15. Peace, Justice and Strong Institutions

Sustainable Development Goal 16: Peace, Justice, and Strong Institutions focuses on promoting peaceful and inclusive societies for sustainable development, providing access to justice for all and building effective, accountable, and inclusive institutions at all levels.

Dr. Ross Upshur is currently the Dalla Lana Chair in Clinical Public Health and Head of the Division of Clinical Public Health at the Dalla Lana School of Public Health, Scientific Director, Bridgepoint Collaboratory for Research and Innovation and Associate Director of the Lunenfeld Tanenbaum Research Institute, Sinai Health. At the University of Toronto, he is a Professor in the Dalla Lana School of Public Health and the Department of Family and Community Medicine, affiliate member of the Institute for the History and Philosophy of Science and Technology, Member of the Centre for Environment and Adjunct Senior Scientist at the Institute for Clinical Evaluative Sciences. He is a Staff Physician at Bridgepoint Active Healthcare, Sinai Health. In 2015, he was named one of the Top 20 Pioneers in Family Medicine Research in Canada by the College of Family Physicians of Canada and was a Tier 2 Canada Research Chair from 2005-2015. He is an elected Fellow of the Hastings Center and the Canadian Academy of Health Sciences. During COVID-19 he has served as the co-Chair of the WHO Ethics and COVID-19 Working group and is a member of the WHO ACTA Ethics and Governance Working Group.

Rushay Naik is an MSc student in Health Policy & Global Health at the University of Toronto. His research centres on health service delivery in conflict-affected states, and has conducted fieldwork for research initiatives in Greece, Mongolia, and Switzerland. Rushay has held research fellowships at UofT's School of Cities, at the Center for the Study of the Presidency & the Congress in Washington, D.C., and at the University of Oxford’s COVID-19 Government Response Tracker. Rushay previously worked for Health Canada’s Climate Change and Innovation Bureau, and is now an incoming intern to the Health Division at the OECD in Paris. 

CREDITS: This podcast is co-hosted by Dr. Erica Di Ruggiero, Director of the Centre for Global Health, and Ophelia Michaelides, Manager of the Centre for Global Health, at the DLSPH, U of T, and produced by Elizabeth Loftus. Audio editing is by Sylvia Lorico. Music is produced by Julien Fortier and Patrick May. It is made with the support of the School of Cities at U of T. 

Transcript

Erica Di Ruggiero [00:00:07] I'm Erica Di Ruggiero and this is Healthy Cities in the SDG Era, a podcast about the Sustainable Development Goals and how research conducted by faculty and students at the University of Toronto is helping to achieve them. We're recording from Toronto or Tkaronto, which for thousands of years has been the traditional land of the Huron Wendat, the Seneca and the Mississaugas of the credit. Today, this meeting place is still home to many indigenous people from across Turtle Island and we are grateful to have the opportunity to work on this land. In this episode we'll look into SDG 16, which focuses on promoting peaceful and inclusive societies for sustainable development, providing access to justice for all, and building effective, accountable and inclusive institutions at all levels. There are several targets for measuring progress on SDG 16. These include developing effective, accountable and transparent institutions at all levels, ensuring responsive, inclusive, participatory and representative decision making at all levels, and promoting and enforcing nondiscriminatory laws and policies for sustainable development. Inclusive and accountable institutions do play a role in creating peaceful and safe communities and are essential to sustainable development. Yet, according to the United Nations, conflict, insecurity, weak institutions and limited access to justice remain threats to sustainable development. A 2020 report from UNHCR, the United Nations Refugee Agency, estimates that about 82.4 million people around the world have been forced to flee their homes due to war, persecution and conflict. And according to the United Nations, this number is likely higher in 2022 due to increases in violence, demonstrations and divisions. In this episode, we'll speak with Ross Upshur about the role of institutions in global health. We will also address some of the challenges associated with developing strong institutions and the governance in these institutions, especially in the wake of the COVID 19 pandemic. Then we'll speak to Rushay Naik about his research on the rebuilding of health systems affected by conflict. Specifically, we'll focus on how health systems and service delivery relate to the peace process. 

Erica Di Ruggiero [00:02:42] Dr. Ross Upshur is currently the Dalla Lana Chair in Clinical Public Health and the head of the Division of Clinical Public Health at the deadline of School of Public Health. He's also the scientific director at Bridgepoint, Collaboratory for Research and Innovation and associate director of the Lunnenfeld Tannenbaum Research Institute at Sinai Health at the University of Toronto. He's a professor in the Dalla Lana of School of Public Health and also the Department of Family and Community Medicine, affiliate member of the Institute for the History and Philosophy of Science and Technology. Member of the Center for Environment. An adjunct senior scientist at the Institute for Clinical Evaluative Sciences. He's also a staff physician at Bridgepoint Active Healthcare Sinai Health. And during the COVID 19 pandemic, he's been actively serving as the co-chair of the W.H.O. Ethics and COVID 19 Working Group and is a member of the W.H.O., ACTA Ethics and Governance Working Group. I'm delighted to welcome my wonderful colleague, Professor Ross Upshur, who's going to speak about SDG 16, which focuses on peaceful and inclusive societies for sustainable development, but also puts an emphasis on how do we provide access to justice for all and build effective, accountable and inclusive institutions at all levels. And I can't think of a better person to speak to us about the role of global institutions and ensuring equity for all. So Ross, maybe you can tell us a little bit about yourself first and and your research. 

Ross Upshur [00:04:15] Thanks, Erica. It's a real pleasure to be here today. So I'm a bit of a mongrel, I guess, in terms of my research and activities, but germane to this discussion. So I'm a professor and division head at the Dalla Lana School of Public Health. And for about 20 years I've worked with the World Health Organization and other organizations such as Medicins Sans Frontiere, mostly around issues and research ethics, but more importantly, ethical issues that arise in epidemics and outbreaks. I have several other hats that I wear that I should mention. I'm also a professor in the Department of Family and Community Medicine and also the associate director of the NFL, Tannenbaum Research Institute at Sinai Health and a staff physician at Bridgepoint Hospital. So I do a multitude of different research activities, but relevant to this I think is the focus over the past, I'd say 5 to 10 years, looking at how global institutions interact, particularly in public health emergencies. 

Erica Di Ruggiero [00:05:19] Yeah, that's great. I know given the many hats you wear, it brings a very unique perspective to these very complex issues. So let's start with a rather large question, but I'm sure you have perspectives on this. Why are strong institutions actually needed to effectively govern at the global level? And we'd love to hear some examples from your experience working with U.N. organizations such as the W.H.O.. 

Ross Upshur [00:05:47] Yeah. So when you're trying to understand global health and global health governance, it's critically important to know who the players are, which institutions, and it's a real admixture of different sorts of organizations and institutions. So you've got the UN system with all of its affiliated members and the W.H.O. is in fact a UN organization. You've got a large number of NGOs active. You know, I mentioned already Médecins Sans Frontieres, it's a nongovernmental organization. Then you've got sort of hybrid organizations like GAVI, which focuses on vaccines, or CEPI, which focuses on epidemic response. You've got funders like the Wellcome Trust and the Gates Foundation, academic institutions such as universities like the University of Toronto, for example, and then the member states. So the remembering that the United Nations is an organization that works in an internationalist framework, that is it's the member states and sovereign states that constitute that organization. And this is a mixed blessing. And this is why strong institutions are important, because they have to work between the competing and rivalrous interests of member states, which are not always harmonized. And so over the past two years, we've seen some interesting innovations in the W.H.O.. Strengths and weaknesses have actually been shown during the COVID 19 response, and a good example of a novel form of bringing together these disparate institutions would be the Act-Accelerator. Now that's the Access to Coronavirus Tools Accelerator. Most people are aware of the COVAX facility, which has worked with the collection and distribution of vaccines to participating members. But there's four pillars to the act, and so there's a diagnostics and a therapeutics, but germane to our discussion there's also a health system strengthening pillar. And one of the interesting things is that when this was put together, it was meant to be nimble, it was meant to be responsive to the types of challenges that the pandemic was posing. But they didn't think, I think enough about governance, about how these organizations will interact. So I've heard quite a lot of experience of working between different sectors. Mostly the most recent one would be not accepting the COVID 19 experience would be the Ebola outbreak from 2014 to 2016. And what I recognized then was that there needed to be more attention to how institutions themselves, strong or weak, interact and what are the rules of engagement. And there's actually a real conspicuous gap in thinking about governance into organizational governance. Most people think that the W.H.O. sets the rules, but they, you know, they have convening power, but they don't necessarily set out the rules. And there's often asymmetries in power and influence between organizations that are brought together to work to solve problems collectively. So just a pitch. We need to think about governance. We need to think about it clearly and carefully. And we need to devote resources to better understanding what optimal and best practice models are so we can complain all we want about organizations and institutions in the way they function. But if we don't invest resources in how we actually govern this, we will be no better off after this experience with COVID 19. 

Erica Di Ruggiero [00:09:37] Well, no arguments for me, having just reviewed this literature for a big report from the public health system in Canada. Certainly the literature is very conceptual, lots of ideas, but we also need to turn our research attention to assessing the effectiveness of these governance models. Any comments on that? 

Ross Upshur [00:09:55] Yeah, it's heavy on PowerPoint ology, right? So if I see another slide with all sorts of little bubbles and arrows, to boxes, you know, saying that this is how things work when those bubbles and arrows are actually completely divorced from anything in the world that you and I live in. So I think you're absolutely correct. We need to I would love to see, for example, the grand challenges in global health governance. What would that mean? That would mean getting funders interested in seeing this as the important problem that it is and using that kind of platform to stimulate funding and bringing the best minds in to think through some of these issues. 

Erica Di Ruggiero [00:10:32] Yeah, and I think that's well said. I really find that governance tends to be a black box that we don't actually unpack and in a convenient container for things we can't explain. However, we need to turn our attention. To that using a complexity lens. 

Ross Upshur [00:10:48] Yeah, which is ironic given that if you look at sort of the animating principles of governance, they'll talk about transparency, accountability, trust and trustworthiness, all of which should mean that you have an idea or insight into how the whole process works and who's making decisions on what grounds. But as we've already established, that's far from the truth. So it seems like these principles are kind of window dressing, but you actually don't see the accountability frameworks, the rules of engagement, so to speak. And I think that needs to become much more evident. And I think that's been a criticism of COVAX, in particular, many civil society organizations who are brought to the table they're unclear of their role at that table. They were also unclear as to how decisions were made and how allocations were made. And I think we need to do a much better job. And it's not difficult to envision a much more transparent and accountable system of governance in global health. 

Erica Di Ruggiero [00:11:52] Yeah. So we need to move beyond that rhetoric and really look at interrogating these structures and their impact. So given your global experience today with the COVID 19 pandemic, and I know that rests on big shoulders that you have from past experiences from many other pandemics, what challenges do you think continue to persist despite those past lessons that we haven't learned? 

Ross Upshur [00:12:19] Yeah, there's. Well, how much time do we have? I'll try. So we do need to take normative discourse seriously. So we've been very good technically, but I would say our social and normative intelligence lags behind our capacity to design and develop products and bring them to market. We still have to think through allocation and how we think about resource allocation in a fair manner. We need to think about inclusiveness and what that means and who needs to be represented at tables. I'm very curious to see how the discussions around the pandemic treaty play out. And for it's for for global health watchers keep a very close eye on who's at the table, who's chairing, who's co-chairing, who's represented, and then ask critical questions of whether you think those are the voices, the interests that need to be at the table to move this forward so that we don't keep repeating the same mistakes over and over again. And a lot of the failings have been, I would say, ethical. You I've written about this before. Most of the challenges we face are about how we actually uphold the uniqueness of each individual life on this planet. When all of the actions and decisions seem to be that some lives matter more than others because they come from a part of the planet that has established historical patterns of wealth acquisition. Not pointing fingers at any particular countries, but the global disparities are just so market. And there's there within countries, as we've seen here within Canada, but between country. The inequity is is really stark. And if you look, for example, at the vaccine rollout in COVAX, it was really hard to for me to sit at tables with colleagues where we're being asked to take a booster for a third dose, where many of my colleagues in low and middle income countries hadn't even been offered a first dose. So that really clear example of inequity is something that I think we need to put mechanisms in to address in the future. 

Erica Di Ruggiero [00:14:39] Yeah. Now. And and so, I mean, many of your reflections have really pointed to ethical principles, and you've already alluded to some of those already. But in a nutshell, what ethical principles actually need to inform our approaches to global health governance, both at the global level, which has its own set of challenges, but also at the national level in a country like ours in Canada. 

Ross Upshur [00:15:05] Yeah, that's a really great question. And, you know, I could point easily to the ones that we've articulated over time as being highly relevant. This goes back to SARs one here in Toronto where we wrote a report that then became a framework for pandemic preparedness ethics that then got taken up by the World Health Organization. And a lot of them were drawing not from principles of ethics for individual level interactions, though those are important you need to sort of supervene up to what I consider to be the gloomier principles, the ones that speak to the public health nature of and the relationality, particularly of epidemics. So if you think about the things that the Director-General, Dr. Tedros has said, if he said solidarity once, he said it a thousand times at the beginning of the pandemic, and as the inequities of distribution of vaccines, he started to talk about equity and justice, justice here being a form of redistribution or distributive justice to ensure that all people who are eligible are able to access vaccines. But things like reciprocity, what we bow to each other and I must say that the latter part of this pandemic response has kind of fractured some of those principles because people are understandably fed up with public health and public health mandates, but want their freedom. So you start to see these principles of of libertarianism rising up when people are, you know, so they've got to even within the concept of freedom itself and liberty are two different rivalrous interpretations. So the more that we can appeal to principles or concepts that are other, regarding that are relational, that focus on the fact that, you know, again, to steal from the Director-General, you know, we're not safe until everyone safe until we actually deeply internalize that a pandemic requires this of us, that we're going to have to make some sacrifices in order for us to actually get through this. And the justification for those sacrifices rest upon these principles of solidarity, reciprocity, trust, and enacting on those in order that we can have equity and justice. But early on, when I was interviewed by a reporter, I said, this isn't for a quotation. I said, I fear that we lack the resolve that as a society that's going to be required for us to actually get through this particular pandemic. And I think we're starting to see signs of that. You cannot will the virus away. We're in a nice interregnum now as we speak because mask mandates and vaccine passports are being lifted. But I hope that we've learned enough that there's good reason why, if we have to reintroduce this, that we will take it seriously. And I hope we go back and take a really careful look at how proportional and how well implemented many of these measures were put in place and that they actually serve the goals and the principles that I've articulated well. 

Erica Di Ruggiero [00:18:31] And on that note, thank you so much for joining us and for really I think, exposing the importance of ethical principles which really need to govern the kinds of societies in which we should be living. Reciprocity, solidarity, equity, social justice are among those principles that really need to be enacted but aren't often realized. So thank you so much, Ross, for your perspective. 

Ross Upshur [00:18:58] My great pleasure. Any time, Erica. Always at your service. 

Erica Di Ruggiero [00:19:02] Oh. Thank you, Ross. 

Erica Di Ruggiero [00:19:12] Rushay Naik is an MSC student in health policy and global health at the University of Toronto. His research centers on health service delivery in conflict affected states and has conducted fieldwork for research initiatives in Greece, Mongolia and Switzerland. Rushay has held a research fellowship at the University of Toronto's School of Cities at the Center for the Study of the Presidency and the Congress in Washington, D.C., and the University of Oxford's COVID 19 Government Response Tracker. Rushay previously worked for Health Canada's Climate Change and Innovation Bureau and is now an incoming intern to the Health Division at the OECD in Paris. 

[00:19:52] Hello everyone, and I'm delighted to welcome you to our episode on SDG 16, focused on peace, justice and strong institutions. And we have Rushay Naik, who is joining us today. Thank you so much, Rushay, for making the time to talk about this topic. I wanted to start off with a sort of an open question. If you could just tell us about yourself and your research and your research. 

Rushay Naik [00:20:18] Sure. Thanks so much, Erica. And it's a pleasure to be on. As you know, I'm a master's student at the University of Toronto and my research centers on trying to better understand the rebuilding process of health systems in countries affected by conflict. And that's really sort of one part of much larger work that's happening around the world by my colleagues and academics in trying to understand global health governance and improve how we operate in a wide variety of sort of health service delivery contexts. My research sort of tends to center and what we call fragile and conflict affected situations. The acronym is FCAS, and that's a term that's used in international development settings to describe states in really challenging situations. These are countries that are actively at war in a civil context or facing other humanitarian crises, and they're often characterized by, you know, fragile and policy and social environments. And so that's sort of where my work sort of tries to fit in. You know, the World Bank will describe these sorts of situations as, you know, involving fractured institutions or consistent crises in maintaining functional government and even things like poor transparency and accountability. And in that mix, we're trying to look at how how best to deliver health services in cooperation with government. And a lot of these issues stem from much deeper systemic challenges that many countries have faced for for decades often. And so I really try to unpack a lot of those influences in exploring the delivery of health services. 

Erica Di Ruggiero [00:22:09] Now that's really interesting and highly timely. And of course, a subject I think merits ongoing attention, really an important nexus between health systems, conflict ridden regions and sort of the role of governance and institutions. But part of, you know, what SDG 16 is about is also looking at how institutions and actually health systems contribute to peace processes. So can you maybe tell us a little bit more about what peace processes look like and how health systems and service delivery relate to them, you know, with relevance to conflict affected regions and I know you've thought a lot about this and are looking at this in the context of your master's research. So we'd like to hear your thoughts about that, including, you know, how might that look like at a, you know, country level? 

Rushay Naik [00:23:02] Sure. So it's a great question. And peace is, of course, a very complicated concept. You know, in in the popular imagination, we often think of peace starting at the end of fighting. It's what we think of conflict is as ending is the putting down of weapons. And that alone is an act of. Of achieving peace. But there's a big difference between that situation, which what we which is what we term in conflict studies as a negative peace and between the movement towards seeking justice and the development of inclusive institutions. And that's what we term a positive peace. And I find that help activities involved in peace processes really traverse this transition. There's three there's peacemaking, peacekeeping and peacebuilding. And those are somewhat laid out in the UN charter, but they're not always discrete and independent. They often mix with each other and they often occur in different phases. You know, very briefly. Peacemaking is that initial development of a fundamental trust building through a treaty or some sort of agreement to resolve the conflict. And that's maybe the start when we engage with some minor humanitarian health activities. But as we move into activities like peace keeping and peace building, that's when we sort of see the achievement of greater security and access for health professionals to enter the space, provide care during issues of health injuries and morbidities caused by conflict all the way to the much more deeper structural changes to the state and the ways in which it operates to create the infrastructure, social infrastructure, the physical infrastructure for the delivery of health care. And that's where I think that interaction is something that peace scholars are really trying to interact with. There is a complicating of this narrative that is now ongoing to add more elements to this this triad of peace processes. Conflict prevention is a big one, and it's often seen in the vein of being a regular state led process alongside with communities and civil society actors and INGOs, to try and navigate that often countries are navigating their own individual processes towards peace. Sometimes it isn't linear. Sometimes it means that negotiations fail. You know, regional instabilities build, grievances develop. And, you know, conflict is fraught again. And so we have to sort of shift away from the notion that that peace will always sort of emerge in the oppositional binary to conflict and is really this this ongoing flow. And health services are one way of understanding how that process is going. You know, we can think of health as this this basic trust and health instruments, institutions is bridging these gaps during the peace process. 

Erica Di Ruggiero [00:26:18] Yeah. No, I was just wondering if you had an example actually of, you know, sort of. 

Rushay Naik [00:26:23] Yeah. 

Erica Di Ruggiero [00:26:24] You know, how, how pieces are, you know, considered not in a static but more dynamic and non-linear way. If you've as you've just beautifully explained, do you have an example of how that sort of plays out in the context of peace through health? 

Rushay Naik [00:26:44] Sure. You know, one of the perhaps the most important ones we have right now is is the experience of Afghanistan. You know, just at a global level, we have the concept of the humanitarian development peace nexus, and that's to try and stitch together actors very different objectives, you know, NGOs from the state, from local community groups. And I think Afghanistan is a really compelling example of that nexus and the work now of international organizations, because we can see how quickly things can change. You know, what I work on in my thesis is what's known as the essential package of health services. It's a tool that the World Health Organization and other bodies use to try and initiate the development of the health system in particularly protracted crises. And Afghanistan's basic package of health services really started to be developed right after the Afghan invasion in the early 2000s and was a process that continued right up until the fall of the previously internationally recognized state in last year. And at the time part of this process of declaring a certain set of health services that the government was going to attempt to finance and governance was really a public statement to try and build confidence in the Ministry of Health and the ministry, public health and other sort of health practitioners. And part of that was having consultations with local shuras or community elders and advisors in rural communities across the country. And if we take a step back, that is sort of an attempt to link and bridge the work that's happening at the international level in Geneva, the national rebuilding process happening within Kabul in the capital, and then, of course, with the intended beneficiaries of some of these newly organized health services, these are where we're talking about communities trying to access primary care, reproductive health care, mental and psychosocial care. So this is really challenging work and not always successful during this period. And of course, as I mentioned, you know, countries have their trajectories and Afghanistan in this case is navigating a new phase of its story. But I think as we as we learn more about the interactions between institutions and power dynamics all the way to the community level, I think actors in international development and in global health will get better at engaging communities from that place of solidarity and dialog, and that's essential for ensuring communities can access their own health care. 

Erica Di Ruggiero [00:29:31] Yeah, I think those are great points. And I, you know, given the complexity that you've outlined using, you know, the the end, the relationship between what's sort of happening at the country level, like in the example of Afghanistan, but also how that connects to sort of the global architecture of governance. You know, it strikes me that, you know, from a research perspective, it might pose some challenges for how you might approach, how you might want to measure the impact of, you know, health systems and delivery in conflict affected regions. So just from from your knowledge of of the literature and the work you're doing through your thesis, you know, how would you approach metrics and and even just coming up with sensitive metrics for evaluating health systems and delivery and any data gaps or challenges that you've experienced so far in your work because, you know, metrics are only part of the story, but can you actually measure them as another part of the story? So I'd love to hear your thoughts on a rather big question I appreciate, but really thinking about it in the context of conflict sensitive regions. 

Rushay Naik [00:30:50] It is the number one question. You know, metrics are always, always, always a really challenging premise in conflict affected contexts. Right. And that's because data is always a challenge. Maybe I'll start with approaches sort of navigating approaches to to valuation and then and then maybe migrate to that space. But you know, when it comes to monitoring and evaluations in in in health system discourse, you know, there's often I think the assumption that a theory of change is kind of motivating the collection of data and the true measurement of the performance of those health services. And that assumes a fantastic governing arrangement and an approach where data collection is is easy to engage with in conflict affected situations that is rarely guaranteed, extremely hard to do, and perhaps even comes at the expense of diverting resources that are already scarce away from actually delivering some care programs that we know are largely evidence based and have been delivered in other contexts. So instead, what we can do in the spaces is two things. One is, is bringing together datasets, qualitative and quantitative, that can speak to various angles of health in the peacebuilding process. And then the other part is maybe evaluating in a limited setting the performance of programs wherever that's feasible in the context of security circumstances. You know, and that first one, there's no data set that that really combines health data and conflict data together in one go. It's phenomenally challenging. But one common technique in in global health and in conflict studies, literatures in the political sciences are kind of metrics, economics, macroeconomics, based studies that try to explore shocks to economic and social conditions. Things like conflict events are really primed for this and the explore to understand how health outcomes shift amid those those events. So often we'll see datasets like the Acclade dataset. This is the armed conflict location and event dataset extremely complex, comprehensive, almost live data regarding conflict events around the world, as well as the Uppsala Conflict Data Program or the UCDP Prio set. And that takes a bit of a longer term view at the state level of, of conflict events. You know, that can be combined with data from ministries of health NGOs that are working in different regions to garner local insights about conflict dynamics and health services and that sort of on the academic and on the more practical end practitioners on the ground, there's a big push for conflict sensitive programing, and that's for international organizations to really work with the principles of humanitarianism in mind to neutrality, effective impartiality in health care provision. And so we see this ranging in things like a The Sphere Humanitarian Standard Handbook that is used internationally by humanitarian actors to deliver effective health services. And it ranges all the way to the actual delivery of the service through one trend is performance based financing, and that is still being evaluated. The BPHS address in Afghanistan was an example where this was used to contract out services. And we're still learning a lot about it, but it's an attempt to try and build in monitoring to the actual delivery of services while it's happening. So we don't need external evaluations to deal with that process. 

Erica Di Ruggiero [00:34:42] Hmm. Now, that's really helpful. And I think you've painted a nice picture of the different data sets and sources that you need to really corral, given the nexus at which you need to be working when you're thinking about health, conflict governance, health system delivery, etc.. So I just want to end sort of with a, you know, broader question. So, you know, you're in the process of finishing up your master's focus very much on this topic. And so just, you know, how can students like yourself or early career practitioners or researchers actually get involved in contributing and advocating for more inclusive institutions in global health, which is certainly a key theme of SDG 16. And of course, you know, thinking perhaps from the perspective of those who are working with conflict sensitive ideas in mind. 

Rushay Naik [00:35:39] It's it's a really great question. And of course, you know, the conflict space, at least the academic study of it, is one in which we always want to be mindful of working from a place of equity and ethically as well. Would you think, of course, in working alongside communities that are facing really difficult challenges, in asserting their own interests and maintaining their own, their own health? So I always recommend really delving into some of the existing policy matter, even courses, academic courses that you might be taking in university or in other graduate studies, even some publicly available from websites like a Coursera, I think are really helpful for building a global knowledge of some of these interdisciplinary concepts. I would recommend courses ranging across the political sciences and international relations related to the study of conflict and understanding how communities are implicated in them, as well as global health courses and that are really helpful for giving us a better sense and providing a fundamental understanding of equity based thinking in health care. And I think the two together ensure that we have the political literacy we need to engage with these very complex situations with a philosophy that is rooted in injustice and in the support of marginalized people. I also recommend just getting involved in student groups, some really prominent NGOs that work on human rights as they relate to health. One thought is Amnesty International has groups at the University of Toronto and among several universities. I would recommend engaging with that kind of research and literature that comes out of those institutions, to to really get a sense of how issues emerge in protracted crises. The last, I would say is if you're ready to go for it, dig into the literature. There's some great reports, even great literature that come out of institutions like the Rebuild Consortium that is chaired by one of the most prominent voices in this space, Dr. Sophie Winter at the Liverpool School of Tropical Medicine. And they've worked for years to bring practitioners and and academics together to better understand the challenges and the ongoing lessons. We are continuing to learn about how to how to deliver these kinds of services in conflict affected settings. Read the news, stay engaged, stay informed. These are things you can do to better support your own communities in in working in solidarity and in tandem with communities at risk of losing access to care during conflict. 

Erica Di Ruggiero [00:38:43] Yeah, I think. Thanks so much for those tips and I thank you for your last point around. The connections even with diaspora in countries like Canada who are, you know, deeply affected by what's going on in their home countries as we're witnessing right now with Ukraine. But this is not uncommon, unfortunately, in many regions of the world, you know, sub-Saharan Africa, Afghanistan, as you've already talked about. And really this this requires multi-disciplinary, interdisciplinary thinking and and many sectors of society working together. So thank you so much, Russia, for your excellent perspectives and for joining us today. Really appreciate it. 

Rushay Naik [00:39:27] Thanks so much, Erica. 

Erica Di Ruggiero [00:39:36] The conversations with our guests today have really shed light on the importance of the conditions needed to attain peace and justice and develop strong institutions, as Ross explained it is not enough to just create institutions. We also need to ensure that our institutions develop effective governance mechanisms that model ethical principles like transparency, inclusiveness and accountability, both within an institution, but also between institutions. This episode has also reconceptualized the idea of the peace making process, as Rushay explained, in fragile and conflict affected situations peace is not a linear process, but is an ongoing, dynamic process. However, we must also not forget that the peace process at the international or national level must include significant engagement with affected communities in order to develop a truly peaceful and accountable society. Healthy cities in the SDG era is made with the support of the School of Cities at the University of Toronto, whose mission is to bring urban focused researchers, educators, students, practitioners and the public together to explore and address complex urban challenges. We'd love to hear your thoughts on healthy cities in the SDG era. If you enjoyed this episode, please rate, subscribe and share to help others find the series. You can find healthy cities in the SDG era on Spotify, Apple Podcasts and the Dow on a School of Public Health YouTube page, as well as our Center for Global Health website. Join us for our next episode where we'll look at stage 12, responsible consumption and production. Thank you for tuning in and we look forward to speaking soon. Take care.