Educating for an equitable and just post-pandemic world

June 17, 2020

As I sit here now and reflect on my four years of medical school and cherish the unique opportunity to graduate virtually with my medical school class over a joint video teleconference – I am overwhelmed with thoughts and emotions on the opportunity and privilege that have led me to where I am today. I think about the community of mentors, friends, family, and importantly, patients and caregivers, that have been integral to my growth and learning as a medical professional entering my postgraduate training in the field of public health and preventive medicine. This is all taking place in the backdrop of a global pandemic caused by COVID-19 and the various unintended health and economic consequences of public health interventions (i.e. physical distancing, quarantine, self-isolation), as well as the exacerbated pre-existing social and health inequities disproportionately impacting racialized and marginalized populations and communities in Canada and around the world. There is also a concurrent reignited dialogue on the critical necessity to take meaningful action on racism and police brutality against Black and Indigenous peoples which forges on in perhaps a watershed moment for dismantling and unpacking systemic racism, colonialism, and discrimination including acknowledging and unpacking white privilege and supremacy.

I have listened to my fair share of convocation addresses, having recently attended my own virtual convocation with the University of Ottawa. I have also been watching old and new graduation speeches over these past few weeks thinking about the class of 2020 at all stages and various fields of training, entering a world that so desperately needs thinkers and doers to tackle inequities and injustices. The significance of education for young people in any form, that provides a foundation of knowledge or the skills and tools to critically think and approach complex issues, cannot be understated and is so urgently needed – as education is ultimately the guiding force and power for action by our future generation of leaders to help shape policy and decisions that protect and promote the health and wellbeing of our communities. Education is also a tool and platform for reinforcing and normalizing institutional racism and discrimination. Conversely, education can be a tool for dismantling pre-existing biases and prejudices for a more accepting individual and collective society that fosters diversity and inclusion in all of its forms and practices, acknowledging privilege and challenging the status quo.

Thus, I can’t help but think and wonder, that a significant piece of the puzzle has been largely left out of the equation in these past few weeks and months – the need to re-evaluate education at all levels so that we are better prepared for public health emergencies and recognize that preexisting and ongoing inequities and injustices are not tolerated and better yet, ought to be addressed urgently with compassion and courage. Only a few days ago, a discriminatory school assignment sent to Grade 7 students by a teacher in the Hamilton-Wentworth Catholic District School Board asked for students to write a speech from a colonialist perspective pretending to be a French colonist. The assignment asked students: “You are going to create a speech (as the French colonists) to convince the aboriginal people to let you stay on their land,” and “the more convincing you are the better your mark will be”. This is likely not the first time such an occurrence has happened in our educational systems, but it begs the question of how and if our educators are committing to teaching the true and unvarnished history of Canada and its relationships with Indigenous peoples and nations.

Reflecting on my own educational journey, I also think about the lack of teaching on the history of Indigenous peoples in Canada during my years in primary and secondary school. It was only until I was in my post-secondary or undergraduate studies at McMaster University, was I first exposed to concepts of social determinants of health and racial equity – and put this into the context of past and present racism, colonialism, and discrimination that is experienced by Indigenous communities in Hamilton and Six Nations of the Grand River. I was also able to learn about the resiliency and strength in self-determining and self-governing communities that were built upon their cultures and languages to support their future generations of young people, despite the historical circumstances of ongoing structural violence and oppression. However, all of this learning and growth was optional from a formal university curricular perspective, but for me as a guest of this land and as an immigrant, I felt it as mandatory learning as a Canadian citizen that has since benefited and continues to benefit from many privileges afforded to me based on the decisions and sacrifices of my parents.

Graduating from medical school feels surreal and looking back, it can be easy to see the experience through rose-coloured glasses. However, upon meaningful reflection, I am reminded of the reality of how I was again unimpressed with the lack of acknowledgement of the institutions and profession of medicine as a tool to oppress and discriminate in a historical and present-day context. I think of the nutritional experiments that doctors did on Indigenous children in residential schools. I also think of the forced sterilization of Indigenous women by doctors. Today, medical practice also continues to demonstrate negligence in how racialized individuals and communities are treated differently by doctors and have worse health outcomes and sometimes are more likely to die because of not their race, but because of racism. Such understandings and knowledge, I have come to realize and learn, had to come from supplementation on the side of the formal educational curriculum. Once again, as a special ‘interest’ or ‘nice-to-know’ from the perspective of medical education. And once again, I strongly feel this knowledge to not only be a ‘need-to-know’, but also a ‘need-to-act’. To cap it off, medical schools and leadership, for the most part, do not value teaching, leadership, and advocacy on social justice issues in the same way that clinical or scientific research is legitimized in the structure of the system. There is great work being done in the form of research to shine a light on inequity and injustice the healthcare and beyond, but if this information is not adapted and translated into educational material or practiced by our future and current healthcare professionals, then it is surely a lost opportunity.

I recall my conversation with Minister Carolyn Bennett a few months back when the global pandemic initially started, and I asked her of her thoughts and reflections as an experienced public servant, past family physician, and past Minister of State for Public Health – having held the role after the 2003 SARS outbreak in Toronto, and leading the creation of the Public Health Agency of Canada and appointing the first Chief Public Health Officer. Minister Bennett reflected on her attendance at a large public health conference the following summer with many public health professionals and experts in the room, but thought and asked, “Where are the teachers? Where is everybody?”. Having lived through a nightmare, one would imagine the lessons should be shared widely and students and youth be equipped with the knowledge and skills to build back better for our systems in Canada. As someone who has fought and advocated for much of her career to improving the health and wellbeing of Canadians and urging for the “need to actually move from healthcare systems to systems for health”, Minister Bennett sees that “we continue to use health and healthcare interchangeable. We want more health, so we actually need less healthcare”. And ironically, these understandings and ideas actually go back to Tommy Douglas, who was a major force behind Canada’s first universal health insurance plan in 1962 – a desire to keep people well and not simply just patching them up when they are sick. And yet, a ‘health-in-all-policies’ approach, investing in community wellbeing, investing in preventative care and measures, and addressing inequities and injustices in the determinants of health, continue not to be the obvious or go-to choices in our systems. The importance of prevention of crises and inequities ought to be taught in classrooms and ultimately more valued in society. In most recent weeks and months, we are reminded of what truly matters most in our lives – our relationships to one another and the land, our connection to community and society at large, and ensuring the most basic of life’s necessities and rights are accessible and provided for all. It’s about time that our educational systems, that shape the next generation, reflect these realities.

COVID-19 and Canada’s Global Health Diplomacy: A Youth Perspective

June 4, 2020

 

COVID-19 and Canada's Global Health Diplomacy: A Youth Perspective

 

The COVID-19 pandemic hit like a terrible storm, hurting people and communities in many different and often disproportionate ways, and we aren’t in the clear yet. The crisis response and recovery effort has been and will continue to be extraordinary, providing an opportunity to build back better – how we will invest and grow a society that we value and reflects the values of equity and justice.

My attention was drawn initially to COVID-19 back in early January 2020, when the outbreak began in Wuhan, China – my birthplace and where many of my relatives live. I’ve been acutely aware of the individual impacts of self-isolation and quarantine, learning of the health impacts and psychological difficulties faced directly from family members in strict lock-down measures as the epidemic grew and public health interventions were put in place. As the COVID-19 pandemic reached Canadian communities, and where I learn, work, and play – the traditional, unceded, and unsurrendered territory of the Algonquin people – I was finishing up my final clinical rotation of medical school in geriatric medicine at the Ottawa Hospital. This came also during my preparations, consultations, and roundtable discussions as the Canadian youth delegate to the 73rd World Health Assembly (WHA) – the highest decision-making body of the World Health Organization (WHO).

For the fifth year in a row, the Government of Canada (Office of International Affairs for the Health Portfolio, Public Health Agency of Canada) has selected a Youth Delegate to join the Canadian delegation at WHA, with the aim of meaningfully including youth perspectives in Canada’s global health diplomacy efforts and processes. As the Youth Delegate to WHA73, I consulted youth on global public health issues, reported back to the Government of Canada on summary findings, and shared lessons and reflections with peers on the experience.

Given the exceptional circumstances of a virtual World Health Assembly during the pandemic, many of these conversations were focused on COVID-19 response in anticipation of an adapted WHA agenda. Overall, Canadian youth I spoke with recognized that a multi-sectoral, evidence-based and equity-based approach is critical to an effective response to the current pandemic and future crises that may arise. Four key areas were identified as areas of priority among Canadian youth:

  1. individual well-being (identity, grief, and belonging)
  2. prevention and preparedness (investing in public health systems)
  3. sustainable development (including climate action, planetary health), and;
  4. education and development (tackling disruptions to education and training).

Similar to many other organizations, conferences, and workplaces in the past few months due to the COVID-19 pandemic, it was announced that the WHA would pivot to a virtual format, and the typically 10-day in-person program hosted at WHO Headquarters in Geneva, Switzerland was reduced to 2 days. From May 18 to 19, 2020, the Canadian delegation convened in-person (while physically distanced!) at the Public Health Agency of Canada offices. Together, we watched the opening of WHA, the election of president/vice-presidents for WHA, and many member state interventions, including by Canada’s Minister of Health Patty Hadju. (I was able to capture some of these moments through Instagram updates – you can check out highlights from day 1 and day 2 here).                             

The Canadian delegation to the first-ever virtual 73rd World Health Assembly attended in-person at the Public Health Agency in Canada. Front row (left to right): Nicolas Palanque, Elisabeth King. Back row (left to right): Kate Trotter, Ryan Melnychuk, Chantele Sitaram, Yipeng Ge

The adoption of the COVID-19 response resolution at WHA, with 194 member states, was quite an exceptional thing during these extraordinary times. An incredible amount of time and energy went into the negotiations process for this resolution, and I was very pleased to see many items discussed with Canadian youth during the consultations process, reflected in this resolution. Some highlights include the importance of universal health coverage and strengthening primary health care, the Sustainable Development Goals, protecting vulnerable populations, and equitable access to medications, vaccinations, technologies. The resolution also calls for the review of the global response to COVID-19, including but not limited to the WHO.

There were also acknowledgements that this is an opportunity to tackle climate change, as these past few months have shown that non-pharmaceutical public health measures to tackle COVID-19 have ‘allow[ed] the earth to breathe again’. Overall, there were resoundingly clear calls and recommendations for a united, collaborative, global effort to address the COVID-19 pandemic – to leave no one behind. With many sentiments from an equity lens to protect those most vulnerable from fragile health systems and building true ‘systems for health’. It has been said that, until everyone is free from COVID-19, the response is not over.

It’s quite an extraordinary year to be the Canadian youth delegate. I find myself in a privileged space of intersectional identities and roles that have provided me with insight and reflection on many aspects of the COVID-19 pandemic response – from a personal lens, a clinical lens, a local public health lens, and from a global health diplomacy lens.

The importance of engaging youth and meaningfully include youth voices and ideas in global public health diplomacy cannot be understated. Youth are not only the next generation of leaders, citizens, policymakers, and healthcare professionals – we will be and already are the generation of peoples living in a world shaped by the decisions and actions (and inactions) made by those that came before us. Youth often identify issues with unparalleled passion, understanding, and virtue – when others turn a blind eye or are complacent to the status quo. As Pearl S. Buck once shared, “The young do not know enough to be prudent, and therefore they attempt the impossible – and achieve it, generation after generation”.