No perfect place
By Asha George, Michelle de Jong, Barbara McPake, Daniel Maceira, George Gotsadze
Equity is a core principle of Health Systems Global (HSG). It is reflected in our Board composition, which is one of few global health organizations boards balanced by gender, geography and generation. We also balance advocating for health policy and systems research (HPSR) at the global level, with engagement with regional and national networks and organizations. Equity is also reflected in how we convene our flagship global event, the Global Symposium on Health Systems Research. Not only do we fundraise to support hundreds of scholarships for policymakers, students and low- and middle-income country participants, but plenaries are also balanced by gender, geography and generation and our website welcomes Symposium abstracts in multiple languages. Another key consideration is where the Symposium is hosted.
As highlighted in an earlier blog post, Symposium city selection is undertaken by the Board assessing bids from an open call made 2-3 years in advance of the Symposium. Given that the two previous Symposia were in the Global North (Vancouver and Liverpool), and in response to HSG membership feedback requesting the location be in an underrepresented region, we selected the most viable option from a pool of only three applicants: Dubai as a host for an Eastern Mediterranean region. The experience in doing so has led to the development of formalised criteria for the selection of future Symposia locations that balances logistical and pragmatic needs with human rights and equity considerations.
To further advance our understanding and dialogue on how and where global health meetings are convened, we spent time looking for databases that provide some information on the different considerations that need to be respected. While not all databases had the comparative information we sought, we agreed on nine indices that span three domains (accessibility, inclusiveness and governance) (Table 1). In essence, Symposia locations need to be accessible to as many participants as possible, be inclusive spaces and enable us to transact business safely. We then picked 6-7 diverse countries within sub-regions to further understand and compare across regions.
Table 1
| Factor | Index | Organization | Components included |
| Visa Accessability | Welcoming Countries Rank | Passport Index by Arton Capital | Countries are ranked according to how many passports they accept visa-free, with visa on arrival or with electronic travel authorization |
| Nations left behind | Henley Passport Index | Henley and Partners | ‘Ranking of all the world’s passports according to the number of destinations their holders can access without a prior visa’ |
| Inclusiveness | Inclusiveness Index | haas institute for a Fair and Inclusive Society | Includes Outgroup Violence, Political Representation, Income Inequality, Anti-Discrimination Laws, Rates of Incarceration, Immigration/ Asylum Policies |
| Gender Equality | Gender Inequality Index | United Nations Development Program | GII reflects how women are disadvantaged in reproductive health, empowerment and economic status |
| Safety | Global Peace Index | Institute for Economics and Peace | Measures the state of peace in 163 countries using three thematic domains: the level of Societal Safety and Security; the extent of Ongoing Domestic and International Conflict; and the degree of Militarisation |
| Foreign Exchange Restrictions | Business impact of rules on FDI (TTC 2017) | World Economic Forum | A sub-index of the Travel and Tourism Competitiveness Index which depicts the restrictiveness of rules and regulations on foreign direct investment |
| Infrastructure | Tourist Services Infrastructure (TCC 2017) | World Economic Forum | A sub index of the Travel and Tourism Competitiveness Index measuring ‘the availability and the quality of key tourism services such as quality accommodation and car rentals.’ |
| LGTBQI acceptance | Global Acceptance Index | The Williams Institute | A consolidation of cross-national, global, and regional surveys that measure attitudes toward LGBT people and rights. |
| Governance | Rule of Law Index | World Justice Project | Measures how Rule of Law is experienced and perceived by the public in different countries across 8 factors: Constraints on Government Powers, Absence of Corruption, Open Government, Fundamental Rights, Order and Security, Regulatory Enforcement, Civil Justice, and Criminal Justice |
While these databases may not be entirely accurate, they nonetheless give us an understanding of how difficult it is to find the perfect Symposium location. While there are regional patterns, there are also variations within each region. In general poorer low- and middle-income countries have more welcoming visa regimes than high income countries, but Ghana, China, Iran and Bolivia are outliers within their regions for positive and negative reasons. While most countries rank well for gender equality, the same is not true for the inclusiveness and LGBTQI index. Latin America and the Caribbean fares the best across all the inclusiveness indexes. Overall, though, no one location fulfils all the criteria.
We are strongly committed to widen the boundaries of who participates in discussions on health policy and systems research and where those discussions are held. This includes providing opportunities to regions that are under-represented, where the Symposium can serve as a catalyst for further network building, and where certain elements of health policy and systems research may remain contested. However, finding alternative locations for a global meeting convened by an independent society across all regions of the world is not a simple process and the decisions do reflect challenging trade-offs.
