eighth Global Symposia on Health Systems Research | Nagasaki, Japan

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Building Just & Sustainable Health Systems: Centering People and Protecting the Planet

SUB-THEME 1: Strengthening Health Systems for Planetary Health

The linkages between planetary health and health system functions remain neglected in research and policy dialogue on health policy and systems community. The sub-theme strengthening health systems for planetary health emphasizes the need for a concerted effort to build health system research, policy, and programmatic momentum in the following areas.

Strengthening climate-resilient health systems: The health of populations – humans and other species – is deeply intertwined with the health of our planet. Yet our health systems, which have traditionally focused on treating illness, are often inflexible by design, and must adapt to address the complex challenges posed by climate change, urbanization, biodiversity loss, and pandemics. We welcome submissions on research exploring the infrastructural and workforce adaptations required to ensure climate-resilient health systems; how climate change may undermine health service delivery, and how systems respond to shifts in service demand associated with disease or population movement. We welcome learnings from experiences of bringing health system experts together with community representatives, activists and Indigenous populations, and non-health disciplines such as social science, climate services, ecology, engineering, futurology, to address climate resilience. Submissions that explore the role of community-based strategies, participatory approaches, and highlight the role of local and Indigenous knowledges in informing efforts to improve climate-resilience health systems, are particularly welcome.

Strengthening environmentally sustainable health systems: Health systems contribute significantly to environmental change and degradation through resource consumption, waste generation, and energy usage. We welcome submissions focused on the science and practice of building sustainable, climate-resilient health systems. This includes forward-thinking work that reimagines healthcare delivery models that are both resilient and low-carbon; One Health approaches capable of responding to complex challenges posed by climate change, rapid urbanization, biodiversity loss, and new pandemics; and private sector engagement looking at environmentally sustainable health care and climate-related commercial determinants of health.

Policy creation and governance for climate resilient and sustainable health systems: Health systems and policy research that engages with policy creation and governance for climate-resilient and sustainable health systems is lacking. This includes macro-level explorations of the political economy of health system adaptation and transformation – e.g. how to navigate the lack of financing within low- and middle-income countries, to effectively support health systems climate change adaptation; down to meso- and micro-level research on the impacts of policy inconsistency and gaps at sub-national (provincial, district, and primary care) levels on public health adaptation to climate change. Health system leaders also have an important role in the prevention and mitigation of current and further planetary damage. We encourage submissions examining the role of health systems leaders as advocates for policies and interventions that address the root causes of planetary health challenges, promoting sustainable practices and fostering a healthier planet for present and future generations.

SUB THEME 2: Advancing justice, inclusion, and belonging in health systems, in times of peace and conflict

Everyone has the right to access quality health care, regardless of their race, ethnicity, gender, disability, socioeconomic status and related conditions. The sub-theme: “Advancing justice, inclusion, and belonging in health systems, in times of peace and conflict,” reflects the ongoing need to identify gaps, and strengthen action on inclusivity and belonging to ensure health systems mediate and redress social inequity rather than deepen it. We welcome submissions in the following areas.

Centering lived experiences in health system: Around the world, and particularly in settings of conflict, people are denied access to health care due to discrimination, health system disruption, service siloes, and scarce resources. We welcome submissions that center lived experiences of the different needs, protections, and expectations of health systems by vulnerable populations (including Indigenous peoples, women, refugees, internally displaced persons, ethnic minorities, LGBTQIA+, people living with disability, people of colour and aging populations) in alternative policy and service-delivery frameworks. Research reflecting on and synthesizing the relational, access-related and quality dimensions of those experiences to consider what it takes to transform health systems is encouraged. HSR2024 seeks to advance discussions about the role of intersectionality and power in health policy and system practice.

Implementation research and practical efforts to advance justice, inclusion and sustainability: Knowledge silos create barriers to transformation health system strengthening. We encourage submissions that describe and evaluate reforms and initiatives advancing justice, inclusion, and belonging across all health system domains. Research focusing on the mechanisms (e.g. financing, legislative, regulatory, activist, community engagement, service re-design) and contextual factors required to both catalyse and sustain meaningful improvements in service coverage and quality is welcome. Work that identifies the adaptive capacities and mechanisms that advance justice, inclusion and belonging in fragile and conflict-affected health systems is particularly needed. Recognising the equity-promoting potential of different health financing models, research focused on new approaches to health financing, and mixed service models that address health system discriminiation and improve health outcomes is welcome. We also encourage research and programmatic learnings from initiatives that address management and organizational bias through purposeful leadership and reflexive workforce practice.

Transforming structural change: Systemic, structural, institutional and interpersonal racism and discrimination have hugely detrimental effects on health outcomes. Work that explores and showcases structural reforms necessary to tackle racism, discrimination, disrespect and abuse, in health systems is encouraged. We welcome submissions that explore the design and implementation of transformative approaches to public health and health service delivery specifically aimed at dismantling such systemic and historical barriers. We welcome practical examples and critical evaluations of initiatives seeking to counter epistemic injustice by centering or integrating Indigenous knowledge systems to realise the rights of marginalized peoples. Sharing research, policies, and interventions that explore strengths-based methodologies and strategies for cultivating respectful people-centered health systems is welcomed.

SUB THEME 3: Health governance, policy and institutional frameworks for just and sustainable health systems.

Effective health governance, policy and institutional frameworks that embody it, should help to create a shared understanding, facilitate coordination and collaboration and encourage accountability, multiple gaps exist in our understanding of how to define, design and enact such institutions in the face of rapidly evolving technological, politico-economic and epidemiologic imperatives. The sub-theme Health governance, policy, and institutional frameworks for just and sustainable health systems emphasizes the need for analytical and empirical work focused on the following areas.

Governance and institutional frameworks for complex health systems: Although good health governance is foundational to the goal of promoting justice and sustainability, the policies and institutional frameworks that give expression to it within complex health systems, are not a given. We welcome submissions that explore the complexities of, and strategies for, developing policy and institutions that strengthen cross-sectoral (public-private, and health-non-health) cooperation, and that explore the role of markets in achieving, distorting, or innovating a path towards high-quality health systems. Of particular interest is work exploring the levers of influence and modes of engagement that are, or could, be used by governments within mixed health systems, and research to understand the varied interests of private sector actors (small and large) and whether and how they align with the goals of a just and sustainable health system. Relatedly, we encourage submissions that map the institutional eco-system within mixed health systems, identify gaps, and propose reforms at system or organizational levels.

Within this sub-theme, we also encourage cutting-edge research and case studies that deepen our understanding of the structural causes of a near-perpetual crisis in human resources for health, including the nature and impact of public policy settings to support or discourage health worker migration, and the implications of migration for geopolitics, peace-building and global health diplomacy; the political economy of health workforce reform in the context of dynamic industrial, political and social conditions; and innovative approaches to health workforce management for dispersed populations including in remote area locations and small-island, and archipelagic nations.

Governance to strengthen public health & address commercial and cultural determinants:  In this “post” pandemic era, we welcome submissions that deepen our understanding of how to strengthen governance for just and sustainable public health functions and population health. Priority topics include: the sufficiency of national policy settings and institutional frameworks for ensuring a skilled public health workforce in both pandemic and non-pandemic times; policy frameworks for integrated health information systems that inform real-time decision-making and more effective use of resources; state-of-the-art policies and strategies (‘offensive’ and ‘defensive’) including modes of surveillance for addressing commercial determinants of health; and approaches to governance that enhance community responsiveness and rebuild trust. Since health governance and institutional frameworks are constituted and function at the global, as well as national and sub-national and local levels, we strongly encourage submissions that deepen our understanding of the impacts of power dynamics and political economy of health policy and governance outcomes in different settings.

Stewardship of digital transformations including AI and big data: The role of technology in health systems globally, and the accelerating rate of digital transformation, cannot be overstated. The WHO Global Strategy on Digital Health 2020-2025 recommends that digital technologies be viewed as “an essential component and an enabler of sustainable health systems and universal health coverage”. Yet many concerns remain regarding the adequacy of stewardship and institutional frameworks governing transformative technologies, including private and security concerns and ethical considerations in the use of AI and machine learning. We welcome submissions focusing on empirical and normative aspects of the governance of digital technologies in health systems, and the formulation of regional, national or sub-national digital health strategies to support health system and population health improvement. In the context of these actual or aspirational transformations, we also encourage submissions exploring the institutional frameworks and regulatory infrastructure necessary to engage with and manage the interests of a rapidly changing information technology sector; and the sufficiency of existing mechanisms of participatory governance for ensuring social accountability and trust, in the context of such change.

SUB THEME 4: Knowledge for just health systems

The production and use of knowledge for health policy and systems is influenced by epistemological, ethical and methodological choices, in turn reflecting the underlying values of both researchers and practitioners. The sub-theme: Knowledge for just health systems aims to extend and amplify conversations about these choices and stimulate debate and shared learning around approaches to the production and use of knowledge better aligned with a just and sustainable health system.

Challenging & transforming epistemic injustice in research, learning & teaching: The production, co-production of knowledge for health policy and health systems is structured by problematic hierarchies of knowledge, evidence and language, and reflected in the exclusion and marginalization experienced by many groups. We welcome submissions that identify, challenge and seek to transform these injustices in research, and learning and teaching practice. We encourage work that explores the significance of intersectionality and the role of social identities in shaping the creation of knowledge; and which explores the transformative potential of Indigenous and other knowledge systems. We welcome explorations of ethical frameworks, anti-racist and power-sensitive methodologies, and knowledge dissemination and publishing practices that invert established power relations, including the centering of data sovereignty and cultural governance. In relation to learning and teaching, we welcome work examining curriculum design and modes of delivery that promote pluriversality and submissions that reflect on the role of counter-narratives and other anti-colonial approaches. More broadly, we seek experiences of field building and reflections on the HPSR competencies required to support and strengthen reflexive, ‘learning health systems’; and health policy and systems teaching and learning strategies, including pre-professional, continuing professional education that actively reflect on knowledge production and use for just health systems.

Surfacing values: Values provide a normative foundation upon which health policy and systems are designed, implicitly guiding decision-making processes in ways that reinforce established approaches to knowledge production, sharing, and utilization. We encourage submissions that explore and identify the values and social identities guiding health system research, learning and teach practices as well as policy choices, and critically analyze the ethical implications and alignment of those choices with broader health system goals of social justice and sustainability. Submissions that explore the mechanisms, and multi-faceted conditions required to shift or embed new values, including participatory priority setting; strategies to amplify non-hegemonic perspectives; and purposeful pathways for ensuring representation in leadership.

Dissemination & translation: Effective translation, communication and integration of complex scientific and socio-cultural knowledge is essential for engaging and empowering diverse stakeholders in health system strengthening efforts. Transparent and clear communication fosters trust by grounding decisions and actions in a shared understanding of issues and diverse evidence. We welcome cutting-edge research exploring innovations in knowledge translation, and importantly, the building of systemic trust. Submissions exploring the role and different models for open-access publishing, data-sharing are encouraged, alongside those that examine best practices in knowledge translation and dissemination for promoting equitable and just health systems.