Thank you for being here today, Geordan! Your work is really interdisciplinary, and you're working across many different spaces and methods. You are a medical doctor and public health academic, and also work on transformative global health, systems thinking, human centred design, participatory research, arts-based approaches and web3. With all of that in mind, how do you define your work and bring all of these strands together in your practice?
Hmm! I will start with what inspires me and what grounds me, which is working with people, particularly in extreme and challenging environments, to try to build agency around health. The reality is that life is complex and messy, and you have to be able to deal with a lot of strands and pull them all together. What's meaningful for people doesn’t tend to fit neatly into a specific academic or policy box. So, I think a lot of my work has intuitively resisted being defined by a particular discipline or boundary and its focus is really on practical things that can support people and their quality of life, as well as building a broader healthy environment.
Going beyond that, I’m interested in different types of tools that could be used to build a regenerative world, and the way that they could be applied. Audre Lorde talks about how the master’s tools will never dismantle the master’s house. So, we need new and creative tools. We have a lot of great approaches in academia to this effect, but they're inaccessible and slow. So, a lot of my work has been to try and make them more accessible and more usable, to inspire and transform people’s lives.
Take a concept like intersectionality, for example. The concept makes sense to people but it's used in a really academic way sometimes which creates barriers, so just trying to break that barrier down. Another example is participatory research. Really, all participatory research is about enabling people to take time to think critically about their lives, and to put into place some reasonable next steps with the resources that they have.
Beyond that, what ties everything together is thinking about how to be more resourceful, thinking in systems, and thinking through complexity and at the centre of all of this truly centring respect for humanity and our planet.
Wonderful, thank you Geordan. You mentioned intersectionality in discussing your work, and intersectionality is the overarching focus of this issue of the Quarterly. Can you tell me more about how your work has informed your approach to intersectionality, and how you have taken that outside of the walls of the academy as well?
Where do I start? I’ve intuitively always thought intersectionally since I was young without really using this term: I’ve had a strong activist spirit since childhood and I had all sorts of issues I felt very strongly about: the environment, feminism, anti-racism. I'd noticed from a very young age was that I was often changing hats when I was talking about these things rather than pulling it all together into something coherent. So, there was a light bulb moment when I came across the concept of intersectionality. It helped me to really understand all of these factors, and the way that it affected me, but also my activism work. I also really like the activism angle of intersectionality.
While working in medicine, thinking through intersectionality helped me to break out of the walls of clinical practice as well to really examine what was meaningful for people. It allowed me to address the wider social determinants, and to address them simultaneously rather than in isolation.
Recently, I learned so much by working with excellent people on the paper “Intersectional insights into racism and health: not just a question of identity” that we wrote for the Lancet series or Racism, Xenophobia, Discrimination and Health. That project pushed me to think about intersectionality beyond an identity or a cause. It's about the systems of power (privilege or oppression) that operate around these. It really forced me to go beyond thinking just in boxes, and to go into broader systems and complexity.
Could you tease out those systems further? How does intersectionality play into these broader systems of power, privilege, and oppression?
Yes, so if you try to trace the origins of health inequality, of poverty, of many major global challenges, you actually have just a few root causes. We need to think at that level of root causality, considering things like capitalism and globalization, and the way in which humans and nature are seen as separate. We can talk about sexuality or ability, or race or ethnicity, but it's actually about understanding that there is a certain system that oppresses or provides privilege based on these characteristics. That system is shaped by these broader structures which determine the way that the world is set up. Through providing a lens of complexity, intersectionality helps you get there.
That’s a really great way of thinking about intersectionality, thank you Geordan. Going from that very upstream thinking on these big root causes to the more downstream considerations of how this impacts people's lives and how we interact with people and research, I'm curious about the interplay of participatory and community approaches in your work, and why these are important for thinking about health, and racism and intersectionality as well. Can you tell me why participatory approaches and community led approaches are so important?
Yeah, of course. Firstly, I think it just makes absolute sense from a moral perspective and from a logistics perspective, it makes sense to centre human experiences, and what better way to do that than to involve those who are most impacted by a certain experience in the shared reflection and action on an issue?
Participatory action research essentially means just that it's participatory in that you participate as co-investigators on a project collaboratively with the community that's impacted by the research topic. You then act on the research. So, it's action-oriented and it has a very strong advocacy focus.
More generally there is a shift in the landscape of global health, with a lot of calls for decolonising approaches. And one thing that I see that needs to happen in parallel is thinking of ways that we localise and decentralise decision making. Starting at that very local level where decisions most impact people is really powerful here, but it goes beyond the individual research or the individual project as well. It's connecting the dots across communities through translocal networks, which I think is essential, too.
To my understanding, you've led a wide variety of different projects and even started up companies. Could you speak to one of those projects that best integrates all of these methods within it, and how that has played out on the ground?
There's two projects that I feel really passionate about right now.
Stema is pioneering new approaches to community health and sustainable development. The focus of Stema is to put resources and tools back into the hands of communities, to think more critically about the local resources that are available to them, and the way that those systems of resources come together to build health. So, it's rooted in a concept of community positive health and what community members can do. We're building frameworks, toolkits, and digital support tools to put into the hands of community members and those most proximal to the decision to be able to support a systems-based approach to building health. We are also looking at creative and arts- based approaches and emerging technology to support localised action. The other thing that Stema does really well is to consider the environment and health interface in a much, much more holistic way. This breaks down siloed thinking and enables us to think through health, environment, livelihoods and systems of care. So that's one example of how this type of thinking can be put into practice.
The other example that I'm working on is with Unexia, which is essentially a next generation funding platform for health. We're using blockchain technologies to create greater transparency and accountability in health financing, and democratising decision making for health. We're taking best practice in financing but mapping that onto the blockchain and this means that anyone anywhere can participate in either giving or receiving funds. This shifts us away from centralised and non-transparent funding mechanisms towards decentralised and nimble funding that can respond to health issues at the right scale.
Those are both so inspiring and so interesting! One final question to bring all of these things together; what do you see as the path forward towards achieving health equity?
Hmm. Well, globally we're on a trajectory of absolute destruction of ourselves and our wider environment. So, the status quo just can't keep happening if we are to survive in a way that we know it. We are past the stage where incremental change is feasible. We know that using the same tools that we currently have isn't gonna work. So, what do we have to start to build?
One of the things I've been using recently is the two loop systems of change. This represents how a dominant system comes to a close, and another system starts to emerge. So you have these two loops. As the dominant system is in decline, we need to preserve the good things about the system. So that might look like data, certain technology, and coordination mechanisms. What needs to happen for a new system to emerge? Well, for a dominant system to come to an end, there needs to be a feasible alternative system emerging. Then, as a new system emerges, we need people who can innovate, who can build networks, and who can solidify these ideas and then scale them up. And so what components do these emergent systems have?I see there being flexible and decentralized mechanisms for decision making and for coordinating and building resources. We’ve seen a lot of promise with social movements, and we've also got a new wave of technologies like blockchain that enable a decentralised governance structures and more.
I see the need to go beyond discussions of health and actually talk about a well-being environment, a well-being economy. I think that we need to think about upstream drivers more holistically. And if you talk about well-being and a well-being economy then you start to see the social and political and economic systems that must be put in place to enable people to live the most quality and the healthiest lives possible. That doesn't mean that you don't need health research and health systems research, but you just address these root drivers more.
I think there's also something going back to the concept of participation, agency and the nature of democracy and the nature of decisions. It’s just bizarre when we're talking about this yet still haven't quite cracked that simple need for representation and equity, equity in decision making.
Thank you, Geordan. That's all of my questions for today. Is there anything else that you would like to that you'd like to add, or any final thoughts you’d like to share?
I’d just like to acknowledge all of my co- authors. I think the one thing I learned about intersectionality in practice through this paper was that there is a range of ways of knowing and doing, and that doesn't always align with the needs of academia and an academic paper. So, the process of this paper was much more collaborative, and probably slower, but I loved the approach that we took. We built up case studies and insights with authors from each national context, and that was a small step to try to overcome the primacy of Western authors in the space. So yeah, just a big recognition and acknowledgement of all of my co-authors on that paper.