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Rebecca Ivers and Sabina Faiz Rashid

Some of the most successful programs have been communities coming up with their own’s not about just saying we have communities involved, but are we engaging with them – because they often know best.

Sabina Faiz Rashid

Poverty, equity and the drivers of health.

Decolonising global health means a dismantling of privilege and the structural barriers to health, both across countries and within. In a world where everyone’s health matters, whose knowledge do we value? Whose voice is loudest and how do we shift the dial?  

Sabina Faiz Rashid, a distinguished scholar in global health, works at the coalface of public health in Bangladesh. Hear her in conversation with UNSW Sydney’s Rebecca Ivers as they discussed Sabina’s research in Bangladesh, and unpack what it will take to achieve true change.   


The Centre for Ideas’ international conversation series brings the world to Sydney. Each digital event brings a leading UNSW thinker together with their international peer or hero to explore inspiration, new ideas and discoveries.


Ann Mossop: Good evening. I'm Ann Mossop from the UNSW Centre for Ideas, and it's my pleasure to welcome you to tonight's event, part of our international conversation series, where leading writers and thinkers from around the globe are in conversation with UNSW researchers about inspiration, discovery and new ideas. We come to you from UNSW Sydney's campus and I'd like to acknowledge the Bidjigal people, the traditional custodians of the land, and pay my respects to their elders past and present, and to Aboriginal and Torres Strait Islander people who are with us this evening. Our conversation tonight is titled Privilege: Poverty, Equity and the Drivers of Health. And it brings together two leading thinkers in population health, Sabina Faiz Rashid from BRAC University in Bangladesh, and Rebecca Ivers from here at UNSW. Let me introduce our host. Professor Rebecca Ivers is Head of School of Population Health at UNSW. Trained as an epidemiologist, her research focuses on injury prevention, trauma care, and how research can improve health policy and outcomes in both high and low income countries. Please join me in welcoming her tonight, and enjoy the conversation.

Rebecca Ivers: Thanks very much, Ann, it's a delight to be here. I'd like to acknowledge that I'm here on the land of the Bidjigal people, the traditional owners of the land, unceded lands, pay my respects to elders past, present and future, and also to acknowledge the tremendous generosity of the Aboriginal and Torres Strait Islander people that I've had the privilege to work with over my career. 

I'd like to encourage you all to join the conversation tonight. There we are using Slideo. So, hashtag UNSW. So please join in, ask some questions. And at the end of this conversation, we'll have the opportunity to talk to you and answer your questions. So please, please join in. So what are we here to talk about? Privilege, poverty, equity, the drivers of health. In these very fraught times. As we're all aware, we're all very much aware of the importance of health, not something anyone will ever take for granted again. But what's become apparent, more so than ever before, are stark differentials in global health and the drivers of these. COVID, as we all know, is a highly infectious disease and doesn't differentiate between the wealthy and poor, everyone's been impacted. But as the pandemic continues, there's huge and glaring inequities in terms of how people can protect themselves. It's the poor who can't lock down. The casual workers depended on day to day payments, who can’t isolate, while the wealthy can shut themselves inside their houses and order food and goods online. And we've seen that play out over and over again, all around the world, both in high income countries and low income countries. But poverty also drives health in many other ways. People with less money have less access to fresh food. They live in suburbs with higher pollution, less access to transport, less green space, less access to sick leave. If you work as a casual taking time off to be sick is a luxury many can't afford. This is a pattern again we see worldwide, both in wealthy and less wealthy countries. And what is it that drives inequities in global health? Well, it's privilege. Privilege is a hegemonic status quo that allows the dominant culture to control resources in a way that protects the privileged and the wealthy. Privilege prioritises Western biomedical approaches to health at the expense of local knowledge, local voices and diverse contexts. It pushes a Western framework that prioritises, you guessed it, the white male voice, and allows institutions to promote the educational products as truth. We teach you about tropical diseases and global health in developing countries because we, as a Western voice, are the holders of truth. There have been, as many of you will know, increasing global conversations about the need for the decolonisation of global health. It's a bit of a buzzword in the US. Just about every university in the US has started holding seminars and conferences about the decolonization of Global Health. We're a bit slower to the party here in Australia. But there's an increasing understanding that the global north has long dominated conversations about global public health. It colonised public health and global health, and consume many resources in doing so. But this has also allowed high income institutions and even philanthropists to dictate global health priorities, often reinforcing inequitable systems and these will never be addressed until something changes, until we decolonise it. The centre of this is privilege. So today, I'm going to have a conversation with my friend and colleague, the very eminent Sabina Faiz Rashid, a public health scholar from BRAC James P. Grant School of Public Health at BRAC University in Dhaka in Bangladesh. Like me, she runs a public health school. Sabina has been in the role for eight years, she's a tremendously successful leader. She's a medical anthropologist, a woman, a social scientist in a fundamentally biomedical environment. That's maybe what gives her the edge to disrupt, to question and to change. So today we're going to talk through what drives her, what direction schools of public health need to go in order to redress the major inequities we're seeing in global health and to hear a little bit about what drives Sabina personally. So I think for both of us, some of these conversations are tough. They require us to be reflexive to gaze inwards at our own privilege and confront it. And it ultimately means also to value other voices and discursive knowledge, to promote, to amplify them and to hand power over to other voices and ultimately give up our privilege making space for others. So that's what this conversation is about. Why do we need to do it? How do we do it? So Sabina, over to you. Lovely to have you here.

Sabina Faiz Rashid: Hi, Rebecca. It's great to be, it's such an honour, such a privilege. I'm very excited. I mean, I get to share some of my own personal opinions, my professional work experiences, some of the challenges, the successes, the journey within this one. And I wanted to say thank you, for the very generous introduction. I appreciate your bias, but it was very generous. I wanted to speak about privilege, or were you going to, did you want to delve a little bit more about the question of privilege because I've often thought about that, you know, I am educated, my family was comfortable. I grew up in five different countries, I studied in Australia, at ANU actually, Canberra. My undergraduate, my master's, my PhD, but more than anything, when I sit in Bangladesh, and I've been working and living here, since I was 23, I, kind of, stumbled into a job. And my life evolved, sort of organically. I think it's really about you know, over time, I've thought about my position, my location, my class, the opportunities that privilege has afforded me, my kind of taken for granted-ness of my entitlement. And as I work with colleagues, and as I would say, heterogeneous communities, or other actors, you know, increasingly when, you know, basically an anthropology you do a lot of reflexivity. Right? Sometimes you do it in the field, sometimes you don't do it with yourself. But something over time is I've been thinking about what are the opportunities, and where are other voices muted? Or where are the voices, when did they become invisible? Or when do we never hear them? And that's, sort of, this personal kind of question I've been asking myself about my own position and location. And particularly in Bangladesh, where there's inequities and inequalities and all kinds of, you know, different stakeholders and actors that one has to engage with as, as someone who runs a school. But as a researcher, as a colleague, as an academic. Yeah, it's sort of interesting. And I wanted to ask you, because you sit in Australia, and I'm sure on a personal level, privilege might mean similar, but quite different things for you. You know? Yeah.

Rebecca Ivers: Yeah, well absolutely. I mean, I think privilege for me does speak to dominant culture. And it's about people in power, protecting assets. And it's about social identity groups, and you know, in Australia that is white, male, to a large extent, but heterosexual, Christians, wealthy. And I certainly, aside from being male, fit very neatly into all of those boxes. So I come from a very privileged background, I need to declare that. And we see I mean, in privileged culture in Australia, we're very good at shutting others out. And you only need to look at our government, the people in power, the people who run businesses to actually see, you know, where privilege is, and what it looks like, and also how resistant those in power are to actually shifting. We don't have, we've got, you know, huge pushback on the idea that you might actually have quotas for business boards, even to get women on them. And, you know, while we talk about a lot about, you know, diversity and actually trying to raise the bar, actually, often when we talk about, well, we're shifting the bar, look, we're doing so well look at our gender equity, but actually, we're still only talking about getting white middle class women into these positions, the whole concept of intersectionality really isn't there, we've got a really long way to go. And we've got a long way to go with the community and these kinds of conversations about recognising other voices and saying, well, you know, what does privilege mean, and how do we actually break that down and let other voices in?

Sabina Faiz Rashid: I think it's really interesting, a couple of things you just said, because even in Bangladesh, we're a dominant Muslim, sort of, population. And how often do we really see Hindu women, Christian women, I mean, yes, you have a few men, priests or ministers in certain positions, but really we dominate the landscape. And if you're educated, well connected, have a lot of money, gives you privilege. And I just thought of COVID was a perfect example because I was listening to your introduction, Rebecca, and I was thinking, what happened with the government, I mean, they've become much more sensitised this year. But last year, we borrowed, imported, a locked down model in countries where there's better social safety nets. And I did my work, I mean, sitting in my house, over a laptop. And as I continue to join today on Zoom, when you look at COVID, it was led by a very coalition, task force led kind of approach, very biomedical. And we were not inclusive of the poorest communities, because for them, COVID was one of the several layers of challenges and risks to their health, and vulnerabilities. Many were hungry, many didn't have jobs. Many lost their jobs, because you have a huge percentage who are informal workers. And for about two and a half months, everything shut down in the entire country. And I remember thinking, we can sit and talk about disease and worrying about access to health, and often some of the very rich left with private, sort of, flights. Some of us, you know, we stayed here. But for the poor, it was very much about do we starve? What do we do about our jobs? And yes, COVID is amongst them. Yes, we're scared of COVID. But they were the first ones when the lockdown opened up, were on the streets back at work. So in many ways, if we look at the pyramid or the hierarchy of privilege, it's always reproducing certain kinds of structural inequalities. And they never have a voice at the table. The decisions are made to favour the few, in our case, who are better off in the middle class. Yeah?

Rebecca Ivers: Absolutely. I mean, and we saw that played out here in Australia. I mean, we've had a very different COVID experience, obviously, being able to shut our borders and really lock down. We've been tremendously successful at that. But there's been some really salient, some big issues that have arisen, certainly when we've had outbreaks, you know, and people have come back and done a whole lot of victim blaming, and said, well, there's these people, and they've travelled around here, and they've worked three jobs. And we have to come back and say, why are these people working three jobs? It's because they're, you know, they're casual workers, they are being paid very low rates, and they need to. So, really, I think, if there became a recognition that we actually had to do something about that. Government certainly stepped in and raised the funding available for welfare, so people who were on job seeker and job keeper awards, were able to actually get more money to allow them to stay at home, which, unfortunately, has now ceased. And that did help. But really, it took a lot of work to actually get everyone to recognise that this was the case, that there were gross inequities, and we would continue to have outbreaks unless we stepped in and allowed everyone some protection, gave casual workers sick leave. So casual workers don't have sick leave, so it was actually bringing in payments so that if you were a casual worker, and you were sick, you're able to then claim money so that you didn't actually have to go to work and that you wouldn't starve. So those kinds of things were important. But I think also part of that was recognising that other voices were important. So you know that just having epidemiologists at the table wasn't going to be enough, we needed to bring in the social scientists, people who could actually understand what was going on, people to actually look at the social determinants of health and really understand what the drivers of infection were going to be. And we really, you know, had to come to a pretty, had a pretty quick reckoning around that, it took us a while, but I guess we got there.

Sabina Faiz Rashid: I mean, I was just thinking about what you were talking about privilege. And I was even talking about privilege and academia, privilege and academic silos, privileging of dominant, what is data? What is evidence? What is valid evidence? And, and I think it's really important, your point, I was gonna ask you in Australia, but in Bangladesh, definitely social sciences is very much on the periphery. And increasingly, there's recognition. But if you look at examples of the Ebola virus, much of the challenges of uptake of services or even reporting was fear, social cultural fears on burials, the lack of risk communication, the lack of engaging with people's lived experiences, and, and it's going to, you know, ask you a little bit about what do you think in your professional work experience? You know, if you look at it, you know, how is that unfolded in terms of privilege? I mean, you hinted to it in terms of epidemiology, certain kinds of data and evidence, but did you want to share a little bit, because I have quite a lot I wanted to, kind of, maybe share today. Yeah.

Rebecca Ivers: Yeah, look, I think it's really important. I mean, as I said, Ann introduced me as someone who's trained as an epidemiologist, and I really do Just sort of learned about data and analysing data and writing it up. And, you know, really the framework in which I learned was very much a, sort of, pretty Western approach to public health, pretty colonial, in fact. And I've been really lucky in that I've been really guided by the people that I've worked with. I, you know, I've had the privilege to work with many Aboriginal researchers who, you know, have taught me some pretty solid lessons about listening. It's taken me a while to come to it, I've made many mistakes along the way. And I've certainly had people around me to pull me up and say, no, think about these things differently, you're not leading this work. And I think one of the, you know, I think, you know, coming around to understand that, you know, I'm privileged to work with communities, I'm privileged to be able to actually help share stories, but it's not my story to tell, it's their story. And my role, there is very much as someone to help facilitate and support and promote and amplify those stories of other people. And then that is, that is what I can contribute. It's not about me, sort of, leading and saying, I am this person that's going to change the world. And I think for many people working in public health, people come in with a bit of a, you know, a white saviour kind of complex. And really, you know, in many ways, that's a way in which our training was, which is about working in developing country settings going in with our knowledge that we have gained from these esteemed high income, you know, elite institutions, and going and working in low and middle income countries, going and working with Aboriginal people. Now, of course, we recognise and I recognise now that, you know, the inadequacy of that training and understanding that actually, really, there's so much more that needs to be considered. And I think, I mean, I hope that I have learned to be you know, a bit more about my own reflexivity, and I, you know, again, my language, my unconscious biases, I've been very much influenced by the people that I work with, I'm very lucky to, you know, have been influenced by say, Seye Abimbola, who, you know, writing is extraordinary on this, Jagnoor, my Indian colleague and former PhD student who, you know, really,pulls me along with her learning. And I think, you know, with, again, with the Aboriginal scholars, Kathy Clapham, Tamara Mckean, Sandra Eades, that I've had the privilege of working with. You know, the way in which I think has absolutely changed, and I wouldn't call myself an epidemiologist anymore. I think one of the, I guess it is about also deficit approaches to public health as well. And the othering of other cultures. And I think othering is something that we do in epidemiology all the time. Now, othering is when you basically on the basis of social identity, you put people in a box and say, well, you know, they're different. And it's about our language, and we say these people are different. And then in epidemiology, we write about them, we talk about other cultures or other people with risk factors. And you know, there's this absolute deficit approach, where every paper that you write, you'll say, the Bangladeshis are over represented in terms of this, child nutrition, malnourishment, and it's always coming in with this negative, we look at the numbers. Now, as a, what I call now a public health researcher, I know, we need to look at context, we need to understand voice, what is what are the local voices tell us? And I think that's taken me, I mean, I think, started my journey back in 1994. And it's taken me a long time to get to this point, the richness of the learning, but you know, I'm privileged to actually now have that knowledge and to be able to apply it.

Sabina Faiz Rashid: You know… yeah, sorry, I was gonna say, listening to you, and I just thought was very interesting, because I started working end of 93, in Bangladesh at BRAC, in research, and one of the turning points for me, and a lot of your concepts… and the fact that we're having this conversation, means that you're obviously, or I'm obviously interested in critiquing a lot of, sort of, the accepted ideas and models, be it evidence, be it disciplines, and recognise, you know, that it's a constant, sort of, learning, you know, challenge that we'd like to engage in. I mean, I think being open to, and I thought, you know, most of my learning has been when I'm in villages or in urban slums, in Dhaka city, every time I'd leave my desk, and I spend time in communities, I would just be so energised. And I just went, oh, my God, you know, I understand so little, I understand, oh, my God, you know. And I have these moments and then I don't have to check myself, Rebecca, like, am I, what I'm writing represent, sort of, the multiple truths? Does it bring into the conversations, as you said, we're just, sort of, facilitators enablers, but what they're telling us, or am I bringing in my biases, my simple formulas to look for policies and programs and interventions, that speaks and dilutes the complexities of their lives? And I just have to, sorry, share this story because I was in the field, and I remember trying to find out about reproductive tract infections. And I was trying to find out about services, NGO’s services and clinics. And I kept asking these women, and it was just, you know, starting with my PhD actually and in early 2000, and I was getting very frustrated, because I thought, they're not answering my question. They talk about different things. And I'd be like, you know, I remember getting in touch with one of my supervisors, Dr. Andrew Whittaker, who is a fabulous mentor and a supervisor. She's in Melbourne. And I said, they don't answer my questions, because I had very focused questions around health, and I was going to improve their health, when I get the information, and then it suddenly clicked over time, they are telling me about health, they're telling me that their husbands don't have jobs, they might be evicted from the slums, if they get evicted from the slums, that clinic is going to be demolished. Sometimes they have to decide between buying food or going to the clinic, they’re talking about quality of care, they're also talking about not being clear about reproductive tract infections, but health was much broader. And going back to your point of othering, Rebecca, we've done this, okay? Yes, there is othering through colonisation, but within Bangladesh, within many countries, what have we done with the poor? We've put them in a box, we've stripped them of identity, they are not living human beings, they’re the poor, they’re targets of research, of evidence, they become objectified for our end goals. I mean, I'm giving very, I'm not saying every researcher, every teacher, every faculty is doing this, I'm saying some of the underlying challenges are that we have stripped the poor of the sort of being alive, being diverse individuals and people, identities that we give respectfully to each other, in this forum today, in this interview, we don't necessarily give the poor. So I think public health itself has remained, in that disease centred framework. And many have challenged it, and there's been a lot of changes. I mean, you've got Paul Farmer, and Nancy Scheper-Hughes… many public health, medical anthropologists, who write about this, but I feel in terms of the structure and the systems, there's certain kinds of dominance, of evidence, and disciplines, and that needs to change particularly during COVID. Right? 

Rebecca Ivers: Yeah…

Sabina Faiz Rashid: I don't know. I mean, I…

Rebecca Ivers: Look, I totally agree. And I think COVID’s really highlighted the importance of that other type of evidence. And I mean, the importance of local knowledge… I mean, Aboriginal people in Australia have been telling us, for years, saying, you know, the local voice is important, local leadership is important, community control is important, and that's how we get things done. And in fact, we've seen that very well, during COVID, that Aboriginal and Torres Strait Islander communities in Australia have barely been impacted by COVID. And that's not because of luck, that's because of Aboriginal community controlled organisations and community organisations that stepped up, recognised the risk, they know their communities, they've got innovative communication, they stepped up and they ran these incredible campaigns, door knocking, working with their communities, and it shifted, it meant that tremendously successful COVID practices. Now, we just haven't heard enough about that. Like, I think we should be shouting to the rooftops about the success of this, we should be learning and listening. They were way ahead of the mainstream, in that context. You know, it was a tremendous success. You know, and there's many other examples of that, where you sit down, I mean, I've got my own, you know, we were working in a slum in Delhi, actually, with older people, talking about falls in older people. And this is probably eight or 10 years ago, sitting around with old people talking about fall prevention programs and what might benefit, and we were asking people about their experiences with falling over. And these old people, some of them came in with unrepaired hip fractures that had never been surgically fixed, and so had resulted in limps, and they said, falls? What do we care about falls?  We've been falling down, our whole lives, we’ve knocked down in the street. No one cares, what we care about, in fact, because we want to get our below the poverty line cards so that we can get access to our heart medication for cheaper, because that's actually the issue, is that we can't afford medication for things that are going to keep us alive. And it was really, you know, it was really important to actually hear those messages and to actually say, well, this is very low on our priority list. This is just not something that we think about.

Rebecca Ivers: Yeah, that makes…. You know, Rebecca during Co…. I mean, if you look at Bangladesh, you know, you're saying there isn't much… in Bangladesh some of our biggest public health successes have been engaging with communities at different levels. The whole diarrhoea ORS, Oral Rehydration Solution came about because women in the communities gave feedback on what worked. These were not highly educated women, but they were smart, they were pragmatic and our late founder Fazle Hasan Abed worked with the communities. If you look at family planning, TV, but with COVID, there wasn't much community engagement and our research in slums recently found, they were coming up with their own… because you see, you're being told, wear a mask, wash your hands, in spaces where you live, have a physical distancing, you've got 15 to a room, you've got 1000s in congested environments, where water is erratic, when you can't afford a mask. They came up with their own rotation, some would cook earlier, some would cook later, because the biomedical messaging did not work for them. So community engagement, and also recognising… I thought, you're talking about Aboriginals, it's not just tokenism, you're talking about, they know what they want. And some of the most successful programs have been communities coming up with their own solutions. And increasingly, there's a lot of discussions around how do we do that? Whether we're doing it? That's a different issue. But there are a lot of debates about why don't we do this? It's not about just saying we've got communities involved, how are we engaging with them? 

Rebecca Ivers: Absolutely. 

Sabina Faiz Rashid: Because they often know best. 

Rebecca Ivers: Look, there's a great question that's come up in our chat, which is about, do you think COVID has reinforced the biomedical model, particularly because of things like the successful development of vaccines? Do you think that just helps reinforce that biomedical model? The fact that we are now reliant on vaccines? I mean, I think that's a good point. I mean, I think, you know, but it is increasing. I mean, we do understand…

Sabina Faiz Rashid: I mean, I think that's forever been this whole thing of dominance of technology, the magic bullet, vaccines, medicines, and a lot of critiques have been written about the power of biomedicine that has decontextualized individuals from their local environments. And that's why I think it's so important when you talk about local voices, but local context, right? Because we cannot remove the social, the economic, the political factors that directly and indirectly inform health and lived experiences, and COVID, even though it's magnified this, what is dominant? I mean, I saw in Bangladesh and globally, Rebecca, they were talking about modelling numbers of how many are going to die, infection rates, and vaccines. No one talked about what are the other… there was some writing on hunger versus, you know, unemployment, versus COVID. And what helped me, some of us wrote the other, but was it dominated by? And you’re right it's back to vaccine. I think, you know, COVID, it just magnified existing structural inequalities and equities. 

Rebecca Ivers: It really has. 

Sabina Faiz Rashid: And I think, you know, we need to go back to the drawing board to talk about this.

Rebecca Ivers: Yeah, I mean, and I think what's happening, I mean, when we think about, when we think about privilege, and dominant cultures, you think about capitalism and globalisation, and that is playing out in front of all of our eyes in India, at the moment, we've got, you know, a largely privatised health system, we've got lots of really complex negotiations around IP, around vaccine development, you know, who owns IP, where the factories are, what resources… I mean, India is a country that is technologically very advanced, they've got huge capabilities, but they're tied up in a whole lot of knots because of all these international laws and contracts and promising vaccines to other countries, but it's needed internally. And then when they do have vaccine capability, not having the internal supply chains set up. So not being able to actually push things out. We see, you know, we see, now, inequities in terms of the wealthy actually really commanding hotels and hospitals for their own need. Now we're in the middle of a crisis, we've got a health system that's under collapse. And, you know, again, you know, also because we've got state based data collection, because of the privatised health system, we've got very poor data collection, and very poor understanding of mortality. So, you know, really, you know, and you can see where we've got into this mess, but then we start to think about, well, how, you know, how are we going to get out of that, and I think it's going to be a huge challenge globally, in terms of global public health, is actually how do we come out of this? We see the absolute benefits of universal health care, universal health systems, the importance of that, you know, because, you know, otherwise, what will happen is that the wealthy command resources and other people don't get access to resources. You know, I think it's, you know, really, really a lot of lessons there.

Sabina Faiz Rashid: I absolutely agree with you and you're talking about universal health coverage, and I work with transgender communities, I've got colleagues who have done work with disabilities, you've got adolescents, and we need to, kind of, give support along with just universal health care. Because I think, you know, it's about financial subsidies, it's about education, it's about you know, giving quotas, yes, to bypass certain systems that keep and exclude people out, who don't have the necessary criteria to get jobs, it's to create that space. It needs a multi pronged approach, from not only the state, from organisations, from institutes, from academics. I mean, Rebecca, I remember having a conversation with you earlier, and you're so passionate about giving opportunities, not just saying, okay, here's universal health coverage. But, how do we then create an enabling space? That added lift, because I always tell my students when I'm teaching them, you have a row of students sitting in a row, you know, 30 of you, and you have a wastepaper basket right in the front, and I remember seeing it in a cartoon, and I asked the ones in the front row, throw a piece of paper in the wastepaper basket, and I asked the ones way at the back to throw paper in the wastepaper basket. And I'm like, well, you know, sorry, tough luck, you all have equal opportunities. And I, you know, I think we really need to recognise, and sometimes I worry about how gender and certain kinds of rights get also diluted under the universal health coverage discussions. And I really think we need to push for the structural inequalities, the, how do we create systems of enabling spaces? Because otherwise, it's like, oh, look, there's universal health coverage, and then you blame, again, the very groups that have to climb 50 times many more ladders than me, or you, or someone else, you know, a male, who has been again, added privilege, particularly for a wealthy male, not a poor male. A poor male is worse off than me, in Bangladesh.

Rebecca Ivers: Yeah, right.

Sabina Faiz Rashid: Inequality is an issue. Yeah.

Rebecca Ivers: I mean, it's a really good point. It's a good, you know, segue. I mean, there's another question about, is academia giving societies the ethical and social tools with which to navigate a world of privilege? Now, that's a great question. And I know, you and I both, we’re heads of schools of public health, we have it in our power to teach students, and I know, for both of us, this is something that we think about, I think, what's important, and it's not just schools of public health, it's actually teaching these things to all students about, what are the drivers of health, and the ethics of health, our responsibility, understanding about privilege, how do we break that down? And I think, you know, when we look at the curricula that we teach, to public health students, to health leadership and management students, to global health students, are we giving them those skills? And, you know, what is it that we need to teach people? I mean, we also need to teach people about voice, and privilege, and reflexivity as well. I think it's really important for us to teach our privileged students about reflexivity, and how to actually look at their own privilege and address that. I mean, how do you think, how do you address that in Bangladesh? Because I know that's an issue you have as well.

Sabina Faiz Rashid: Now, we're trying. So I think one thing is that, I've been pretty lucky, I've been working with a external consultant, I brought him in 2016. His name is Mikhail Islam, I think you've been introduced on email about something else. And what he did was, he challenged me to think outside the boxes of research and as a teacher, because I've studied this, I've done research on structural violence and inequalities. And he said, how do we adapt curricula to developing world context, right? Because he does a lot of competency based skills development in a training institute. And I just thought, all that I've learned is from communities, they have been my best teachers. Of course, there's the books and the faculty over the years, but the best, sort of, medical anthropology I've learned, at its finest, has been from the villages and the urban, rural, you know, urban informal settlements. And we started doing some reform on curriculum, and one thing that always existed at the school was immersive community based learning. But in 2017, I was working with them, and we piloted some courses on very much bringing in discussions around what is the ethos of public health? Why are you a practitioner? Because often in Bangladesh, and in many places, you know, we have a lot of medical doctors at our School of Public Health. And they will admit, some of them are critical… they're deified, you know, they're reified. You're a doctor, oh my God, you know? And here, we're having conversations where I'm saying, I'm sorry, the communities are our teachers. What are our values? It has to be humility, why do we need to learn from there? Because in public health, why am I in public health? Why are you Rebecca? I mean, ideally, it's to improve the lives of the disadvantaged, without sounding like the saviours. So how do we work with communities who often know best. And we're far from there, I'll be honest, but we're trying. So we've reformed some courses to bring in very structured learning, and an element of solutions thinking. Go and work with communities, share your ideas, validate, get inputs from them, and we have some courses in there. I also, kind of, have brought about, I think that's more a personal passion of mine, where I talk about sexuality and diverse sexualities, because communities means engaging with people of different ethnic backgrounds, religious diversity, sexual diversity. And overall, we're a bit of a contradiction, we're conservative space, but I'm very strong, and so as my Associate Dean, Professor Malabika Sarkar, I mean, we work very well together. She's a Hindu widow, who is the number two at the school, and we work together. And we feel very strongly that our policies, our teaching, reflects on some of these diversities, you know? They have to visit disadvantaged populations, elderly, people living with disabilities, gay populations, you know, and understand the need and the basic human rights. So I think, it comes in our content and our teaching, we use our research a lot. But I think, if some of it's about getting students to critically reflect that you're a Bangladeshi doctor, or your Bangladeshi woman, or your Bangladeshi maid. We also have a lot of international students, so we have, every year, you know, half the class is international, we've had about 540 students, a small class, and 31 countries. And it's getting to them to reflect, and there's a lot of arguments that break out, you know, like, but you know, disease is the problem, and if they don't want to take medicines, they're ignorant. And it's trying to unpack that saying, well, there's a lot of I thither, there’s also a lot of local understandings, and knowledge, if we tried to listen, as opposed to being dismissive, yes, they are harmful practices, but so is over prescribing antibiotics. Right? 

Rebecca Ivers: Absolutely. And then there's a lot of learning that is, people get… yeah look, I think it's important because it is about what we teach people in all the, sort of, clinical disciplines as well, what do we teach clinical practitioners about health? And some of that is actually about… and again, traditionally, we've taught people we talk about health literacy, and normally, when we talk about health literacy, you're talking about the health literacy of the patient. Well, actually, health literacy is actually more on the side of the practitioner. So we talk about… and again, it's a little bit about othering, it's about talking about the person in the community, or the patient as the vulnerable, the person, they're not compliant, they're not complying with the treatment that they give them. Well that's because we're giving them the wrong treatment. We're not recognising their needs, we're not valuing their voice, we're not we're not listening to what they say. So we need to, we need to train our students to understand that and turn that around. Both individual clinicians but also public health practitioners to understand that. So when we're talking about health promotion, we don't talk about, we're not talking about vulnerable communities, we're talking about underserved and marginalised communities, we are not meeting their needs. It's not that there's something wrong with them, there's something wrong with the health system. It's not sufficiently flexible. It's not adapting. So I think that's important for our students. And I mean, I think the other angle of it is… sorry…

Sabina Faiz Rashid: Sorry, I was just thinking Rebecca, something you just said was quite powerful. I was thinking about, in our MPH program we brought in not only faculty and academics, we bring in practitioners, we bring in people in the private sector to speak about the experiences of working, of doing program design. We also ask them to talk about failures and challenges. Because I think it's very important, we don't talk enough about our failures, reflecting… be it research, or teaching. We don't do that a lot. I have to be honest. But I'm trying to do that, other faculties are trying to do that, because I think it's important to realise practitioners can come in and share experiences. Because I think the fundamental, I think, life skill for all of us is – and I struggle, I’m the first one to raise my hand – is the sense of inculcating humility, and the willingness to listen, I mean, sometimes I don't even listen to you finish your sentence, or my other colleagues, if I have something to say. So, you know, and then and that's in meaningful partnerships, but can you imagine with communities that we almost have already othered? We've already got the answers in our head, we know at all, and I think it's like going back to the drawing board and unpacking the arrogance in us, that, you know, that basic fundamental humility, and I do think it's a life skill, really, and that will help you with everything, but it also recognises the value of learning from others, communities, practitioners, not just academics, others, you know, who've worked in the field, who are committed, we're passionate activists, I do think, and listening to failures and trying to see what can we learn from that? We're so scared to talk about failures, because I think it's a traumatic experience.

Rebecca Ivers: Of course, it's a difficult conversation. As I said, at the beginning, it is hard, it's confronting, but we need to do it. I think I mean, I think we can move on now to thinking about funding of global health. And you know, and again, traditionally we've had this whole issue, is that we have, you know, again, the colonial model is that we have the colonisers, providing funding to the colonised. So we have the big philanthropists, we have all the aid organisations we have, you know, Australian Aid. Now, that largely is always on the side of the funder. So you know, even for aid agencies for Australian Government, UK Aid, often very much the funding actually goes through Australian consultancies, Australian workers in those countries, there is money, there is work that gets done in country, but there are many, many Australian and Australian industries and companies that are the beneficiaries. Likewise with research funding. So we have research funding, I think the UK is unique in that there are you there, I mean, possibly some US funding sources, but funding that comes from the UK, you can have a principal investigator from a low and middle income country who can be the recipient of the funding. Right? But that's been cut back now. I think Australian government funding to low and middle income countries for research is not like that. We have Australian investigators, most of the money will end up being spent for Australian investigators, we need…  how do we actually decentralise the funding? How do we localise it? How do we get more local funding owned by local researchers? How do we build local capacity with the constraints of this, kind of, colonised world of global research funding?

Sabina Faiz Rashid: So you know, I think it's, you know, when the FCDO cuts happen. I work with many partners, it was a consortium of eight partners, we are entirely self funded, the school. So one of the I would say one of the successes are that we're financially independent, as a school of public health. But one of our biggest challenges are when your hands are in someone else's pocket, you have to go wherever they go. And with the funding cuts, what I have to say is that sometimes it's not so black and white. I saw of colleagues in the UK, who are struggling with the 67% cuts, because they have to rethink their salaries, their colleagues salaries, what would happen to some of their inputs and time. Because their money also comes from soft funding. It's not that all of them have core funding. In our case, what happened was, we went from a large couple of year grant, to looking at one year, and cutting back on many activities, and some of it was actually community engagement. So we raised issues around the ethics of grants, and cutting. But I think it calls into larger questions, Rebecca, which are a little bit messy. There's messy spaces of, you know, these are taxpayers' money. So taxpayers need to know how money's being spent abroad. There's also messy questions of entitlement. It's very hard, Rebecca, to ask someone who already has taken for granted entitlement, where knowledge academia has dominated from a particular region in the world, where we are looked at as our capacities need to be built. So although many partnerships are very equal, I have to be honest, they are partnerships in the past where I've pushed back on these ideas. So it's a very, sort of, structured system where there's a state, there’s you know, agendas, there's also university, that don't want to fund their colleagues in these universities in the north, and they say, bring in your own money. So it's just creating a very competitive, and not a very, sort of, a world where you can build meaningful partnerships, right?

Rebecca Ivers: No, no…

Sabina Faiz Rashid: BecauseI don't think you… I don't know about you, but I don't think we are placing also… I think there's a lot of faculty in the north that are struggling with funds, as well. So to say now, everything has to be redeemed… I agree. I do think decentralising would help. I do think LMIC would help. I think I'm in a position, you know, 25 years later, where I can argue for certain kinds of a partnership. And in some cases, at great risk, I will say no to a partnership. But it's taken me time and there's always that risk and dilemma. But the reality is, it's a really messy space, and it's unfair, and it's unidirectional. I agree from north to south, certain ideas of capacity.

Rebecca Ivers: Yeah, I mean, I think there's lots of things that can happen. We can help support networks, from south-south who are researchers working together to build collaborations or partnerships and strength research, and obviously, equitable partnerships from the north to the south. We have a question about whether there's major funders who understand about listening to communities rather than imposing solutions. I don't know about that. I mean, I think in Australia now with Aboriginal and Torres Strait Islander research, researchers do have to actually address the criteria about how they're addressing capability and sustainability, and working with community, and building capacity, and that's absolutely a start. That means that NH and MRC won't be funding research that is just about people with no experience, or no capacity. But we're still a long way off. And I think actually applying the same, kind of, rules to research with low and middle income country researchers, I think is really important. To actually look at demonstrable capacity building and so on, I think that's important. I'm certainly seeing though, and I think it's, it is a bit of a change. and it may well be just because of my own biases in terms of the kind of research that I do, and that I'm interested in. But mixed methods research is becoming more popular. The research frameworks that we use around implementation science, and really are actually leading people down that pathway. So understanding about the need to work with consumers all the way through. The focus on consumers and users, and actually building them in. Funders saying, yes, you do need to be working with consumers, and no, we won't give you the money unless you do. Consumers have to have a voice. And I think that's different. The mixed methods research. Also, it does also prioritise local voice, because it allows you to do qualitative research, which actually brings out those local voices, and the local, the importance of that local contextualisation of what's actually happening on the ground. And I think that's important. I think the days of actually people doing… I mean, it still happens obviously, but I think we're moving away from just very, very focused epidemiological clinical studies that aren't contextualised. And hopefully funders will stop funding those things.

Sabina Faiz Rashid: I think there's a lot of factors. And I agree. So a lot of the partnership, there is a shift, a lot of the, when we're writing grant proposals, there's a lot of prioritising of what are your needs and priorities? And I've seen this at least in the grants I'm involved in. Two, it depends on who the reviewers of those boards are. I'm part of an MRC Review Board, and there's many different review boards. And one of the projects did not get funding, and there were many different factors. Their approach to the partnership was very much, you data collector, us, knowledge bearers. And they didn't actually get the funding. So I really think it's about the kind of review committees we have. I think you need to have an beyond, you need to have diverse disciplines who challenge it. Three, I think, like you were saying, decolonising public health, community engagement is also a flavour of the month word. I think, you know, if you have reviewers, or you have researchers or you have people working together, and this kind of bringing in interdisciplinary, multidisciplinary groups together, you can actually discuss what do we mean by community engagement? Unpack that further, in terms of what does that mean, and get us to, kind of, have that, kind of, inner critique and discussion about each other. And I think those are the kinds of conversations. I don't know if funders themselves delve deeply. I think if you have the key words, it's fine. I think it's our role in some ways to push those boundaries. 

Rebecca Ivers: Yeah, absolutely. 

Sabina Faiz Rashid: And I think some of that is, you know, also sharing, you know, diversity of reviewers, diversity of even journals, right? I mean, Rebecca, I was gonna ask you your thoughts on journals, research journals, and publications. But, you know, sometimes your paper is read by people who are in a completely different discipline. And I'm thinking, why did they even read this? Because they don't even understand the nuances of what we're trying to say. I just want your thoughts on, sort of, journals and publications.

Rebecca Ivers: Yeah. Well, I mean, it's another area where you need diverse voices. So you need diverse voices on research, you know, research committees, reviewing grants. Absolutely. And we see that I've just been on a few recently, myself. And it's very clear that the diversity of voices really is really important. And it is important for people to step up and actually speak out and sit on those committees. So I would encourage everyone here to do so if you have the opportunity. Likewise, with journals. So again, this is a really important thing. And we are seeing a lot of change, and I think Seye Abimbola, and BMJ global health and, and all the new journals that are coming out in global health are changing. And there's been papers that have been published, some by my colleagues around, looking at diversity on international journal boards, and actually looking, putting… and I think we should all be putting pressure on the big prestigious journals to say, hey, who are on your editorial boards? And I don't care if you've got an editorial board with 200 people, it's the central board. It's the people that are the decision makers that are allocating the papers and making the decisions. That's where we need to see diversity. So we do want to see diversity there. We have to think about language. How do we support people with English language? So if these are English journals, and we're discriminating against people because they don't have English language authors, and we're not offering Editorial Services, and then we're charging people $5,000 to publish? Well, there's a big problem. And then, again, we are deliberately and structurally excluding people with different and diverse experiences from actually publishing, and we are stopping career progression. So those things are important and I really applaud the moves that people are making to actually shift that, that's really important. And again, this is where our voice is important, and people need to be looking critically at all of these things and saying, hey, how are these things changing? So I think that's important, but for us as researchers, so for myself, I think, and we are seeing shifts. So, we now see that professors like you and I we’re stepping back, we shouldn't be. So you should not look at someone's track record and see that A, certain professors have published 60 papers in a year as first author now, they cannot possibly do that. That's just exploitation of all their PhD students and postdocs. And I think there's increasing recognition that that's an issue. But, what we do need to be doing is stepping up and promoting and supporting diverse voices to come through the ranks of academia and research. So supporting people, and also recognising that people who come from marginalised communities or underprivileged backgrounds, are not going to have the same set of resources to actually catapult them through academia. It can be a hostile, very, you know, very difficult world to navigate. Now, if you feel the first person in your family to go to university, if you don't have adequate resources to cover childcare, if you're travelling for hours every day, if you've got hugely challenging personal circumstances at home, because of intergenerational trauma, it's going to be very hard for you to attain all those normal metrics, all those academic metrics. So we need to create systems that support, and mentor, and enable people to actually step forward, and to value those voices, and those experiences, so that we are saying, all right, well, in this area, you should be the voice, you should be the leader and we're going to help, we're going to support you to get there. And I think that's important. We are seeing, increasingly, mechanisms within our funding agencies to allow that to happen. But there's not enough and it's not happening quickly enough. As we can see from the metrics. I think that's important. It's important for global health research, we do need to be giving those local voices. So when we see publications coming from Bangladesh, from big international consortia, we should not be seeing a Bangladeshi author as being the last two or three people on the list as token, you know, token authors, we should see them as first or senior or both. And I do feel quite strongly that we should be really pushing that and making sure that we don't see people over and over again, from high income countries leading, you know, fabulous pieces of work from low and middle income countries at the expense of the researchers that have been the people that have done the work on the ground. And I think that's really important. So I mean, I'm sure you have similar thoughts on that.

Sabina Faiz Rashid: Yeah, no, I'm not going to add to it. But I do think resources are a big thing. And we are very disadvantaged in terms of where are we going to get 2500 pounds to publish? But your value as a professor, your voice in the global stage, but being taken seriously, is very much by these journals. I have to acknowledge BMJ, they do waivers for LMIC countries. But, Bangladesh is going to hit middle income status at some point, politically, our Prime Minister haS declared. So where does that leave us? Secondly, I do think, you know, Professor Madhukar Pai talks about, sort of, global malpractice. And it's very interesting, because he said, we write about the developing world, but it's the leadership or the authorship and first authors are a small percentage group in developed countries. And I see in Bangladesh, though, there's also another structure or hierarchy where we rarely allow younger people, I would say, junior mid-level faculty or colleagues to take a leadership role in first authorship. Of course, you know, they need to be able to also be proactive, and write, and want to publish. And there's a few that are very proactive, but I think it is important to break some of that because we come from a very culture of hierarchy. But we've got the global politics of journals, publication resources. But then in  Bangladesh, also, I would say, many PIs will say, I'm going to be first author, I'm going to present in every panel, I'm going to be the face of everything. I'm exaggerating, but it's true. So how do we motivate and create the next generation of younger public health leaders, be it writing, be it going to conferences and meetings? And my colleague, Professor Malabika and I have actually put into policies… I mean, she was director of research for about eight years, you know, where we set up journal clubs, writing clubs, attending, presenting research, getting feedback on methodology, how to do scientific writing, you know? She and I, you know, put away capacity building funds, so they could go to conferences and attend and present. You know, with the limited funds we have, and I think that's very important because, you know, I thought, I was struck, Rebecca, by, you said that your PhD student really influenced you, and I thought, fabulous, I mean that just shows the way you think, because I think… I was trying to think, okay, hang on, I, you know, I have a lot of MPH students, and there's some who I've really been, I admire and I've been impressed by. But I've already thought about it. And I think, you know, there are our teachers and we can always learn from a new generation, I think, you know, yeah.

Rebecca Ivers: Well, that's what's gonna drive us forward. I mean, I think I've had many PhD students, and, you know, I learned from them. And if we're not, we're not constantly learning from the people around us, we may as well give up and go home now, because they are the future. These people, we create a structure, we help, we help support them, and then we amplify their voices, and we allow them to flourish. But I learned so much from them. What I am now is as much driven by what my students have taught me, that’s been my experience. I think we need to wrap up soon, and we've got a couple of really interesting questions. So we'll just quickly go to them. One is, is there a possibility that privilege discussions over emphasise racism and sexism, and under emphasise classism and ageism? You know… I mean, I think, I mean, obviously, racism and sexism is critically important. But I mean, I mean, I myself think absolutely classism is critical. And I think this is actually fundamentally what we've been talking about is classism, elitism within Australia, within Bangladesh, I mean, you see, you've got, you know, I think that's a massive structural issue in Bangladesh, isn't it?

Sabina Faiz Rashid: Absolutely. I mean, I was just thinking about, you know, when we have gender discussions, and they talk about men, women, and I said, listen, I mean, this is taking me time, and I, you know, I sometimes forget, taken for granted my position, my location, but increasingly, as I get older, I realise that the man on the street who's struggling to earn an income, he's male, but my class, my status, my privilege, means I'm over valued, I have voice, I have access to opportunities, I even have access to basic citizens, rights. Food, you know, housing, you know, I can go to a lawyer if I am harassed. I mean, I'm saying that gender is cost cutting, but class and intersexual factors and the privilege… ageism! I became a dean at 44. The late Fazle Hasan Abed who founded BRAC, convinced me, I wasn't sure. And you know, initially Rebecca, when I'd walk into rooms, people would look at me waiting for where's the Dean? So they'd be waiting and waiting, I'd be sitting and then they'd be like, so when is he coming? Because the assumption would was he's male, and he's older, because the last Dean was older and white, and the last Dean before that was older and Bangladeshi. And you know, and they think, and I'd be like, No, I'm the Dean. Oh, okay. So, class, yes, privilege, opportunities, access, and I try and remind myself, and how we, how that plays out in terms of what I can vocalise,  but also, I think, you know, I grew up in five different countries. I did face discrimination. I faced racism. I also faced, embracing the exotic, tell us a little bit about yourself. And I think, I'm kind of sensitive to being, you know, always wondering, where do you fit in? Because when I first came back to Bangladesh, they would call me, some of my friends would tease me, you're black on the outside, you're white on the inside. Because you know, white behaviours and what I was… but anyways, yes, class is a huge issue. We don't talk about it enough. We don't talk about gender in a more complex way… this is about class,  and intersectional factors… we don't talk about ageism at all. But there is this kind of, if you have a certain age, or a certain kind of look, you are the right Dean. What does that mean? I don't know. But yeah.

Rebecca Ivers: I mean, I do not want to diminish, I don't think you can say well, we talk too much about racism and sexism, because we don't, we actually don't address it enough. It is the elephant in the room. Intersectionality is critically important and until we actually start acknowledging, and again, for someone, race does not impact on me, but I know how it's a huge issue. And it is something that I'll never understand. But I don't ever want to diminish that. I think it's critically important that we recognise the importance of racism, of sexism, and classicism, and ageism, and the fact that they are all interrelated. And until we actually have an intersectional approach to this, we're not gonna get anywhere. So I think we need to put to the thought that we focus on some things over others, we don't, we don't focus on any of it anywhere near enough. So now we're going to wrap up, so…

Sabina Faiz Rashid: I just wanted to say, I think that's an excellent point because it is so interrelated… *distorted audio* as a token global South woman, and I may challenge certain discussions and they're like, okay. I think racism, look at what's happening in America with Black Lives Matter, Aboriginals, look at ethnic communities, re-persecuted, continue to persecute, all of these need to continue. And they're so interrelated. I really have to agree with you. Yes, you're absolutely right, Rebecca. Thank you.

Rebecca Ivers: Yeah. Now we do need to wrap up. I mean, I think it's been a fantastic conversation. And I think we could easily, you and I sit here for another two hours and keep talking. But unfortunately, everyone needs to go and have their dinner and wrap up. Thank you so much. It's just been an absolute joy and a pleasure to have this conversation with you. I think there's so much that we can do and things. I mean, there's so much of an agenda ahead for all of us. Any final remarks from you, Sabina, before we close?

Sabina Faiz Rashid: Thank you so much. It's been a real pleasure, Rebecca, you may be sitting in Australia, and I'm sitting in Bangladesh. But it's interesting. The issues we discussed, the matters that are important to us, to our fellow colleagues, are very similar. We have different life experiences, but also similar kinds of experiences, in different ways, because of who we are and where we're located in our positions. And it's been a real pleasure, and I and I learned a lot. And I'm really honoured and privileged to be part of this series given by your university. Thank you so much. And I look forward to, I hope we can work together, continue to work together. I know we've started the conversation. So thank you so much.

Rebecca Ivers: And thank you, Sabina. Thank you very much, and thanks to our audience. Bye bye.

Ann Mossop: Thanks for listening. For more information, visit, and don't forget to subscribe wherever you get your podcasts.

Sabina Faiz Rashid

Sabina Faiz Rashid

Sabina Faiz Rashid is a medical anthropologist and Dean of the James P. Grant School of Public Health at Brac University in Dhaka, Bangladesh. She is world-leading researcher in health systems and urban health issues, specialising in gender, sexual and reproductive health, sexuality, poverty and the rights of marginalised populations in Bangladesh. 

Rebecca Ivers

Rebecca Ivers

Professor Rebecca Ivers is Head of the School of Population Health, UNSW Sydney, and National Health and Medical Research Council Senior Research Fellow. Ivers leads a global research program focusing on the prevention and management of injury, taking a public health and systems focused approach. Her work has a strong focus on equity, implementation, sustainability, and capacity development. 

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